Methodological Development of the Interactive INTERLINKS Framework for Long Term Care

There is increasing international research into health and social care services for older people in need of long-term care (LTC), but problems remain with respect to acquiring robust comparative information to enable judgements to be made regarding the most beneficial and cost-effective approaches. The project ‘INTERLINKS’ (‘Health systems and LTC for older people in Europe’) funded by the EU 7th Framework programme was developed to address the challenges associated with the accumulation and comparison of evidence in LTC across Europe. It developed a concept and method to describe and analyse LTC and its links with the health and social care system through the accumulation of policy and practice examples on an interactive web-based framework for LTC. This paper provides a critical overview of the theoretical and methodological approaches used to develop and implement the INTERLINKS Framework for LTC, with the aim of providing some guidance to researchers in this area. INTERLINKS has made a significant contribution to knowledge but robust evidence and comparability across European countries remain problematic due to the current and growing complexity and diversity of integrated LTC implementation

Evaluation of the Outpatients consultation in East Kent

CHSS undertook to support Kent and Medway Commissioning Support (KMCS: acting on behalf of East Kent Hospitals University NHS Foundation Trust and NHS Canterbury and Coastal Clinical Commissioning Group) in undertaking an independent analysis of a consultation on Outpatient services in East Kent. The aim of the consultation was to gain opinions from the public of a proposed Outpatient Clinical Strategy that intends to improve local access to, and facilities for, Outpatient services, and to offer a wider range of services on each site. CHSS advised on the survey, evaluated the consultation process, ran focus groups and carried out quantitative and qualitative analysis of the responses gathered during the consultation period (9th December 2013 to 17th March, 2014 - originally 9th March but period was extended). Ethical approval was not required for a consultation process, but ethical principles have been adhered to regarding data confidentiality and informed consent for the focus groups

Service Development Programme: Maximising Life Opportunities for Teenagers. Teenagers' Views and Experiences of Sex and Relationships Education, Sexual Health Services and Family Support Services in Kent - Survey findings for Year 2

This brief report provides findings from data collected in year 2 of a survey of teenagers' views and experiences of sex and relationships education and sexual health services in Kent. The data in year 2 was collected in Autumn 2005, a year after the data collected in year 1. The purpose of this report is to highlight the results in year 2 which differ from the year 1 survey data. It is to be used in conjunction with the report in year 1 entitled "Service Development Programme: Maximising Life Opportunies for Teenagers: Teenagers' Views and Experiences of Sex and Relationships Educatioon, Sexual Health Services and Family Suupport Services in Kent: Survey Findings July 2005". The final report on the survey will consist of findings from further analysis of the data from year 1 and year 2 merged together, available at the end of 2006

Contracting for integrated health and social care: a critical review of four models

In the current climate of service reorganisation and sensitivity surrounding cost, it is clear that commissioners and providers in the health and social care economy are striving to strengthen integrated care as a means of improving quality and reducing costs (Curry and Ham 2010; Ham and Walsh 2013). Across England, health and social care systems are having to confront many pressures. For example, most of the funding is tied up in acute and long term social care, current NHS contracts are widely regarded as insufficient for the transformation agenda with block contracts stifling innovation, and Payment by Results does not incentivise the reduction in admissions or social care changes but in fact acts as a perverse incentive (Curry et al 2011). In addition, Advanced Assistive Technology should be embedded within integrated care but is often peripheral. As a consequence, commissioners must rapidly consider commissioning and contracting arrangements to enable them to drive forward service integration that is innovative, sustainable and transferable. Recently, there has also been support from NHS England Chief Executive Simon Stevens for promoting more flexible approaches to commissioning and contracting, strongly suggesting that CCGs could explore alternative approaches. These ideas have become more formalised in NHS England’s Five Year Forward View, with Multi-Specialty Community Providers (MCPs) and Primary and Acute Care Systems (PACS) eventually evolving to hold a delegated budget for the health and care of whole populations (NHS England 2014). These new integrated care models require strong relationships and trust between the different organisations and professionals delivering care, which should be underpinned by sound contracting mechanisms that have relational concepts embedded within them. However, there is currently scanty evidence on contracting approaches that would have a good fit with the transformation agenda, particularly concerning how agencies can work towards joint outcomes. This paper presents the findings of an international literature review of contracting approaches, models and designs, with the aim of critically analysing their suitability to the integrated health and social care agenda. An important feature of this was to capitalise on learning from agencies and industries external to our health and social care systems and to identify in particular evidence of effectiveness and what could be usefully be transposed. The approach and search strategy of the literature review can be found as an appendix

Older People Have Their Say! Survey of Older People’s Needs in Westgate Ward, Canterbury

Although a lot of effort in the last few years has been made to address the needs of people in old age, surprisingly not much is known about the views of this age group in the Canterbury City Council area. To address this lack of knowledge, the Canterbury and District Pensioners’ Forum was funded by the Canterbury City Council to explore the needs of older people living in this area. Our Forum decided to collaborate with the University of Kent to produce a survey on the needs of older people within the District of Canterbury. During the process of the project, we decided to base the survey on the Westgate Ward in Canterbury because we felt that older people living in this area represent a good example for highlighting needs that involve ‘ordinary’ older people. This ward is quite diverse in many ways; it spreads from a semi-rural area through to town dwelling. It is not seen as an area of deprivation, thereby has not generated any special money from the Government to help with social problems in the provision of social centres, community learning, social activities etc. Yet we know from our own experience that what may appear in many parts as fairly affluent is quite deprived of places for people to meet; and has large public housing areas with no amenities at all. The present Government put through legislation, which said that public services should be surveyed, and the part of that legislation that we are particularly interested in is “The National Service Framework for Older People”. That framework asks that older people are treated with dignity by NHS and Social Care organisations; and that Councils –County and District, examine existing services- housing, leisure and transport – to identify opportunities to promote health and well-being. We felt that Westgate Ward would be representative of many other areas within our District that had not received any special investment. The work that has been done in producing this survey has been done by members of the Canterbury & District Pensioners’ Forum with help from the University of Kent. It is a survey of older people, carried out by older people. It is our work. Information generated by this project will be assisting the Forum’s work to promote important issues related to older people’s quality of life and access to health and social care services. A comment from J.F. Kennedy we believe sums up the approach that we took at the start of this survey: “It is not enough for a nation to have added years of life. Our object must be to add new life to those years

Nurses’ experiences of transitions of older patients from hospitals to community care. A nation-wide survey in Norway

Moving older patients from hospitals to community services is a critical phase of integrated care. Yet there has been little large-scale research on the quality of these transitions. We investigated how Norwegian nurses working in community care services (N = 4,312) and at in-patient wards at hospitals (N = 2,421) experienced the quality of transitions of older patients from hospitals to community care. We tested hypotheses derived from qualitative research and consistent with predictions, we found that compared to hospital nurses, the nurses working in community care experienced lower quality of patient transitions and were less satisfied with information exchange on patients’ condition and needs. Further, when comparing groups of community nurses, we confirmed the hypothesis that nurses in home nursing were more dissatisfied with the quality of transitions and information exchange than nurses in nursing homes. We conclude that hospital nurses should have more face-to-face or telephone contact with community nurses, and specifically with home nurses. Further, we suggest that means are implemented to promote a mutual understanding of the older patients’ pathway from one service to the other, and to improve co-ordination across the services

Developing a joint outcomes contracting model for integrated health and social care for older people

Purpose Current debates surrounding the NHS contract in England are suggesting that it is in need of change to support an integrated health and social care transformation agenda that meets the needs of an ageing chronically ill population. This paper describes a three phase project in England that sought to develop and validate a whole systems contracting model for integrated health and social care focusing on older people with long term conditions, and based on joint outcomes. Design/methodology/approach A participative mixed-method approach for the development of the contracting model was used; this consisted of 1) a literature review, 2) a design phase drawing on consensus method through stakeholder discussions and 3) an international validation phase. Findings The final contracting model consists of four overarching and interrelated core elements: (i) outcomes; (ii) partnership, collaboration and leadership; (iii) financial: incentives and risk; and (iv) legal criteria. Each core element has a series of more detailed contracting criteria, followed by further specifications attached to each criteria. Research limitations/implications While the policy environment appears to be conducive to change and encourages the adoption of new ways of thinking, there are difficulties with the implementation of new innovative models that challenge the status quo, and this is discussed. Practical implications The paper concludes with reflections on the way forward for local development and implementation. Originality/value There is currently much discussion for the need to realign contracting for integrated care that has a better fit for the transformation agenda, but until now, there have been no attempts to develop a whole systems approach that focuses on joint outcomes. This research bridges the gap but recognise

Advancing integrated care evaluation in shifting contexts: blending implementation research with case study design in project SUSTAIN

Background: Despite many studies evaluating the effectiveness of integrated care, evidence remains inconsistent. There is increasing commentary pointing out the mismatch between the ability to capture the somewhat ‘illusive’ impact of integrated care initiatives and programmes, and the most appropriate way to do this. Focusing on methodology, this paper describes and critically reviews the experiences of SUSTAIN, a Horizon 2020 funded project (2015–2019) with the purpose of advancing knowledge and understanding of cross-European integrated care evaluation. SUSTAIN sought to improve integrated care initiatives for older people in seven countries, and to maximise the potential for knowledge transfer and application across Europe. The methods approach drew from implementation research, employing the participative Evidence Integration Triangle (EIT) and incorporating a mixed method, multiple embedded case study design. A core set of qualitative and quantitative indicators, alongside context and process data, were created and tested within four key project domains (person-centredness, prevention-orientation, safety and efficiency). The paper critically discusses the overall approach, highlighting the value of the EIT and case study design, and signalling the challenges of data collection with frail older people and stakeholder involvement at the sites, as well as difficulties developing the core set of indicators. Conclusions: Lessons learned and recommendations for advancing integrated care evaluation are put forward that focus on the status of integrated care as a complex intervention and a process. The use of implementation research methods and case study design are recommended as an additional evaluation approach for researchers to consider, alongside suggested ways of improving methods of data collection with frail populations and cost analys

Proof of concept evaluation of a project using ‘conversations inviting change’ methodology to support the development of in-place systems leadership in local care hubs

This evaluation took place between March and August 2018 and was commissioned by the NHS Leadership Academy on behalf of Kent and Medway Sustainability and Transformation Plan (STP) and delivered by East Kent Community Education Provider Network (EK CEPN). The programme consisted of three development sessions carried out over two sites, or multi-professional teams known as hubs, clusters or primary care networks by an experienced facilitator using the model ‘conversations inviting change’. This model embodies a narrative approach that recognises the domains identified by the National Leadership Academy of individual effectiveness, relationships and connectivity, innovation and improvement, learning and capacity building (NHS Leadership Academy, 2017)