Abstract
BackgroundPolicy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. We evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies.MethodsOf the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes.ResultsCCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI:7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes.ConclusionsHealth and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.
Highlights
Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use
We defined four groups of Clinical Commissioning Groups (CCGs): 1) those involved in the Pioneer programme only; 2) those involved in the Vanguard programme only; 3) those involved in both innovative programmes; and 4) those involved in neither
Of the 206 CCGs in England in the study period, 86 CCGs had some involvement in the programmes (41.8%). 55% of them were located in the North and Midlands
Summary
Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. We evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Despite the several attempts at such integration, there is little evidence that these initiatives have been effective Their success has often been presented, at least in part, in terms of their ability to reduce the need for emergency hospital admissions [11]. Another reason is that the different schemes contain different key features, so drawing lessons on the key ingredients of a successful integration initiative is difficult
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