The wrong sort of integration?

Integrated care doesn’t seem to be very good at reducing emergency admissions. The Evercare evaluation published in 2007 showed no significant reduction in admissions and our more recent evaluation of the English Integrated Care Pilots showed a significant increase in admissions among pilots focusing on intensive care management of frail elderly .

Now the Nuffield Trust has published its preliminary findings on the impact of North West London integrated care pilots on hospital admissions. Although the authors are appropriately cautious about their conclusions, the fall in emergency admissions for patients in the pilot areas appears to have been less than for patients in control areas. Among other things, the report points out that this is very early days in the evaluation, and that international experience suggests that integrated care interventions may take 3-5 years to come to maturity.

But international experience also suggests we may be barking up the wrong integration tree. The Kings Fund has suggested in several reports that the sort of integration that seems to work well in other countries is that which involves vertical integration between primary and secondary care (e.g. Kaiser Permanente, Group Health). This is just what we can’t do in the English NHS. Or can we? Maybe the CCGs which will be really successful will be those that manage to find ways round the purchaser-provider split to have really meaningful discussions with their local consultants about planning services.



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