The impact of the new integrated older people's care services in Cambridgeshire on service users

Abstract

Social care and health services for older people in Cambridgeshire have been integrated since April 2004. This study examines the effect of the integration programme on service users. Previous research into health and social care integrations predominantly centre on process issues and pay much less attention to outcomes. No study has evaluated the impact of fully-integrated care services for the whole user group of older people. Theory-led programmatic approach was used in this study. Multi-method data collection and analysis were employed to uncover and examine the causal links, the contextual conditions, the implementation process, causal mechanisms, and intended and achieved outcomes of the integration programme. This study reveals an improvement in the physical functioning of one in three occupational equipment users; a rise in the level of satisfaction of 85% of occupational health and 82% of physiotherapy users; older people with complex problems and high-level needs were able to be helped to live at home; and waiting time for both assessment and for services within two weeks and four weeks were below the national achievement and the ministerial targets. It also reveals a lack of change outcomes in social care, and service users’ low level of satisfaction with social care services, which appear to be associated with the privatisation of long-term social care and the predominant aim in social work of achieving maintenance and prevention outcomes. The integration programme’s goals—unifying the care system, easier and simpler access to services and a single and quick assessment—were not fully reached, mainly because of users’ low awareness of the integration, incompatible ICT systems and lack of funding. This study contributes to knowledge on how the total integration in Cambridgeshire has benefited users and how theory-led programmatic approach can be used in this area and in the study of this kind of complex social programme.