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Saturday 1 October 2016
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Patient care 'worsened' under integrated care pilots

Patients found no improvement in their care under a DH-led integrated care pilot programme, a report has claimed.

Sixteen practices from across England took part in the initiative, including those in North Cornwall, Wakefield, Newquay and Nottinghamshire.

Ernst & Young and RAND Europe carried out a two-year evaluation of participating practice performance and praised their success for providing patients "with a greater sense of continuity of care".

However, while integrated care services helped drive "process improvements" – such as an increase in the use of care plans and the development of new roles for care staff, it is understood patients did not reap the rewards.

Almost 500 patients were surveyed both before and during the pilots.

Results showed patients felt GPs listened to their concerns less well, were less involved in decisions made about their care and were less likely to see their preferred GP or nurse.

On a more optimistic note, patients said the pilots did improve their knowledge of care plans and clarity of care follow-up arrangements.

"Patients did not, in general, share the sense of improvement," said the report.

"We believe that the lack of improvement in patient experience was in part due to professional rather than user-driven change, partly because it was too early to identify impact within the timescale of the pilots…and partly because some pilots found the complex changes they set for themselves harder to deliver than anticipated."

The report also speculated that some older patients were "attached" to the pre-pilot ways of delivering care, which may have explained the disappointing user experience results.

Worryingly, a "significant" increase in emergency admissions to hospitals in patients from pilot practices was also discovered.

The report described the rise as "unexpected" and was down to the "imperfect matching of cases and controls".

Care Services minister Paul Burstow said he doesn't dismiss the analysis as the evaluation "makes clear" the gains to be had from integration are "hard won"



"Time and time again when I meet patients and their families I am told one of the main problems they face is the variety of doctors, health workers and social workers they meet," he said.

"I hear stories how these professionals don't work as a team and how patients are asked the same questions again and again. 



"That's why integration matters. It means health and social care professionals talking to each other and seeing each other as colleagues rather than adversaries."