“Integration” has been a word often abused and confusingly used by NHS England: but do any of the projects carried out in its name actually deliver on their promises?

A new research paper examining whether or not integration of health and social care services can deliver the promised result of reduced demand on emergency admissions comes up with a guarded positive reply.

This is potentially important, since as the study points out:

“Reducing emergency admission rates has been a feature of English health policy over the last decade and continues to be one of the most commonly used measures of success for system change initiatives. To date, however, there has been little evidence of initiatives successfully reducing emergency admissions.”

But the periods studied were several years ago, and we are not told which areas are being studied. The researchers were examining policies brought in by “pioneer” projects in England: but their study compares performance from a “pre-pioneer baseline period (April 2010 to March 2013) over two follow-up periods: to 2014/2015 and to 2015/2016.”

The findings could be very different after another three years of austerity funding of the NHS and cutbacks in local government and social care budgets.

It is also notable that the ‘baseline’ period from 2010 came at a very early point in the imposition of what has become a virtual freeze on real terms NHS funding, and was also prior to the implementation of the 2012 Health & Social Care Act, which established Clinical Commissioning Groups and NHS England. So two very different periods are being compared.

The overt allocation of existing resources to the pioneer projects was limited: “Each pioneer was given access to limited support and expertise over a 5-year period and a one-off fund of £90 000 to help with initial development.”

However given the focus on such ‘pioneer’ projects it’s likely that these projects were less subject to cutbacks, staffing shortages and funding pressures than services elsewhere.

Even so the result was hardly dramatic. The pioneer areas managed to slightly limit the increase in emergency admissions: “we found a lower increase in emergency admissions for the pioneers than the non-pioneers”.

Any such relief must be welcome, but the study points out a problem in generalising from this experience:

“…it is not possible to identify precisely which elements of the programme, if any, led to any differential change observed (since the pioneers were not working from an agreed template)”

The researchers also warn that:

“1. The effect appears to be temporary: and as such the effect may have been linked to changes that took place in the early stages of the pioneers or pre-pioneer but were not sustained; or the non-pioneer areas introduced changes which have subsequently reduced the difference between them and the pioneers.

“2. The changes in emergency admissions were not shown in all places and even varied between local authority areas within the same pioneer.”

Are we any wiser? Perhaps it underlines the importance of service working closely together: if this can read across to the need to avoid fragmented contracts and privatisation, the lesson could be a useful one. We may have to wait a while for such conclusions.

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