Key messages

This is an update of a previous systematic review on the factors that promote and hinder joint working between health and social care services. It demonstrates some positive outcomes of such an approach for people who use services, carers and organisations delivering services.
Three broad themes are used to organise the factors that support or hinder joint or integrated working: organisational issues; cultural and professional issues; and contextual issues.
There is significant overlap between positive and negative factors, with many of the organisational factors identified in research as promoting joint working also being identified as hindering collaboration when insufficient attention is paid to their importance.
Securing the understanding and commitment of staff to the aims and desired outcomes of new partnerships is crucial to the success of joint working, particularly among health professionals.
Defining outcomes that matter to service users and carers is important. Outcomes defined by service users may differ from policy and practice imperatives but are a crucial aspect of understanding the effectiveness of joint or integrated services.
Although most service users and carers report high levels of satisfaction, more can be done to involve them in care planning and influencing future care options. Joint and integrated services work best when they promote increased user involvement, choice and control.
The evidence base underpinning joint and integrated working remains less than compelling. It largely consists of small-scale evaluations of local initiatives which are often of poor quality and poorly reported. No evaluation studied for the purpose of this briefing included an analysis of cost-effectiveness.
There is an urgent need to develop high-quality, large-scale research studies that can test the underpinning assumptions of joint and integrated working in a more robust manner and assess the process from the perspective of service users and carers as well as from an economic perspective.