Abstract
PurposeAll areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary and community health services, and involve local authorities and the voluntary sector. ICSs build on previous pilots, including the Integrated Care Pioneers in 25 areas from November 2013 to March 2018. This analysis tracks the Pioneers’ self-reported progress, and the facilitators and barriers to improve service coordination over three years, longer than previous evaluations in England. The paper aims to discuss these issues.Design/methodology/approachAnnual online key informant (KI) surveys, 2016–2018, are used for this study.FindingsBy the fourth year of the programme (2017), KIs had shifted from reporting plans to implementation of a wide range of initiatives. In 2018, informants reported fewer “significant” barriers to change than previously. While some progress in achieving local integration objectives was evident, it was also clear that progress can take considerable time. In parallel, there appears to have been a move away from aspects of personalised care associated with user control, perhaps in part because the emphasis of national objectives has shifted towards establishing large-scale ICSs with a particular focus on organisational fragmentation within the NHS.Research limitations/implicationsBecause these are self-reports of changes, they cannot be objectively verified. Later stages of the evaluation will look at changes in outcomes and user experiences.Originality/valueThe current study shows clearly that the benefits of integrating health and social care are unlikely to be apparent for several years, and expectations of policy makers to see rapid improvements in care and outcomes are likely to be unrealistic.
Highlights
The Integrated Care and Support Pioneer programme was initiated by the Government in England to run over a five-year period (2013–2018), and aimed to improve the quality, effectiveness and cost-effectiveness of care for people whose needs are best met when the different parts of the health and social care systems work in an integrated way
Key informant characteristics In 2016, at least one key informant (KI) participant completed the survey in all 25 Pioneers; in 2017, there was at least one KI from 24 Pioneers; and in 2018, there were KI participants from 23 Pioneers
15 KIs participated in all three surveys, and a further 38 participated in two of the three
Summary
The Integrated Care and Support Pioneer programme was initiated by the Government in England to run over a five-year period (2013–2018), and aimed to improve the quality, effectiveness and cost-effectiveness of care for people whose needs are best met when the different parts of the health and social care systems work in an integrated way. The Department of Health (DH) commissioned the Policy Innovation and Evaluation Research Unit (PIRU) to conduct an 18-month “early” evaluation of the Wave 1 Pioneers (Erens et al, 2017). It found considerable heterogeneity in Pioneers’ initial aims, but growing convergence over time in the reported activities of most Pioneers towards specific interventions for older people with multiple long-term conditions, with a particular focus on establishing multi-disciplinary teams based in primary care. The early evaluation demonstrated that improving health and social care coordination is not a short-term process
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