Journal of interprofessional care
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The overcoming of professional boundaries to collaboration in patient care has become one of the goals of mental health service policy in England over the past 25 years, predominantly through the creation of community mental health teams. However, research has shown that these boundaries have been slow to come down, and some commentators have pointed to the benefits of appropriate boundaries. This paper introduces a theoretical framework, which seeks to categorise boundary activity in organisations and then examines the boundary activity of professional groups and community teams during the integration of mental health and social care service provision in one locality in the southwest of England. The paper identifies the ways in which this integration impacted on boundary activity and draws out the messages for mental health policy and practice that emerge.
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The inquiry into the services provided by the paediatric cardiac surgical team at Bristol Royal Infirmary between 1984 and 1995 marks a watershed in the development of health and social care services in the UK. There was an organisational failure of foresight based on a series of systemic and communication failures which contributed to oversight of an 'incubating' hazard which ultimately led to disaster. The recommendations of the Bristol inquiry have provided a major stimulus to the modernisation programme and especially of governance in health and social care which aims to restore public confidence and create 'high-trust' organisations. While it is premature to evaluate the impact of the changes, there is little evidence at present to indicate that they will improve the quality of professional decision making and the safety of users or enhance user and public confidence in the NHS and other public services.
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Interviews with senior professionals in accident and emergency (A&E) healthcare, policing and social services to map the ethical dimensions of interagency collaboration suggest that the main ethical themes for systematic research are information sharing and confidentiality, consent, professional values and autonomy, human rights, formal (organisational) accountability, staff safety and public interest collaboration. An emerging specific issue is the extent of A&E disclosure to the police and to the social services and its legal and ethical parameters.