Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

Abstract

Background Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. [We] evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Methods Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes. Results CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI: 7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes. Conclusions Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.

Integrated Care in England – what can we Learn from a Decade of National Pilot Programmes?

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Governing Integrated Health and Social Care: An Analysis of Experiences in Three European Countries

“…This was deemed especially important given that new ways of working were not always reported to result in immediately tangible benefits to participants. Evaluations of integrated care approaches in different settings have demonstrated that evidence of impact at population level is likely to be seen only after several years following implementation [30,31]. Supporting local innovation requires enduring commitment and long-lasting mandates to provide greater certainty over longer time-scales.…”

The effects of multi‐disciplinary integrated care on healthcare utilization: Evidence from a natural experiment in the UK

“…Recent policies have hoped that improving the integration of health and social care should reduce demand for emergency care services and unnecessary hospitalizations. During the last decade, the Integrated Care and Support Pioneer programmes and the Vanguards sites (Morciano et al., 2021) are two large national integration care initiatives in the NHS in England. In 2013, the Integrated Care and Support Pioneer program promoted horizontal integration between the local health and social care systems by encouraging the implementation of new ways of working together.…”