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Objective To compare effectiveness of patient care in hospital at home scheme with hospital care.

Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings.Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services.Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.

Policy on care in the community was founded on the premise that the care of frail elderly people with disabilities would be a joint responsibility for health and social care professionals, and family carers, supported by people within their social networks. The policy assumes that such social networks are common features of all communities in contemporary Britain, containing a reserve of people who can be called upon to provide support to carers. The present paper draws on material gathered for a qualitative study of the experiences carers in South Asian communities to examine the quality and quantity of informal support that was available in different types of households. Male and female carers were selected from the Punjabi Sikh, Gujarati Hindu, and Bangladeshi and Pakistani communities. A total of 105 carers participated in the project. Participants were caring for people in all age groups with physical and/or mental distress, and in some cases, with multiple and complex impairments. The analysis of carers' accounts suggested that, for a variety of reasons, the main carer, irrespective of gender, had limited support both in nuclear and extended households. In addition, societal attitudes towards disability and the fear of obligation prevented the seeking and accepting of help from wider social networks. The paper concludes that the evidence does not support the assumption about extended families, and their willingness and ability to support carers. Many issues highlighted in this paper have far-reaching implications for policy makers in many countries in the West where South Asian people have made their homes.

Further high quality studies are required to inform policy and practice for mental health service users, which lags behind other adult social care groups in the use of personal budgets.

Hospital at home can deliver care at similar or lower cost than an equivalent admission to an acute hospital.

What is known about this topic dHealth and social care systems find it difficult to deliver the continuity of care service users want. Not being able to define and describe continuity may contribute to these difficulties. A programme of research projects has explored the concept and delivery of continuity in a range of health conditions and this paper has reviewed these. What this paper adds dReviewing the outputs of the research programme showed that there is a broad common framework that can be used to understand continuity. Continuity of care is coconstructed dynamically between service users, their families or carers and professionals. AbstractHealth and social care systems experience difficulty in delivering the continuity of care that service users want. Lack of clarity about what continuity means hinders service organisation and delivery. The NIHR Service Delivery and Organisation programme funded a series of research projects to tackle this conceptual confusion, and subsequently commissioned a review of the projects' outputs. The aim was to assess how the projects had progressed conceptualisation and measurement of continuity, and increased knowledge about what influenced it. This paper concentrates on two questions: what is continuity of care, and what influences it? We reviewed the projects' outputs and extracted data using techniques adapted from systematic reviewing methods. We treated the outputs as 'transcripts' and used the Framework approach to qualitative analysis to handle them. This maintained the coherence of individual projects while allowing cross-project themes to emerge. We then produced a narrative synthesis of findings. Service users and carers valued good relationships with professionals; this did not always mean seeing the same person and encompassed trust, the professional's style and communication skills, and the time made available. Service users and carers also valued understanding the patient's condition and treatment. This went beyond giving information, to include communication that recognised individuals' capacities and that was skilled, given sufficient time, and from a trusted source. Service users valued co-ordination between professionals and services; this covered communication, planning, and services' storage and use of information about them. Co-ordination with carers and others was also important. Experiences of continuity were influenced by service users' characteristics and circumstances, care trajectories, the structure and administration of services, professionals' characteristics, carer participation, the wider context of the 'whole person' and satisfaction. The review highlighted how service users, carers and professionals construct continuity dynamically between themselves. This has implications for both professional training and service users' expectations.