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Although the functions of sleep are not clearly understood, it is generally accepted that it is necessary for the maintenance of good health, and that the need for sleep increases with illness. The findings of a study on the hospital in-patient night show that many patients do not consider that they have sufficient sleep in hospital at night; that discomfort, worries and pain may contribute to their wakefulness; that the sleep of many is disrupted by a variety of sources of disturbances; that ward lights are dimmed for the night for no longer than required by the average, healthy person; and that patients continue to be woken early in the morning. A variety of ways of tackling these problems is proposed. Differences in the perceptions of nurses and patients about certain aspects of in-patient care at night demonstrate the importance of systematically asking patients about their experiences. Once viewed through patients' eyes, the everyday procedures, routines and environments of the hospital become visible and tangible influences on patient care, rather than part of the taken-for-granted context in which patients receive that care.

PurposeIntegrating health and social care is a priority in England, although there is little evidence that previous initiatives have reduced hospital admissions or costs. Twenty-five Integrated Care Pioneers have been established to drive change 'at scale and pace'. The early phases of our evaluation (April 2014-June 2016) aimed to identify their objectives, plans and activities, and to assess the extent to which they have overcome barriers to integration. In the longer-term, we will assess whether integrated care leads to improved outcomes and quality of care and at what cost. Design/methodology/approachMixed methods involving documentary analysis, qualitative interviews and an online key informant survey. FindingsOver time, there was a narrowing of the integration agenda in most Pioneers. The predominant approach was to establish community-based multi-disciplinary teams focused on (older) people with multiple long-term conditions with extensive needs. Moving from design to delivery proved difficult, as many barriers are outside the control of local actors. There was limited evidence of service change. Research limitations/implicationsBecause the findings relate to the early stage of the 5+ years of the Pioneer programme (2014-19), it is not yet possible to detect changes in services or in user experiences and outcomes. Practical implicationsThe persistence of many barriers to integration highlights the need for greater national support to remove them. Originality/valueThe evaluation demonstrates that implementing integrated health and social care is not a short-term process and cannot be achieved without national support in tackling persistent barriers. AcknowledgementsThe authors would like to thank the members of staff in all the Pioneer sites who kindly agreed to be interviewed and to complete the online survey. We would also like to thank members of our PPI (patient and public involvement) Steering Group, who provided many helpful comments on documents and reports that formed part of our early evaluation. This work is an independent evaluation commissioned and funded by the Department of Health's Policy Research Programme. The views expressed are not necessarily those of the Department or its partners.

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