Researchers from the Nuffield Trust and Imperial College London have today published the findings from an evaluation of the first year of a pilot designed to deliver more integrated care to patients in North West London.
The Inner North West London Integrated Care Pilot is a large-scale programme focused on developing new models of care planning and coordination for people with diabetes and those who are over 75 years of age.
The pilot is being implemented at a time of major reform of the NHS in England, and has been the subject of significant attention among policy makers and commissioners wanting to encourage new models of integrated care.
The benchmarks set in this first evaluation report provide a sound basis for the pilot to assess its progress against, particularly in relation to activity, cost, and health outcomes Dr Judith Smith, Director of Policy, Nuffield Trust
The pilot was evaluated by the Nuffield Trust and Imperial College London between September 2011 and July 2012, with funding from the Imperial College Healthcare Charity. They found that the foundations for change had been laid, with the pilot making good progress in designing and implementing a complex intervention. Progress was underpinned by a new set of governance arrangements and financial incentives.
However their report also notes that analysis of the first tranche of patients treated under the new case management arrangements did not show any significant reduction in emergency admissions or significant changes in the wider use of services. The researchers warn that it would take longer to see any such impact.
“Our evaluation described the early impact of the integrated care pilot to help its development beyond the first year and to inform other integrated care initiatives in the UK and overseas” said Dr Judith Smith, Director of Policy at the Nuffield Trust.
“The benchmarks set in this first evaluation report provide a sound basis for the pilot to assess its progress against, particularly in relation to activity, cost, and health outcomes. International evidence points to the fact that integrated care takes years to develop, and a minimum of three to five years is needed for such initiatives to show impact in relation to activity, patient experience and outcomes”.
Imperial College London’s e-Health Unit Director Dr Josip Car added: “The evaluation reveals the achievements and challenges that would be familiar to those who have attempted to bring about large-scale transformational change in the NHS in the past.
“There were some changes in the process of care recorded on GP information systems. For example, there was a marked increase in diagnoses of dementia after August 2011, when the pilot started and in the frequency of testing for diabetes.”
Key findings include:
- Health care professionals had a high level of commitment to the integrated care pilot, in particular to the care planning process. They reported that work on care planning, and multidisciplinary groups, had resulted in improved collaboration across different parts of the local health and social care system.
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The project made considerable progress in formalising engagement between a range of organisations in a relatively short time. This set-up phase was helped by financial and other support from NHS London which enabled investment in IT, leadership, co-ordination of multidisciplinary groups, and project management. The pilot will need to consider carefully how best to embed its support structures, to ensure long-term cost-effectiveness beyond the pilot phase without risking loss of momentum.
Professionals conceded that the IT tool had the potential to track and capture health and social care usage in ways that were not possible before, and that this was vital to the new care planning approach. The care planning IT tool nevertheless had led to dissatisfaction amongst many practitioners, with concerns aired about duplication of data entry, problems with interoperability, and functionality.
- There was no evidence of changes in the pattern of service use amongst the first 1,236 patients for the three months after receiving case management. These cases need to be followed for longer to assess whether the pilots were leading to changes in emergency hospital admissions and total patient costs.
Notes to editors
The Nuffield Trust/Imperial College London evaluation comprises four distinct streams of work:
- Strategic implementation and the policy context (Nuffield Trust)
- Quality of care and health outcomes (Imperial College London)
- Understanding patient and provider experience and communication (Imperial College London)
- Impact on service use and cost (Nuffield Trust).
Since the evaluation a second larger pilot building on the model developed in Inner North West London has since been established in Outer North West London. Together both are looking at moving to a more ambitious ‘whole systems’ approach, based on risk stratification rather than disease pathways.