A study of 16 integrated care pilots (ICP) across England finds that while the staff involved believe that such moves have led to process improvements, this view is not shared by patients.
Nor have the ICPs had any effect on reducing emergency hospital admissions, according to a report on the two-year Department of Health initiative published by RAND Europe and Ernst & Young.
The need to integrate and better coordinate fragmented care services, to provide supportive, person-centred care that would facilitate earlier and more cost-effective intervention, was initially articulated in Professor Lord Darzi's 2008 NHS Next-Stage Review. It was then reinforced in the government White Paper, Equity and Excellence: Liberating the NHS and received further attention more recently with changes to the Health and Social Care Bill.
The Department's two-year programme of ICPs aimed to explore difference ways of providing integrated care, with approaches and interventions that reflected local needs and priorities. While the 16 pilots chosen for the study had variations, they shared a number of aims, including: - bringing care closer to the service user; - providing service users with a greater sense of continuity of care; - identifying and supporting those with greatest needs; - providing more preventive care; and - reducing the amount of care provided unnecessarily in hospital settings.
Most pilots concentrated on horizontal integration, eg, between community-based services such as general practices, community nursing services and social service, rather than vertical integration, e.g., between primary and secondary care.
The study found that the staff involved believed the initiatives had led to process improvements such as an increase in the use of care plans and the development of new roles for care staff, and that these were leading to improvements in care, even if some of these were not yet apparent.
However, patients did not appear to share this sense of improvement, the report notes. It suggests that this could have been because the process changes reflected the priorities and values of staff, or because the benefits had not yet become apparent to service users. Other reasons could be poor implementation or because the interventions were an ineffective way to improve patient experience.
Patients were also reluctant to seek help from community pharmacy rather than GP surgeries. One pilot, run by NHS Tameside and Glossop, invited patients at particular risk of developing cardiovascular disease (CVD) to attend screening and advice sessions at their GP practice or a pharmacy. However, the report notes that "the focus of the pilot changed from pharmacies to GP surgeries during the course of the pilot because of people's reluctance to attend these services at pharmacies."
Also, while a key aim of many pilots was to reduce hospital use, the study found no evidence of a general reduction in emergency admissions, although there were reductions in planned admissions and in outpatient attendance, say the authors. They also found no overall significant changes in the costs of secondary care utilisation.
The approaches to integrated care found in these pilots will not save money in the short term, and certainly not inevitably, although there is evidence that the case management approaches used could lead to an overall reduction in secondary care costs, says the report.
The most likely improvements following integrated care activities are in healthcare processes, and they are less likely to be apparent in patient experience or in reduced costs, the authors conclude.