News / Study: integrated care savings not inevitable

By Seamus Ward

Integrated care may reduce care costs but not in the short term, according to the findings of a two-year study.
 
The study, carried out for the Department of Health by Cambridge University, Rand Europe and Ernst & Young, added that it was 'not inevitable' cost savings would follow integration.

It looked at the 16 sites in the integrated care pilot, which has tested a range of integration models, and found that while staff backed the initiative and processes improved, patients generally did not believe services had improved.

Across all sites, there were big increases in emergency admissions costs, but these were balanced by significant reductions in costs for elective admissions and outpatient attendances, leading to a non-significant reduction in overall secondary care costs (£37 per patient/service user).

Notional secondary care costs were calculated using the 2008/09 tariff. Activity that was not covered by tariff was calculated using national reference cost data.

Sites that used case management – where a clinician saw at-risk elderly patients regularly and co-ordinated their care – showed more promising results. While changes in admissions and outpatient attendances were similar to other sites, case management led to a significant reduction in overall secondary care costs (£223 per patient/service user over the six-month period following an intervention).

The researchers said the costs were calculated from a purchaser perspective and though they had not calculated costs from a provider perspective, it was possible there were reduced costs for acute trusts in providing care for patients from the pilots.

None of the pilots had savings as a primary aim and the Department said they had demonstrated that well led and well managed integration could improve the quality of care for patients.

Care services minister Paul Burstow said the independent evaluation was a valuable and welcome addition to the evidence base for integration. Many of its findings resonated with the recently published NHS Future Forum's report on integration.

'This report is an important wake-up call, showing that actioning more integration is challenging even when organisations volunteer to collaborate,' said Mr Burstow.

'Our health reforms put in place the legal framework to support greater integration but to succeed it will require leadership at every level,' he added.