Better coordination within the health care sector, and between the NHS and local government, in the commissioning and provision of services, has long been a policy aspiration in England. It is frequently stated that integrated care should lead to more person-centred, better coordinated care, deliver more efficient services that improve outcomes for individuals, and provide better value for money. The national programme of Integrated Care and Support Pioneers aspires to encourage the ‘most ambitious and visionary’ local areas to become integration Pioneers which will drive change ‘at scale and pace, from which the rest of the country can benefit’.
PIRU has been commissioned by the Department of Health and Social Care to carry out an evaluation of the Pioneers for up to 5 years (starting in July 2015). This follows two projects PIRU carried out from autumn 2013 through June 2015.
- The first project was to convene an expert group to provide advice to the Pioneers on a set of candidate indicators of integration performance based on routinely collected data that they can use individually and collectively to monitor their progress.
- The second project was to carry out a largely qualitative early evaluation focusing on progress of the 14 first wave Pioneers in the first 15-18 months in relation to their initial integration objectives.
The overall aim of the longer-term evaluation is to assess the extent to which the Pioneers are successful in providing ‘person-centred coordinated care’, including improved outcomes and quality of care, in a cost-effective way. The evaluation is expected to help build the evidence on what works best in delivering quality integrated care in different contexts. All 14 first wave and 11 second wave Pioneers are included. The evaluation consists of three interdependent work packages (WPs).
WP1 aims to:
- Understand how Pioneers are pursuing their aims, and their experiences of making integration-related service changes. This involves surveys and interviews with a panel of managerial and delivery staff from all 25 Pioneers and other local stakeholders, such as patients/service users. The surveys take place on a regular basis throughout the life of the evaluation.
- Develop a typology of Pioneers and their schemes/initiatives.
- Use the typology of Pioneers and their schemes/initiatives to inform the selection of interventions and schemes for the WP2 cost-effectiveness evaluations.
- Compare differences, at Pioneer level, between Pioneers and matched non-Pioneer areas in England in terms of changes in key indicators of the extent of care co-ordination and its consequences. This will be done this using relevant, routine, national and local data sources.
- Identify similarities and differences between the approaches to system-level (macro) integration adopted by the Pioneers and those in the NHS’s ‘Five Year Forward View’.
WP2 aims to:
- Assess the cost-effectiveness of systemically important integration initiatives undertaken by Pioneers, using a range of designs, such as quasi-experimental, depending on circumstances.
- Understand how the initiatives’ impacts are affected by context, by undertaking qualitative interviews and focus groups with key stakeholders in the Pioneers participating in the cost-effectiveness analyses.
- The first such economic evaluation is looking at community-based integrated health and social care multi-disciplinary teams within three Pioneers.
WP3 aims to:
- Synthesise findings from WP1 and WP2, by assessing the extent to which integration initiatives’ achievements (WP2) can be related to the higher level approach taken by Pioneers (WP1).
- Derive and spread evidence-based insights from WP1 and WP2 to improve integrated care, as well as feeding this information back into the research process to encourage reflexive learning. This includes regular interactive workshops involving the research team, Pioneer and patient/user representatives, and other key experts and stakeholders.
The evaluation team involves a collaboration between PIRU researchers based at LSHTM (Nicholas Mays, Mary Alison Durand, Ties Hoomans, Nick Douglas, Tommaso Manacorda, Sandra Mounier-Jack, Bob Erens), along with Gerald Wistow from LSE, Martin Bardsley and Eilis Keeble from Nuffield Trust, and Judith Smith and Robin Miller from the University of Brimngham.
A short summary of the longer-term evaluation can be accessed here>>
Further detail about the Pioneers can be found on the NHS England website. Read more>>