Little progress by ‘integration pioneers’, DH’s study finds

An independent evaluation of the initiative, which was designed to bring about joined up care, also found that many of its sites have scaled back their ambitions. And, it said the wider health policy environment had become less supportive of transformation since the pioneers launched.

The study was carried out and published by the policy innovation research unit at the London School of Hygiene and Tropical Medicine.

The pioneers were launched in November 2013 by the then care and support minister Norman Lamb. Initially there were 14 pioneer sites, with a further 11 added in early 2015.

The programme was intended to fire the “starting gun” for integration, with pioneer sites demonstrating to the rest of the system how services could be joined up.

Research for the evaluation took place between spring 2014 and summer 2015. The report says little progress was made during the first 18 months of the programme.

The report states:

• There is “limited evidence of change in service delivery to date except in a few pioneers… despite the expectation that pioneers would be able to get into delivery mode quickly and enable other areas to build on their experience”.
• “There was insufficient support from the centre to tackle some of the systemic barriers to integrated care”. The study also identifies a set of major systemic barriers to integration. These include: rules around information sharing; payment systems; regulatory regimes; job boundaries; and workforce planning. There was “increasing exasperation” among pioneers over the lack of progress made in removing them.
• Competing pressures – such as the demands on providers to hit accident and emergency targets – meant “integrated care was not always treated with the same degree of urgency by all stakeholders.”
• The wider health policy environment “is getting harsher and in many respects, increasingly unsupportive of whole systems transformation”. Finance pressures were potentially undermining efforts to integrate care “by diverting energy and resources to ‘fire fight’.”
• There has been a “narrowing of objectives” compared with the original ambitions stated by the pioneer sites. This may have been a pragmatic response to the failure of national bodies to remove barriers to integration.

Mr Lamb told HSJ he had had “battles” with NHS England during his time as health minister over the “inadequate” support the pioneers were offered. “There was a constant dialogue between me and NHS England that they were not taking it seriously enough”, he said.

He said he was frustrated over the lack of action on removing barriers to integration, adding: “My fear is that the same barriers are likely to prove just as challenging for the vanguards.”

Mr Lamb also expressed concern that transformation had become a “second order” priority after financial control. “Crisis management can so easily take precedence over brave transformational change - so the money keeps pouring into an unreformed, dysfunctional system.”

The DH has commissioned a further evaluation of the programme which will finish in 2020.

NHS England was approached for comment.