Sharing premises does not make service delivery any more effective

So called integrated health and social care
teams who in reality simply share the same offices are no more
effective than traditional non-integrated methods of service
delivery, according to new research.

A
study by Wiltshire Council and Bath University suggests that to see
benefits to services users, structural change, such as a move to
care trusts, is needed and not just co-location.

The
report looked at the impact of “integrated” primary care-based
health and social care teams on older people living in the
community.

It
found that the degree of integration “does not appear to be
sufficiently well developed to have had an impact upon the clinical
outcomes for older people”.

Despite a speedier response from
referral to assessment in the “integrated” teams and a higher rate
of self-referrals, more people went into residential care over the
18-month period than those being cared for by traditional teams.
And a higher proportion reported being depressed and having a lower
quality of life. The “integrated” approach also appears to be less
cost effective.

Louise
Brown, co-author of the report and lecturer at Bath University,
said of Wiltshire: “It hasn’t gone far enough. It needs to go as
far as it can with integration: structures, management,
budgets.”

But
Brown also warned of the “unintentional consequences” of
integration: “The potential problem with that is that you move
social care staff into medical health settings. That is maybe why
we saw an increase in the number of people in residential care. Is
that the medical model creeping in?”

Ray
Jones, chief executive of the Social Care Institute for Excellence
and former director of Wiltshire social services, commented: “Until
we are actually one organisation, we still leave real problems for
staff who are pulled apart by separate organisational requirements
and arrangements… The view that we were taking is that we needed
to take a further step by bringing people together in one
organisation where there would be one set of budgets, one set of
procedures, one manager, and then we can have a truly integrated
service.”

Wiltshire is currently developing
three care trust sites, each to cover services for older people,
people with physical disabilities, people with learning
difficulties and the health care needs of children. The three are
expected to go live in 2003-4.

–
The Impact of Integrated Health and Social Care Teams on Older
People Living in the Community from 01225 386949