‘Trying to do a jigsaw without the picture on the box’: understanding the challenges of care integration in the context of single assessment for older people in England

Introduction: Demographic ageing is one of the major challenges for governments in developed countries because older people are the main users of health and social care services. More joined-up, partnership approaches supported by information and communications technologies (ICTs) have become key to managing these demands. This article discusses recent developments towards integrated care in the context of one of the arenas in which integration is being attempted, the Single Assessment Process (SAP) to support the care for older people in England. It draws upon accounts of local SAP implementations in order to assess and reflect upon some of the successes and limitations of service integration enabled by ICTs. Description of care practice: At the Department of Health in England, policy and strategy are directed at the integration of services through a ‘whole systems’ approach, with services that are interdependent upon one another and organised around the person that uses them. The Single Assessment Processes (SAP) is an instance of inter-organisational and cross-sectoral sharing of information intended to improve communication and coordination amongst professions and agencies and so support more integrated care. The aim of SAP is to ensure that older people receive appropriate, effective and timely responses to their health and social care needs and that professionals do not duplicate each others efforts. This article examines examples from two programmes of work within the context of SAP in England: one with the direction coming from local government social services, the other where the momentum is coming from the National Health Service (NHS). Conclusion and discussion: Both examples show that the policy and practice of ICT-supported integration continues to represent a significant challenge. Although the notion of integrated care underpinned by ICT-enabled information sharing is persuasive, it has limitations in practice. The notion of an ‘open systems’ approach is proposed as an alternative way of improving communication and coordination across the domains of health and social care

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Inter-organisational motility of construction knowledge practices

This paper presents a new model of intra-organisational knowledge management in terms of motility of knowledge practices. While existing conceptualisations of knowledge, such a tacit and explicit have proved a valuable lens for focusing on knowledge practices within organisations and in relatively well understood or stable contexts, this paper argues that their use may be less effective in considering knowledge practices shared and communicated between organisations and when knowledge needs are still being negotiated. Based on research into the construction industry’s approach to the issue of sustainability and the knowledge challenges it poses, this paper introduces the concept of motile knowledge practices as an alternative lens through which to make sense of, and improve, the industry’s ability to support innovation for sustainability. The notion of motile knowledge helps us to focus on the fundamental property of knowledge practices as they move, mutate and decay. Seeing knowledge as essentially motile it is possible to question the application of existing approaches to knowledge management within inter-organisational domains. The paper concludes with a discussion of the implications for practice made apparent by the lens of knowledge motility

Motility of practiced knowledge: an exploration within the UK construction industry

This paper introduces a model of intra-organisational knowledge management in terms of motility of practiced knowledge. While existing conceptualisations of knowledge, such a tacit and explicit, have proved a valuable lens for focusing on knowledgeable practices within organisations and in relatively well understood or stable contexts, this paper argues that their use may be less effective in considering practiced knowledge as it is shared and communicated between organisations and when knowledge needs are still being negotiated. Based on research into the construction industry’s approach to the issue of sustainability and the knowledge challenges it poses, this paper introduces the concept of motility of knowledge as an alternative lens through which to make sense of, and improve, the industry’s ability to support innovation for sustainability. A motile account of knowledgeable practice helps us to focus on movement, mutation and decay, and to question the application of existing approaches to knowledge management within inter-organisational domains. The paper concludes with a discussion of the implications for practice