The NHS has set out to ‘join up’ care in England more closely between GPs, hospitals, community services, social care and patients themselves.
This should help people access the right care at the right time, close to home and avoid unnecessary hospital care.
QualityWatch is assessing what impact this policy has had on the quality of care in recent years, and whether patients and the public are likely to notice any difference.
Care at home and in the community
An integrated health care system should support and empower people to manage long-term conditions at home and in the community. This should reduce the need to access emergency care.
People feeling supported to manage their long-term condition
If patients feel supported, it indicates that they are able to help look after themselves and should reduce the need for unnecessary hospitalisation. Every year the NHS surveys people to ask whether they are getting the support they need for ongoing conditions.
Trend over time
Getting worse
Source: NHS England, GP Patient Survey. Sample size (2018): 253,306
How supported people feel varies considerably depending on what condition they have
People being involved in decisions about their care
Involving patients in decisions about their care and treatment can improve outcomes and the experience patients have. It can also save the health system money while supporting people to manage their conditions better themselves. The NHS regularly surveys people to find out how involved they feel in their care.
Trend over time
Not improving
Source: NHS England, GP Patient Survey. Sample size (2017): 769,869
How involved people feel varies considerably by ethnicity
People being able to see or speak to their preferred GP
Continuity of care is a key feature of integrated health care. Asking patients how often they are able to see or speak to the GP they prefer at their surgery is one way of measuring this.
Trend over time
Getting worse
Source: NHS England, GP Patient Survey. Sample size (2018): 362,373
Admissions to hospital
Better integrated care should reduce the frequency and necessity of emergency admissions for conditions which can be better managed outside hospital.
Potentially preventable emergency admissions
Ambulatory care sensitive conditions and urgent care sensitive conditions are the sorts of conditions that can be managed outside of hospital.
Trend over time
Not improving
Hospital Episode Statistics data (years 2011/12 to 2017/18) Copyright © 2019, re-used with the permission of NHS Digital. All rights reserved.
Admissions for potentially preventable conditions have remained relatively stable since 2011. This is arguably a good result given that the total number of emergency admissions to hospital has increased considerably over that time.
What are ambulatory and urgent care sensitive conditions?
Urgent care sensitive conditions:
COPD, acute mental health crisis, non-specific chest pain, falls (aged 74 and over), non-specific abdominal pain, deep vein thrombosis, cellulitis, pyrexial child (aged 6 years and under), blocked tubes, catheters and feeding tubes, hypoglycaemia, urinary tract infection, angina, epileptic fit, minor head injuries.
Ambulatory care sensitive conditions:
Chronic viral hepatitis B, diabetes mellitus, sideropenic dysphagia, anaemia, dementia, epilepsy, hypertension, angina pectoris, chronic ischaemic heart disease, heart failure, atrial fibrillation, pulmonary oedema, bronchitis, emphysema, chronic obstructive pulmonary disease, asthma, bronchiectasis.
Leaving hospital
A more integrated care system should enable people to leave hospital and get the onward care they need for their condition in other settings.
Delayed transfers of care
A ‘delayed transfer of care’ occurs when a patient is ready to be discharged from care but is still occupying a bed. Delayed transfers of care should be minimised through effective planning and joint working between health and care services to ensure transfers are made safely and for the right reasons.
Trend over time
Not improving
Between 2014 and 2017, the number of delayed transfers of care increased rapidly to reach a peak of 6,660 patients delayed on average per day in February 2017. Since then, the number has generally decreased.
The three most common reasons for delay were
Awaiting a care package in a person’s own home
Awaiting further NHS care outside hospital
Awaiting nursing home placement or availability
Carer-reported quality of life
Millions of carers provide unpaid care for ill, older or disabled family members and friends. Local authorities are responsible for assessing carers’ needs for support in doing so. Measuring the quality of life of carers gives us an indication of how well local authorities are looking after them.
Trend over time
Getting worse
Source: NHS Digital, Adult Social Care Outcomes Framework (ASCOF), Sample size (2016-17): 51,230
Between 2012-13 and 2014-15, the self-reported quality of life of carers worsened.
Percentage differences between 2012–13 and 2016–17
People who die in their usual place of residence
The majority of people would prefer to die at home. This is another measure of joined-up working between services to ensure patients have sufficient choice and access.
Trend over time
Improving
The proportion of deaths occurring at a person’s usual residence has increased in recent years.
But this varies greatly depending on where people live
Use the map to find out what percentage of deaths occur at a person's usual residence and how this varies between different areas in England.
- 38%+
- 40%+
- 42%+
- 44%+
- 46%+
- 48%+
- 50%+
Summary of trends
Are patients benefitting from better integrated care?
Overall, there is limited evidence that patients are benefitting from better integrated care: only one of the seven indicators has improved, three have deteriorated, and three show either no change or an inconsistent pattern.
Patients and carers are feeling less supported and less involved in their care, and there are important variations between different groups of patients.
However, the NHS is managing to keep the rate at which people are admitted to hospital with conditions that should be managed in the community relatively steady, despite a large growth in the number of admissions. The proportion of people who are dying in their usual place of residence has also increased.