Social care professionals were ‘marginal’ to flagship government pilots designed to integrate support for people with long-term conditions, an evaluation has concluded.
Most of the 16 integrated care pilots concentrated on joining up different parts of the NHS with no change in the role of social care in providing support, found a two-year study commissioned by the Department of Health.
This is despite the pilots being targeted at improving care for people with social care needs, including those with dementia, other mental health problems, end-of-life care needs, substance misuse and other long-term conditions.
No change in social care role
“Most of the pilots focused on the integration between primary and secondary care, with social care often playing a marginal role in the wider integrated care agenda,” said the evaluation, conducted by Ernst & Young, Cambridge University and research institute RAND Europe. “In fact, the role of social care in integration had been regarded as unchanged for most sites.”
One social care manager interviewed for the study said: “They started a model of integrated teams, which only means in surgeries [there are] health professionals, physios, nurses, operating in a more integrated way. Where’s the social care in that? So what is integration?”
The study has been published amid increasing focus on the need for health and social care professionals to work more closely together to both improve outcomes and reduce the costs of care for people whose needs cut across both sectors.
The study found a mixed picture of success in the pilots. Though one of the key goals of the pilots was reducing emergency hospital admissions, these rose by 2% for pilot patients.
On the plus side, elective admissions and outpatient attendances in hospitals fell by 4% and 20% respectively over the course of the pilots.
In general staff were positive, with 54% of those interviewed saying patient care had improved as a result of the pilot, 60% saying they worked more closely with other team members and 64% reporting that their job had become more interesting.
However, there was a five percentage point drop in the proportion of patients and service users who felt involved in their care over the course of the pilots, and a 15 percentage point fall in the numbers who felt their preferences were taken into account.
Loss of focus
“It may be that staff within the pilots have concentrated on improving their professional care but, in the process, lost focus on the individual patients at the centre of that care,” said Ernst & Young partner and research co-leader Dr Richard Lewis.”
More positively, the proportion of patients who knew who to contact after leaving hospital rose from 71% to 80% of those surveyed over the course of the pilots.
Lewis said there were grounds for optimism in the research that integrated care will “deliver at least some of the hoped for benefits”, but warned: “Change takes time and, it may still be too early to provide a complete picture of the outcomes of integrated care.”