Evaluating the Implementation of Integrated Care for Older Persons as a path to Universal Health Care

Implementing integrated care for older persons is a core challenge for a fragmenting health care system with the additional barriers of being two-tiered complex public/private mix with high cost-barriers to accessing care, deeply siloed and fatigued due to economic crisis, budgetary constraint and organisational uncertainty 1.

The Irish National Integrated Care Programme for Older Persons NCP OP is working in this difficult context to establish integrated care for older persons. To do this the Programme developed a 10 Step Implementation Framework now in use for two years 2.

Equally relevant in the Irish context is a concerted political drive toward Universal Health Care UHC for the first time in the history of the Irish State. UHC aims to ensure timely access to healthcare for all citizens on the basis of medical need rather than ability to pay 3. Through partnership between the ICP OP and UHC researchers at Trinity College Dublin, the 10 Step Framework as implemented is framed as a practical pathway to UHC in fact.

Evaluating the utility of the 10 Step Framework and exploring the challenges of implementing it in practice is therefore essential to sustaining current progress towards both integrated care for older persons, and universal health care for the Irish population. Ireland is an outlier as a High Income Country in Europe that does not have UHC 4.

The intervention is an online survey evaluation of the 10 Step Framework, and three co-produced case studies with pioneer sites implementing integrated care for older persons.

The change theory underpinning the evaluation is both social cognitive and constructionist in seeking to reinforce the learning emerging from using the Framework so that new experiences lead to better understanding and changed practice. This is achieved through identifying the experiences, documenting and feeding them back to stakeholders for further exploration and application in the on-going planning cycle. The intervention is aimed at service providers in the Community Health Organisations CHOs and Acute settings in Ireland who deliver health and social services using the 10 Step Framework. The Framework has been in use for two years and the evaluation which began in December 2017 will run to April 2018.

The evaluation informs the implementation of integrated care for older persons, and supports establishment of UHC in Ireland on practical terms as the country seeks to re-imagine health service delivery. Evaluation is critical to the sustainability of new practice; this project identifies lessons for an international audience interested in understanding the links between UHC, Integrated Care for Older Persons, and the challenges of implementing complex service delivery change. Findings will translate through the ICP OP pioneer sites and networks as important insights for on-going planning and service delivery changes. They also inform the national debate on the capacity of the Irish Health System to deliver UHC; a challenge relevant internationally as governments respond to the difficulty of funding and delivering health and social care on a universal basis to older populations with complex needs 5.