Background to the integration

Background contextual conditions refer to the situation or environment previous to the integration programme. From the data, six background contextual conditions were identified, as presented below.

Government policy was increasingly calling for a more effective joined-up approach

Judging by the five policy documents and four sets of minutes that I had access to and the two staff interviews and one informal interview with a member of staff I had conducted, there was a strong sense that the introduction of the integration of health and social care services for older people in Cambridgeshire was government policy-driven or in response to the calls of government policy makers for enhanced and more effective joined-up working. In one of the policy documents, one of the reasons for the integration, given by the Cambridgeshire County Council, is:

Government policy also supports a more joined-up approach. The recent Green Paper following on from the Victoria Climbie enquiry recommends much closer working relationships between Health, Education and Social Services. Both the White Pater on Social Services from 1998 and the Health and Social Care Act 2001 project similar messages for adult services.

(C4)

One staff member believed that ‘the integration is statistics driven by the Department of Health’ (S7).

Members of Integration Steering Group considered the integration programme

consistent with the government’s health and social care agenda which supported the integration of health and social care. When the Department of Health published Our Health, Our Care, Our Community: Investing in the Future of Community Hospitals and Services (Department of Health, 2006) and Your Health, Your Care, Your Say:

Research Report (Opinion Leader Research, 2006), the directors and managers at the meeting of the Integration Steering Group, Cambridge City and South

Cambridgeshire Primary Care Trusts cheered, saying ‘We are completely on the right road!’ (M36).

Other authorities had taken steps towards greater integration

One policy document (C4) and two members of staff (II 12, II 15) pointed out that other authorities in England had already taken steps towards greater integration, and this was another reason for introducing the integration programme in

Cambridgeshire. It seemed that Cambridgeshire County Council and the four Primary Care Trusts did not want to be left behind. During an informal interview I asked one of the senior staff members whether she was sure that the integration of health and social care for older people in Cambridgeshire was a unique form of integration in the country. She said proudly:

Yes, we are. Other counties are working partnerships. They do not transfer staff on the NHS payroll. We are unique in the country. I presume Cambridge wants everything to be different from others. (Extract from my notes of informal interviews II 15)

Research had shown that there were many advantages to integration

Although only one of Cambridgeshire County Council’s policy documents stated that

‘research has shown that the advantages are many’ (C4) and none of the staff

interviewed said anything about previous research, the designers or decision makers

of the integration programme seem to have considered the results of previous research in the field even though there was no evidence of this. From this point of view the introduction of the integration programme was evidence-based.

Increasing care needs of local older people

Two policy documents (CP2 and C9) assessing the care needs of local older people point out that an increase in the age of the Cambridgeshire population was

accompanied by an increase in care needs. In these documents there is a sense of urgency about meeting these needs.

According to policy document CP2, over the last two decades Cambridgeshire experienced considerable population growth. From 1995 to 2007, the population (all ages) registered with the 76 GP practices in Cambridgeshire increased from 524,000 to 598,000. Since 1995, 16% of this population growth was in over 65-year-olds.

Between 2006 and 2011 Cambridgeshire’s population was projected to grow and the greatest proportional population change will be in those aged over 75 (by 9%). The population aged 75-84 is forecast to increase by 24% by the year 2016 and 54% by the year 2021and the population aged 85 and over will increase by 57% by the year 2021.

The increase in age of the local population is accompanied by an increase in care needs. Older people made up 72% of all social services clients. Of the 4,140 people of all ages who made new contacts and completed assessments in 2006/07, 3,290 (79%) were 65 and over and 2,680 (64.7%) were 75 and over (CP2).

Calls for improvement to the standard of social care services in the county As was clearly reflected throughout the policy documents that one of the main

objectives of the integration programme was to improve the quality of care services.

Although no indication of a low standard of social care service in the county prior to integration was found in the policy documents I analysed or in the staff interviews I did, during an informal interview a member of staff of Cambridgeshire County Council (not of Cambridge City PCT) told me:

Integration is supposed to integrate good practices. But [social services]

were slim, overspent, not good and had nothing to offer. The County Council just chucked it away. (Extract from my notes of informal interview II 12)

She indicated that the standard of social care service in Cambridgeshire County Council prior to the integration was low and that the County Council had taken the opportunity to pass the provision of care services to the PCTs. In any case one of the aims the Cambridgeshire County Council was trying to achieve through the

integration was to improve the standard of social care services in the county.

Users in favour of closer working across agencies

During the initial integration consultation period local discussions with service users, carers and representative groups showed that users were ‘in favour of closer working across agencies’ (C4). Users’ expectation of good-quality care services was growing.

Public awareness and expectations are growing and older people want to be supported to live in their own homes and communities for as long as possible and to avoid institutional care wherever possible. (C9)