Integrated care pilots 'made services worse', say patients

Emergency admissions rose significantly and patients saw no improvement in services in areas covered by integrated care pilots (IPCs) set up by the DH, a study has found.

Intensive case management cut A&E visits in some areas
Intensive case management cut A&E visits in some areas

A two-year national evaluation of integrated care pilots, commissioned by the DH, was carried out by Ernst & Young, RAND Europe and the University of Cambridge.

The study covered 16 pilot sites across England, which piloted different ways of integrating care between general practices, community nurses, hospitals and social services.

Pilot areas included Bournemouth and Poole, which ran a scheme to improve care in dementia; North Cornwall, which worked to improve mental healthcare; and Northumbria, which worked on COPD.

Despite staff satisfaction rising across the pilot areas with staff reporting higher levels of responsibility and breadth in their work, the evidence showed that patients saw no real improvement in their care.

A survey of 700 patients who were treated under the pilots found that they felt less involved in decisions about their care, less likely to see the nurse they preferred, less in control of their lives and less likely to have their preferences taken into account by social services or care workers.

The authors of the report said the results could be due to some pilots setting themselves challenges that were harder to deliver than anticipated.

‘We also speculate that some service users (especially older patients) were attached to the "pre-pilot" ways of delivering care, although we recognise this may change over time,’ the author added.

Although patients did not report an improvement in their own care, 54% of staff taking part in the pilots said they believed their patient’s care had improved.

The research also found that the pilots did not reduce A&E admissions in the pilot areas. The study said: ‘In analyses of individual patients and matched controls we found a significant increase in emergency admissions in patients from pilot practices, most marked in case management sites.

Despite increasing emergency admissions, the study found that hospital care was needed less for patients of those pilots that focused on the introduction of intensive case management.  

For patients in these areas, outpatient visits fell by 22% and planned admissions by 21%. Consequently, savings of 9% were made in the overall cost of hospital care.

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