TY - JOUR
AU - A. Pacho
AU - G. Wistow
AU - N. Mays
AU - L. Thana
AU - L. Rehackova
AU - N. Douglas
AU - M. Al-Haboubi
AU - M. A. Durand
A1 - 
AB - ObjectivesCentral government has been promoting closer integration between the National Health Service (NHS) and local government social services in England for more than five decades. Improved coordination between primary, hospital, community health and social services has been advocated as a cost-effective response to growing care needs in an ageing population. This paper concentrates on one of the principal local care coordination mechanisms: community-based multidisciplinary teams (MDTs) involving NHS and social services staff. It reports local leaders' perceptions of MDTs' current and future contributions to more coordinated care and support systems in two integrated care Pioneer sites.MethodsThirty-two qualitative semi-structured interviews with 25 local system leaders and operational managers in two contrasting Integrated Care and Support Pioneer areas were conducted between October 2018 and April 2021, as part of a wider evaluation of the Integrated Care and Support Pioneer Programme. Eight of those interviews took place after the start of the COVID-19 pandemic and between lockdowns. Interviews were analysed thematically.ResultsLocal leaders in both areas broadly shared a vision of integrated care in which MDTs were essential mechanisms for coordinating improvements in health and wellbeing, especially for older people who are frail, experience falls and have long-term health conditions. Organisational differences between and within sites influenced local decisions about the purpose and structure of MDTs, but, despite such variations, interviewees identified similar challenges to implementation. Staff turnover, often linked to funding uncertainties, and the lack of shared information systems, were among the most frequent operational challenges noted. System leaders valued national policy frameworks as potential enablers of integrated care but also recognised the role of local contexts in shaping local implementation decisions. Interviewees highlighted benefits emerging from multidisciplinary working, including its potential to deliver more holistic care, fewer instances of work duplication, speedier access to care and enhanced home care provision. However, they were concerned such benefits were not always captured by commonly used performance indicators and thus the value of MDTs could be under-estimated.ConclusionsLocal contextual variables and local understandings of these variables appeared to be the main influences on variations in local responses to national expectations of improvements in care integration. Local leaders in both areas broadly shared a vision of integrated care in which MDTs provided essential mechanisms for securing interdependent improvements in both the health and wellbeing of local populations and improvements in workforce job satisfaction.
AD - Policy Innovation and Evaluation Research Unit, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.; Care Policy and Evaluation Centre, London School of Economics, London, UK.; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK.
AN - 40682524
BT - J Health Serv Res Policy
C5 - Education & Workforce
CP - 1_suppl
DA - Jul
DO - 10.1177/13558196251349353
DP - NLM
ET - 20250719
IS - 1_suppl
JF - J Health Serv Res Policy
LA - eng
N2 - ObjectivesCentral government has been promoting closer integration between the National Health Service (NHS) and local government social services in England for more than five decades. Improved coordination between primary, hospital, community health and social services has been advocated as a cost-effective response to growing care needs in an ageing population. This paper concentrates on one of the principal local care coordination mechanisms: community-based multidisciplinary teams (MDTs) involving NHS and social services staff. It reports local leaders' perceptions of MDTs' current and future contributions to more coordinated care and support systems in two integrated care Pioneer sites.MethodsThirty-two qualitative semi-structured interviews with 25 local system leaders and operational managers in two contrasting Integrated Care and Support Pioneer areas were conducted between October 2018 and April 2021, as part of a wider evaluation of the Integrated Care and Support Pioneer Programme. Eight of those interviews took place after the start of the COVID-19 pandemic and between lockdowns. Interviews were analysed thematically.ResultsLocal leaders in both areas broadly shared a vision of integrated care in which MDTs were essential mechanisms for coordinating improvements in health and wellbeing, especially for older people who are frail, experience falls and have long-term health conditions. Organisational differences between and within sites influenced local decisions about the purpose and structure of MDTs, but, despite such variations, interviewees identified similar challenges to implementation. Staff turnover, often linked to funding uncertainties, and the lack of shared information systems, were among the most frequent operational challenges noted. System leaders valued national policy frameworks as potential enablers of integrated care but also recognised the role of local contexts in shaping local implementation decisions. Interviewees highlighted benefits emerging from multidisciplinary working, including its potential to deliver more holistic care, fewer instances of work duplication, speedier access to care and enhanced home care provision. However, they were concerned such benefits were not always captured by commonly used performance indicators and thus the value of MDTs could be under-estimated.ConclusionsLocal contextual variables and local understandings of these variables appeared to be the main influences on variations in local responses to national expectations of improvements in care integration. Local leaders in both areas broadly shared a vision of integrated care in which MDTs provided essential mechanisms for securing interdependent improvements in both the health and wellbeing of local populations and improvements in workforce job satisfaction.
PY - 2025
SN - 1355-8196 (Print); 1355-8196
SP - 25s
EP - 35s+
ST - The role and functions of community-based multidisciplinary teams in two integrated care and support Pioneers: Perspectives from local system leaders
T1 - The role and functions of community-based multidisciplinary teams in two integrated care and support Pioneers: Perspectives from local system leaders
T2 - J Health Serv Res Policy
TI - The role and functions of community-based multidisciplinary teams in two integrated care and support Pioneers: Perspectives from local system leaders
U1 - Education & Workforce
U3 - 10.1177/13558196251349353
VL - 30
VO - 1355-8196 (Print); 1355-8196
Y1 - 2025
ER -