Implementing health and social care integration in Scotland: Renegotiating new partnerships in changing cultures of care

Abstract

Health and social care integration has been a long-term goal for successive governments in Scotland, culminating in the implementation of the recent Public Bodies (Joint Working) Scotland Act 2014. This laid down the foundations for the delegation of health and social care functions and resources to newly formed Integrated Joint Boards. It put in place demands for new ways of working and partnership planning. In this article, we explore the early implementation of this Act and how health and social care professionals and the third sector have begun to renegotiate their roles. The paper draws on new empirical data collated through focus groups and interviews with over 70 professionals from across Scotland. The data are explored through the following key themes: changing cultures, structural imbalance, governance and partnership and the role of individuals or "boundary spanners" in implementing change. We also draw on evidence from other international systems of care, which have implemented integration policies, documenting what works and what does not. We argue that under the current framework much of the potential for integration is not being fulfilled and that the evidence suggests that at this early stage of roll-out, the structural and cultural policy changes that are required to enable this policy shift have not yet emerged. Rather, integration has been left to individual innovators or "boundary spanners" and these are acting as key drivers of change. Where change is occurring, this is happening despite the system. As it is currently structured, we argue that too much power is in the hands of health and despite the rhetoric of partnership working, there are real structural imbalances that need to be reconciled.

Changing Logics in Healthcare and Their Effects on the Identity Motives and Identity Work of Doctors

“…In this context, senior medical professionals in the acute sector are increasingly required to accommodate, re-interpret and integrate market, corporate and state logics into their professional identities and relationships with other clinical and care professionals (Pearson & Watson, 2018).…”

Partnership between primary health and social care services in the long-term care of older people with dementia: a vignette study

“…Our data suggest that the attitude of non-cooperation between social and health care providers, and a lack of systematic approaches for e cient collaboration (e.g., uncertainties about professional roles and functions, lack of mutual formal communication pathways) hamper provisions of integrated care for patients with complex needs. Previous research indicates that a policy shift toward integration is not an easily achievable task, as individual innovators, and not legal imperatives are often the key drivers of change [8]. A study assessing the different types of collaborative ties between healthcare and social care services organizations concluded that co-sponsoring projects could be listed among the most effective ways of fostering effective partnerships [13].…”

“…Research suggests that patients with complex LTC needs experience multiple parallel care processes, which may have con icting or competing goals within their individual patient trajectories [7]. Thus, the reorganization of social and health care processes focusing on dementia patients has become one of the top priorities across countries, and a large array of tools, including attitudinal, organizational, and regulatory transformation of care delivery, have been applied with the aim to foster integrated service delivery [3,[7][8][9][10]. Studies indicate that a partnership between health care and social services results in higher user satisfaction with the care received [11,12], and lower avoidable health care use and spending [13].…”

Paljon palveluja tarvitsevien asiakkaiden yksilöity sosiaali- ja terveyspalvelujen yhteen kokoaminen

“…Myös arviointitietoa toimeenpanon sujumisesta ja tuloksista oli niukasti vielä saatavilla. Pearson & Watson (2017) tunnistivat Skotlannin sosiaali-ja terveydenhuollon integraatiota koskevassa tutkimuksessaan alkuvaiheen kokemuksia integraation toimeenpanosta. Heidän huomionsa mukaan integraation rakentaminen on jätetty yksittäisille toimijoille.…”