Social Care Reform Research Articles

A lost decade? A renewed case for adult social care reform in England

AbstractDrawing on a 2010 analysis of the reform and costs of adult social care commissioned by Downing Street and the UK Department of Health, this paper sets out projected future costs under different reform scenarios, reviews what happened in practice from 2010-19, explores the impact of the growing gap between need and funding, and explores the relationship between future spending and economic growth. In the process, it identifies a ‘lost decade’ in which policy makers failed to act on the warnings which they received in 2010, draws attention to the disproportionate impact of cuts on older people (compared to services for people of working age) and calls for urgent action before the current system becomes unsustainable.

The role of unjust treatment for experienced unmet need for health care among Finnish Roma

Abstract Background Finland is currently undergoing a major reform of social and health care, one aim of which, is to reduce inequalities between different population groups in access to care. Previous studies showed that Finnish Roma minority are more likely to experience unjust treatment in health services and other public services in comparison to other minorities in Finland. Unjust treatment may influence health behaviors, including the use of health services, by decreasing trust towards health professionals as well as decreasing social, emotional, and physical resources. This study examined the association between experienced unjust treatment in public services and self-assessed unmet need for health care among Roma in Finland. Methods We used data from the Roma health and wellbeing study (Roosa), conducted in Finland (2017-2018). The data was collected by the snowball method in different areas of Finland including a health examination and a structured interview. It covers 365 adults, and of those 223 (61.1%) were women. The outcome measure for unmet health care need was based on the question: “Do you feel that you have adequately received primary care services during the past 12 months?” Logistic regression was used to test the association between unjust treatment and unmet need for health care. Potential confounders were gender, age, marital status, education, employment and self-estimated health. Results The prevalence of unmet need for health care was 37.8 percent among men and 43.7 percent among women. Those who experienced unjust treatment in public services had higher odds (OR = 6.23; p < 0,001) for unmet need for health care than those who felt treated just. This association remained after adjustments for the confounders. Conclusions Over every third of the Finnish Roma experienced unmet need for health care. Unjust treatment seems to be a significant risk factor in access to care among Finnish Roma and its role needs further studies. Key messages Unjust treatment in public services is an indirect indicator of systematic and/or institutional discrimination. It is important to study the extent, nature and consequences of unjust treatment and discrimination to allow vulnerable groups to be taken into account better when renewing health services.

Partnership working across sectors: a multi-professional perspective

PurposeThe Public Bodies (Joint Working) (Scotland) Act 2014 set the framework for the integration of adult health and social care services. Teams, organisations and sectors are now required to work in partnership and interdependently to deliver shared outcomes for the people they serve. The purpose of this paper is to explore any features, practices and behaviours that could influence effective partnership working across sectors.Design/methodology/approachA questionnaire was designed and distributed to a range of stakeholders working in health, social care and the third sector. With reference to the changing health and social care reform agenda, the aims of the survey were to gather views, experiences and perceptions of working across sectors, and any workforce development needs.FindingsThe majority of respondents were from the NHS (80.3 per cent, 118/147), and experiences were largely drawn from those working with the third sector. The utility of working with the third sector was positively highlighted; however, there were limited opportunities to fully engage. Whilst formal education and training was welcomed, workforce development needs were mostly related to fostering relationships and building mutual trust.Originality/valueThis paper highlights views, perceptions, enablers and barriers to integrated care in Scotland. Whilst the Scottish integration landscape is currently not fully fledged, insights into prevailing attitudes towards integrated care, by a cohort of the Scottish health and care workforce, are offered. In particular, reflections by the NHS workforce to working with third sector services are discussed.

The reform of the English National Health Service: professional dominance, countervailing powers and the buyers’ revolt

The 2012 English Health and Social Care Act marked a fundamental reform of statutory healthcare in England in ways which elevated the interests of the government over the interests of patients or the professions, and which undermined traditional alliances between professions and patients. Drawing on a countervailing powers framework we present a thematic analysis of parliamentary papers, press releases and other publicly available materials produced across the reform process by four key actors in the healthcare field—the government, medical profession, patients and ‘for profit’ providers. This analysis explores how the pursuit of sectional interests by these actors may have acted to constrain potential alliances and ultimately contributed to the enactment of the legislation by default. This conclusion has relevance for other Beveridge model healthcare systems undergoing health and social care reform under the auspices of austerity.

Enacting integrated care in the system-wide social and health care reform in Finland

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Refugee crisis in Finland: Challenges to safeguarding the right to health for asylum seekers

In 2015 Finland received an unprecedented number of asylum seekers, ten times more than in any previous year. This surge took place at a time the Finnish Government was busily undergoing a wide-range health and social care reform amid growing nationalist and populist sentiments. Our aim is to explore the governance of a parallel health system for asylum seekers with a right-to-health approach.We concentrated on three right to health features most related to the governance of asylum seeker health care, namely Formal recognition of the right to health, Standards and Coordination mechanisms. Through our qualitative review, we identified three major hurdles in the governance of the system for asylum seekers: 1) Ineffectual and reactive national level coordination and stewardship; 2) Inadequate legislative and supervisory frameworks leading to ineffective governance; 3) Discrepancies between constitutional rights to health, legal entitlements to services and guidance available.This first-time large-scale implementation of the policies exposed weaknesses in the legal framework and the parallel health system. We recommend the removal of the parallel system and the integration of asylum seekers’ health services to the national public health care system.

Access to Care by Older Rural People in a Post-Reform Chinese Hospital: an Ethical Evaluation of Anthropological Findings.

This paper examines older people's access to care experiences in rural China by integrating anthropological investigation with ethical inquiry. Six months of fieldwork in a post-reform primary hospital show how rural residents struggle to access gerontological and nursing care under socially disadvantageous conditions. This anthropological investigation highlights the unmet needs in medical and nursing care for older people, as well as some social, institutional and structural elements that impede access to care. Centring on protecting the vulnerable as informed by feminist ethics scholarship, this paper argues that the failure to meet older people's dependency needs is unjust, on the premise that it suggests a denial of the inherent value, rights and dignity of older people. This paper appeals for the provision of greater care and support by the state through putting in place social arrangements that better advance older people's access to care. Some policy recommendations concerning health and social care reform for older people in rural China are also proposed.

Modular approach in managing and organising integrated care in the system-wide reform of social and health care in Finland

An introduction: This research pre-evaluated the application of modular approach in managing and organising integrated care in the system-wide reform of social and health care in Finland. The modular approach bases on an idea where the service delivery is divided into smaller and manageable parts from which client’s service package can be composed to meet his/her needs. The system-wide reform of social and health care in Finland bases at least implicitly on the modular approach. The drivers for the reform have been weak accessibility of the primary health care, rising costs, inequality in health and ageing population with several service needs. In the reform the responsibility for organising social and health care will be transferred from the municipalities to the eighteen new counties, while the service delivery will be the responsibility of the unincorporated county enterprises, private companies and third sector organisations. If the freedom of choice will expand in the way proposed, clients can choose which health and social services centre they want to use. Methods: The study analysed official and unofficial pre-evaluation documents concerning the suggested laws to organise and produce the health and social care services in the future in Finland. The qualitative analysis mapped and classified the possibilities and challenges of the reform defined in the evaluations in relation to integrated care. Results: Possibilities: The counties will have several tools to direct the multiple service providers to co-produce integrated care; such as, the procedure for accepting actors for providing services, the conditions to be defined in the contracts with respect to integrated care, and the definition of capitation fees. For the service providers the common client’s care plan gives an intermediary for collaboration. To a client the modular service architecture gives a possibility to choose and compose from the service modules a workable service package to meet his/her needs. Challenges: For the counties a demanding challenge is to be able to use the tools available for directing the service production. The lack of competent employees will be evident. The system will be such a complex modular architecture that it will be challenging to enact integrated care for the clients with several needs. For a client the whole service system might look confused. It can be difficult for a client to choose the “right” service modules to his/her service package. Discussion and conclusions: The modular architecture of the planned Finnish system takes notice of several tools for integrating care. A much of the success of the system depends on the ability of the counties to manage the service production. Lessons learned: To translate a system-wide modular architecture into a workable practice requires a continuous collaboration and co-development between all the different stakeholders with respect to integrated care. Limitations and suggestions for future research: This research analysed merely the pre-evaluations of the reform. New research is needed to analyse the enactments of the service wholes and chains when composing and enacting clients’ service packages.

Professional identity in interprofessional teams: findings from a scoping review

ABSTRACTIntegrated care has been identified as being fundamental to health and social care reforms. How this interprofessional working impacts on professional identity is unclear. There is a lack of reviews synthesising this growing body of literature. It is therefore timely to conduct a scoping study of the literature which explores the intersection between interprofessional care and professional identity. The aim of this study is to identify the factors that impact on professional identity when working in interprofessional teams. A scoping review was conducted; Business Source Complete (EBSCO); CINAHL; Proquest; Medline; Scopus; and Cochrane Reviews (January 1980 to July 2018) were systematically searched for studies focusing on professional identity and interprofessional teams. Inclusion and exclusion criteria were identified and applied, data were charted, and a synthesis of the narrative was conducted. Sixteen papers are identified as central to this scoping review. Analysis of the papers highlights three key areas of interest: the creation of professional identity; challenges and barriers to professional identity; and implications for leadership and management. The significance of this review is considered along with an agenda for future research. Expanding the research to include more empirical studies to consider areas such as the value of interprofessional education programmes and to include the voice of those professionals no longer working or choosing not to work in an interprofessional care setting should also feature within future research.

The Gospel of Reform: The Social Gospel and Health Care Reform Attitudes

AbstractMost research on the social gospel, a religious interpretation that obliges people to care for the less fortunate and correct social inequalities, has focused on elite rhetoric. However, it is not clear the extent to which members of the public also adhere to this socioreligious philosophy. The moralistic tone of the 2010 health care reform debate has led many to argue that there is a revival of the social gospel. To what extent has this debate gained traction among citizens writ large? Which individuals will be most likely to be influenced by elite discourse that draws social gospel? Using two unique surveys and an experiment, we demonstrate that Social Gospel adherents have distinctive political attitudes. Specifically, they are more attentive to social policy issues and are more supportive of expanding the social safety net. Second, we demonstrate that elite rhetoric that draws from the Social Gospel tradition can influence policy preferences.

General practitioners and eldercare reflected in a survey by questionnaire

According to statistical data, the number of healthy life years is not increasing in proportion with the longer average life expectancy. In the ageing societies, the long-term care systems are increasingly overburdened; cost-efficient operation and the related coordination of services is one of the key questions for their sustainability. The present separation of the health care and social care systems causes numerous difficulties. One aim of the online research by questionnaire was to survey the attitude of general practitioners - who play a very important part in care for the elderly - towards their elder patients, the patients' family members, and social workers providing eldercare. The other aim was to gather information on shortcomings experienced by doctors in the care system and on what possibilities general practitioners see for the improvement of eldercare. Semi-structured questionnaires were applied and analysed by descriptive and content methodology. The questionnaires were sent out to 5060 addresses around the country: a total of 145 were returned filled in. The respondents made many recommendations for the improvement of eldercare in the categories of development of social services, family support, development of health services, and societal cooperation. The areas in need of development named by the general practitioners are closely interrelated: the reform of social care would support the health care system and vice versa. More effective operation of the health and social care systems would ease the burdens of families, and at the same time encourage more active participation of families in the care process. And the systematic education of society and communities is a long-term investment that would strengthen a positive attitude towards old age and a value-oriented view of the ageing process that is one of the basic conditions for successful social integration of the elderly. Orv Hetil. 2018; 159(8): 312-319.

Keys to analyzing societal reforms – the case of social and health care reform in Finland

Keys to analyzing societal reforms – the case of social and health care reform in Finland

Progress in Building Integration: Lessons from Great Britain, Northern Ireland and the Basque Country

The integration of health and social care has been a constant policy goal of successive UK governments for over 40 years and is a contemporary priority now supported in Great Britain by legislation. It has been noted that the ‘imperative to integrate and transform has never been greater’ (NHS Confederation/Local Government Association, 2016). The main rationales for the importance of integration have also been largely accepted relating to; a holistic approach; facilitating a more person centred approach; producing a better experience and outcomes for users; reducing the complexity of organisational divisions, responding to more complex conditions and delivering more effective and efficient use of resources. Integration is also accepted as an appropriate response to increasing demands on both health and social care services. The challenges to transforming delivery are a consequence of well-established factors. Demographic change, with larger numbers of older people, changes in life expectancy, the needs of people with multiple health problems and complex conditions and large increases in the numbers of older people without a child to care for them if needed. The importance of integration has also been enhanced by the broader direction of change relating to health provision and the desirability of making a shift from acute hospital provision and institutional care to more community based provision covering community health services and social care. Integration is thus part of the envisaged transformation in care in health related areas. Other challenges have come from the impact of economic recession and austerity policy with reductions in the funding resources and increasing costs of services. The task of producing effective integrated care involves in Great Britain bringing together two separate institutional configurations, the NHS and local authority social services and also developing the delivery of integrated services and integrated practice. Numerous policy and delivery initiatives have been developed but generally progress has been piecemeal and limited. The Commission on the Future of Social Care (2014) noted the compelling case for bringing health and social care together, enabling better alignment of the two systems and leading to transformational change. In 2015 much closer integration of health and social care was identified as one of the three major challenges faced by the NHS (Ham, 2015). The Nuffield Trust (2015) has identified five factors to pursue in improving UK health care, each of which relates to integrated approaches, the NHS and social care reform; the quality of care; the workforce; new models of care delivery and older people and complex care. The existing, research on integrated care concludes that there is no one size fits all for achieving this ambition for integration, although factors such as leadership, financial incentives, clinical pathways and aligned IT systems have emerged as significant factors. This paper draws on the authors’ experiences of health and social care in Northern Ireland and the Basque country to suggest the key factors that drive transformation in healthcare systems and ensure that they achieve their full potential.

Pitfalls of integrated care pathways for high needs patients

Introduction: In the forthcoming extensive reform of social and health care in Finland these services will be fully integrated at all levels of care. One of the most challenging target groups of the reform are patients making much use of both social and health care services, i.e. ‘high needs patients’. This paper introduces a study addressing the problems identified by care professionals working in the field in implementing integrated care pathways for this patient group. The study is part of a research project entitled ‘Successful Integration in Health and Social Care’, coordinated by the University of Eastern Finland and funded by the Foundation for Municipal Development (KAKS). The research question of the sub-study presented here is: What are the pitfalls in implementing integration in the care pathways for high needs patients? Theory/Methods: The study draws on the theoretical approaches to care pathways (Campbell et al. 1998; Rosstad et al. 2013), integration of health and social care (Nolte & McKee 2008; Valentijn 2015); integration models (Sampalli et al. 2012; Grembowski 2015); development of care services for people with multimorbidity (Rijken et al. 2016); and collaboration among health and social care professionals (e.g. D’Amour 2005; Schepman et al. 2015). The data was gathered in Finland in spring 2016 from participants on the Better Everyday Life project. Twenty-two teams of composed of various care professionals (altogether 130 people) representing primary, specialized and social care conducted a problem analysis of the development challenges in pathways for high needs patients. The professionals used the LEAN-based ‘fishbone tool’ for analyzing the pathways. The data were analyzed by two researchers using content analysis and the ATLAS.ti qualitative data analysis software. Results: Four main categories of problems in the care pathways were identified: helpless professionals, tired patients, insufficient coordination of care between the ‘silos’ of health and social care and lack of support from management. Professionals often find patients with multiple needs burdensome and that they lack the capacity to solve their problems. The only way to deal with them is to pass them on to another professional or care provider. Patients suffer from fragmentation of services: they get lost in the jungle of separate services and wear themselves out. Nobody in the care system is responsible overall for a patient needing services from several separate actors. Management is unaware of the problems at the operative level and does not give enough support for the care professionals to improve the pathways through collaboration. Discussions and Conclusions: (comprising key findings) Successful implementation of care pathways for high needs patients requires multi-professional and inter-organizational collaboration beyond professional, organizational and sectoral silos. Lessons learned: Thorough consideration of state-of-the-art of care pathways by grassroots professionals is a fruitful starting point for development work. Limitations: The findings are based on a small-scale study in the health and social care context of a single country. However, the challenges of integrated care pathways may be quite similar in other European countries. Suggestions for future research: In addition to listening to grassroots professionals, high needs patients themselves as well as managers should be involved in the study.

Managing and Leading in Inter-agency Settings (second edition) Dickinson Helen and Carey Gemma Managing and Leading in Inter-agency Settings (second edition) 304pp £12.99 Policy Press 9781447329848 1447329848

In a climate of national and international health and social care reform, there is increased emphasis on the role of partnership working across public, private and third-sector services.

Managing and Leading in Inter-agency Settings Dickinson Helen and Carey Gemma Managing and Leading in Inter-agency Settings 304pp £12.99 Policy Press 9781447329848 1447329848

In a climate of health and social care reform, partnership working across public, private and third-sector services is being emphasised.

Dementia prevalence, care arrangement, and access to care in Lebanon: A pilot study

IntroductionIn North Africa and the Middle East, studies about dementia prevalence are scarce. A pilot study was conducted in Lebanon to assess dementia prevalence, using the Arabic-validated 10/66 Dementia Research Group (DRG) diagnostic assessment for case ascertainment. The study also examined care arrangement and access to care. MethodsA random sample of 502 persons older than 65 years and their informant were recruited from Beirut and Mount Lebanon governorates through multistage cluster sampling. ResultsThe crude and age-standardized dementia prevalences were 7.4% and 9.0%, respectively. People with dementia were mainly cared for by relatives at home. Access to formal care was very limited. DiscussionDementia prevalence in Lebanon ranks high within the global range of estimates. These first evidence-based data about disease burden and barriers to care serve to raise awareness and call for social and health care reform to tackle the dementia epidemic in Lebanon and in North Africa and the Middle East.

‘There’s a lot of places I’d like to go and things I’d like to do’: the daily living experiences of adults with mild to moderate intellectual disabilities during a time of personalised social care reform in the United Kingdom

Adult social care services in the United Kingdom have undergone a period of transformation over recent years, characterised by a drive towards personalised care. Concurrently, social care budgets have been significantly reduced. This study aimed to explore the daily living experiences of adults with mild/moderate intellectual disabilities, who are at risk of no longer meeting eligibility criteria for statutory support. Focus group discussions, which included both people with intellectual disabilities and support workers, were analysed thematically. Two broad themes are presented: independence and agency; and social capital and well-being. While some participants echoed ideas central to the personalisation narrative, a number of contextual barriers to achieving greater independence and agency were discussed. Moreover, greater independence was not a desired goal for all participants. The findings highlight the potential mismatch between personalised social care, as delivered within significant budget constraints, and the needs of adults with intellectual disabilities.

Commissioning for health improvement following the 2012 health and social care reforms in England: what has changed?

BackgroundThe wide-ranging program of reforms brought about by the Health and Social Care Act (2012) in England fundamentally changed the operation of the public health system, moving responsibility for the commissioning and delivery of services from the National Health Service to locally elected councils and a new national public health agency. This paper explores the ways in which the reforms have altered public health commissioning.MethodsWe conducted multi-methods research over 33 months, incorporating national surveys of Directors of Public Health and local council elected members at two time-points, and in-depth case studies in five purposively selected geographical areas.ResultsPublic health commissioning responsibilities have changed and become more fragmented, being split amongst a range of different organisations, most of which were newly created in 2013. There is much change in the way public health commissioning is done, in who is doing it, and in what is commissioned, since the reforms. There is wider consultation on decisions in the local council setting than in the NHS, and elected members now have a strong influence on public health prioritisation. There is more (and different) scrutiny being applied to public health contracts, and most councils have embarked on wide-ranging changes to the health improvement services they commission. Public health money is being used in different ways as councils are adapting to increasing financial constraint.ConclusionsOur findings suggest that, while some of the intended opportunities to improve population health and create a more joined-up system with clearer leadership have been achieved, fragmentation, dispersed decision-making and uncertainties regarding funding remain significant challenges. There have been profound changes in commissioning processes, with consequences for what health improvement services are ultimately commissioned. Time (and further research) will tell if any of these changes lead to improved population health outcomes and reduced health inequalities, but many of the opportunities brought about by the reforms are threatened by the continued flux in the system.

Crisis and Scandal: Government, Local Government and Health Reform in Northern Ireland, 1939–44

The history of public health in the United Kingdom is often based around local responses. Historians have noted that political and medical alliances effectively determined the character of public health provision. The importance of this can be measured by the fact that Northern Ireland had traditionally lagged far behind the rest of the United Kingdom in the years following devolution. However, between 1939 and 1944, this began to change and would result in a raft of reforms in health and social care which would culminate in the establishment of the National Health Service in Northern Ireland.