SCIE Research briefing 41: Factors that promote and hinder joint and integrated working between health and social care services
By Ailsa Cameron, Rachel Lart, Lisa Bostock and Caroline Coomber
Published: May 2012
Review date: May 2015
The aim of this research briefing is to give people who provide and use social care services an overview of the research evidence for joint and integrated working by identifying and systematically describing:
- different models of working between health and social care services at the strategic, commissioning and operational levels
- evidence of effectiveness and cost-effectiveness
- factors promoting and obstacles hindering the success of these models
- the perspectives of people who use services and their carers.
This briefing updates a previous systematic review by Cameron and Lart1 that reported on the factors that promote and hinder joint working between health and social care services. Given their prominence in terms of policy debates about joint and integrated working, the briefing focuses on jointly-organised services for older people and people with mental health problems in the UK only. In line with the original review, papers have only been included in this briefing if:
- they refer to an actual, rather than proposed, model of joint working
- they include primary data
- an evaluation of the model has been carried out.
Papers reported evaluations published before 2000 have been excluded from this briefing but papers published before are reported in Cameron and Lart. Taken together, the findings provide a 30-year overview of UK-based evaluations of joint working in health and social care. Please note that ‘joint working’ is used as an umbrella term to describe all models of working together, with ‘integrated services’ used only to refer to health and social care services that have been merged.
- This is an update of a previous systematic review on the factors that promote and hinder joint working between health and social care services. It demonstrates some positive outcomes of such an approach for people who use services, carers and organisations delivering services.
- Three broad themes are used to organise the factors that support or hinder joint or integrated working: organisational issues; cultural and professional issues; and contextual issues.
- There is significant overlap between positive and negative factors, with many of the organisational factors identified in research as promoting joint working also being identified as hindering collaboration when insufficient attention is paid to their importance.
- Securing the understanding and commitment of staff to the aims and desired outcomes of new partnerships is crucial to the success of joint working, particularly among health professionals.
- Defining outcomes that matter to service users and carers is important. Outcomes defined by service users may differ from policy and practice imperatives but are a crucial aspect of understanding the effectiveness of joint or integrated services.
- Although most service users and carers report high levels of satisfaction, more can be done to involve them in care planning and influencing future care options. Joint and integrated services work best when they promote increased user involvement, choice and control.
- The evidence base underpinning joint and integrated working remains less than compelling. It largely consists of small-scale evaluations of local initiatives which are often of poor quality and poorly reported. No evaluation studied for the purpose of this briefing included an analysis of cost-effectiveness.
- There is an urgent need to develop high-quality, large-scale research studies that can test the underpinning assumptions of joint and integrated working in a more robust manner and assess the process from the perspective of service users and carers as well as from an economic perspective.
About the development of this product
Scoping and searching
Focused searching was carried out between September and October 2011. The scope included peer-reviewed papers reporting UK-based evaluations of different models of joint working across the health and social care interface. It updates a previous systematic review by Cameron and Lart (2003) that reported on the factors that promote and hinder joint working between health and social care. Papers published before 2000 were excluded; papers before 2000 are reported in Cameron and Lart (2003).
Peer review and testing
The authors have research and topic expertise. The briefing was peer reviewed internally for methodology. It was peer reviewed externally by a leading academic expert, Professor Jon Glasby, Director of the Health Services Management Centre (HSMC), Birmingham University. We are grateful for his comments.
About SCIE research briefings
SCIE research briefings provide a concise summary of recent research into a particular topic and signpost routes to further information. They are designed to provide research evidence in an accessible format to a varied audience, including health and social care practitioners, students, managers and policy-makers. They have been undertaken using methodology developed by SCIE. The information on which the briefings are based is drawn from relevant electronic databases, journals and texts, and where appropriate, from alternative sources, such as inspection reports and annual reviews as identified by the authors. The briefings do not provide a definitive statement of all evidence on a particular issue. SCIE research briefing methodology was followed throughout (inclusion criteria; material not comprehensively quality assured; evidence synthesised and key messages formulated by author).