Reflections on Integrating Medical and Social Care: Five Laws Revisited

ABSTRACT

This paper reviews, rethinks, expands and applies the author's 'laws' of integration, which were first published six years ago. This approach one as well as the other introduces the laws to readers who don't know them, and proofs their utility for those who do. In survey real-world integration efforts mix and match the original composings of linkage, co-ordination and replete integration. But the message remains to work at all horizontals keep it simple, make finances supportive and empower social care.

KEY WORDS: INTEGRATION; INTEGRATING; LONG-TERM CARE; SOCIAL CARE; MEDICAL CARE; senior CARE; CO-ORDINATION; CASE MANAGEMENT; CARE MANAGEMENT; INTEGRATED SYSTEMS

Introduction

It's an honour to be asked by means of the editor to reflect upon my paper, 'Five laws for integrating medical and social care' (Leutz 1999) The supplication reflects continuing world-wide interest in integration, an interest that remains herculean for reasons now familiar to researchers, providers and policy-makers in medical care, social care and other supportive services. Industrial countries have ageing populations whose wants are getting clearer, and the take away froms of their care are going up And interest in integration is not limited to earlier borns but also relevant to other populations that use services simultaneously from multiple care a whole s such as individuals with physical and intellectual disabilities or mental illness.

Concern also remain about declines in informal support potential - fewer multi-generational households, more women working, more divorce and changing elections Interest in models of care for chronic illness has increased, along with a realisation (among many at least) that a disease-specific, acute care mould is inappropriate for people with multiple chronic illnesses, who ne more continuity and broader co-ordination of services. A mould for the management of like long-term conditions is currently being promot by dint of the UK Department of Health (DoH, 2005)

One counter-trend is the consumer-centr care prototype which questions the kinds of professional management and co-ordination that accompany integration. on the contrary I remain convinced that the availability of an accessible range of co-ordinated services is consistent with focus upon consumer preferences.

Since my original thinking is now eight years advanced in years and the integration efforts I reviewed are now generally a decade elderly or more, I know of more novel developments than I could possibly review here, and there is certainly more happening than I know about. in the way that rather than try to be comprehensive, I will use the 'laws' to assess a scarcely any of the current integration initiatives that I know best. I reliance that this approach will the two introduce the laws to readers who don't know them, and ordeal their utility for those who do. I will also toy with a small in number new laws.

Why think that these laws are still (or at any time were) relevant?

For one thing, they are fairly simple notions in a true complex field. There are other deliberative and more comprehensive frameworks for co-ordinating across service a whole s large studies have been administrationed (for example in Europe, PROCARE, and in the USA, PACE and MMIP; diocese links, after References) and this is not the single journal devoted to integration. I also had the audacity to call them laws'; I knew that it was presumptuous and far-fetched, on the other hand it did get attention.

The original five laws are shown in chest 1, below. But rather than simply re-hash the laws in detail, to frame the discussion, I will introduce them in a fresh order to help answer three stations of questions.

* Why is integration for a like reason difficult?

* Can we make it any easier?

* What other guides for integration exist?

Why is integration in like manner difficult? (4th law)

The fourth law of integration states that You can't integrate a square peg into a circular hole, and it frames a certain number of important answers to this question. The square-round notion is that medical care and social care contain a series of Inherent differences in financing, administration, providers, clinical orientation, access and benefits which make it difficult to integrate these combination of parts to form a wholes (Table 1, opposite). The nation involved simply see and do things differently, and they are supported by dint of different kinds of funding and benefit combination of parts to form a wholes The financing differences are the greatest in quantity problematic. On the medical side, greatest in quantity people in the US, and everyone in the UK has a relatively uniform medical care entitlement, on the other hand on the social care side, eligibility for services is many times means-tested, that is, you can't number on most people's having access to them.

Compounding the challenges to integration is the widespread belief that the solitary truly effective way to overbear these square-round differences is an all-or-nothing approach. That is, when clan talk about 'integration' they mean something multi-dimensional - pooling finances, joint purchasing of services, shared information a whole s common assessments and care co-ordination by the agency of teams. The view is that, unles you advance all the way, the filled benefits in terms of clinical issues and system efficiency won't be achieved. in the way that how have such full integration initiatives fared in novel years?