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If tailored to local circumstances, well-led and well-managed integration can improve the quality of care for patients as a major study has found.
More joined up health services and social care was also well liked by staff and reduced hospital costs.
The two-year study, commissioned by the Department of Health, looked at 16 sites across England which formed the Integrated Care Pilot programme. The sites piloted different ways of integrating care, such as between general practices, community nurses, hospitals and social services.
The research carried out by Ernst & Young, RAND Europe and the University of Cambridge considered the impact of better integrated care on elderly people at risk of emergency hospital admissions and the treatment of conditions including dementia and mental health problems. It analysed staff and patient views on the work of the pilots as well as the impact on hospital admissions and lengths of stay in hospital.
The study found:
- Sixty per cent of staff thought they worked more closely with other team members;
- Seventy-two per cent of staff reported better communication with other organisations;
- Eighty-four per cent of staff said their job had expanded, with 64 per cent saying their role had become more interesting.
- Overall, 54 per cent of staff thought patient care had improved as a result of the pilot.
The evaluation team consider that these figures suggest that many of those involved in delivering integrated care had real confidence that it was providing benefit for service users.
The study revealed that hospital care was needed less for patients of those pilots that focused on the introduction of intensive case management which involved the identification of elderly people at risk of hospital admission and then the coordination of care by a case manager. For those patients, outpatient visits fell by 22 per cent and planned admissions by 21 per cent. Consequently, savings of 9% were made in the overall costs of hospital care.
The pilot locations also saw increases of eight per cent in patients receiving care plans and a 9 per cent rise in those knowing who to contact with questions after hospital discharge.
Care Services Minister Paul Burstow said:
“This two-year independent evaluation report is a valuable and welcome addition to the evidence base for integration. Many of its findings resonate with the recently published NHS Future Forum’s report on integration.
“This report is an important wake-up call, showing that actioning more integration is challenging even when organisations volunteer to collaborate. Our health reforms put in place the legal framework to support greater integration but to succeed it will require leadership at every level.”
Dr Richard Lewis, Partner at Ernst & Young, and co-leader of the research says:
“These evaluation results provide grounds for optimism that integrated care will deliver at least some of the hoped for benefits. The issue of poor care integration has long been highlighted as a key faultline in the NHS and the wider care system so these findings are significant.
“However, this optimism must be cautious at this stage. Change takes time and, it may still be too early to provide a complete picture of the outcomes of integrated care.
“The professional staff involved in the pilots clearly believed that integrated care allowed them to practise in a more effective way. However, the reaction of patients to integrated care is surprising. While some essential processes such as care planning have become more common, important aspects of the patient experience appear to have diminished. It may be that staff within the pilots have concentrated on improving their professional care but, in the process, lost focus on the individual patients at the centre of that care.”
Martin Roland, Professor of Health Services Research at the University of Cambridge and co-leader of the research, says:
“Improvement in care processes is certainly a key benefit of integrated care, but we cannot afford to lose sight of the patient who may have a different perspective on the services they receive, such as the importance of having continuity of care from doctors and nurses.
“We have also seen how difficult it is to reduce emergency admissions for vulnerable elderly people even when everything appears to be set up to manage demand for hospital admission. This is not the first study with such findings suggesting that there may be genuine unmet need among this group of patients and that services should be planned taking this into account. However, the study also shows the potential to move other types of care from hospital into the community, for example reducing the need for outpatient attendance.”
Dr. Tom Ling, Director of Evaluation Rand Europe and co-leader of the research, says:
“This evaluation takes us beyond the more simplistic question of ‘is integrated care good or bad’ and encourages us to look more carefully at how appropriate integration can both improve the effectiveness of health and social care and still meet the needs of service users.
“Successful integration is tough to deliver but by carefully crafting improvements to local circumstances and providing strong leadership more integrated care can help deliver real benefits for those who most need health and social care.”
Notes to Editors
For media enquiries contact the Department of Health news desk on 020 7210 5221.
The research followed the NHS Next Stage Review of 2008 which highlighted the need for more integrated care within the NHS and between the NHS and social care.
Since then, the independent NHS Future Forum, the body advising the Government on NHS reform, has also identified integration as a key priority.
The two-year study by Ernst & Young, RAND Europe and the University of Cambridge commenced in 2009 and looked at 16 sites across England who undertook different ways of integrating care, for example, between general practices, community nurses, hospitals and social services.
The evaluation was designed to understand what whether integrated care offers benefits for patients, staff and the wider NHS. It drew on a number of different evaluation methods: ‘before and after’ staff and patient questionnaires, analysis of hospital activity data and costs compared to matched controls, interviews with patients and staff, a regular journal.
Despite variations across the pilots, they broadly shared a number of similar aims: bringing care closer to the service user, creating teams that crossed organisational boundaries, providing greater continuity of care, providing more preventive care and avoiding unnecessary hospital care. In particular, a subset of six pilots focused on intensive case management of elderly people at risk of emergency hospital admission. Most of the pilots concentrated on integrating community based services (such as general practice, community nursing and social services) and far fewer on ‘vertical’ integration between primary and secondary care.
The NHS Future Forum was tasked with reporting on integration as one of four themes relating to driving improvements and achieving higher quality of care and their report was published on 10th January. These reports present similar messages around the need to further improve the integration of care and the benefits that this will bring for patients and their carers.