Improving coordination between health services, and across health, social care and the voluntary sector, can improve patient experience and quality of care. More integrated care can also reduce emergency admissions for conditions which can be better managed outside hospital. There have been many policies over the last 20 years to encourage integration between services. The latest policies to provide joined-up care to patients at the right time and in the right setting were first set out in the NHS Long Term Plan in 2019, and are a core part of the government’s White Paper published earlier this month.
In 2019, QualityWatch asked “Are patients benefitting from better integrated care?”. Two years on, we’ve re-examined our indicators looking at the quality of integrated care using the latest available data, which mostly covers time periods before the coronavirus (Covid-19) pandemic. While some measures, such as the employment rate among adults with a long-term condition, have improved over time, others, such as support for people with multiple long-term conditions, and the proportion of people with multiple emergency admissions in the last year of life, have not. However, measuring integration is difficult and there is a lack of data from social care and community services.
A summary of our integrated care indicators is shown below. Click on the links for more detailed content and analysis.
Supporting people in employment
- The rate of employment among adults of working age (16-64) with a mental illness increased markedly from 27% in Q1 2007/08 to 52% in Q4 2019/20.
- Between 2017/18 and 2019/20, the proportion of adults in contact with secondary mental health services who are recorded as being employed increased slightly from 7% to 9%.
- The proportion of adults with a learning disability in paid employment is very low and has fluctuated over time, from a high of 7.1% in 2011/12 to a low of 5.6% in 2019/20.
- The employment rate among adults with a long-term condition increased from 58% in Q1 2007/08 to 66% in Q2 2019/20.
Carer-reported quality of life
- Between 2016-17 and 2018-19, the average carer-reported quality of life score decreased from 7.7 to 7.5 (out of a maximum score of 12), indicating a deterioration in their overall quality of life.
Adults with learning disabilities who live in their own home or with their family
- The proportion of adults aged 18-64 with a learning disability who lived in their own home or with their family increased from 74% in 2014/15 to 77% in 2017/18, and it has remained constant since.
Supporting patients to manage their long-term condition(s)
- Between 2018 and 2020, the proportion of patients who ‘definitely’ had enough support from local services or organisations to help them manage their long-term health condition(s) decreased from 43% to 40%.
- Only 70% of patients aged 16 to 24 ‘definitely’ or ‘to some extent’ felt supported to manage their long-term condition in 2020, compared to 84% of respondents aged 65 to 74.
- In 2018/19, a smaller proportion of people from the most deprived areas (52%) felt supported to manage their long-term condition compared to people from the least deprived areas (63%).
Do patients feel involved in decisions about their care?
- In 2019, 81% of Cancer Patient Experience Survey respondents said they were ‘always’ involved in decisions about their care and treatment. Only 52% of Community Mental Health Survey respondents said that they were ‘definitely’ involved as much as they wanted to be in agreeing what care they would receive.
- Between 2018 and 2020, the proportion of patients who were ‘definitely’ involved as much as they wanted to be in decisions about their care and treatment during their last general practice appointment decreased slightly from 61% to 60%.
- The percentage of Adult Inpatient Survey respondents who said they were ‘definitely’ or ‘to some extent’ involved as much as they wanted to be in decisions about their care and treatment remained stable at around 89% between 2009 and 2019.
Potentially preventable emergency admissions
- Between 2008/09 and 2019/20, the rate of emergency admissions per 1,000 population for ambulatory care sensitive (ACS) conditions and urgent care sensitive conditions remained relatively stable.
- Rates of emergency admissions for ACS and urgent care sensitive conditions improved for people aged 0 to 15 and 64 to 74 but worsened for people aged 25 to 34, and 85 or over.
- Between 2008/09 and 2019/20, the rate of emergency admissions increased for falls, cellulitis, urinary tract infections, COPD and acute mental health crisis, but decreased for angina and non-specific chest pain.
Emergency admissions for children with chronic conditions
Asthma
- Between 2008/09 and 2019/20, the rate of emergency admissions for asthma in children and young people aged 5 to 19 remained relatively constant. But the rate in children aged 0 to 4 years decreased considerably. This could largely be due to a reduction in over-diagnosis of asthma in young children by clinicians.
Diabetes
- The rates of emergency admissions for Type 1 diabetes have decreased for children aged 0 to 14 and remained roughly stable for young people aged 15 to 19.
- There has been a striking increase in emergency admissions for diabetes in young people aged 20 to 24, from 66 emergency admissions per 100,000 population in 2008/09 to 94 per 100,000 population in 2019/20. The worsening trend is likely to be explained by fragmented and variable service quality, as young people with diabetes transition to adult services.
Epilepsy
- Overall, emergency admissions for epilepsy have remained relatively constant over time for children and young people. Children aged 0 to 4 have the highest emergency admission rate for epilepsy, at 102 per 100,000 population in 2019/20.
Supporting older people’s recovery after illness or injury
- The proportion of older people (aged 65 and over) who are still at home 91 days after discharge from hospital into reablement services has varied little over time, reaching 82% in 2019-20.
- The proportion of older people who receive reablement services after discharge from hospital has fluctuated over time at around 3%. In 2019-20, 2.6% of older people discharged from hospital received the service.
End of life care
- Between 2009 and 2018, the proportion of people with three or more emergency admissions in the last year of life increased from 21% to 25%.
- The proportion of people dying at their usual place of residence has increased substantially over time, from 35% in 2004 to 47% in 2019. Provisional data for 2020 (covering October 2019 to September 2020) shows that the proportion of people dying at their usual place of residence increased to 52%.
For more information and analysis on integrated care, see these Nuffield Trust blogs: