Fourteen NHS and social care sites in England are testing new ways to join up services, from hospital discharge to home care, while a separate pooled budget system—the Better Care Fund—provides financial incentives for collaboration. This five-year evaluation asks whether these “Integrated Care and Support Pioneers” actually improve patient experience and outcomes cost-effectively, and whether the whole-system context matters more than individual initiatives. The problem is that fragmented care wastes resources and frustrates patients. Previous integration efforts have produced mixed results, and policymakers need to know which approaches work, under what conditions, and at what cost. The evaluation compares Pioneer areas with matched non-Pioneer areas using administrative data, surveys staff and stakeholders across all 24 sites, and conducts detailed cost-effectiveness analyses of specific initiatives. If successful, this research will give NHS and local government leaders practical, evidence-based guidance on how to design and fund integrated care that delivers better outcomes without breaking the budget. The findings could reshape how health and social care are organised across England, influencing everything from GP referrals to long-term support for elderly people living at home.
View original technical description
Background In November 2013, 14 Integrated Care and Support Pioneers were launched to drive change at scale and pace from which the rest of the country could benefit. Ten more will start in 2015. Also in 2013, the Government announced the Better Care Fund (BCF), a pooled budget system designed to provide strong incentives for joint working between NHS, social care and other services to make better use of scarce resources while improving outcomes. Pioneers are to provide examples of best practice in relation to both initiatives. This 5-year evaluation aims to assess the extent to which Pioneers in the context of the BCF are successful in improving patient/user experience and outcomes in a cost effective way. In particular, it recognises that the cost-effectiveness of particular initiatives may depend on the whole systems within which they are located as well as the characteristics of individual initiatives, themselves. Aims The evaluation consists of three interdependent work packages (WPs). WP1 aims to: understand the service changes implemented and the experiences of those working in and with Pioneers, in particular, to identify facilitators and barriers to integrating services and how barriers are overcome; examine changes in key indicators of the extent of care coordination and its consequences at Pioneer level compared with non-Pioneers; ascertain whether Pioneer approaches to integration that are most similar to those in the NHS Five year forward view appear to perform better or worse than others. WP2 aims to: undertake cost-effectiveness (C-E) evaluations of specific integrated care initiatives identified in WP1; understand how and why these initiatives impacts are affected by different contexts. WP3 aims to: synthesise the findings from WPs 1 and 2 by assessing the extent to which the performance of integration initiatives (WP2) can be related to the approach taken at a higher level by the host Pioneer l (WP1) and the contribution of initiatives to the overall performance of the Pioneer; derive and spread practical insights from WPs 1 and 2 that will lead to better integrated care. Research plan and methods WP1 consists of: identifying aggregate indicators of integrated care and its consequences using administrative datasets (including in relation to the BCF) and comparing Pioneers with matched areas; a panel of staff and stakeholders from all 24 Pioneers, surveyed through a mix of interviews and web surveys, depending on topic. WP2 consists of: selecting specific service developments within Pioneers for detailed C-E evaluation, using a range of designs depending on circumstances; an integral qualitative component in each of the C-E analyses to understand the facilitators and barriers encountered compared with the experience of similar initiatives provided by other Pioneers in different contexts. WP3 consists of: workshops (following each WP1 survey) aimed at a mix of Pioneer stakeholders (including the WP1 panellists), policy-makers, international and domestic experts, and patients/users; blogs, podcasts, articles in the professional press and peer-reviewed journals, reports for individual Pioneers, etc. Research team The team already successfully collaborates in the Policy Innovation Research Unit (PIRU). All bar one of the team are also involved in the early evaluation of the integrated care Pioneers (January 2014-June 2015). The team has extensive experience of evaluating integrated care programmes in England (e.g. POPP, Integrated Care Pilots, NW London Integrated Care Pilot, Virtual Wards, Whole Systems Demonstrators) and overseas (e.g. in New Zealand). Anticipated impact of this research With regular reporting and workshops highlighting the development of the Pioneers, along with analysis of the factors that enable or inhibit progress towards integration and its contribution to better outcomes, the evaluation will identify the factors that f
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know