The Balance of Care Approach to Health and Social Care Planning for Older People with Mental Health Problems: Development, Opportunities and Challenges

Student thesis: Phd


This thesis demonstrates how the author refined and developed the Balance of Care (BoC) approach in the course of three empirical studies that explored the optimal service mix to provide for older people with mental health problems. It also shows how the author’s research fits within the wider BoC literature and explores the opportunities and challenges faced by future BoC researchers. As such, its focus is on the methods/implementation (rather than the findings) of BoC studies. The BoC approach offers service commissioners, planners and providers a systematic framework for exploring potential changes in the mix of health and social care, community and institutional services for a particular client group in a defined geographical area. There are three main stages: the specification of current care arrangements; the identification of people whose care needs could be met in more than one setting; and a comparison of the costs and consequences of the alternative care options. However, there is no one rigidly defined way these must be undertaken. Against this background, the first two of the ten submitted papers synthesise and appraise how the key elements of the approach have been operationalised in past studies, whilst the remaining eight publications illustrate how the author’s research sought to take the approach forward. Chapters 1 to 3 of the accompanying critical appraisal set out the background to this work. The first describes the difficulties faced by health and social care decision-makers charged with allocating resources for older people with mental health problems; the second outlines the theoretical underpinnings of the BoC approach and summarises its past employment; and the third describes the context to, aims of, and author’s responsibilities on the empirical studies. Chapters 4 to 6 subsequently explore how each of the main activities were operationalised (including their strengths and weaknesses) and consider a range of possible ways forward for future applicants. The seventh and final chapter reviews the overall utility of the BoC approach as a framework for health and social care decision-makers, explores the reception of the author's work and summarises and reflects on her main achievements. These include expanding the use of the BoC to new client groups and settings; strengthening the data collection and client profiling exercises; exploring different ways of incorporating users’ and carers’ experience in the planning process; investigating the use of BoC data in understanding practitioner decision-making; extending the BoC approach to include more qualitative methods; and co-developing a set of publicly available Excel-based worksheets plus an accompanying handbook to enable decision-makers to use the BoC approach independently.
Date of Award1 Aug 2021
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorLinda Davies (Supervisor)

Cite this