IRISS Insight 24: Delivering integrated care and support
By Reports & Resources,

This document is based on a report prepared for ADSW at the time of the Public Bodies (Joint Working) (Scotland) Bill (Petch, 2013) and seeks to distill key evidence to assist health and social care partnerships in Scotland in their delivery of integrated care and support.   It works from the premise that structural change by itself does not deliver the improved outcomes sought for service users and communities, unless equal or greater attention is paid to a range of other key factors (Ham and Walsh, 2013; Ham et al, 2013).

These other factors can be grouped using the categories in the diagram below which summarises the conclusions from an earlier evidence review (Petch, 2011; IRISS 2012a).

Many of the dimensions are inter-related; those seeking to deliver successful integration have to chart a path which both draws on successful examples from elsewhere and adapts to the specific local context.  Given the lack of structural determinism, the directives should be equally applicable whether the approach adopted be the ‘body corporate’ or lead agency model.

The key points are as follows:  
•    The achievement of personal outcomes for individuals should be the focus of integrated care and support.
•    Six dimensions are key to the delivery of integrated care and support: vision; leadership; culture; local context; integrated teams; and time. Factors that facilitate delivery of each of these dimensions are highlighted.
•    Transformational and distributed leadership led by a vision that is shared and maintained is essential.
•    Individuals working as ‘boundary spanners’ are valuable for reaching across organisational boundaries.
•    The drive to deliver integrated care and support should lead to the emergence of new cultural identities rather than forcing together the old.
•    The delivery of integrated care and support must be responsive to local assets and partnerships.
•    There is no single prescription for an integrated team structure or management but clear lines of accountability are essential.
•    Timescales of several years are required to develop and embrace integration.