International Journal of Geriatric Psychiatry. 2003;18( 10):887-93.
OBJECTIVE: This paper seeks to address whether integrated structures are associated
with more integrated forms of service. Northern Ireland has one of the most structurally
integrated and comprehensive models of health and personal social services in Europe.
Social and health services are jointly administered and this arrangement should, in
theory, promote collaborative working and interdisciplinary arrangements. DESIGN:
The study employed a cross-sectional survey of consultants in old age psychiatry in
England and Northern Ireland. Potential respondents were sourced from the UK Royal
College of Psychiatrists membership list and locally collected information. MEASURES:
A self-administered postal questionnaire. Along with general service arrangements,
the domains measured reflect core policy issues for older people's services. Under
particular scrutiny in this study were the degree of integration of health and social
service provision, as well as inter-professional team working. RESULTS: The integrated
health and social care services in Northern Ireland do appear to provide more integrated
patterns of working, primarily in managerial arrangements and in the location of staff.
There was no evidence of the impact of integration on practice in areas such as: assessment,
referral and medical screening. The factors found to be associated with greater integration
of health and social care in the prediction model fell into three categories: provision
of specialist services; provision of outreach activities; and shared policies by which
the whole team worked. CONCLUSIONS: Health and personal social services in Northern
Ireland have a distinct advantage over their counterparts in comparable areas of England.
The results indicate that integrated structures in old age psychiatry services are
associated more with integrated management systems and less with integrated practice-related
activities. Further research is required on the effectiveness and cost effectiveness
of integrating services in general. It is important that future intervention studies
systematically measure the component parts, nature and extent of integration and their
individual and joint contribution to the effectiveness and efficacy of services. Copyright
2003 John Wiley & Sons, Ltd.