National Care Service - national systems of social care in Nordic and Scandinavian countries: learning and evidence review

4. Conclusion

We undertook a systematic and comprehensive search of integrated care across the Nordic and Scandinavian countries but also included studies from pan-European and some OECD projects where Scandinavian and Nordic countries were included. We did not restrict any aspects of social care if they related to higher level or national structures such as paid/unpaid care, social services and specific types of care e.g. rehabilitation or palliative care. Although this resulted in a large number of studies, the potential for missing important learning was greatly reduced. This report was limited to a rapid scoping review and did not take the country specific health or social care systems into consideration so any transferability may be difficult.

We found limited evidence from across the included countries and pan-European programmes of care to support any one model of integrated care. How integrated care is delivered differed considerably in terms of governance, structure, funding and flexibility, both at a national and local level. We also found that how care is delivered varies within countries and over time – changing from central control to local control and then back depending on specific county welfare regimes and political climate at a particular time.

Evidence on how different integrated care structures impact on changes in health at a population level was also limited, but a consistent theme was inequality of access to services especially for those who require it most. Countries also vary in where they deliver care – most are mixed in terms of formal care establishments and in the users own home although there is a drive towards home care as being preferred by users.

What is more consistent is the need for better integration between organisations and professionals. Better collaboration, communication and trust is important in working together with a clear vision and understanding of what is required at all levels of staff. Although few studies focused on the workforce, better professional development, skills training, autonomy and working conditions were identified.

Identified gaps in the literature point towards a need for robust programme evaluations of national care systems, although these are difficult to do in practice.