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These included the failure of the police to take the threat Reynolds posed seriously; the lack of coordination between services that could and should have intervened; the serial attacks on women that were ignored or not fully investigated.
A man whose urology care stopped when he was 18. Lack of coordination between services meant he had no follow-up care for eight years, during which he developed a large kidney stone that "was the main cause of his death".
Other important missing variables were related to social services, nursing homes, intermediate care, and system-level variables such as integration and coordination between services.
Thus, we must urgently adapt our operations and resources through the use of case management, a single entry point, a unique assessment tool, and an individualized service plan to promote better coordination between services.
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This indicates lack of standard protocols, poor convergence and patchy coordination between service providers and health system managers.
However, the results of this study confirm, that the details of care organization and coordination between service providers including rehabilitation facilities and nursing homes are very important and coordination does not happen automatically even within very well established national healthcare systems like the DHS.
To tackle systemic barriers to healthcare provision, a range of solutions has been proposed, including integrated care models such as co-location of physical and mental health services or the use of case managers or other liaison staff to undertake a coordination role between services.
Although care-coordination can be provided by a case-manager, ideally the health and social services should be more integrated and have coordination between the services to supply the best available options for the individual needs of older persons.
First, ensure good coordination between security services and police.
There is a more troubling distortion though: the NHS budget has been inflated, throughout this parliament, by money it has to give local authorities for social care, public health and better coordination between their services.
Despite injunctions, arrests and even jail sentences, a lack of coordination between social services and local police allowed Jan to take up his stalking where he had left off.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com