The greater integration of care has no significant impact on the cost of secondary care, with benefits cancelled out by “unexpected” increases in emergency admissions, a major review has found.
Savings from a 4 per cent reduction in elective admissions and a 20 per cent fall in outpatient attendance were balanced by a 2 per cent increase in emergency admissions. There were also “mixed results” for patient experience.
The two-year government commissioned study evaluated the 16 sites comprising the Department of Health’s Integrated Care Pilot programme. The schemes used a variety of models. The majority of models concentrated on “horizontal” integration – between primary care, community services or social care – rather than “vertical” integration, including acute trusts.
Researchers from Ernst & Young, RAND Europe and Cambridge University compared 8,691 patients managed by the pilots with 42,206 controls.
They found the pilots resulted in a non-significant reduction in overall secondary care costs of £37 per patient.
In addition, while surveys carried out as part of the evaluation found the schemes improved teamworking and communication between staff, this was in “contrast to staff experiences”.
Patients said it was significantly more difficult to see the nurse of their choice, were listened to less frequently and were less involved in decisions about their care – though they did report receiving care plans more frequently and that post-discharge care was better coordinated.
The report also noted the challenge involved in integrating care should not be underestimated. “The scale and complexity of delivering integrated care activities can easily overwhelm even strong leadership and competent project management,” it said.
Responding to the report, care services minister Paul Burstow described it as a “valuable and welcome addition to the evidence base for integration”. The study’s authors were more cautious in their optimism.
Martin Roland, professor of health services research at Cambridge University, said the findings showed “how difficult it is to reduce emergency admissions for vulnerable elderly people, even when everything appears to be set up to manage demand for hospital admission”.
Co author Richard Lewis, a partner at Ernst & Young, added: “The reaction of patients to integrated care is surprising. It may be that staff within the pilots have concentrated on improving their professional care but, in the process, lost focus on the individual patients at the centre of that care.”
Results from a local evaluation of one of the pilots in Norfolk identified a small reduction in emergency admissions, which it described as “encouraging”.