The parallel universes of integrated care: the process of change is as important as the content Norman Lamb’s announcement of a second wave of 10 integrated care pioneers at our recent integrated care summit signaled the continuing commitment of ministers to joining up care around the needs of patients and populations.
The achievements of the first wave of pioneers were showcased at the summit in a presentation from colleagues in Greenwich demonstrating how they have reduced emergency hospital admissions by targeting high risk groups in the population. In Greenwich and elsewhere priority is being given to intervening early to support these groups through closer integration of health and social care. The emphasis now placed in the Better Care Fund on cutting emergency admissions seems likely to reinforce these initiatives.
The national director of the Better Care Fund, Andrew Ridley, gave an upbeat report on progress at the summit. He explained that revised local plans for the use of the Better Care Fund were now being reviewed and that feedback will be provided to all areas shortly. The further work done on the plans over the summer had introduced much more rigour, giving greater confidence that they will deliver the 3.5 per cent reduction in emergency admissions being sought across England, although this will still be challenging. The National Audit Office will publish its assessment of the Better Care Fund soon.
European speakers at the summit provided a helpful reminder of the time and investment needed to demonstrate the impact of integrated care. Helmut Hildebrandt from Gesundes Kinzigtal explained that his work in Germany showed the need to build the foundations of integrated care carefully before expecting to see the results. This meant committing to a programme of work over 5–10 years and resisting the temptation to terminate worthwhile innovations before they had had time to improve outcomes. The architects of the pioneer programme and the Better Care Fund should take note.
The palpable enthusiasm of health and social care leaders at the summit contrasted strongly with presentations by researchers who were much more cautious about the strength of the evidence to support integrated care. A rapid review of systematic reviews and meta-analyses found that evidence of economic impact was either mixed or uncertain, while also noting weaknesses in the design of many evaluations.
The question this raised for many participants was how to bridge the gap between the parallel universes of researchers and practitioners?
The Fund’s position is that evidence and experience from around the world already provides grounds to believe that integrated care brings benefits (see the Clinical and service integration report). These benefits often arise when factors not usually studied in formal evaluations by health services researchers are in place. These factors include effective leadership and skills in implementing complex service interventions.
Reviews that show ‘mixed evidence’ may simply be reflecting variations between areas in paying attention to these factors rather than casting doubts on the benefits of integrated care. The organisations that succeed and prosper will be those that ensure the right leadership is in place to realise the benefits of the investments made through the pioneer programme and the Better Care Fund with the support of senior staff dedicated to making it happen.
Evidence from the NHS and other systems means we now know a great deal about the ingredients of effective care, including risk stratification, case management, care co-ordination, multidisciplinary teams and well-organised primary care. There is also growing evidence abouthow to use these ingredients to improve outcomes for patients and populations. Bridging the gap between the parallel universes of researchers and practitioners requires both groups to pay attention to the process of change as well as to the content of change. The King's Fund
The achievements of the first wave of pioneers were showcased at the summit in a presentation from colleagues in Greenwich demonstrating how they have reduced emergency hospital admissions by targeting high risk groups in the population. In Greenwich and elsewhere priority is being given to intervening early to support these groups through closer integration of health and social care. The emphasis now placed in the Better Care Fund on cutting emergency admissions seems likely to reinforce these initiatives.
The national director of the Better Care Fund, Andrew Ridley, gave an upbeat report on progress at the summit. He explained that revised local plans for the use of the Better Care Fund were now being reviewed and that feedback will be provided to all areas shortly. The further work done on the plans over the summer had introduced much more rigour, giving greater confidence that they will deliver the 3.5 per cent reduction in emergency admissions being sought across England, although this will still be challenging. The National Audit Office will publish its assessment of the Better Care Fund soon.
European speakers at the summit provided a helpful reminder of the time and investment needed to demonstrate the impact of integrated care. Helmut Hildebrandt from Gesundes Kinzigtal explained that his work in Germany showed the need to build the foundations of integrated care carefully before expecting to see the results. This meant committing to a programme of work over 5–10 years and resisting the temptation to terminate worthwhile innovations before they had had time to improve outcomes. The architects of the pioneer programme and the Better Care Fund should take note.
The palpable enthusiasm of health and social care leaders at the summit contrasted strongly with presentations by researchers who were much more cautious about the strength of the evidence to support integrated care. A rapid review of systematic reviews and meta-analyses found that evidence of economic impact was either mixed or uncertain, while also noting weaknesses in the design of many evaluations.
The question this raised for many participants was how to bridge the gap between the parallel universes of researchers and practitioners?
The Fund’s position is that evidence and experience from around the world already provides grounds to believe that integrated care brings benefits (see the Clinical and service integration report). These benefits often arise when factors not usually studied in formal evaluations by health services researchers are in place. These factors include effective leadership and skills in implementing complex service interventions.
Reviews that show ‘mixed evidence’ may simply be reflecting variations between areas in paying attention to these factors rather than casting doubts on the benefits of integrated care. The organisations that succeed and prosper will be those that ensure the right leadership is in place to realise the benefits of the investments made through the pioneer programme and the Better Care Fund with the support of senior staff dedicated to making it happen.
Evidence from the NHS and other systems means we now know a great deal about the ingredients of effective care, including risk stratification, case management, care co-ordination, multidisciplinary teams and well-organised primary care. There is also growing evidence abouthow to use these ingredients to improve outcomes for patients and populations. Bridging the gap between the parallel universes of researchers and practitioners requires both groups to pay attention to the process of change as well as to the content of change. The King's Fund
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