Is care moving closer to home? A snapshot in England in 2014

Introduction: In view of the demographic change with its increasing demand for and cost of institutional care, current approaches to health care delivery are not sustainable. To meet future healthcare needs, the National Health Service (NHS) started an extensive transformation following the Health and Social Care Act 2012 in England, changing the structure, accountabilities, funding arrangements and working relationships within the care system. The goal is to improve the integration between different professions and in particular transitions between health and social care.The aim of this transformation is to shift the balance from hospital to the community setting, providing holistic and patient-centric care.The qualitative study described in this abstract examines if and how different stakeholders experience this transformation process.Methods: The study design involved qualitative methods including reflection exercises, individual and focus group interviews, mapping of care network and trigger cards. Patients with a present chronic condition using one or more social and/or community service(s), professionals and representatives from service providers and informal care giver (ICG), were enrolled for this study. Both patients with and without ICG support were included.Data collection and sample: The study involved semi-structured interviews in 22 subjects: six patients (age 70 ± 13; 4 female 4 COPD, 1 HF, 1 mental disorder), five ICG (age 55 ± 10; all female), eight NHS professionals (5 nurses, 1 service commissioner, 1 quality assurance and 1 rapid response team representative) and three representatives from care service (CS) providers.Patients and ICG were asked about the support they received, social and community services they are using and the associated motivation/obstacles, means of communication with different providers and their vision of future care. Professionals and CS providers explained their professional background, tasks and responsibilities, amount and means of interactions with patients and ICG, role in arranging services, coordination, collaboration and follow-up with service providers as well as expected changes in the future.Findings: Insights on integrated care.Community and social service providers lack access to patient information (e.g. health condition). Data sharing and collaboration between health and care organizations is essential to enable holistic care, but currently not sufficiently in place as trust and clear responsibilit