Providing Integrated Health and Social Care in Italy

In Italy, although some experiences have been realised, we cannot say that there is a single integrated health and social system, but two distinguished ones, the system of health services and the one of social services, that have managed to establish more or less stable or tight organisational ties. This dualism fostered the proliferation of divergent patterns of approaches to long-term care, both from a territorial and organizational perspective. In Italy, at least until the 1990s, there was an unclear perception of older persons’ care needs, and there were unclear typologies of services aimed at maintaining their health. Furthermore, different regional contexts, different functions performed by institutional actors, associations and families consistently influenced the territorial organization of integrated services for older persons. Nevertheless, after a period of strong diversity among territories during the 1990s, almost all Italian regions have been implementing similar structures of care provision. Convergence towards similar modes of integrated care is the outcome of the transfer of policy knowledge from Regions in the van (North and Centre) to other ones. Territorial integrated health and social care for older persons is focused on the promotion of older persons’ security and autonomy. The system of care provision has a network configuration, involving different local services, with clear and common goals, processes, instruments and methods of evaluation. Regions represent the institutional level devoted to define strategic goals for the local integrated network. They have to plan the local system of care provision and they are responsible for its financial and economic management. Local Health Units and their Districts, in particular, are liable for providing health services and for planning individual care. Municipalities are, in turn, liable for the coordination of the whole network. Recently, a renewed attention towards “weak citizens”, especially older persons (who represent almost the 20% of Italian population), joined to the birth of a new administrative culture - due to administrative and social reforms launched by the Italian government during the 90s – have fostered the experimentation of innovative care services, especially at the regional level. For instance, latest regional integrated services for older persons in Veneto, Tuscany and Emilia Romagna, try to combine recent organizational theories with new ways of working (i.e. project management, quality management, empowerment techniques, etc), and a client-oriented approach. Such services represent new model ways of working that promote quality: − at a structural level: by integrating different organizational units and by using new technologies for a rapid data exchange among services (Single Point of Home Care - Municipality of Empoli) − during the process of care provision: by creating multi-professional teams for a multi-dimensional needs assessment (The Multidimensional Evaluation Unit - Regione Veneto) − at a client level: by adopting a quality management strategy or a person-centred approach (Operative Unit of Seamless Care – Local Health Unit Vicenza; Quality of Home Care – District of Correggio; The Alzheimer Day Centre “Stella del Colle” – Municipality of Florence). Although legislative, organizational, financial, and cultural impediments have hampered for years the development of integrated health and social care in Italy, such factors have not prevented the blooming of many pioneering projects and experiences at the local level. In particular, some stakeholders have taken initiative based on different rationales, for instance: − administrators who consider the integration of health and social services as a strategic factor qualifying the system and overcoming financial gaps (principle of effectiveness – efficiency); − professionals who are convinced that they cannot produce satisfying results if they do not increase the collaboration among the various professions (principle of technical effectiveness); and, last but not least − citizens who become aware of their complex needs and claim for more coherence of the supply system (principle of strategic effectiveness).