. 2021 Jul 14;20:108. doi: 10.1186/s12904-021-00802-6

Table 1.

Overview of themes

	Overview of theme	Policy goals for health and social care	Mechanisms for delivery
Theme 1: Integrated Care	Re-organisation of services is proposed as a way to improve care delivery; this is proposed through ‘integration’ of existing services. Integrated care is a general term that includes integration of health and social care, of primary and secondary care, of generalist and specialist care, and of physical and mental health care	Present across almost all of the documents: - To ‘dissolve the divide’ between services, to ensure seamless and co-ordinated care for patients (IDs 1, 2, 3, 4, 5, 6, 7, 9, 10, 14, 15) - To reduce avoidable hospital admissions, thereby reducing unnecessary expenditure (IDs 1, 2, 3, 6, 9, 10, 11, 12, 13) - To reduce delayed transfers out of hospital to reduce pressure on the emergency services and the NHS (IDs 1, 2, 3, 10, 11, 12) - To improve access to, and quality of, care in the community to enable people to stay at home and remain independent (IDs 1, 2, 3, 4, 8, 9, 10, 11, 12, 13, 14, 15) - To enable personalised care, with services tailored around the patient to allow multiple needs (e.g. health and social or mental and physical) to be addressed at the same time (IDs 1, 4, 5, 6, 9, 10, 12, 13, 11)	- New models of care: Introduction of Integrated Care Systems and Sustainability and Transformation Partnerships between the NHS and local councils to develop more co-ordinated services and agree on system wide priorities (IDs 2, 3, 4, 6, 7, 15) The Vanguard Programme (IDs 1, 2, 6, 10) was an NHS initiative that focused investment on new models for care delivery, which may be adopted by different CCGs, allowing them to tailor healthcare delivery to suit local pressures. Models included 1) Multispecialty Community Providers (MCP’s); 2) Primary and Acute Care Systems; 3) Acute Care Collaborations (ACCs); 4) Enhanced Health in Care Homes Increased investment in primary care in the community to enable expansion of GP services through increasing access to out-of-hours weekend and evening appointments (IDs 1, 2, 3, 12, 14, 15) Modernised community facilities with MDTs embedded around GPs to increase access to a wider range of specialist resources in the community, and Primary Care Networks to integrate GP practices with community teams (IDs 1, 2, 3, 11, 12, 13, 14, 15) Increased focus on public health and prevention, to minimise the need for hospital admissions (IDs 2, 12, 13, 11) - New funding mechanisms: Integrated personal budgets for both health and social care, to allow for multiple patient needs to be addressed under a single assessment (ID5) - New technology: Digital health that enables people to get the help they need at home, such as remote video consultations and monitoring equipment to avoid unnecessary trips to hospital (IDs 1, 2, 3, 6, 9, 10, 13, 11) Simplified online booking processes and the use of apps to help people manage their own health (IDs 2, 6, 10) Technology infrastructure that improves communication between different systems (IDs 2, 3, 6, 9, 10)
Theme 2: Personalised Care	Personalised care allows people to shape and manage their own care according to their preferences, and to make meaningful choices Personalised care is considered a way of improving the efficiency for health and social care by ensuring timely access to services with provision tailored to individual needs. This approach intends to maximise benefit and reduce harm and waste from overtreatment	The goals ranged from aspirational to more specific: - An ambition to provide ‘person-centred care’, with a focus on a holistic approach (IDs 1, 2, 3, 4, 5, 6, 11, 12, 13, 14) - The goal of personalised care is more satisfaction with care, better outcomes, more control, and less tick-box medicine (IDs 5, 6, 15) - Aim to empower patients to take a greater role in their treatment and care, to provide more autonomy (IDs 1, 2, 3, 4, 5, 6, 11, 12, 13, 14) - Personalised care improves the delivery of community care and reduces avoidable hospital admissions (IDs 1, 2, 10, 11) a consequence of this is less medical intervention (ID12) - Personalised care will lead to reduction in inequalities in health care outcomes (IDs 4, 9) -Where specific goals of personalised care were mentioned these were frequently around providing choice over place of care (and place of death) (IDs 1, 2, 3, 11, 13)	- New ways of managing budgets for health and social care including Personal Health Budgets, Integrated Budgets and Integrated personal Commissioning (IDs 1, 2, 3, 4, 5, 6, 10, 13, 15) - Encouraging healthcare professionals to utilise ‘social prescribing’, where patients are referred to a wide range non-clinical local support services, such as befriending schemes or exercise classes, with the aim of addressing patients’ conditions in a more holistic manner (IDs 1, 2, 3) - Use of new technologies and digital tools, such as paperless health records, online appointment scheduling, wearable monitoring technologies and health promoting apps. (IDs 1, 2, 3, 11, 12) -An aspiration to move towards coproduction, ensuring a more equal partnership with patients when making decisions and encouraging discussion between healthcare services and patient. (IDs 1, 2, 4, 5, 6, 7, 11, 12, 13, 14, 15) - Acknowledgement that self-management of health conditions will be aided by increased health literacy, and needs to be underpinned by long term culture change (IDs 2, 3, 4, 7, 11, 12, 13, 14, 15) - Targeting treatments and interventions to a patient’s genetic make-up is an important component of personalised care (IDs 1, 2, 3)
Theme 3: Support for unpaid carers	Carers are recognised as a potentially vulnerable group who contribute greatly to the economy. The overriding message is to improve the support provided to carers, both in their caring role and in their lives outside of caring	- To help carers avoid reaching ‘breaking point’ as a result of carer burden, resulting in themselves or the person for whom they care requiring admission to hospital (ID 2) - To reduce the mental and physical health inequalities that carers face (IDs 2, 3, 4, 5, 10, 11, 12, 14) - To support carers’ ability to care, to avoid hospital admission for the carer and dependent (ID2) - To enable carers to continue their critical contribution to society (IDs 13) and sustaining the NHS (ID1) - To empower carers, and increase their involvement in the care of their dependent (ID 2, 4, 12)	- Facilitate access to improved support through better and early identification of carers (IDs 1, 2, 4, 5, 9, 15) - Increased support through financial aid, for example the provision of personal health budgets that encompass carers needs as well as those for whom they care (ID 5, 13) - Initiatives proposed to increase carer independence, such as improving provision of respite care and advocating the right of carers to build careers and meaningful relationships outside of caring responsibilities (ID 13) - Introduction of a ‘carer passport’ to identify carers, allowing healthcare staff to involve them in a patient’s care (IDs 3, 4). This contributes to the wider aim of encouraging shared decision making (IDs 2, 3, 5, 12, 14) and empowering carers to choose the course of care (IDd 4, 11, 13)

Overview of theme

Policy goals for health and social care

Mechanisms for delivery

Theme 1: Integrated Care

Re-organisation of services is proposed as a way to improve care delivery; this is proposed through ‘integration’ of existing services. Integrated care is a general term that includes integration of health and social care, of primary and secondary care, of generalist and specialist care, and of physical and mental health care

Present across almost all of the documents:

- To ‘dissolve the divide’ between services, to ensure seamless and co-ordinated care for patients (IDs 1, 2, 3, 4, 5, 6, 7, 9, 10, 14, 15)

- To reduce avoidable hospital admissions, thereby reducing unnecessary expenditure (IDs 1, 2, 3, 6, 9, 10, 11, 12, 13)

- To reduce delayed transfers out of hospital to reduce pressure on the emergency services and the NHS (IDs 1, 2, 3, 10, 11, 12)

- To improve access to, and quality of, care in the community to enable people to stay at home and remain independent (IDs 1, 2, 3, 4, 8, 9, 10, 11, 12, 13, 14, 15)

- To enable personalised care, with services tailored around the patient to allow multiple needs (e.g. health and social or mental and physical) to be addressed at the same time (IDs 1, 4, 5, 6, 9, 10, 12, 13, 11)

- New models of care:

Introduction of Integrated Care Systems and Sustainability and Transformation Partnerships between the NHS and local councils to develop more co-ordinated services and agree on system wide priorities (IDs 2, 3, 4, 6, 7, 15)

The Vanguard Programme (IDs 1, 2, 6, 10) was an NHS initiative that focused investment on new models for care delivery, which may be adopted by different CCGs, allowing them to tailor healthcare delivery to suit local pressures. Models included 1) Multispecialty Community Providers (MCP’s); 2) Primary and Acute Care Systems; 3) Acute Care Collaborations (ACCs); 4) Enhanced Health in Care Homes

Increased investment in primary care in the community to enable expansion of GP services through increasing access to out-of-hours weekend and evening appointments (IDs 1, 2, 3, 12, 14, 15)

Modernised community facilities with MDTs embedded around GPs to increase access to a wider range of specialist resources in the community, and Primary Care Networks to integrate GP practices with community teams (IDs 1, 2, 3, 11, 12, 13, 14, 15)

Increased focus on public health and prevention, to minimise the need for hospital admissions (IDs 2, 12, 13, 11)

- New funding mechanisms:

Integrated personal budgets for both health and social care, to allow for multiple patient needs to be addressed under a single assessment (ID5)

- New technology:

Digital health that enables people to get the help they need at home, such as remote video consultations and monitoring equipment to avoid unnecessary trips to hospital (IDs 1, 2, 3, 6, 9, 10, 13, 11)

Simplified online booking processes and the use of apps to help people manage their own health (IDs 2, 6, 10)

Technology infrastructure that improves communication between different systems (IDs 2, 3, 6, 9, 10)

Theme 2: Personalised Care

Personalised care allows people to shape and manage their own care according to their preferences, and to make meaningful choices

Personalised care is considered a way of improving the efficiency for health and social care by ensuring timely access to services with provision tailored to individual needs. This approach intends to maximise benefit and reduce harm and waste from overtreatment

The goals ranged from aspirational to more specific:

- An ambition to provide ‘person-centred care’, with a focus on a holistic approach (IDs 1, 2, 3, 4, 5, 6, 11, 12, 13, 14)

- The goal of personalised care is more satisfaction with care, better outcomes, more control, and less tick-box medicine (IDs 5, 6, 15)

- Aim to empower patients to take a greater role in their treatment and care, to provide more autonomy (IDs 1, 2, 3, 4, 5, 6, 11, 12, 13, 14)

- Personalised care improves the delivery of community care and reduces avoidable hospital admissions (IDs 1, 2, 10, 11) a consequence of this is less medical intervention (ID12)

- Personalised care will lead to reduction in inequalities in health care outcomes (IDs 4, 9)

-Where specific goals of personalised care were mentioned these were frequently around providing choice over place of care (and place of death) (IDs 1, 2, 3, 11, 13)

- New ways of managing budgets for health and social care including Personal Health Budgets, Integrated Budgets and Integrated personal Commissioning (IDs 1, 2, 3, 4, 5, 6, 10, 13, 15)

- Encouraging healthcare professionals to utilise ‘social prescribing’, where patients are referred to a wide range non-clinical local support services, such as befriending schemes or exercise classes, with the aim of addressing patients’ conditions in a more holistic manner (IDs 1, 2, 3)

- Use of new technologies and digital tools, such as paperless health records, online appointment scheduling, wearable monitoring technologies and health promoting apps. (IDs 1, 2, 3, 11, 12)

-An aspiration to move towards coproduction, ensuring a more equal partnership with patients when making decisions and encouraging discussion between healthcare services and patient. (IDs 1, 2, 4, 5, 6, 7, 11, 12, 13, 14, 15)

- Acknowledgement that self-management of health conditions will be aided by increased health literacy, and needs to be underpinned by long term culture change

(IDs 2, 3, 4, 7, 11, 12, 13, 14, 15)

- Targeting treatments and interventions to a patient’s genetic make-up is an important component of personalised care (IDs 1, 2, 3)

Theme 3: Support for unpaid carers

Carers are recognised as a potentially vulnerable group who contribute greatly to the economy. The overriding message is to improve the support provided to carers, both in their caring role and in their lives outside of caring

- To help carers avoid reaching ‘breaking point’ as a result of carer burden, resulting in themselves or the person for whom they care requiring admission to hospital (ID 2)

- To reduce the mental and physical health inequalities that carers face (IDs 2, 3, 4, 5, 10, 11, 12, 14)

- To support carers’ ability to care, to avoid hospital admission for the carer and dependent (ID2)

- To enable carers to continue their critical contribution to society (IDs 13) and sustaining the NHS (ID1)

- To empower carers, and increase their involvement in the care of their dependent (ID 2, 4, 12)

- Facilitate access to improved support through better and early identification of carers (IDs 1, 2, 4, 5, 9, 15)

- Increased support through financial aid, for example the provision of personal health budgets that encompass carers needs as well as those for whom they care (ID 5, 13)

- Initiatives proposed to increase carer independence, such as improving provision of respite care and advocating the right of carers to build careers and meaningful relationships outside of caring responsibilities (ID 13)

- Introduction of a ‘carer passport’ to identify carers, allowing healthcare staff to involve them in a patient’s care (IDs 3, 4). This contributes to the wider aim of encouraging shared decision making (IDs 2, 3, 5, 12, 14) and empowering carers to choose the course of care (IDd 4, 11, 13)

Themes identified as opportunities for widening access to palliative and end of life care, the policy goals they fulfill, and mechanisms by which they may be achieved