'Team Production' and Policy for the Care of Older People: Problems with Theory and Evidence

Social and health policy analysis is at the heart of "value for money" considerations in public provision and/or production. Economic appraisal is about meeting a potential efficiency test in the use of resources. In an increasingly "silver" society providing for older people in the community, who are over time less likely to be living in a close-knit family, will be a growing resource commitment. Such provision can be organised in a number of ways and as such is an important area for government policy (eg the 2005 Department of Health Green Paper, Independence, Well-being and Choice) and policy appraisal. In particular this paper examines one dimension of provision in the form of delivery by integrated health and social care teams and by traditional arrangement. The analysis covers some of the theoretical and conceptual issues related to modelling "integrated" team production and introduces the concept of "team capital". Some empirical evidence from a three-stage eighteen-month interview based study is reported. As regards the main benefit explored the study revealed that the delivery of services through "integrated" health and social care teams did not result in a greater proportion of older people remaining living independently in the community indicating the importance of relative costs of provision. The focus is the theoretical and empirical problems concerning the cost of provision services under different arrangements. The study was unable to fully explore whether the integrated model of provision was any more costly than the traditional approach. The partial data on costs that were obtained are suggestive of the integrated approach being relatively expensive. However, it would be premature to base any policy decisions on the data presented as a more extensive evaluation needs to be furnished.