Patients wait longer for care under integrated care systems, analysis finds

An analysis of integrated care systems has revealed patients waited longer than the national average for treatment under flagship plans to join up health and care.

The Centre for Policy Studies (CPS) looked at the performance of 13 pilot integration areas in England finding that delayed transfers of care increased by an average of 24% between 2016 and 2020.

The figure for the rest of England in the same time period was just 9%.

The think tank has warned the evidence base for Integrated care Systems (ICS) was “alarmingly thin” and called upon the government to scrap plans for them to become law until the is a more “robust” evidence base.

The upcoming Health and Care Bill will see Integrated Care Systems (ICS) enshrined in law, splitting the NHS into 42 ICSs in a bid to drive collaboration and more joined up care.

Karl Williams, report author and senior researcher at the CPS, said: “The Government’s determination to tackle the long-term problems facing health and care provision is welcome, but it is important to take the time to get things right.

“Everyone seems to be in such fervent agreement that the ICS model of integration and collaboration is the future of the NHS that hardly anyone appears to have looked properly at whether this approach works in practice.

“Ministers need to take a step back and let the pilot schemes run their course so we can properly evaluate their success. Now is not the time to push through costly and disruptive reforms that are not supported by the data, especially given the current pressures on the NHS and its staff.”

Facts and figures

In Manchester, the first region in England to integrate its care systems, there was a 65% rise in delayed transfers of care under flagship integrated care schemes in Manchester, resulting in “generally weaker of unchanged performance”.

Data collected and analysed before the Covid-19 pandemic as part of the ‘Is Manchester Greater?’ report also revealed a decline in productivity, with a 9% increase in the size of the region’s NHS workforce relative to its population, and a 23% increase in the number of senior managers.

Further afield West Yorkshire and Harrogate Health and Care Partnership – a more typical of what the ICS model would look like in practice – saw a 14.4% increase in emergency readmissions to hospital by 2019-20, higher than the national average.

The think tank found “no evidence” of significant performance improvements yet there had been a 20% increase in managerial staff since 2016.

Gloucestershire and Frimley experienced a spike in delayed transfers of care by 111% and 95% respectively from 2016 to 2020.

But there were integrated care schemes performing well, the report found. Buckinghamshire, Oxfordshire and Berkshire West had a 2% drop in delayed transfers of care, while Nottingham and Nottinghamshire had a 7% drop.

Surrey Heartlands; Dorset; Bedfordshire, Luton and Milton Keynes all experienced small increased in delayed transfers of care, lower than the national average of 9% in England.

Yet for those areas that experienced a drop, or minimal increase, in delayed transfers of care there was also an above average increase for A&E attendances.

Nottingham and Nottinghamshire had an 18% increase in emergency attendance while Dorset topped the list with a 23% increase.

Greater Manchester had a 6% increase in A&E attendances, below the England average of 13%, and experienced a 0.4% increase in emergency readmissions, also below the England average of 1.1%.

The CPS said there should be fewer A&E admissions under integrated systems due to a greater focus on “preventative healthcare” but added there was a “pattern of mixed progress and continuing regional variation”.

A Greater Manchester Health and Social Care Partnership spokesperson said: “We recognise that our performance on some of the constitutional standards remains below national averages, however they are not the only metric of success, or evidence that our journey to an integrated care system has been without merit.

“Our focus has always been on improving the health and wellbeing of the Greater Manchester population as quickly as possible and our efforts here influenced the NHS Long Term Plan and design of integrated care systems nationally.”

Louise Patten of the NHS Confederation, which represents Integrated Care Systems, said the CPS report attempts to measure success or failure against hospital wait times but ignores wider ambitions for ICSs to move away from traditional hospital-based care.

“The NHS Bill going through Parliament is merely catching up with collaboration of local services that have been taking place for several years. NHS leaders want this and believe the changes will improve care for patients and deliver more value for money for taxpayers,” she said.

“Any delays to the Bill will set back months of progress and, ultimately, harm patients.”

‘Accountability dashboard’

The CPS made a number of recommendations to create a stronger evidence base for ICSs before they are passed into law.

It called on NHSX to set up an “ICS Accountability Dashboard” covering the original 13 pilot sites for ICSs.

“This could begin through drawing on existing NHS Digital datasets and would be a natural outgrowth of the ‘NHS System Oversight Framework’ now under development. It would allow for easy but detailed and meaningful comparisons between ICSs on a broad range of outcomes,” the report states.

It also called for ICSs to explore further development of standardised referral and care pathways to “streamline” patient flow between settings, and for aggregate data to be used to drive competition between ICSs to incentivise innovation and best practice.

“It would help to tip system designers towards focusing on patients and population health outcomes, rather than becoming overly preoccupied either with managing public perceptions or with structures and processes for their own sake,” the report adds.

An NHS spokesperson said: “This report fails to recognise that only half of these systems have been in place for a year, and largely ignores the very obvious benefits of integration to patients and the public that we have demonstrated in the past year, including the world-leading precision and pace of the NHS Covid vaccination programme..

“What’s more, this report actually acknowledges that most of the early adopter sites have already ensured more people got the care they needed in the right setting, avoiding unnecessary trips to A&E and there were fewer delays when ensuring fit and healthy people could be discharged from hospital.”