Integrated care: meaning, logic, applications, and implications – a discussion paper

Integrated care is a burgeoning field. As is often the case in new areas of inquiry and action, conceptual clarification is demanded. Without such attention, it would be difficult to advance theory and practice in this increasingly important professional arena. In the following discussion paper, the authors explore the intellectual territory of integrated care, and underscore the need for a patient-centric imperative and meaning. They also examine the practical applications and implications arising from their views. The intention is to stimulate fruitful dialogue and debate about what ‘integrated care’ could and should be.

People-centred and integrated care: what the evidence may look like

-

Acute hospitals and integrated care

In March 2015, the King’s Fund published a report regarding the progress made by five acute hospital providers in England towards developing more integrated models of care. According to the report, becoming more closely integrated with primary care has proved a considerable challenge for these hospitals. This is partly due to the lack of alternatives to building relationships on a practice-by-practice basis. As the report explains, GP provider groups or federations “are still at an early stage of development in many areas of the country, and where they do exist it is not always clear that they are sufficiently cohesive to represent local practices and have leverage over them”. 

However, the report identifies a number of factors which facilitate the coordination between hospitals and primary care. These include strong clinical leadership in general practice; employing people with a primary care background at a senior level within the acute provider ...

What does it take to make integrated care work?: A ‘cookbook’ for large-scale deployment of coordinated care and telehealth. A personalised approach that will benefit patients in your organisation.

Evidence on integrated care is not only needed to show which interventions work, but also to understand how organisational processes affect these interventions. Therefore, evidence from large-scale implementations is especially important. In October 2015, the consortium of the EU-funded programme 'Advancing Care Coordination and Telehealth Deployment' (ACT) published a ‘cookbook’ of good practices, focusing on the structural and organisational drivers as well as barriers to large-scale deployment of care coordination and telehealth in five European regions. The report centres on chronic patients and elderly people, giving recommendations regarding staff engagement,  patient adherence, risk stratification and programme assessment. The report does not only look at health outcomes, but also economic outcomes such as the total cost per patient and the transition of resources towards primary care. An example of good practice from the Northern Netherlands is the programme Embrace. A core element of Embrace is the work of multidisciplinary teams led ...

WCIC4 – 4th World Congress on Integrated Care: “Investing in our Future: Improving the Health of People and Communities”

Personalised Integrated Care Programme

All too often older people living with long-term conditions do not have a sustainable care plan to keep them out of the hospital. Launched in Cornwall in 2013, Age UK’s Personalised Integrated Care programme uses risk stratification to both identify those older people who are at risk of recurring hospital admissions and provide a combination of medical and non-medical support. This support starts with a 'guided conversation' between the older person and an Age UK Personal Independence Co-ordinator. In this conversation they outline the goals that the older person identifies as most important to him or her and they draw a care plan which will include a combination of voluntary, health and care organisations. Following this, an Age UK volunteer is matched with the older person, both to help in achieving his or her goals, but also to encourage them to be more independent in managing their own care ...

International Summer School Integrated Care (ISSIC)

The International Summer School on Integrated Care, “Integrated Care in Theory and Practice” is organized by the Integrated Care Academy© and provides a one-week intensive training on theory and practice of integrated care. It is aimed at health and social care professionals, clinicians, researchers and managers who want to strengthen their understanding of integrated care, get a comprehensive overview of the state of the art in theory and practice, and hone their competencies in analyzing, designing, evaluating and practicing integrated care. The course has been developed for those who are tasked with designing, implementing, leading and/or managing integrated care and want to learn more about the tools and instruments which are available to them with evidence from around the world.

The International Summer School Integrated Care is designed as a stand-alone education and training course and is eligible for Continuous Professional Development (CPD) or Continuous Medical Education (CME) credits ...

The Right Medicine: Improving Care in Care Homes.

The increase of polypharmacy together with the population aging is making care homes a central point to develop health care programmes, specially related to medicines management and integration of different health care proffessionals.

The Royal Pharmaceutical Society has recently published a report addressing the main issues of medicine use in care homes. The needs identified by the authors include developing better communication systems, reducing falls in care homes, decreasing inappropriate use of psychotropic medicines, improving coordinated end of life care and lowering waste of medicines at home.

The report includes some recommendations such as giving pharmacists a major role in care homes medicine management, strengthening coordination between physicians and pharmacists or developing programmes of regular medicines review and staff training in integrated teams with other practitioners.

Bringing together physical and mental health: A new frontier for integrated care

In March 2016, the King’s Fund published a compelling case for this ‘new frontier’ for integration:physical and mental health. It gives service users’ perspectives on what integrated care would look like and highlights 10 areas that offer some of the biggest opportunities for improving the quality and controlling costs: 

1. Incorporating mental health into public health programmes
2. Promoting health among people with severe mental illnesses
3. Improving management of medically unexplained symptoms in primary care
4. Strengthening primary care for the physical health needs of people with severe mental illnesses
5. Supporting the mental health of people with long-term conditions
6. Supporting the mental health and wellbeing of carers
7. Supporting mental health in acute hospitals
8. Addressing physical health in mental health inpatient facilities
9. Providing integrated support for perinatal mental health
10. Supporting the mental health needs of people in residential homes

The key findings of this report are precisely that the efforts to develop ...

Physical and mental health: a new frontier for integrated care.

Traditionally, integrated care has been focused on closing the gaps between social and health care. Nevertheless, integrating mental and physical care should also be seen as a way to develop integrated care. In this report published by the King’s Fund, this topic is addressed, describing the current situation of mental and physical care and identifying ten areas where this kind of integration would be most needed:

1. Incorporating mental health into public health programmes.

2. Promoting health among people with severe mental illness.

3. Improving management of medically unexplained symptoms in primary care.

4. Strengthening primary care for the physical health needs of people with severe mental illnesses.

5. Supporting the mental health for people with long-term conditions.

6. Supporting the mental health and wellbeing for carers.

7. Supporting mental health in acute hospitals.

8. Addressing physical health in mental health inpatient facilities.

9. Providing integrated support for perinatal mental health.

10. Supporting the mental health needs of people ...

Delivering integrated care for older people with frailty

The conference was focused on the ways in which integrated care can be delivered for older people with frailty, looking at interactions between acute, primary, community and social care services, older people living with complex co-morbidities and ways in which older people with frailty can be supported to maintain their health and wellbeing.

Presentations are available in this link: Delivering integrated care for older people with frailty 

4th International Conference on Evidence-based Policy in Long-term Care

The 4th International Conference on Evidence-based Policy in Long-term Care will be held from 4th to 7th of September 2016 at the London School of Economics and Political Science, London. Building on the success of the three previous editions, the conference will focus on empirical research with direct relevance to long-term care policy offering an opportunity to debate with international experts policy issues related to the organisation, delivery, funding and regulation of long-term care services.

Some of the main thematic areas to be covered include: care models; case management; economics of long-term care; equity and efficiency; funding systems; health and social care integration; housing and care; institutional dynamics and politics; international comparative analysis; local vs. central policy interactions; personalisation of the care system; policy implications of dementia; service commissioning and regulation; technology and long-term care; unpaid carers; workforce and migrant workers. Abstracts on other relevant LTC policy evaluation topics will ...

The MDG To SDG Transition: the role of hospitals and integrated primary care.

In 2016, the world will be moving from the Millenium Development Goals (MDG) to the Sustainable Development Goals (SDG). Regarding health-related goals, most of the funding in recent years has been focusing on disease-specific programmes and strengthening primary care; nevertheless, public health, health promotion, prevention, and controlling risk factors through a broad range of policy interventions, both within and outside the health sector, must be an important focus in the era of SDGs.

In this post, integrated health services are seen as a main factor to achieve the health-related topics in the SDGs. The author defends not only strong primary care services to deliver broad quality care, but also that these services should be integrated with essential hospital services. The article emphasizes that this kind of integration would be even more important in countries with a weak health system, in order to build a strong system that could face the ...

Age UK’s Personalised Integrated Care Programme: where are we now?

Age UK launched its personalised integrated care programme in 2012 in Cornwall. In this post, published in its blog, some data about its evaluation are shown and discussed.

The main objectives of this programme are to improve health and wellbeing of older people by tailoring services to meet their needs, improve the experience and quality of care received, and to reduce unplanned hospital admissions amongst older people with multiple long-term conditions.

The evaluation showed a 31% reduction in all hospital admissions, a 26% reduction in emergency ones, and a 20% improvement in older people’s health and wellbeing. In addition, one fifth of aged people participating in the programme became volunteers in order to be able to improve other people’s health and wellbeing.

In 2015, this programme expanded to nine more places across the United Kingdom, a substantial challenge because, as it is said in the post, the needs ...

Integrated care – taking specialist medical care beyond the hospital walls

The Royal College of Physicians has published in 2016 a document titled “Integrated care -  taking specialist medical care beyond the hospital walls”.

In the first part of this document they are described some of the main topics about integrated care, how it is conceptualize and what it really implies for patients, professionals and for the whole system.

Afterwards, some study cases are shown as examples to go deeper into different dimensions of integrated care such as the need for sustainable models of integrated care, leadership, management and governance or self-management and care.

Finally, the document lists five key areas where physicians should focus in order to improve integrated care: (I) Ensure that the patient’s and carer’s perspective is the organising principle of service delivery across organisations, (II) Support population health and wellbeing outside the hospital walls, while offering specialist care within the hospital and being an advocate for ...

Ten actions required to improve health, social care and well-being in Wales

Health and social care organizations from Wales joined in the Welsh NHS Confederation’s 2016 Challenge Policy Forum and the published  a document called “Ten actions required to improve health, social care and well-being in Wales", trying to establish their priorities in order to get a better system.

The ten priorities described are: long term vision, ensuring financing, planning workforce, person centred and integrated care, public health perspective, improve preventive measurements, creating a culture of honest and open communication with population, improving mental health support, ensuring equal access to health and social care and improving the use of technology.

Integrating funds for health and social care: an evidence review

Objectives

Integrated funds for health and social care are one possible way of improving care for people with complex care requirements. If integrated funds facilitate coordinated care, this could support improvements in patient experience, and health and social care outcomes, reduce avoidable hospital admissions and delayed discharges, and so reduce costs. In this article, we examine whether this potential has been realized in practice.

Methods

We propose a framework based on agency theory for understanding the role that integrated funding can play in promoting coordinated care, and review the evidence to see whether the expected effects are realized in practice. We searched eight electronic databases and relevant websites, and checked reference lists of reviews and empirical studies. We extracted data on the types of funding integration used by schemes, their benefits and costs (including unintended effects), and the barriers to implementation. We interpreted our findings with reference to our framework ...

SUSTAIN Project: Sustainable tailored integrated care for older people in Europe.

SUSTAIN is a cross-European research project and stands for sustainable tailored integrated care for older people in Europe. It aims to concretely improve the way care services for older adults are organised and delivered across Europe, and especially for those who have multiple health and social care needs. 

The project started from the observation that in all European countries, care for older people is often poorly coordinated. This prevents care from adequately meeting the needs of older adults, and it shows that quality of care and outcomes could be much improved. 

Concretely, the project will:

• Analyse the 14 care services by gathering data and by interviewing several persons who are involved (practitioners, users, policy makers, health insurers etc.).
• With a group of organisations (associations, groups, etc.) at local level, design and implement a set of improvements of the care service, with regards to key principles and values for quality of ...

New primary care model yielding early results

Several ways of shaping primary care are being developed all around the world. Improving the role of nurses or giving general practitioners new competences are just a couple of ways of moving primary care towards a more comprehensive way of working.

In this post in the NHS Confederation Blog, some of the initiatives performed to change primary care are explained and some of the challenges that future primary care will face are listed.

One of the main points outstanded is the need of integrating care and workforce from different levels of health care. As it is said in this post “Patients will benefit from easy access to a single integrated, multidisciplinary team drawn from a wide range of health and social care professionals”

Voices on person-centred care

What is person-centred care to a patient, a physician, a nurse, a hospital head of department, an industry representative and a researcher? How do these people, who all have experience of receiving or working with person-centred care, see person-centred care from their perspectives? Short film clips from the University of Gothenburg Centre for Person-centred Care - GPCC. GPCC is an in terdisciplinary research centre, established in January 2010, with the support of the Swedish government's strategic investment in health and care research. Uniquely GPCC has evaluated the effects of person-centred care in controlled studies. This has established that person-centred care is capable of enhancing the efficiency of the care process. Apart from considerable monetary savings resulting from amongst other things shorter hospital stays, significant positive effects from a patient perspective have been seen, as care is adapted to each individual person and his or her resources are made use of.

Partnership, Person-Centredness in Health Care

Person-centred care is an emerging concept in health care. Many people ask what is new about it, and as a matter of fact many health care professionals believe that they work in a person-centred way already. But shifting to a person-centred care practice often involves a profound change in culture and structure, and the key is a different approach in seeing the patient as a partner. The main thing is about being able to listen. Being able to listen to the patient and co-create a care plan; to create a partnership in health care.

The University of Gothenburg Centre for Person-centred Care - GPCC, performs research, education and innovation in person-centred care. Many of the centre’s projects are performed in partnership with Sahlgrenska University Hospital, one of the biggest in Europe, which is closely linked to the University via the The Sahlgrenska Academy.

This short film sets the scene by ...

GPCC Person-centred care research centre web site

This research centre web site contains a range of information, films, presentations, resources and links; from basic information on person-centred care to information on a wide range of individual research projects from health and elderly care and rehabilitation. It also contains news, events, scientific publications and implementation.

The Gothenburg University Centre for Person-centred Care (GPCC) is an interdisciplinary research centre, established in January 2010, with the support of the Swedish government's strategic investment in health and care research. Uniquely GPCC has evaluated the effects of person-centred care in controlled studies. This has established that person-centred care is capable of enhancing the efficiency of the care process. Apart from considerable monetary savings resulting from amongst other things shorter hospital stays, significant positive effects from a patient perspective have been seen, as care is adapted to each individual person and his or her resources are made use of.

(A summary commentary ...

The University of Gothenburg Centre for Person-centred Care - GPCC

The University of Gothenburg Centre for Person-centred Care - GPCC is an interdisciplinary research centre, established in January 2010, with the support of the Swedish government's strategic investment in health and care research. The centre performs interventional and explorative studies on person-centred care in a wide variety of health care settings. This research has established that person-centred care is capable of enhancing the efficiency of the care process. Apart from considerable monetary savings resulting from amongst other things shorter hospital stays, significant positive effects from a patient perspective have been seen, including improved self-efficacy and increased patient satisfaction, as care is adapted to each individual person and his or her resources are utilised. In addition the centre applies its findings to implementation, innovation and educational courses and workshops in academic and healthcare settings.

GPCC's vision: Sustainable health through sustainable care: To prevent and reduce suffering and strengthen the efficiency ...

Consolidating the social health insurance schemes in China: towards an equitable and efficient health system

Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes.

ICIC16 – 16th International Conference on Integrated Care

The conference will be held in Barcelona from the 23th to the 25th of May and will bring together researchers, clinicians and managers from around the world who are engaged in the design and delivery of integrated health and social care. They will share experience and the latest evidence about integrating Public Health, Health and Social Care and the New roles and Possibilities for Hospitals, producing Positive and Curative Integrated Mental and Physical Care, mobilising key enablers like policy making and Mobile and Digital Health Solutions, and investment in an Integrated Care Workforce, clinical leadership and coproduction with individuals, careers, communities and populations.

The conference can follow with the hashtag #ICIC16 and will be streaming live to the global audience in English and Spanish. It is possible to take part in the discussions and ask questions to the speakers from your own home or from your institution as an individual ...

SUSTAIN: Sustainable tailored integrated care for older people in Europe

Problem: The project started from their observation that in all European countries, care for older people is often poorly coordinated. This prevents care from adequately meeting the needs of older adults, and it shows that quality of care and outcomes could be much improved.

Solutions:  SUSTAIN will in particular aim to support and improve what we call ‘integrated care’. By a better ‘integration’ of care, it means that: care for older people is better organised, and professionals coordinate the care they deliver; older persons’ health and social care needs are well assessed; care services listen carefully to older persons and informal carers, seek to involve them in the decisions affecting them and deliver care in line with their needs and preferences as much as they can (‘person-centred care’); professionals from different disciplines (prevention, healthcare, social care) are included in the care team, and different types of support are offered (including ...

WCIC4 Extended deadline for submission of abstracts

The International Foundation of Integrated Care (IFIC), in partnership with General Practice New Zealand (GPNZ) and Healthcare Quality and Safety Commission (HCQSC) , presents the 4rd World Congress on Integrated Care “Investing in our Future: Improving the Health of People and Communities” to take place in Wellington, New Zealand 23 to 25 November 2016.

They extended the call for submission of abstracts until Friday 1 July 2016. Follow the link below for more information. 

People centred Care in theory and practice

On the 23-25 May 2016, the 16th International Conference on Integrated Care in Barcelona attracted 1200 delegates from nearly 50 countries, and a further 600 persons per day watching events via the live stream.

One of the highlights of the conference, is the speech of Dr Angela Coulter, Senior Research Scientist, from The Nuffield Department of Population Health (NDPH), University of Oxford, UK, about "People centred Care in theory and practice".

The creative potential of health work to develop an integrated care model in Brazilian primary health care  

In November 2015, at the 3rd World Congress on Integrated Care and 8th National Congress of Integrated Medicine, “Co-producing High Quality People-Centered Integrated Care for ALL”, Debora Santos presented her PhD research on primary health care teams in Alagoas, the most unequal state in Brazil. According to Debora Santos, while Brazil's Unified Health System (SUS) is headed by principles of integrated care, in practice a biomedical conception of health typically prevails instead of one focused on integrated care. Therefore, the objective of her research was to identify potential ways to develop an integrated care model of primary health care focused on the principles of social health rights, integrated access, equity, team work and health promotion. Through focus groups and interviews with primary health care teams she identified several challenges and potentialities for integrated care. For example,  the teams faced both objective (clinical) and subjective (emotional) needs but had limited ...

Can hospital services work in primary care settings?

In this post, the author analyzes how recent changes in primary care in the National Health Services could face the purpose of moving some services from hospital to primary care settings.

The author bases her discussion on a report published by RAND corporation (“Outpatient Services and Primary Care”) that identifies five main areas to be considered when moving services from hospital to primary care:

1. Transfer: The substitution of services delivered by specialists for services delivered by primary care clinicians.
2. Relocation: Shifting the venue of specialist care from hospitals to primary care settings.
3. Liaison: Joint working between specialists and primary care clinicians to provide care to individual patients.
4. Professional behaviour change: Changing the way GPs refer patients to specialists.
5. Patient behaviour change: Helping patients make informed decisions about their care.

There is not a unique way of moving these services; many studies suggest that patients’ satisfaction usually grows when services are ...

Integrated Care Summit 2016: Improving local population health and delivering accountable care

This conference will explore the ways NHS organisations and their partners can collaborate in order to meet the needs of the population they serve. Showcasing learning from national and international accountable care systems, as well as other emerging new care models, conference sessions will provide a key opportunity to hear and learn from local areas on the journey towards more systemic and integrated approaches to improving population health.

Achieving triple integration: The central role of mental health in integrated care

During the 16th International Conference on Integrated Care that was held Barcelona last May,  one of the keynote presentation that was highlighted was "Achieving triple integration: The central role of mental health in integrated care"by Chris Naylor, Senior Fellow and Policy from The King's Fund.

The Spanish version of the video is available here: Achieving triple integration: The central role of mental health in integrated care. 

17th International Conference in Integrated Care "Building a platform for integrated care: delivering change that matters to people"

The 16th International Conference in Integrated Care "Building a platform for integrated care: delivering change that matters to people" will incorporate the 5th World Congress on Integrated Care as it comes to Europe for the first time. It will take place in Dublin, Ireland, from the 8-10 May 2017. 

The conference themes include: Promoting the health and welfare of people, families and communities; Timely transitions: optimizing patient flow across care settings: Preventing and managing chronic disease: engaging and empowering people; Ageing health and well being; and Implementing integrated care.

For more information, please visit: http://www.integratedcarefoundation.org/icic17 

Governance for new care models

Dr Rachael Addicott, Senior Research Fellow from The King’s Fund, discussed about her research into governance for new care models during the event on Multi-specialty community providers and primary and acute care systems (7 June 2016)

If you are interested in other presentations from this event, click here

Understanding integrated care: a complex process, a fundamental principle

Recent Editorial in the International Journal on Integrated Care, written by Nick Goodwin, emphasising the importance of the Framework. Around the past year Nick Goodwin has been involved in a range of research and development activities that seek to understand and/or promote the successful adoption of integrated care. In each of these, a common opening statement from protagonists is to typically say that “there is no universally accepted definition of integrated care, no one model of care that can be replicated locally, and little evidence to tell us that it works”. Whilst the latter might be disputed it remains true that people struggle with what integrated care means and particularly how it can be applied.

Read more...

Power and Integrated Health Care: Shifting from Governance to Governmentality

Integrated care occurs within micro, meso and macro levels of governance structures, which are shaped by complex power dynamics. Yet theoretically-led notions of power, and scrutiny of its meanings and its functioning, are neglected in the literature on integrated care. We explore an alternative approach. Following a discussion on governance, two streams of theorising power are presented: mainstream and second-stream. Mainstream concepts are based on the notion of power-as-capacity, of one agent ­having the capacity to influence another—so the overall idea is ‘power over ’. Studies on integrated care ­typically employ mainstream ideas, which yield rather limited analyses. Second-stream concepts focus on ­strategies and relations of power—how it is channelled, negotiated and (re)produced. These notions align well with the contemporary shift away from the idea that power is centralised, towards more fluid ideas of power as dispersed and (re)negotiated throughout a range of societal structures, networks and ...

Healthy China : deepening health reform in China building high-quality and value-based service delivery

As many other countries, China faces big challenges to meet the health care needs of her citizens, associated with a rapidly aging society and increasing burden of non-communicable diseases (NCDs). Also, health costs have been growing at a rate higher than GDP growth since 2008.

Since the launch of health reform in 2009, China has invested significantly in health infrastructure at the grassroots level and made progress in building the primary care doctors system. Basic public health services capacity has been significantly enhanced. China is progressing quickly to achieving universal health coverage and some of the reform achievements have attracted worldwide attention.

The reform commanded many innovative pilots in health financing and service delivery at the local level and provided a strong foundation for the next stage of reform. This report aim to support China during this reform phase by recommending 8 sets of strategic reform directions, referred to as ...

Organizational Context and Capabilities for Integrating Care: A Framework for Improvement

Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability.

Purpose: This study develops and validates a conceptual framework of organizational capabilities for integrating care, identifies which of these capabilities may be most important, and explores the mechanisms by which they influence integrated care efforts. 

Methods: The Context and Capabilities for Integrating Care (CCIC) Framework was developed through a literature review, and revised and validated through interviews with leaders and care providers engaged in integrated care networks in Ontario, Canada. Interviews involved open-ended questions and graphic elicitation. Quantitative content analysis was used to summarize the data. 

Results: The CCIC Framework consists of eighteen organizational factors in three categories: Basic Structures, People and Values, and Key Processes. The three most important capabilities shaping the capacity of organizations to ...

From vision to action. Making patient-centred care a reality

The NHS have worked with The King´s Fund to translate their themes into outcomes for patients and set out the most important priorities for action to achieve these outcomes. Under each of their five themes: 

- Co-ordinated care

- Patients engaged decisions about their care

- Supported self-management

- Prevention, early diagnosis and intervention

- Emotional, psychological and practical support

they have described the outcomes that they most want to achieve for patients. In order to achieve these outcomes, they hace then selected the service improvements that, if met, will have a major impact on the quality and cost-effectiveness of care. 

Integrated care for patients and populations: Improving outcomes by working together

This report examines:

- The case for integrated care

- What current barriers to integrated care need to be overcome and how

- What the Department of Health can do to provide a supporting framework to enable integrated care to flourish

- Options for a practical and technical support to those implementing integrated care, including approaches to evaluatin its impact 

The report asserts that developing integrated care should assume the same priority over the nect decade as reducing waiting times had during the last. The report makes a constructive contribution to the debate about integrated care and will be of interest to policy-makers, health and social care commissioners, and researchers with an interest in integrated care, as well as to health and social care organisations. 

What can a participatory approach to evaluation contribute to the field of integrated care?

Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground.

We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms.

While there is still much to learn about the benefits ...

WEBINAR Integrated Care Matters Series: Anticipatory Care Planing

The International Foundation for Integrated Care is delighted to introduce a new series of webinars on people-centred integrated care in practice.The series will be hosted by IFIC – Scotland in collaboration with Healthcare Improvement Scotland, the Health and Social Care Alliance, the University of the West of Scotland and the Scottish School of Primary Care.

Each monthly webinar will feature health and care practitioners from Scotland in conversation with colleagues from across the World. All of the ‘Home and Away’ presenters have lived experience of implementing people-centred integrated care and will offer practical tips and peer support as part of IFIC’s global community of practice.

Each one hour session will include insights from people who currently use health and social care support and from undergraduate students as the future workforce.

Each webinar will extend IFIC’s on-line knowledge tree of tools and resources related to the specific integrated care ...

WEBINAR Integrated Care Matters Series - A House of Care and Compassion

The International Foundation for Integrated Care is delighted to introduce a new series of webinars on people-centred integrated care in practice.The series will be hosted by IFIC – Scotland in collaboration with Healthcare Improvement Scotland, the Health and Social Care Alliance, the University of the West of Scotland and the Scottish School of Primary Care.

Each monthly webinar will feature health and care practitioners from Scotland in conversation with colleagues from across the World. All of the ‘Home and Away’ presenters have lived experience of implementing people-centred integrated care and will offer practical tips and peer support as part of IFIC’s global community of practice.

Each one hour session will include insights from people who currently use health and social care support and from undergraduate students as the future workforce.

Each webinar will extend IFIC’s on-line knowledge tree of tools and resources related to the specific integrated care ...

WEBINAR Integrated Care Matters Series - Locality Interdisciplinary Teams

The International Foundation for Integrated Care is delighted to introduce a new series of webinars on people-centred integrated care in practice.The series will be hosted by IFIC – Scotland in collaboration with Healthcare Improvement Scotland, the Health and Social Care Alliance, the University of the West of Scotland and the Scottish School of Primary Care.

Each monthly webinar will feature health and care practitioners from Scotland in conversation with colleagues from across the World. All of the ‘Home and Away’ presenters have lived experience of implementing people-centred integrated care and will offer practical tips and peer support as part of IFIC’s global community of practice.

Each one hour session will include insights from people who currently use health and social care support and from undergraduate students as the future workforce.

Each webinar will extend IFIC’s on-line knowledge tree of tools and resources related to the specific integrated care ...

WEBINAR Integrated Care Matters Series - Community centred Palliative Care

The International Foundation for Integrated Care is delighted to introduce a new series of webinars on people-centred integrated care in practice.The series will be hosted by IFIC – Scotland in collaboration with Healthcare Improvement Scotland, the Health and Social Care Alliance, the University of the West of Scotland and the Scottish School of Primary Care.

Each monthly webinar will feature health and care practitioners from Scotland in conversation with colleagues from across the World. All of the ‘Home and Away’ presenters have lived experience of implementing people-centred integrated care and will offer practical tips and peer support as part of IFIC’s global community of practice.

Each one hour session will include insights from people who currently use health and social care support and from undergraduate students as the future workforce.

Each webinar will extend IFIC’s on-line knowledge tree of tools and resources related to the specific integrated care ...

Integrated Care: theory to practice

"Integrated care" is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team management is frequently the primary focus of integrated care when implemented internationally. This study examine the practical application of integrated care in the NHS in England to exemplify the prevalence of the case management focus. It looks at the evidence for effectiveness of multi-disciplinary team case management, for the focus on high-risk groups and for integrated care more generally. They suggest realistic expectations of what integration of care alone can achieve and additional research questions. 

Progress on integrated care

This year´s conference of the International Foundation for Integrated Care (IFIC16) in Barcelona attracted over 1000 delegates and participants. Shortly afterwards, the World Health assembly adopted a global framework on integrated people-centred health services develope by the WHO, and an alliance of organisations created a European call for action to implement the framework at EU level. 

Read more

Integrated Diabetes Care: A Multidisciplinary Approach

Integrated care is an approach that seeks to improve the quality of care for people with diabetes by ensuring that services are well coordinated around their needs. Healthcare professionals, people with diabetes and the system must be aligned to support improvement both in the delivery of care and in achieving better outcomes for people with diabetes.

SUSTAIN goes live: video-interviews with representatives from the sites

SUSTAIN is a cross-European research project and stands for sustainable tailored integrated care for older people in Europe. The project aims to concretely improve the way care services for older adults are organised and delivered across Europe, and especially for those who have multiple health and social care needs.SUSTAIN is a cross-European project with thirteen partners from nine countries. SUSTAIN is working with fourteen initiatives in seven participating countries. These initiatives aim to achieve integrated care for older people living at home and SUSTAIN will support them in further improving this care.

The project consortium has produced a series of video-interviews aimed at sharing the early experience of professionals directly involved in the implementation of the project within the SUSTAIN sites. In particular, we aimed at getting views and opinions on motivations, goals and objectives, implementation challenges and cross-countries exchenges between the SUSTAIN sites.

The first round of videos ...

Integrated care in practice- the South Eastern Sydney Experience

The purpose of this paper is to describe the recent efforts of a large publicly funded healthcare organisation in sidney, Australia to implement the IC "at scale and pace" in the messy, real world context of a District Health Service. The paper outlines the theoretical and practical considerations used to design and develop a localised IC Strategy informed by the “House of Care” model (NHS England, 2016). The need for cross-agency partnership, a shared narrative, joint leadership and an IC Strategy underpinned by proven theoretical models model is described. This paper highlights key factors relating to implementation and evaluation of a local Integrated Care (IC) Strategy in the real world. 

The theory and practice of integrative health care governance: the case of New Zealand´s alliances

The purpose of this paper is to outline the theory and practice of governance for integrated care, using the case of New Zealand´s healthcare alliances.

This paper argued that the new "experimental" governance models are needed for effective development of integrated care, illustrated through the example of alliance governance in New Zealand. While the alliances are in a relatively incipient state, they hold considerable promise when compared with the alternatives: corporate, democratic or clinical governance. Alliance governance provides for a different way of working, and for boldstering clinical leadership as central to this. 

At Risk Individuals (ARI) programme, Counties Manukau Health (CMH) Auckland, New Zealand

The model of care provides early and planned interventions, establishes general practice as the centre of coordinated healthcare, provides care based on patient set goals and improves access to a range of specialist and community services; uses risk profiling as means to identify and judge patient eligibility; care goals are set and progress overseen by an assigned care coordinator; funded by flexible regime managed by the providers to ensure care goals can be achieved.

Integrated Care: A Pill for All Ills?

There is an increasing policy emphasis on the integration of care, both within the healthcare sector and also between the health and social care sectors, with the simple aim of ensuring that individuals get the right care, in the right place, at the right time. However, implementin this simple aim si rather more complex. In this editorial, they seek to make sense of this complexity and ask: what does integrated care mean in practice? What are the mechanims by which it is expected to achieve its aim? And what is the nature of the evidence base around the outcomes delivered?

Understanding and Evaluating the Implementation on Integrated Care: A "Three Pipe Problem"

Altought we have come a long way in being able to articulate the key building blocks of integrated care, the interplay between them is so complex and interwined that it seems an impossible challenge to create any simple implementation model. Yet, if integrated care is to advance, we must become better at smoothing over the many obstacles and challenges to implementation that have bedevilled the uptake and roll-out of even the most proven of integrated care interventions.

This is quite the "three-pipe problem" for integrated care since science has yet to make the real breakthrough to address how we might better understand the implementation and sustainability of complex innovations. Recent attems hace used a blend of realistic synthesis, behavioural theory and mixed-methods to understand implementation effectiveness.

The Development, Description and Appraisal of an Emergent Multimethod Research Design to Study Workforce Changes in Integrated Care Interventions

In this paper, they provide a detailed and explicit description of the processes and decisions underlying and shaping the emergent multimethod research design of their study on workforce changes in integrated chronic care. They argue that the terminology developed for the description of mixed methods designs should also be used for multimethod designs such as the one presented here. 

Bringing integration home: policy on health and social care integration in the four nations of the UK

This paper outlines relevant policies on the integration of health and social care in four home nations: Scotland, Wales, Northern Ireland and England. The aim of the paper is to offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy. Also in this paper reveals considerable opportunities for further research and comparative modelling of integration approaches. 

Early findings from the evaluation of the integrated care and support pioneers in England

Integrating health and social care is priority in England, although there is little evidence that previous iniciatives have reduce hospitals admissions or costs. Twenty-five Integrated Care Pioneers have been established to drive change "at scale and place". The early phases of their evaluation (April 2014-June 2016) aimed to identify their objetives, plans ans activities, and to assess the extend to which they have overcome barriers to integration. In the longer-term, we will assess whether integrated care leads to improved outcomes and quality of care and at what cost. 

Integrated Person-Centered Health Care for All Women During Pregnancy: Implementing World Health Organization Recommendations on Antenatal Care for a Positive Pregnancy Experience

In 2015, Unnited Nations member states adopted the Sustainable Development Goals (SDGs) in order to continue the momentum of the Milennium Development Goals and address a broarder range of development issues. The World Health Organization (WHO) identified target 3.8, universal health coverage, as the key to achieving all other health-related SDGs. To that end, Every Woman Every Child movement developed the Global Strategy for Women´s, Children´s, and Adolescentss´Health (2016-2030) with the aim of ending all preventable deaths of women, children, and adolescents and ensuring their health and well-being. The strategy provides a framework for countries to achieve the highest attainable standards of health for all women, children, and adolescents to  "Survive, Thrive and Transform". 

The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization

The integration of phychological and behavioral health services into safety net primary care clinics has been viewed as a step toward reducing disparities in mental health treatment and addressing behavioral factors in chronic diseases. Though it is posited that integrated behavioral health (IBI) reduces preventable medical costs, this premise has yet to be tested in a safety net primary care clinic. 

Case Management for Patients with Complex Multimorbidity: Development and Validation of a Coordinated Intervention between Primary and Hospital Care

In the past few years, healthcare systems have been facing a growing demand related to the high prevalence of chronic diseases. Case management programs have emerged as an integrated care approach for the management of chronic desease. Nevertheless, there is little scientific evidence on the impact of using case management program for patients with complex multimorbidity regarding hospital resource utilisation. 

This study tested wheter improved continuity of care resulting from the integration of community-based and hospital services reduced the use of hospital resources amongst patientes with complex multimorbidity. 

“On the Margins and Not the Mainstream": Case Selection for the Implementation of Community based Primary Health Care in Canada and New Zealand

Healthcare system reforms are pushing beyond primary care to more holistic, integrated models of community based primary health care (CBPHC) to better meet the needs of the population. In order to scale up and spread successful models of care it is important to study what works and why. The first step is to select "appropiate" cases to study. In this commentary, this study reflect the difficulty in identifying "successful" models to study, the value of drawing on clinical and organisational networks and experts, and the association between policy context and ease of case selection. Such insights have important implications for case study methodology in health services and policy research. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to strengthen African health systems in order to address communicable and non-communicable diseases. The aim of this study was to assess the position of civil society-led community unity home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demands arise. 

The SELFIE framework for integrated care for multi-morbidity: Development and description

The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease-towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. The framework structures relevant concepts in integrated care for multimorbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation. 

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review

A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispending pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. 

Integrated care in practice – the South Eastern Sydney experience

The purpose of this paper is to describe the recent efforts of a large publicly funded health care organisation in Sydney, Australia to implement integrated care (IC) "at scale and pace" in the messy, real-world context of a District Health Service. This paper highlights key factors relating to implementation and evaluation of a local IC Strategy in the real world. 

The theory and practice of integrative health care governance: The case of New Zealand’s alliances

The purpose of this paper is to outline the theory and practice of governance for integrated care, using the case of New Zealand´s healthcare alliances.

What’s integration got to do with it?

Observations and Lessons from the Franciscus Gasthuis & Vlietland Study Trip to North-West London.

1st Asia Pacific Conference on Integrated Care (APIC1)

Presentations from the conference are available to download here

Videos from the conference are available to watch here

Pictures from the conference are available to view and ...

Health assessments for health governance—concepts and methodologies

For better supporting the science-governance interface, the potencial of health assessments appears underrated. The aims of this study are to identify what various types of health assessment have in common, how they differ; which assessments to apply for which purpose; and what needs and options there are for future joint development. 

Developing accountable care systems: lessons from Canterbury, New Zealand

The health system in Canterbury, New Zealand, has undertaken a significant programme of transformation over the past decade. As a result of the changes, the health system is supporting more people in their homes and communities and has moderated demand for hospital care, particularly among older people. Change was achieved through developing a number of new delivery models, which involve better integration of care across organisational and service boundaries, increased investment in community-based services, and strengthening primary care. The experience in Canterbury offers useful lessons for the NHS in terms of how to redesign care in this way. Key approaches include the development of a clear, unifying vision of ‘one system, one budget’; sustained investment in giving staff skills to support them to innovate and giving them permission to do so; and developing new models of integrated working and new forms of contracting to support this. The transformation has taken ...

Effective Organizational Leadership in the Implementation of Integrated Care; Lessons from 9 cases in the iCoach Project

Policy makers in many countries are encouraging the development of integrated care strategies and the development of new models of integrated care. These new models require changes at a clinical or service level, organizational level and system level with strong leadership necessary at all three levels. Despite the key role of leadership in these efforts, there has been only limited study of what organizational leadership approach is successful in different contexts for integrated care. 

Challenges and achievements in integrated care: different health and social care providers working together. Successful projects that show that this is the way

The Catalan health system is a public healthcare system, funded by taxes, with universal coverage and public healthcare services portfolio. There´s a mixed healthcare providers network. Delivery of integrated health and social care witha a shift to a patient-centered model is one of the main challenges of our public system. this artcile share three experiences of different models developed to improve integration of social and healthcare services, to guarantee the continuum of care and to achieve quality health and social care outcomes. 

Health and social care in aging population: an integrated care institution for the elderly in Greece

The purpose of this article was to describe the nature of the services actually offered to the elderly in Greece by an institution of integrated care, as opposed to those that should be offered according to the relevant law, and to investigate the factors influencian the supply of those services. 

Integrating terminology for integrated care

The plan is to transform a fragmented and largely uncoordinated model into a multidimensional care model that integrates social care systems with health care systems. To achieve this integration successfully, a strong conceptual framework must be constructed, in which terminology will play an important part. Since language mediates a particular vision of reality, when creating a new care model it seems important to focus on terminology. 

Organizational Context and Capabilities for Integrating Care: A Framework for Improvement

Interventions aimed at integrating care have become widespread in healthcare; however, there is significant variability in their success. Differences in organizational contexts and associated capabilities may be responsible for some of this variability. 

The Impact of Integrated Case Management on Health Services Use and Spending Among Nonelderly Adult Medicaid Enrollees

Medicaid plans, whose patients often have complex medical, social, and behavioral needs, seektools to effectively manage enrollees and imprive access to quality care while containing costs. 

The aim of this study is to examine the effects of an integrated case management (ICM) program operated by a Medicaid managed care plan on health service use and spending for nonelderly, non-pregnant adults. 

The Kings Fund: Learning from new care models here and abroad - Making accountable care happen

Whether you’re working on developing new care models, sustainability and transformation partnerships or accountable care systems, this event will provide valuable lessons to help you overcome the issues you face as you work towards integrating health and care services.

Why you should attend

Lessons from international health systems

Understand your local context

Revisiting Organisational Learning in Integrated Care

Progress in health care integration is largely linked to changes in processes and ways of doing. These changes have knowledge management and learning implications. For this reason, the use of the concept of organisational learning is explored in the field of integrated care. 

People-Centered Integrated Care

Video made by Andalusian School of Public Health in Andalusia with Dr. Salman Rawaf, Professor of Public Health and Director of the WHO Collaborating at the Imperial College London.

Digital Technologies Supporting Person-Centered Integrated Care – A Perspective

Shared electronic health and social care records in some service systems are already showing some of the benefits of digital technology and digital data for integrating health and social care. These records are one example of the beginning "digitalisation" of services that gives a glimpse of the potential of digital technology and systems for building coordinate and individualized care. 

Integrated Care in Action: A Practical Guide for Health, Social Care and Housing Support.

Integration is now a key expectation within the delivery of health and social care services in the UK and internationally. However, it still remains difficult to achieve and sustain in practice. Based on learning from successful, and unsuccessful, integrated care initiatives, this book is an invaluable guide for those responsible for leading, managing and delivering integrated care across health, social care and housing.

Written by an experienced team of researchers who have studied, led and supported integrated care for many years Integrated Care in Practice draws on latest evidence, innovative practice and helpful theory. It provides insights into the common pitfalls that such initiatives can encounter and demonstrates positive approaches to anticipating and responding to such challenges. Throughout, real-case examples are provided, and concepts and models are connected with the realities of day-to-day life for those working within these services.

Integrated care is a goal to aspire to - this book ...

Global Conference on Integrated Care 2018

The Global Conference on Integrated Care (GCIC) 2018 is an international conference that will bring together clinicians, health and social care professionals and practitioners, and policymakers from around the world to share knowledge, experiences, ideas and innovations in integrated care delivery. The conference will be used as a platform to look beyond the immediate horizon, future-proof healthcare delivery, and strengthen relationships between policymakers and public users to enable successful care integration.A world-class programme of keynote lectures, plenary sessions and symposia has been designed to facilitate impactful knowledge exchange and foster fruitful dialogues with internationally renowned experts.

It will cover the three key themes of:
- Care Integration in Practice
- Enabling Care Integration
- Transcending Boundaries in Integrated Care

Who should attend?
- Clinicians, health and social care practitioners
- Healthcare administrators
- Academics and researchers

For more information and registration, please visit: https://gcic2018.sg/ 

Managing multimorbidity: profiles of integrated care approaches targeting people with multiple chronic conditions in Europe

In response to the growing populations of people with multiple chronic deseases, new models of care are currently being developed in European countries to better meet the needs of these people. This paper aims to describe the occurrence and characteristics of various types of ntegrated care practices in European countries that target people with multimorbidity.

Enhanced health in care homes: Lessons from good practice on embedding integrated care

This conference is for care home providers, health care providers, and commissioners who are thinking through how to improve the quality of life and health care for people living in care homes. It will share lessons from the six vanguards for enhanced health in care homes, and other local examples of good practice, to enable attendees to learn from initiatives that have worked well and can be replicated across the country.

Instruments Measuring Integrated Care: A Systematic Review of Measurement Properties

Integrated care is an important strategy for increasing health system performance. Despite ots growing significance, detailed evidence on the measurement properties of integrated care instruments remains vague and limited. This systematic review aims to provide evidence on the state of the art in measuring integrated care. 

Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark

Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to improve new health policies more effectively. Their aim was to analyse the role and capacity of healht professions in driving organisational change in interprofessional working and patient-centred care.

Using Information Communication Technology in Models of Integrated Community-Based Primary Health Care: Exploring ICT in the iCOACH Study

Information and communication technology (ICT) is a promising enabler to support delivery of integrated care by inter-disciplinary teams by supporting information sharing across professional and  organizational boundaries; arguably a crucial aspect of successful models of integrated care

Individual determinants of integrated care for indigent patients: an experimental study in Brussels: Pierre Smith

In metropolitan area, socially deprived patients with chronic disease undergo the fragmentation of health and social care services because of their complex needs. Integration of health and social care would benefit these patientes, however, it is not feasible or appropriate to integrate all the services for all vulnerable patients. This study aims at identifying the indicidual determinants of deprived patients´preferences in integration of health and social care. 

Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care

Introduction: A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care components to support complex patients and their families in the community.

Methods: Expert panel focus groups with 24 care providers, working in health and social care sectors across Toronto, Ontario, Canada were conducted. Patient vignettes illustrating significant health and social care needs were presented to participants. The vignettes prompted discussions on i) how best to meet complex care needs in the community and ii) the barriers to delivering care to this population.

Results: Categories to support care needs of complex patients and their families included i) relationships as the foundation for care, ii) desired processes and structures of care, and iii) barriers and workarounds for desired ...

Enhanced health in care homes: learning from experiences so far

Enhanced health in care homes can be achieved by close co-ordination between care homes and the range of health services required to meet the needs of older people living in the care homes. When these services work closely together – for example, through regular GP visits to care homes and regular comprehensive assessments – they can actively promote good health rather than just reacting to ill health.

Defining indicators for assessing integrated care (2012-2014): Lessons learned on methodology and the evolution in assessment approach

Integrated care interventions are extremely complex as they tend to invilve multiple actors and different care levels. When evaluating such programmes indicators provide several benefits in comparison with other approaches. The Agència de Qualitat Avaluació Sanitàries de Catalunya, through a new collaborative approach, has been working on the development of indicators specially aimed at assesing integrated care. The aim of this study was to present the methodology developed and review the evolution of the prioritized indicators in three different projects aimed at assessing chronic integrated care initiatives. 

Managing In- and Out-Migration of Health Workforce in Selected Countries in South East Asia Region

There is an increasing trend of international migration of health professionals from low -and middle- income countries to high-income countries as well as across middle- income countries. The WHO Global Code of Practice on the International Recruitment of Health Personnel was created better address health workforce development and the ethical coduct of international recruitment. This study assessed policies and practices in 4 countries in South East Asia on managing the in -and out- migration of doctors and nurses to see whether the managementet has been in line with the WHO Global Code and has fostered health workforce development in the region; and draws lessons from these countries. 

The Western Sydney Integrated Care Program (WSICP): Qualitative Evaluation

The ageing population together with an increasing prevalence of chronic conditions require a systems wide integrated approach to health care. This includes overcoming barriers between primary and secondary care, physical and mental health, and health and social care in order to provide patient centred care. In Australia, the New South Wales Ministry of Health is piloting an innovative Integrated Care Program in Western Sydney, foccussed on care facilitator roles to coordinate patient care between General Practices and hospitals. 

Translating the Elements of Health Governance for Integrated Care from Theory to Practice: A Case Study Approach

Against a paucity of evidence, a model describing elements of health governance best suited to achieving integrated care internationally was developed. The aim of this study was to explore how health meso-level organizations used, or planned to use, the governance elements. 

Reimagining community services: making the most of our assets

The purpose of this research was to understand the current state of community services and to explore how the health and care systems needs to change to enable these to meet the needs of the population now and in the future

Communities and health

The role of communities in improving health is receiving increasing, and long overdue, attention in health policy and practice. Stronger recognition of the role communities can play and greater involvement are needed if there is to be a successful move to population health systems. As part of this shift in focus, sustainability and transformation partnerships and integrated care systems need to take the role communities can play in improving and sustaining good health seriously.