Radcliffe Medial Press, 2004, 11 chapters, 139 pages+index
ISBN 1 85775 821 8
Integrated care has been a recent concern in health and social policies in many European countries. Care trust is an example of these policies within the UK context. It is a new type of agency proposed by the government to bring health and social care together into a single organisational entity, which would commission and/or deliver health and social care. Thus, it represents a structural solution to the problem of further integrating care.
This book describes the care trust concept, assesses its implementation with case analysis, and provides examples of broader partnership working. It has 11 chapters and is divided into two parts. In the introduction, the editors illuminate the background of this policy initiative in a succinct description of the health and social care divide in the UK. This divide is stated to be a major reason for a fragmented service provision.
The first chapter draws on the lessons learned from the partnership working literature by summarising the factors that contribute to effective partnership. It is, however, a pity that this literature review is restricted to the UK, for reviews of studies conducted in other countries would have offered relevant information.
The following three chapters report evaluations of several partnership working initiatives: a national evaluation of the flexibility of the Health Care Act, an evaluation of the Somerset mental health partnership and another national evaluation of intermediate care. The editors deserve special recognition for the ending of the first half of the book. This chapter gives an exceptional and touching account of an authentic user perspective, written by a mental health service user on her experiences as a trust board member. This account explains how difficult it is to include the user perspective in the development and management of integrated care.
The second half begins with an optimistic view, which illuminates care trust as one alternative among other ways to further partnership working. It is followed by a sceptical view on care trusts, which pinpoints many factors that could prevent care trust from being the assumed service improvement vehicle. Chapters 8 to 10 summarise experiences from care trust and their establishment in three localities (Northumberland, Sandwell and Hampshire). Taking into consideration that the book reports mainly government funded policy evaluations, it is laudable that negative and sceptical views on care trusts are also included, yet the chapters describe more success than what has been published in respective evaluations on policy implementation. This leads the reader to question whether the rather positive conclusions are fully justified on the basis of evaluation results so far.
The editors state that the care trust proposal has the potential to revolutionise the way in which public services are organised and provided. How revolutionary the change is, or will be, is not yet possible to assess on the basis of the reported evaluations. It takes time before it is justifiable to expect care outcomes to be identifiable through research.
According to the cover, the book is directed “to all healthcare and social care professionals with responsibility for, involved in, or affected by the new partnership working arrangements”. It could be added that it offers useful information also to the researchers, consultants, administrators, and politicians in other countries with different health and social care systems than that of the UK. For example, for a reader interested in the content of welfare policies and their creation, this book provides interesting information about efforts to further social inclusion by integrated care. It also provides an example of what the rather abstract “third way” approach can mean with regard to health and social care.
In addition, the book shows how difficult it is to make and implement policies introducing structural reforms in situations which have well established structures and vested interests of powerful actors (e.g. the Association of Local Authorities, NHS agencies, and health and social care professionals). The tensions mentioned seem similar to those encountered in some other countries' efforts to introduce structural solutions to integrate care (e.g. the Finnish mergers of municipal health and social authorities with their strategic, operative, and service providing parts). Also, the arguments used to justify care trusts that are reported in the articles are rather similar to those presented in many other countries regarding the development of integrated care.
Given the above, I hope this book will inspire comparative research to explore, in-depth, obstacles and facilitators of these kinds of reform in order to develop theory on integrated care. In this way, it might be possible to gain deeper insight and understanding for ensuing integrated care in practice.
In summary, this book has special value in applying a contingency theoretical approach, while emphasising the importance of taking local traditions in partnership working and other conditions into account in the efforts to establish care trusts. Although fewer abbreviations would have made it more reader friendly, it makes for useful reading, not only for health and social care professionals (doctors, nurses, social workers) in the UK context, but also for policy makers, administrators and researchers evaluating respective policy reforms in other countries.