Priorities for the development of older people's services in South Korea : lessons from the United Kingdom.

This thesis aims to inform the older people's service agenda for South Korea by drawing lessons from recent appraisals of British health care and social care services for older people, the rationale for recent reforms, and an evaluation of a specific service innovation (the Barnsley Rapid Response Service). The research has three main elements: (1) an appraisal of unmet service needs among older people and key services delivery problems in South Korea (2) an evaluation of the new intermediate care service in Barnsley, and (3) the implications of the findings for the UK and for South Korea. The Barnsley RRS provides a valuable holistic assessment service for a particular group of older people with chronic health problems and disabilities, and in certain respects responded to unmet needs. Its brief episodes of care in some cases also achieved a reorganisation of the patient's care and treatment, to the benefit of the patient and achieving reduced staff involvement and patient contact. However, the impact of RRS was limited by its qualified acceptance by both GPs and hospitals. If intermediate care schemes are to make a difference, they need to be given greater 'powers' in relation to GPs and hospital physicians. The social circumstances of older people in South Korea have changed radically in recent decades and the need has increased for formal care services for those who are frail and have no informal carers. However, the dominant influence of physicians on health service development underlies the low current priority for 'care' as opposed to 'cure', as also for improving the management of chronic conditions and rehabilitation. The experience of the UK strongly suggests that South Korea should develop domiciliary health and social care services alongside institutional care to meet older people's various care needs. Furthermore, a comprehensive system of treatment and care for under-served patients with chronic health problems should be developed. South Korea should consider establishing innovative care services like the UK 'intermediate care' schemes to overcome the fragmented services and to encourage collaborative delivery. To achieve these innovations, education and training in multidisciplinary team working are required. Another priority should be to improve the quality of care by adopting minimum standards of care and stronger systems of regulation and inspection. To overcome the difficulties of innovative service implementation, feasibility planning and careful preparation are essential.