Option Three seemed to address some of the key issues faced by Options One and Two, so it was considered to be the best option in theory, towards the integration of Housing into the whole system of care. However, the Steering Group felt that from a practical perspective, moving support to a separate entity would not be feasible in Conwy. This is despite the fact that this option was developed to address the Steering Group's concerns with Options One and Two. The main problem with this option is that four of the five RSL's (all but Cartrefi Conwy) operate across multiple counties and have standard systems in place for support provision. For example, Wales and West Housing has one hundred and twenty schemes for older people across Wales and the West of England, and only six of these are in Conwy, so only 5% of their volume of housing for older people is in this county (Wales and West Housing, 2012). Therefore, a change to their warden system in Conwy was not something that would fit with their support policy; this change would make Wales and West Housing's support service fragmented. This is a common problem in achieving integrated care, as identified by Leutz’ “Law 3: Your integration is my fragmentation” (Leutz, 1999). The representatives from these four RSL's felt that they would not have the power to instigate this high level of change within their organisations. To operate differently in Conwy compared to other counties would not be cost effective and this option would only be worthwhile with the commitment of all RSL's to integrate their support services into a single entity. This made this option impractical with regards to implementation.
The Steering Group discussed the three options in detail and finally decided to move forward with Option One as this seemed the most feasible option to
142 implement. Option Two was ruled out early in the discussion as the group deemed it to be too radical, especially after concerns were raised that perhaps Health were not fully committed to the project. Some members of the Steering Group felt that Option Three would be worth pursuing, arguing that without substantial change to the way support is provided, Housing would remain on the perimeter of the whole system of care. However, others felt that the costs would outweigh the benefits, and were wary of losing control over their own support service. The SSM activity is not about reaching a consensus among the group, it is about finding an accommodation which usually requires compromise (Checkland and Poulter, 2006:55). Details of how the chosen option was implemented are included in Chapter 8.
5.4 Summary
This chapter focused on Research Objective 1: Explore the current model of Health, Social Care and Housing in Conwy using soft system methodology (SSM) in order to identify potential integrating functions. SSM provided a structured model of enquiry and the researcher found that extra care housing and residential homes are integrated with the whole system of care in Conwy, whereas sheltered housing and non-specialist housing are not, so the latter is where the research needs to focus. Developing a rich picture of the problematic situation helped to identify three potential integrating functions from existing services that visit older people in their homes: carers, support workers and reablement teams.
This SSM study concluded that support was the most feasible integrating function in Conwy, having ruled out reablement and carers. The benefits of using support are are:
i. Support providers already have relationships with tenants in sheltered housing, so the change necessary to integrate Housing into the wider system of care is less substantial by using this existing service;
ii. The support role is at risk due to changes to Supporting People funding, making it essential to demonstrate the value of this service;
143 iii. The changes to Supporting People funding mean that support now needs to be provided on a needs-basis and thus should be offered to people living in non-specialist housing anyway. By capitalising on a change that is happening already due to a change in policy, the RSL's in Conwy can shift this external influence from a threat to an opportunity.
SSM was effective at helping the Steering Group to develop an understanding of the whole system of care in Conwy, how the entities interlink and potential ways in which Housing could be integrated. Conducting the research in this way enabled the members of the Steering Group to sympathise with the pressures on other organisations within the system, thus breaking down barriers between them. Gaining the wealth of knowledge provided by bringing these people together was essential in conducting this research as, with a system as complex as this one, building a rich picture would not be possible without the experts who are able to describe how their own entity contributes and their perspective of the system.
This chapter then focused on Research Objective 2 which was to develop conceptual models for integrating Housing into the whole system of care using support. Three options were detailed and the Steering Group chose to implement Option One, which would involve standardising current warden services across RSL's, and offering support on a tenure neutral basis, meaning that anyone can receive support regardless of the type of housing they live in. A subgroup was established to implement the action plan for this in Conwy which was part of the OPHS. More information about this is included in Chapter 8.
The next step in this thesis is to investigate changes to warden services in more detail in order to establish which operating structure is most appropriate on a micro level. A survey of warden structures in Wales was carried out in order to identify the strengths and weaknesses of the different models being adopted and to conclude how Conwy should move forward.
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