出版社：Utrecht University, Maastricht University, Groningen University
摘要：The Isle of Man is an Island community of approximately 85,000 people living in a mix of urban and rural settings. It is a self-governing nation. In 2015 the Department of Health and Social Care published a strategy on the future of health and social care, and in 2016 Commissioning Intentions for older people services. In 2018 the Department reorganised and Mental Health, Primary Care and Social Care became one directorate. Strategic direction is aimed at improving outcomes for service users by implementing person-centred integrated care. A project team was established consisting of four members; one each from Mental Health, Community Nursing, Adult Social Care and Dementia Care Services. An area of the Island was chosen to pilot an integrated care model. It was selected due to it having a representative demographic profile, mix of urban and rural living, a single General Practitioner Surgery, community resilience and 10% of population. The project aim is to improve outcomes for service users by improving their satisfaction levels through simplifying access and navigation of services. Individual practitioners communicate effectively on the ground but systems supporting this are lacking, leading to delays accessing required services, frustration for service users/ practitioners and over reliance on acute medical or residential services. We need to change our organisational culture aligning values between health and social care providers. Our focus has been seeking the views of practitioners and service users. The project team is in the consultation phase and aims to present its recommendations by December 2018 and implement them from February 2019. Results have been very positive in that practitioner groups, and public, agree regarding what works well, which we will retain, and what needs addressing. There is recognition that integrated care is a model whose time has come. Over reliance on acute and residential care is unsustainable long term and undesirable for service users. We aim to deliver the right care, at the right time, in the right place. Whilst Community Care is not a cheap option it can foster empowerment and resilience in the community. Timely interventions prevent situations deteriorating for individuals. Even in a small community there are significant differences in culture and need. We are aware that one size will not fit all but our intention is to cascade integrated care island wide. It may look different in each area but that is fine as long as it works. We are at the start of a long journey. We will be guided by what the community tell us they want. We have found that people are not asking for more things, just things to operate simply and effectively. Next year we will have a clear picture of what this means and what we can do to facilitate effective change. So far we have learned that you cannot over consult. People want involvement because they value health and social care services. Also the consensus is that people don’t want more, they want better. Our task is to work out how we can deliver it!.
关键词：island ; integration ; practice ; engagement ; communication
