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On 5-6 November we organised our annual seminar in Manchester which addressed the concept of integrated care with more than 100 participants from 24 European countries.
Across Europe, when people talk about “integration” they may refer to structural reorganisation and improved governance; for instance, having a single accountable agency responsible for commissioning services. Others mean improving cooperation between professionals from different sectors working with the same client. There are yet more who refer to integrating various strands of finance by pooling budgets or creating specific integrated funds to support specific groups with complex needs. They are all important and in some form or another they are all integration, but do they improve people’s outcomes?
Defining “integration”
That's why if we are to use the word “integration”, we ought to have some common definition. In the European Social Network (ESN), we have defined the term “integrated services” as the range of activities, depending on sectors, target groups and governance contexts, implemented to achieve more efficient coordination between services and improved outcomes for service users.
So at the seminar we listened to various experiences, which highlighted how changes in the care landscape may benefit service users as support becomes more holistic. New integrated support requires new skills and new ways of working. Therefore, new roles are emerging, new career paths are being developed, and joint training is taking place to enhance mutual understanding as public social services, education, health and employment rise to the challenge of integrated services.
Examples of service integration across Europe
In Manchester, public service reform revolves around integrated, co-ordinated and sequenced bespoke support packages; family-based approaches to changing behaviour; and choosing interventions on strength of the evidence. An evaluation following the first phase of the implementation of the Troubled Families (TF) programme demonstrated that 67% of the children, who were assessed as children in need, had that status removed within 6 months of the end of their key worker intervention (compared with an estimated 50% without TF intervention).
In Andalucía, Spain, the network of early intervention for young children with developmental problems has developed software that is available for all professionals from education, health and social services working with these children. This tool allows all professionals working in the region to access the unique records of each child to ensure continuity of care and prevent the need for individuals to have to repeat their story to other professionals.
In Renfrewshire, Scotland, the co-location of the day services for adults with learning disabilities has been a collaborative effort between social and leisure services to develop facilities that provide a platform for the promotion of healthy lifestyles, integration and inclusion in the community. Social services, health services and a third sector partner are working collaboratively to establish an accessible garden space, where adults with learning disabilities can have training, employment and personal development opportunities through a social enterprise.
In many jobcentres in Germany, several organisations have been merged into one single agency for service delivery (including traditional job-seekers’ support such as advice, counselling and training), housing support, mental health and childcare support. In addition, there is a network of cooperation with a variety of organisations, including schools, immigration offices, housing organisations, youth welfare services, employers’ associations and third-sector organisations.
The Finnish service integrator – Kotitori – gathers all older people’s services from public and private providers that are available in Tampere, and provides guidance for service users so that they can choose the most suitable. This is a public-private partnership where a private company provides the software whilst the municipality covers costs for needs assessment and advice. According to self-reported evaluations, service users are highly satisfied as the integrator helps them access all necessary services through a single point.
Summing up
These examples show that integration is certainly about making organisational, governance, budgetary, structural or cultural changes but most importantly the i-word is about people. There is a need to invest in the organisations’ learning environment, joint training and skills development but also in the human side of professionals’ relationships, such as trust-building, common understanding and assessment. Ultimately the aim is to ensure that the move to integration improves people’s outcomes and their quality of life.
Further ESN work on integration
The European Social Network (ESN) has been working with the knowledge institute on long-term care Vilans (The Netherlands) to review current literature and practice on integrated services in Europe. The seminar was organised to gather ESN’s members input on the findings so far and integrate them onto a final report, which will be launched in the beginning of 2016.
Resources
• Learn more about current policy on integrated services in Europe
• Learn more about current literature and research on Integrated Services across Europe