Emergent Approaches to Care Coordination in England: Exploring the Evidence From Two National Organizations

Abstract

For many years, there has been an international concern about the fragmented nature of health and social care services for vulnerable older people and younger adults. This article examines the implementation of two major policies in England designed to ensure frail adults and older people receive services appropriate to their needs. First, care management, which was introduced in 1993 and provided by local government, and second case management, which was introduced in 2005 and provided by primary care through the National Health Service. An analysis of the implementation of the two policies is presented, and data from two national surveys are used to describe similarities and differences between the two approaches in terms of goals, arrangements, service characteristics, and indicators of integration and differentiation within care coordination arrangements. Both were designed to promote the provision of care at home as an alternative to more costly alternatives. Discretion within the policy implementation process has militated against the development of a more differentiated approach to care management in local authorities as compared with case management in primary care trusts and more generally, integration between the two. Future developments within both service settings will be influenced by the introduction of personal budgets.

Implementação da Saúde do Idoso na Estratégia Saúde da Família: visão dos profissionais e gestores

“…The coordination of this RAS carried out by the primary care system requires reordering the health system so that care is guided through the network 31 . This perspective on the fragmentation of the system with an eye to integrating health care services is seen in England, leading us to conclude that it is a problem common to Western countries 14 .…”

“…It should be noted that there are also concerns about the fragmentation of care for the elderly in countries such as England. Brazil has also identified similar difficulties 14 . It is noted that for RAS to be implemented and operate effectively, changes are required in the management, culture, and training of professionals who work in the Unified Health System (SUS), as it is the dynamic practices of social actors that will make innovations in health care effective 15 .…”

Care coordination for older people: an exploratory framework

“…Degree of differentiation: this was defined as the extent to which care coordination arrangements distinguished between service users with multiple needs requiring a multi-service response and those with less complex needs often met by a single service response provided by one agency (Hughes et al, 2011). Four attributes were identified in this domain.…”

“…The first was the degree of specialism represented by an indicator capturing the presence of specialist multi-agency and review teams in old age services (Department of Health, 2002b, 2009Cm 6737, 2006). Next, reflecting the definition of differentiation above, variability could occur in the degree to which targeting in the care management process was evident to provide, for example, a differentiated response in terms of grade of staff or case complexity (Hughes et al, 2011). Hence the attribute of care coordination referred to as "intensive care management" was noted in social care services for older people or multidisciplinary old age mental health services (Department of Health, 2009; Challis and Hughes, 2012).…”

“…Whilst some agencies had arrangements permitting the same worker to follow a case through assessment, care planning, monitoring and review others focused staff activity on assessment with ongoing work often referred to service providers. Degree of differentiation: this was defined as the extent to which care coordination arrangements distinguished between service users with multiple needs requiring a multi-service response and those with less complex needs often met by a single service response provided by one agency (Hughes et al, 2011). Four attributes were identified in this domain.…”