National evaluation of Department of Health’s integrated care pilots [UK] – March 2012, released 22 May 2012

Posted on May 25, 2012. Filed under: Health Mgmt Policy Planning | Tags: |

National evaluation of Department of Health’s integrated care pilots [UK] – March 2012, released 22 May 2012

Author:    Ernst & Young, RAND Europe and the University of Cambridge

“Key messages

● While much of the wider literature focuses on ‘models’ of integrated care, we found that Integrated Care Pilots (ICPs) developed and implemented a loose collection of ‘integrating activities’ based on local circumstances. Despite the variations across the pilots, a number of aims were shared: 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 – e.g., integration between community-based services such as general practices, community nursing services and social services rather than vertical integration – e.g., between primary care and secondary care.

● Integrated care led to process improvements such as an increase in the use of care plans and the development of new roles for care staff. Staff believed that these process improvements were leading to improvements in care, even if some of the improvements were not yet apparent. A range of other improvements in care were reported by pilots following local evaluations. We have reported these but they  lie beyond the scope of the national evaluation.

● Patients did not, in general, share the sense of improvement. This could have been because the process changes reflected the priorities and values of staff (a so-called professionalisation of services); because the benefits had not yet become apparent to service users (‘too early to tell’); because of poor implementation; or because the interventions were an ineffective way to improve patient experience. We believe that the lack of improvement in patient experience was in part due to professional rather than user-driven change, partly because it was too early to identify impact within the timescale of the pilots, and partly because, despite having project management skills and effective leadership, some pilots found the complex changes they set for themselves were harder to deliver than anticipated. We also speculate that some service users (especially older patients) were attached to the pre-pilot ways of delivering care, although we recognise this may change over time.”

… continues


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