Integrated Care Systems: What can current reforms learn from past research on regional co-ordination of health and care in England? A literature review (original) (raw)
Related papers
New localism in the English National Health Service: What is it for?
Health Policy, 2006
This paper discusses the decentralisation in the English National Health Service (and the new organisational form of Foundation Trusts, in particular) in the context of the trend for decentralising public services generally since the New Labour government started its second term of office in 2001. It considers the likelihood of decentralisation achieving the aims policy makers have set: these are better services and an increase in local people's participation in the planning and running of services (active citizenship). Looking at the evidence to date, both about decentralisation of health services and about Foundation Trusts, the achievement of these goals seems uncertain. desirable to involve the 'community' in local decision making about public services . The latter idea is about process, while the former is about outcomes. It is possible that these two objectives are not always achievable. The paper will discuss how the ideas are articulated, and what the evidence to date shows about the likelihood of success, in the case of the NHS, and FTs, in particular.
Still a fine mess? Local government and the NHS 1962 to 2012
Journal of Integrated Care, 2012
Purpose-The purpose of this paper is to take 'a long view' of initiatives taken to promote integration between local government and the NHS with the objective of seeking to understand why they have achieved consistently disappointing results. Design/methodology/approach-The paper's analysis is based on a historical overview drawn from official documents and empirical research from the time of the creation of the NHS in 1948, but primarily focussing on the principles shaping the separate but parallel reorganisations of 1974 and their continuing influence up to and including the current White Paper, 'Liberating the NHS', and the Health and Social Care Bill. Findings-The fundamental sources of integration barriers today lie in the foundational principles of basing (a) their responsibilities on the skills of providers rather than the needs of service users and (b) their organisational forms on separation rather than interdependence with national uniformity driving the NHS and local diversity local authorities. In addition, frameworks for integration have been established on a paradigm of seeking to build bridges at the margins of organisations rather than seeking to interweave their mainstream systems and processes. Research limitations/implications-Future empirical research will be necessary to establish whether the currently proposed arrangements for integration do, in fact, experience the same limited results as previous ones. Practical implications-Local and national strategies for improving integration should be reviewed in the light of the understandings set out here and local frameworks should seek to align and integrate mainstream systems and processes so far as possible. A thorough and dispassionate analysis should conducted of whether a free-standing, single purpose, national organisation still provides the most appropriate structure for delivering health services in light of changing needs, care models and resources. Originality/value-The paper provides offers a distinctive analysis of the possible causes of disappointing outcomes from successive attempts to improve integration. If accepted it 1 This paper was one of a number commissioned for a special issue marking the 20 th anniversary yof the
Collaboration between Health and Local Authorities: Why is it necessary?
Social Policy & Administration, 1982
In contrast with current proposals, collaboration with local government was a dominant factor in the 1974 reorganisation of the NHS. Four categories of such collaboration are identified in this paper: the sharing of services; coordination of service delivery; joint planning; and joint prevention. The need for each is discussed in the context of the reorganisation debate and of subsequent events. In essence, the DHSS case for collaborationand in particular, its emphasis on joint planningis seen as both a cause of reorganisation and a consequence of the form which that reorganisation eventually took. Emphasis is placed upon the potential role of collaboration as a vehicle for a preventive health strategy and as an important instrument for the development and implementation of major central government policy objectives. Finally prospects for the continuing evolution of joint working are considered in relation to NHS restructuring. It is concluded that the present government's approach to the structure and management of the NHS is likely to undermine its substantive policy objectives especially in the field of community care.
Regional Leadership in Public Health: Fragmented London and the
This report is sold subject to the condition that is shall not, by way of trade or otherwise, be lent, hired out or otherwise circulated without the publisher's prior consent in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser.
Health Policy, 2017
Link to publication on Research at Birmingham portal General rights Unless a licence is specified above, all rights (including copyright and moral rights) in this document are retained by the authors and/or the copyright holders. The express permission of the copyright holder must be obtained for any use of this material other than for purposes permitted by law. • Users may freely distribute the URL that is used to identify this publication. • Users may download and/or print one copy of the publication from the University of Birmingham research portal for the purpose of private study or non-commercial research. • User may use extracts from the document in line with the concept of 'fair dealing' under the Copyright, Designs and Patents Act 1988 (?) • Users may not further distribute the material nor use it for the purposes of commercial gain. Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.
Regional Governance in England: A Changing Role for the Government’s Regional Offices?
Public Administration, 2008
Political devolution has transformed constitutional arrangements in the Celtic nations. By contrast, in the English regions a less radical approach has been adopted, but the outcome has been a strengthening of the institutions of regional governance. A key feature has been the enhanced responsibilities of the Government's Offices for the Regions, which have been encouraged to build on their traditional administrative functions and adopt a more strategic role. This article explores the Offices' contribution to regional and local governance. Our central argument is that although increasingly expected to act as a bridgehead between national and sub-national government and a focus for regional policy coordination, their potential role in filling the missing gap in English regional governance has not yet been fully grasped. democracy or some form of regional representation' (Cabinet Office and DTLR 2002, p. 36). Despite this outcome, 'the Government are committed to the development of fitfor-purpose regional institutions and to continue their clear policy to devolve and decentralize power to regions, where this adds value' (Cooper 2006). This is underpinned by the view that regional institutions bring a unique strategic perspective to policy development and investment decisions, that economic differences between regions demand different forms of policy intervention and that some issues, which cross local authority boundaries, require a coordinated response. Furthermore, regional institutions have demonstrated an increasing capacity for policymaking, which suggests that 'bottom-up' regionalism will continue to grow. While falling short of institutional reforms introduced elsewhere in the UK these developments can be viewed as evidence of a recalibration in the functions and relationships between and within territorial scales of government and the creation of a more protean, multi-tiered form of governance (Stirling 2005). Regional actors are increasingly expected to operate within flatter inter-organizational structures that cross public, private and community sector boundaries, opening the prospect of a more holistic approach to regional management (Rhodes et al 2003; Koppenjan and Klijn 2004; Rhodes 2000). Increasing weight is also being placed on boosting the vertical links between the centre and regional and local agencies and regional actors have been urged to develop and refine their governance capacity and cooperate to maximize their influence in Whitehall. Central departments, too, are increasingly expected to take account of the views of regional stakeholders in determining national policies and spending programmes (Flinders 2002). 'The Government believes that when decisions interdepartmental Regional Coordination Unit (RCU), initially attached to the Cabinet Office, but transferred to the new Office of the Deputy Prime Minister (ODPM) in 2002, was also established. It would administer and monitor the GO network, provide a channel of communication between GOs and the centre, facilitate a more corporate approach to regional issues across departments and oversee and coordinate Area Based Initiatives (ABIs) (Regional Coordination Unit 2003). Furthermore, instead of being accountable to separate departments, GO Regional Directors would report corporately to the RCU's Director General. Despite these measures, regional and local officials continued to struggle to integrate separate government initiatives dealing with the same problem or the same client group (Regional Coordination Unit 2002). Moreover, although more spending departments were drawn into regional working, Whitehall's engagement in the GOs remains uneven. Apart from the small public health teams collocated in GOs, the Department of Health (DoH) has no regional operations. In 1998, a review of its executive agencies led the Department for Culture, Media and Sport (DCMS) to establish 'Regional Cultural Consortiums' and increase its GO presence, but staff numbers remain small. Similarly, the Department for Education and Skills (DfES) and its predecessors largely bypassed the regional tier in favour of sub-regional Learning and Skills Council (LSC) offices and only in 2006 were the department's GO-based activities fully integrated. The Ministry of Agriculture, Fisheries and Food (MAFF) also resisted establishing a GO presence until 2001, by which time MAFF had been merged in a ministerial reshuffle into a new department, the Department for the Environment, Food and Rural Affairs (DEFRA). Although the Home Office had a presence in the GOs since 1994, this was limited to a Table 1: Expenditure (£million) managed or influenced by Government Offices,
Primary care in the UK: understanding the dynamics of devolution
Health and Social Care in the Community, 2001
The United Kingdom is ostensibly one country and yet public policy often varies between its constituent territories -England, Scotland, Wales and Northern Ireland. Health policy illustrates the dilemmas inherent in an apparently unitary system that permits scope for territorial variation. Administrative devolution has now been accompanied by political devolution but their interaction has yet to produce policy outcomes. This paper describes recent health policy reform with regard to primary care in terms of the tension inherent in current policy between notions of a 'one nation NHS' and the territorial diversity wrought by devolution. The paper provides a framework for understanding the emergent outcomes by exploring various concepts. In particular, the existing character of territorial policy networks, the properties of policies in devolved territories and intergovernmental relations are considered from various disciplines to examine whether greater diversity or uniformity will result from the dual reform process. Whilst this evaluation can, at this stage, only be preliminary, the paper provides a framework to appraise the emerging impact of devolution upon primary care in the UK.