Evaluating UK Integrated Care Pilots
Demands on health and social care are changing in scope and scale as the English population ages, new treatments become available, and public expectations change. Improving interventions through integrated care has been identified as one way of effectively addressing these changing health needs.
To assess more fully the possibilities integrated care might offer, the English Department of Health established a programme of Integrated Care Pilots (ICP) — a two-year initiative to explore different ways of providing health and social care services to improve the health and wellbeing of four groups of individuals:
- elderly people
- people with long term conditions such as diabetes, cardiovascular disease and chronic lung disease at risk of emergency hospital admissions
- people with dementia and other mental health problems
- people engaging in substance misuse
"Integration" refers to new models of delivering care as well as new ways of working between organisations that cross boundaries between primary, community, secondary and social care.
A team comprising RAND Europe, Ernst & Young, University of Cambridge and the Nuffield Trust evaluated the national programme and concluded that, if tailored to local circumstances, well-led and well-managed integration can improve the quality of care for patients.
Additionally, the team's report noted that staff liked the pilots and had confidence in the programme's benefits:
- 84% of staff claimed their job had expanded
- 63% thought their role had become more interesting
- 60% of staff thought they worked more closely with other team members
- 72% reported better communication with other organisations
- Overall, 54% of staff thought patient care had improved over the previous year as a result of the pilot, compared to 1% who thought it had got worse.
However, patients did not, in general report an awareness of improved care.
- 15% fewer patients reported feeling that their opinions and preferences were taken into account by social services or their care workers
- 5% fewer patients felt involved by their doctors in decisions about their care
- 9% fewer patients felt they were able to see the nurse of their choice
In sum, the team's evaluation report noted that caution is required when developing integrated care programmes, as no single approach suits all occasions and change may take much longer than anticipated. Additionally, the complexity of delivering integrated care activities needs strong leadership and be scaled to match local capacity. However, for teams willing to think creatively, integrated care often finds multiple creative ways of reorganising work in new organisational settings to reduce waste and duplication, deliver more preventative care, target resources more effectively, or improve the quality of care.