Academic journal article Care Management Journals

Emergent Approaches to Care Coordination in England: Exploring the Evidence from Two National Organizations

Academic journal article Care Management Journals

Emergent Approaches to Care Coordination in England: Exploring the Evidence from Two National Organizations

Article excerpt

For many years, there has been an international concern about the fragmented nature of health and social care services for vulnerable older people and younger adults. This article examines the implementation of two major policies in England designed to ensure frail adults and older people receive services appropriate to their needs. First, care management, which was introduced in 1993 and provided by local government, and second, case management, which was introduced in 2005 and provided by primary care through the National Health Service. An analysis of the implementation of the two policies is presented, and data from two national surveys are used to describe similarities and differences between the two approaches in terms of goals, arrangements, service characteristics, and indicators of integration and differentiation within care coordination arrangements. Both were designed to promote the provision of care at home as an alternative to more costly alternatives. Discretion within the policy implementation process has militated against the development of a more differentiated approach to care management in local authorities as compared with case management in primary care trusts and more generally, integration between the two. Future developments within both service settings will be influenced by the introduction of personal budgets.

Keywords: care management; case management; community care; frail adults and older people

The origins of care coordination across the globe arose from the need to bring together a range of support, provided from multiple sources, to achieve a common goal of effective care. Subsequently, its development has been the focus of many policy initiatives both in the health and social care sectors in many countries over a considerable period (Challis, 2003). In England in the 1990s, a key component of the community care reforms was the introduction of care management arrangements. These had the underlying objectives of cost containment and promoting choice within an overall goal of shifting the delivery and accountability from institution-based services toward care at home (Department of Health, 1989). This service is provided by local authority (LA) adult social care departments, units of local government. In some respects, the introduction of the National Health Service (NHS) and social care model in England a decade later mirrors that of the community care reforms, with its origins in a move away from a reliance on high-cost inpatient acute services toward treating more clients with enduring long-term health problems in community settings. Within this, long-term conditions case management has an explicit focus on clients with multiple complex needs (Department of Health, 2005b). It is provided by primary care trusts (PCTs), organizations with responsibility for delivery of community-based health care.

One of the barriers to effective care coordination, the fragmentation of health and social care, is common to many countries, and policies to achieve greater integration have been widely sought for many years (Eklund & Wilhelmson, 2009; Hébert et al., 2010; Howe, 2000; Kodner, 2006). Long-term conditions policy emphasizes the importance of coordinated health and social care services for the most vulnerable people with complex long-term conditions living in the community (Department of Health, 2005b). However, policy guidance relating to LA care management is expressed differently. Two forms have been advocated: either a generic care coordination approach or, for a much smaller group with complex needs, intensive care management requiring an integrated approach to assessment and service provision (Social Services Inspectorate [SSI], 1997). The latter can sometimes be seen in old age mental health services where it is used to support older people with dementia in the community (Challis & Hughes, in press). The importance of interagency working for older people with complex needs has been reiterated in policy guidance since the introduction of the community care reforms (Department of Health, 2000, 2006; SSI/Social Work Services Group [SWSG], 1991a). …

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