Greater integration of
health care has led to improved care processes, more satisfied staff
and reduced use of hospitals
If tailored to
local circumstances, well-led and well-managed integration can
improve the quality of care for patients, 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 10 th
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.
List of pilot sites are attached.
Contacts:
Department of Health
Phone: 020 7210 5221
NDS.DH@coi.gsi.gov.uk