Better Sooner More Convenient Primary Care - New Zealand Doctor

Similarly Glendenning 12 observes that integration is more likely when the following are present:
joint goals
tight knit highly connected professional networks
high degree of mutual trust
joint arrangements which are part of „core business‟ rather than marginal integration at
the edges
joint arrangements covering operational and strategic issues and shared or single
management arrangements.
Degeling and Erskine 13 describe the importance of changing governance arrangements if true
integration of services is to occur:
“Efforts to establish and maintain networks [voluntary connections across
organisational boundaries] are often purely rhetorical. …all too often tangible
achievements on the ground are minimal …” (pg 35) … “Despite their membership in a
network, for most network partners their employing organisation remains their primary
affiliation.” (pg 36)
“Put simply, effective joined-up “local-to-local” collaboration requires equivalent joinedup
governance at the centre …” (pg 36)
“… there is evidence showing how trust and network stability depend on the extent to
which network partners (by way of contracts) have formalized what they can expect of
each other and have established robust governance arrangements through which
partners can be held to account. … These findings suggest that a network‟s
effectiveness depends to a large extent on the degree to which its membership has
been able to institutionalize both its internal operations and its independent existence
from its sponsoring organisations.” (pg 37)
“… the more that service settings (as between primary, acute, community and social
services) are constituted as separate and distinct organisations, the more beliefs will
differ about what should be done and who is best placed and equipped to do it. The
“service gaps” than then result are unlikely to be resolved by, for example, “better
networking”. Because the new service models for long-term conditions of necessity
challenge the biases of existing approaches to service delivery in acute, community and
social care settings, mere administrative solutions (such as the establishment of a
network) are rarely able to produce what is required. Rather policy and funding
authorities are likely to find that success will depend on the extent to which they have
set in place new institutional arrangements and patterns of resource allocation … that
will support the required forms of service integration between different service
settings.” (pg 41)
12 Glendenning, C (2002) „Breaking down barriers: integrating health and care services for older people in England‟,
Health Policy 65: 139–151.
13 Degeling P, Erskine J. Chapter 2. New models of long-term care and implications for service redesign. In Rechel B,
Wright S, Edwards N, Dowdeswell B, McKee M. Investing in hospitals of the future. World Health Organisation, on
behalf of the European Observatory on Health Systems and Policies Investing in hospitals of the future. 2009
Business case EoI V38 AC 25Feb10 Page 40