Health service design for older people the role of community, and the community and voluntary sector in the implementation of the living well at home piece of the integrated care programme for older people in kilkenny

Abstract

The Integrated Care Programme for Older People (ICPOP) is part of how health and social care delivery is being envisaged in Ireland (ICPOP, 2018). The Living Well at Home piece of ICPOP, includes community and the community and voluntary sector in healthcare delivery (ICPOP, 2018). This research looks at the role of co-designing with community the implementation of the Living Well at Home piece of ICPOP answering two questions – 1. Through co-design investigating what is important to all stakeholders in the design and delivery of healthcare for older people. 2. What role can the community in which an older person resides, and the community and voluntary sector play in the delivery of healthcare, enabling people to age well in place. The literature review investigates • the concepts of co-production, integrated care and person-centredness mentioned in ICPOP • in addition, it examines the impact of power, perceived or real, within and across medical disciplines and systems and, between patients and clinicians, and how it can be alleviated • furthermore, it considers the impact Covid-19 had on older people and its implications on healthcare delivery • finally, it explores social prescribing and how it can improve health and wellbeing alleviating pressure on healthcare delivery. Research through design (RtD), a qualitative methodology, was used over three stages of field research: interviews, a co-design session with older people and a stakeholders’ co- production workshop. Data were thematically analysed using grounded theory and findings from one stage informed the next, allowing a ‘collective voice’ to emerge (Smithson, 2000. P. 109). The research findings show: • an organisational culture and leadership style of innovative and collaborative practice is essential to the implementation of ICPOP • a culture of person-centredness, as espoused by McCormack and McCance (2017), is important • good communication between disciplines and practitioners and, practitioners and the older person is critical • and key to ICPOP delivery is the involvement of community and the community and voluntary sector. Finally, the research examined the practice of co-design and concluded that co-design is the first stage of the co-design process which includes co-production and co-creation. It is a reflective, iterative, and democratic practice involving all stakeholders at all stages.

Areas for future research include • widening the geographical area to verify the findings nationally • examining the concepts of person-centredness and co-production to ascertain a universally accepted definition in a healthcare context • using the framework developed through this project, examining how a comprehensive understanding of RtD can be put in place • and finally further investigation into power and trust in the co-design process is warranted for a comprehensive understanding of its practice.