Demand for health and social care continues to rise in the UK as people are living longer and a greater proportion have multiple health conditions requiring long-term treatment or care (such as diabetes, heart disease or dementia). Integrating health and social care has been considered as a possible response to these demographic changes, with the potential benefits including improved patient experience, and better quality of care through increased coordination and efficiency. It has been argued that effective integration could result in reduced use of hospital beds, lower hospital admissions rates, shorter hospital stays, shorter recovery periods and lower readmission rates. However, evidence on the impact of integration is mixed, with evaluations variously showing positive, negative and no effects. Cost savings have also been cited as a potential benefit, although reviews have noted that the economic evidence is limited and contradictory.

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A number of integration models are being piloted (POSTnote 532), which aim to reduce duplication of services, minimise delays for services, decrease demand for costly hospital care, and improve user experience (including better access to services, improvements in health and well-being and better self-management of conditions). Evaluating how well different models are meeting the aims outlined above is difficult for several reasons, including:

  • Efforts to integrate or coordinate health and social care services have a long history, with successive governments over many decades trying to bridge the divide. As a result, the vast majority of services are undertaking some form of integration and there are no easily available comparisons with services where there has never been any attempt at integration.
  • Integrated care has many different definitions and, although there are emerging overarching models in which integration interventions are being trialled, these models encompass a wide variety of different initiatives that are not clearly defined. This lack of clear definitions makes comparison and creation of an evidence-base difficult.
  • Integration is an ongoing and developing process, which contributes to the difficulty of measurement. Effects from integration interventions also may not occur immediately and can require time to appear in a measurable way.
  • There are no specifically designed measures to look at people’s experiences of integrated care, quality of integrated services and their outcomes, or the efficiency of integrated services and systems. This means that they are difficult to measure reliably, making development of a national evidence base problematic.
  • Methods that are traditionally used to assess effectiveness of the health or social care system are difficult to apply to integrated models. It is possible to assess effectiveness for one simple intervention. However, integrated models combine multiple interrelated interventions, which are much more complicated to assess.

This POSTbrief provides a background on the history of integrating heath and social care in the UK and the current pressures faced by these two sectors. As healthcare and social care are devolved matters, the focus is predominantly on England and Wales. It then presents examples of some of the different models of integration currently being piloted. Next it outlines the measures frequently used to assess integration, before describing the challenges of large-scale evaluation.

Acknowledgements

POSTbriefs are responsive policy briefings from the Parliamentary Office of Science and Technology. This POSTbrief is based on a literature review, interviews with external stakeholders and peer review. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

Professor Jenny Billings, University of Kent *

Professor Katherine Checkland, University of Manchester*

Martin Caunt, Improvement Analytics Unit, NHS England

Dr Mary-Alison Durand, Policy Innovation and Evaluation Research Unit

Samantha Hinks, NHS England

Professor Nick Mays, London School of Hygiene and Tropical Medicine*

Professor Judith Smith, University of Birmingham

Dr Adam Steventon, Health Foundation

Charles Tallack, Health Foundation

Deborah Rozansky, Social Care Institute for Excellence*

Nuffield Trust*

*denotes people and organisations who acted as external reviewers of the briefing

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