Governing integrated health and social care: an analysis of experiences in three European countries

Exley, J. et al. (2024) Governing integrated health and social care: an analysis of experiences in three European countries. International Journal of Integrated Care, 24, 9. (doi: 10.5334/ijic.7610) (PMID:38344427) (PMCID:PMC10854466)

Abstract

Purpose: Achieving greater health and social care integration is a policy priority in many countries, but challenges remain. We focused on governance and accountability for integrated care and explored arrangements that shape more integrated delivery models or systems in Italy, the Netherlands and Scotland. We also examined how the COVID-19 pandemic affected existing governance arrangements. Design/methodology/approach: A case study approach involving document review and semi-structured interviews with 35 stakeholders in 10 study sites between February 2021 and April 2022. We used the Transparency, Accountability, Participation, Integrity and Capability (TAPIC) framework to guide our analytical enquiry. Findings: Study sites ranged from bottom-up voluntary agreements in the Netherlands to top-down mandated integration in Scotland. Interviews identified seven themes that were seen to have helped or hindered integration efforts locally. Participants described a disconnect between what national or regional governments aspire to achieve and their own efforts to implement this vision. This resulted in blurred, and sometimes contradictory, lines of accountability between the centre and local sites. Flexibility and time to allow for national policies to be adapted to local contexts, and engaged local leaders, were seen to be key to delivering the integration agenda. Health care, and in particular acute hospital care, was reported to dominate social care in terms of policies, resource allocation and national monitoring systems, thereby undermining better collaboration locally. The pandemic highlighted and exacerbated existing strengths and weaknesses but was not seen as a major disruptor to the overall vision for the health and social care system. Research limitations: We included a relatively small number of interviews per study site, limiting our ability to explore complexities within sites. Originality: This study highlights that governance is relatively neglected as a focus of attention in this context but addressing governance challenges is key for successful collaboration.

• Item Type: Articles
• Additional Information: Funded by the NIHR Policy Research Programme through its core support to the Policy Innovation and Evaluation Research Unit (Project No: PR-PRU-121 7–20602(05, 09)).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Stewart, Professor Ellen
• Authors: Exley, J., Glover, R., McCarey, M., Reed, S., Ahmed, A., Vrijhoef, H., Manacorda, T., Vaccaro, C., Longo, F., Stewart, E., Mays, N., and Nolte, E.
• College/School: College of Social Sciences > School of Social and Political Sciences > Urban Studies
• Journal Name: International Journal of Integrated Care
• Publisher: Ubiquity Press
• ISSN: 1568-4156
• ISSN (Online): 1568-4156
• Copyright Holders: Copyright © 2024 The Author(s)
• First Published: First published in International Journal of Integrated Care 24:9
• Publisher Policy: Reproduced under a Creative Commons license