Age UK’s Personalised Integrated Care Programme (PICP) is a scheme that aims to improve the lives of older people through practical support, underpinned by a change in the way that the health and care system works together for these people locally. The scheme is targeted at older people who are deemed to be at risk of a future emergency admission. Age UK commissioned the Nuffield Trust to determine whether the programme has been able to reduce cost pressures on health and care systems and whether there has been any impact on the levels of hospital use of the older people referred to Age UK's programme.
Using data linkage, we analysed the hospital use of 1,996 older people who had received a service from PICP in eight areas in England, and we compared their activity to that of a carefully selected control group. Our detailed analysis concludes – with some confidence – that it has almost certainly not been able to reduce costs or emergency admissions. While in some areas there was no apparent impact on hospital activity, overall there was a higher than expected use of emergency and outpatient services, and a corresponding increase in costs. These effects were detectable from the very start of the service and persisted for more than a year after.
However, the results suggest that the scheme may be identifying unmet need in the population, which manifests in greater use of hospital care. This might be to the ultimate benefit of the older people in the longer term.
Age UK’s PICP is one of a number of schemes in recent years that have sought to prevent unnecessary hospital use in older people by the provision of community-based forms of care. It is far from alone in not being able to show corresponding reductions in hospital activity. There is a frustrating lack of evidence about what types of interventions might be able to achieve this aim. There is a strong case for future evaluations to consider a broader range of impacts – and over a wider set of care sectors – given the complex needs that such programmes address.