Abstract
PurposeIn 2011, community nursing services were reorganised in England in response to a national policy initiative, but little is known about the impact of these changes. A total of three dominant approaches emerged: (1) integration of community nursing services with an acute hospital provider, (2) integration with a mental health provider and (3) the establishment of a stand-alone organisation, i.e. without structural integration. The authors explored how these approaches influenced the trends in emergency hospital admissions and bed day use for older people.Design/methodology/approachThe methodology was a longitudinal ecological study using panel data over a ten-year period from April 2006 to March 2016. This study’s outcome measures were (1) emergency hospital admissions and (2) emergency hospital bed use, for people aged 65+ years in 140 primary care trusts (PCTs) in England.FindingsThe authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010). The authors similarly found no difference in the trends for emergency hospital bed use.Research limitations/implicationsPCTs were abolished in 2011 and replaced by clinical commissioning groups in 2013, but the functions remain.Practical implicationsThe authors found no evidence that any one structural approach to the integration of community nursing services was superior in terms of reducing emergency hospital use in older people.Originality/valueAs far as the authors are aware, previous studies have not examined the impact of alternative approaches to integrating community nursing services on healthcare use.
Highlights
The global trend towards ageing populations and increases in those experiencing long-term and multiple health conditions is resulting in a common aspiration to re-orientate health and care systems towards more preventative and person-centred models of care
The authors found no statistically significant difference in the post-intervention trend in emergency hospital admissions between those PCTS that integrated community nursing services with an acute care provider and those integrated with a mental health provider (IRR 0.999, 95% CI 0.986–1.013) or those that did not structurally integrate services (IRR 0.996, 95% CI 0.982–1.010)
Integration with acute hospital provider was the most common organisational model selected by primary care trusts for their community nursing service in 2011/12 (n 5 58), followed by integration with a mental health provider (n 5 38), a community trust (n 5 30) and a community interest company (n 5 14). 11 primary care trusts were excluded from our later analysis: six that adopted a mix of organisational models, two that selected a supplier using an any willing provider (AWP) approach, two that postponed the transfer to community nursing and one whose organisational model was not known
Summary
The global trend towards ageing populations and increases in those experiencing long-term and multiple health conditions is resulting in a common aspiration to re-orientate health and care systems towards more preventative and person-centred models of care. Most countries have introduced programmes to divert those with less intense needs from hospital settings. Many of these are founded on the premise that better integrating care will facilitate the necessary changes in clinical practice, resource allocation and organisational behaviour (Minkman, 2012; Valentijn et al, 2015). Fragmentation of care can occur when several organisations with different cultures, operating practices and financial imperatives are involved in delivering components of care to an individual (Cameron et al, 2014; Miller et al, 2016). One potential solution is to merge organisations, creating a single entity with authority to allocate resources, reconfigure services and incentivise staff members to deliver more coordinated and flexible care (Miller et al, 2011; Shaw et al, 2011)
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