Policies to integrate health and social care services made little difference to patient care

There is little evidence to suggest that policies to integrate health and social care services across the UK have made a difference to patients and services users, according to a new report by the Nuffield Trust.

The report finds that certain policies, such as pooling budgets and creating new integrated boards and committees, has had little impact on patient experience, quality of services or supported the delivery of more care outside of hospitals.

The report comes as the latest reforms continue on their journey through parliament, with the authors warning that without concurrent investment in social care and broader public service, these reforms will be unlikely to yield the results ministers hope for.

The changes have not led to any meaningful improvement in satisfaction with care and support

The report, Integrating health and social care: A comparison of policy and progress across the four countries of the UK, also found that while each country in the UK has different approaches to how they organise health and social care, each nation has attempted to drive integrated care delivery by changing the way services are planned, financed and commissioned in hopes that more coordinated service delivery will naturally follow.

However, the changes in policies in England, Wales and Scotland have not led to any meaningful improvement in satisfaction with care and support, improvements in delayed transfers of care have not been sustained and the age-adjusted rate of emergency admissions to hospitals has not fallen.

The policies also failed to overcome longstanding barriers to support more joined up working, or provide for the resources, infrastructure and necessary staff to meaningfully integrate services and move more care out of hospitals.

Furthermore, while short-term funding has enabled some change, the constraints on funding from the government in broader health and social care services has been a limiting factor. The report also notes that while financial savings should not be the primary goal of integration policies, there is limited evidence that pooling budgets across health and social care has created savings.

More attention must be paid to “services themselves and the experiences of those who use them”

The authors are now urging policymakers to shift focus away from organisational and structural reform and instead focus on the behaviours, incentives, skills and resources needed to integrate services at the front line.

They say that varying levels of financial resources in health and social care in each of the four countries has slowed efforts to reform, and there has been falling investment in housing, education and wider public services which all play in part in people’s health and wellbeing.

Nuffield Trust Senior Fellow Sarah Reed, the co-author of the report, said that if more than 20 years of reforms has translated into only modest improvements, we must question what integrated care can realistically achieve.

She explains: “Part of the explanation may be that policymakers have continuously fallen back on the same financial and structural levers to encourage integration, including short-term funding pilots, setting up joint boards and committees, and pooling budgets. Often these initiatives have failed to learn from or build on the efforts that came before it, or address the broader culture, incentives, and infrastructure needed to make integration work.”

Reed concludes that if we are to create meaningful change for services users, then “more attention must be paid to services themselves and the experiences of those who use them.”

Louise Patten, Director of the NHS Confederation’s ICS Network, said the ICS welcomes the key lessons highlighted in the report and says their members are “committed to prioritising improving the patient experience, tacking health inequalities and using a population health management approach to work with partners to address the wider determinants of health for the first time in a truly integrated way.”

“We need to give systems the chance to grow and thrive, shape services for the future, and support them with the right metrics to measure success,” she added.