Author: Freeman T and Peck E
Journal: Health and Social Care in the Community, 2006
Volume/pages: Vol 14(5), pp408-417

About the study
The paper describes an evaluation of integrated mental health care in one county in England, and also contributes to knowledge about the most appropriate approaches to evaluating integrated working. The integrated system included a partnership trust which provided the integrated service, as well as pooled budgets and joint commissioning. The service was evaluated using semi-structured interviews with staff, focus groups with service users and carers, and staff questionnaires exploring role clarity and job satisfaction before and after the implementation of the integrated system.

Findings
Generally staff had a positive experience of integrated working, despite some concerns including the blurring of professional boundaries; while service users also viewed it positively for a range of reasons including staff ability to liaise with other services. The questionnaire revealed slight overall improvements in role clarity and job satisfaction although there were variations, including reduced job satisfaction in two of the five localities. In carrying out the evaluation, a number of challenges were presented, including the widely differing local contexts, the constantly evolving national policy, and high staff turnover.

Key messages

• Staff, service users and carers can have a positive experience of organisational level integration and joint commissioning, although careful attention should be paid to potential problem areas and concerns of these stakeholders
• Models for evaluating integrated working require careful anticipation of potential challenges and a flexible design that can adapt to complex systems and widely varying local contexts