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DH scheme to integrate care ‘reduces patient satisfaction’

Department of Health pilots to create ‘seamless' care have had a broadly negative effect on patient satisfaction and have not delivered any tangible cost savings, says an official analysis.

Integrated care pilots in 16 areas were launched in 2009 and aimed to ‘transform the way people experience health and social care'; however, a DH-commissioned analysis concluded they had ‘lost sight' of the views of patients.

The report from Ernst and Young and Rand Europe looks at the results of the integrated care pilots two years on, and compared the results with before the pilots.

They found that more than half of doctors and other healthcare staff believed the scheme had improved patient care, but patients did not ‘share the sense of improvement'.

The evaluation showed more patients knew they had a care plan, but the proportion of patients who felt in control of their daily life fell from 49% to 43% and those who rated their GPs as ‘very good' at involving them in decision about their care fell from 60% to 54%, compared with before the pilots.

Costs of running the pilots varied hugely, with labour start-up costs ranging from £2,000 to £145,000, and non-labour start-up costs ranging from nothing to £1.2m.

They found no evidence of a reduction in emergency admissions, but there were reductions in planned admissions and in outpatient attendance, and there was ‘no significant impact' overall on secondary care costs.

Richard Lewis, a partner at Ernst and Young, and co-author of the report, said he was optimistic for the future of integrated care despite the report's findings.

 ‘There were falls in patient satisfaction measures, but they were from a pretty high level, and it does take time for changes to go through the system,' he said.

‘Possibly in the professionalisation of care, staff lost sight of the views of the patients.'

Dr Sam Everington, a GP in east London and chair of NHS Tower Hamlets CCG, questioned the report's assessment.

‘Integrated care makes sense, but you have to look at it over a significant period time, and it is almost impossible to measure, particularly with all the various changes that have been going on in the health service,' he said.

‘I hope CCGs won't use this as evidence that integrated care doesn't work.'


BOX: Effects of integrating care

50% - proportion of NHS staff who saw improvements in care

54% - patients who felt they were being involved in decisions over their care

2% - increase in emergency admissions

4% - reduction in elective admissions

20% - reduction in outpatient attendances

Source: National Evaluation of the Department of Health's Integrated Care Pilots, March 2012