Integrating health and social care services in England during the Covid-19 pandemic: findings from a key informant survey
Authored by Bob Erens, Mary Alison Durand, Nicholas Mays
Lack of integration between health and social care can lead to inefficiencies, poorer patient experiences and outcomes, and less value for money. In England, there have been a number of initiatives over the past 50 years which have attempted to integrate health and social care services, but with little evidence they have had much impact on, for example, levels of emergency admissions or cost savings. Against this background, 14 local ‘Integrated Care and Support Pioneers’ were announced by then Department of Health in November 2013. Each Pioneer was to: encompass whole system integration involving health and social care; drive change at ‘scale and pace’; deliver improved patient-centred care and outcomes; and realise financial efficiencies. An additional 11 Pioneers were announced in early 2015.
PIRU has been evaluating the Pioneers since 2014. The Pioneer programme came to an end in March 2018. Since the end of the programme, we have continued to examine integration activities taking place in the 25 geographical areas that were designated as Pioneers. Our overall aim is to assess the extent to which the Pioneers, and subsequent integration initiatives, have been successful in making progress towards providing ‘person-centred coordinated care’, including improved outcomes and quality of care, in a cost-effective way. The evaluation consists of several elements, one of which is to understand the experiences of those implementing service change in the 25 Pioneer sites. One method for achieving this has been to collect data over time by carrying out annual surveys among ‘key informants’ (mainly senior managers) identified as being involved in the development or implementation of health and social care services integration initiatives at Pioneer level. Our fifth, and final, key informant survey was carried out in autumn 2020, about six months after the first national ‘lockdown’ was imposed in England on 23rd March, due to the Covid-19 pandemic. Since the pandemic had significant impacts on England’s health and care system at all levels, and quickly placed substantial additional pressures on many health and care organisations and both managerial and clinical staff, our survey aimed to collect key informants’ perceptions on the effect of the pandemic on local integration activities.
Not surprisingly, the Covid-19 pandemic had a profound impact on the individuals and organisations involved in the planning, management and delivery of integrated health and social care initiatives. Two-thirds of the survey key informants said their own role had changed due to the pandemic, usually leading to the individual taking on additional pandemic-related roles and responsibilities.
In terms of the integration of health and social care services, the pandemic was said to have had both positive and negative impacts. Some of the positive impacts included:
- reinforcing the importance of providing ‘joined-up’ services, such as hospital discharge and transfer of care
- strengthening both strategic and operational relationships between local health and social care services, such as improved communication and trust between organisations, improved team working across organisations and lowering barriers between services such as increased information sharing
- much faster implementation of initiatives that would have taken far longer to put in place in normal times (e.g. especially the shift to virtual consultations)
- progress in reducing unplanned hospital admissions and helping patients to better manage their own care.
On the other hand, key informants identified some negative impacts arising from the pandemic including:
- generating considerable pressures on health and care managerial and clinical staff and services, which required significant extra staff time and resources to deal with
- a drastically increased workload leading to increased stress and reduced wellbeing among staff
- working from home leading to the breakdown of some working relationships
- the inability to visit patients’ homes during lockdown resulting in less insight into patients’ circumstances and social connections
- hindering progress in improving quality of patient care, and in making services more accessible and cost effective.
The overall impression gained from most key informants was that the positive impacts of the pandemic on health and social care integration at a local level outweighed the negative ones, at least at the relatively early stage of the pandemic. Moreover, many thought that the ongoing pandemic would continue to help strengthen local collaborations, partnership working, etc. over the next 12 months. However, the disparity in funding between health and social care, as well as between different sectors of the NHS, was identified as a potential challenge to working relationships. Several key informants thought some of the improvements (e.g. in working relationships) might dissipate over time, as pent-up demand and the impacts of the pandemic on patients and staff continued to take their toll. In the extreme, a few key informants thought the pandemic could even deter future collaborations and lead to a withdrawal into organizational silos.
Results from our survey appear to suggest that an extreme jolt to the system, such as that triggered by the Covid-19 pandemic, can lead to a number of developments that promote the integration of local health and social care services. Different services and organisations had to pull together to deal with the considerable challenges created by the pandemic and to find their own ways to overcome some of the regulatory, financial and other barriers to joint working. Whether local NHS and social care services are able to maintain these integration-related gains over time remains to be seen. Support from national policy-makers – e.g. for the continued development of local integrated care systems and primary care networks, and providing equitable and sufficient financial resources for both the NHS and local authority social services – will be important to enable the continued development of sustainable integrated services.
The full report of the key informant survey results can be accessed here >>
Results from the fifth survey (autumn 2020) of Pioneer Key Informants: perceived effects of the Covid-19 pandemic on integration activities. (July 2021) Bob Erens, Mary Alison Durand, Gerald Wistow, Agata Pacho, Mustafa Al-Haboubi, Lavanya Thana, Nicholas Mays.