SUPPORTING CHILDREN, YOUNG PEOPLE AND FAMILIES

Supporting children, young people and families

Supporting Children, Young People And Families

In almost every country of the developed world, there are problems of fragmentation and a lack of continuity in services for frail older people and other groups with complex, multiple needs (see Glasby, 2004 for a summary; see also Banks, 2004; Leichsenring and Alaszewski, 2004 for further examples). Almost irrespective of language, culture, structure, context and funding, there are different services responsible for different aspects of service provision and with different financial and regulatory systems, roles and responsibilities, and organisational and professional cultures. In pursuit of more joined-up services, a number of models have developed more formally integrated health and social care structures (such as Care Trusts in the UK context). These tend to share a number of characteristics such as a focus on a particular at-risk group and a defined catchment area, overall responsibility for arranging and/or delivering comprehensive services, the active involvement of primary care services and a focus on multi-disciplinary teamwork at ground level.

Such an approach is a powerful idea and intuitively seems like a sensible way forward. In theory, such integration could lead to more seamless services, user- centred care, an emphasis on prevention and rehabilitation, greater continuity of care, improved access to services, more integrated primary and secondary care and a reduction in inappropriate service use. However, key concerns include the difficulty of combining medical and social models and the risk of acute care (and the high cost of such services) distorting priorities.

There are a range of different models in different countries - each with strengths and limitations. Examples include the Program of All-Inclusive Care for the Elderly (PACE) and Social Health Maintenance Organisations in the US; the SIPA and PRISM projects in Canada; the Rovereto Project in Italy; and Co-ordinated Care Trials in Australia (see, for example, Kodner and Kay Kyriacou, 2000 for a summary).

In the UK, partnership working between health and social care is a central feature of current government policy and the focus of a significant range of activities at a local level. Although there has long been a recognition of the need for inter-agency collaboration to provide seamless services for users and carers (see, for example, Glasby and Littlechild, 2000; Means and Smith, 1998), this has acquired increasing impetus following the commitment of the New Labour government to achieving 'joined-up solutions' to 'joined-up problems'.

Responding to the emphasis of central government on partnership working, a large number of different partnership arrangements are being developed in different parts of the country, including:

Care Trusts

Use of the Health Act flexibilities

Joint appointments

The use of staff secondments/joint management arrangements

More recently, the need for services to work together has been re-asserted in the government's NHS Improvement Plan with particular reference to the needs of people with long-term conditions. In particular, evidence suggests that:

Around 80% of GP consultations relate to a long-term condition.

Patients with a long-term condition account for 60% of hospital bed days and two- thirds of emergency ...