Together we stand

In the current financial climate, the NHS is finding itself under increased pressure to reduce costs and at the same time improve patient outcomes. Many professionals now see integration, which enables the joining up and more efficient use of resources to better meet people’s needs, as the obvious solution, saysRichard Kramer

Turning Point’s experience of working with people with complex needs shows that services must become more joined up in order to effectively meet the needs of the most vulnerable people in society. People with complex needs will present a greater burden and cost to society if their needs aren’t met effectively and they fall through the gaps between fragmented services.

Turning Point ‘s report, Meeting Complex Needs, published with ippr in 2004 called for a much more connected approach to service delivery and for the voice of the community to be central to the design and delivery of services.

Turning Point’s response, Connected Care supports commissioners by improving patient experience through our programme of community engagement; delivering better health and social outcomes through a change management programme to guide commissioners on service redesign; and reducing costs to the population by looking at models of integration and early intervention across health, housing and social care. We are currently working in ten areas across the country.

Through this work, it has been identified that there is a real need for commissioners to have a good understanding of the business case for the integration. In particular, if we are to begin working across boundaries and taking a more integrated approach, there needs to be a strong economic rationale for change.

For this reason, Turning Point’s Connected Care team have undertaken a systematic review of the research evidence from the UK and abroad on the business case for greater integration between health and social care. In total, over 80 studies were included in the review and these were selected on the strength of their evidence and/or methodological technique.

Early intervention

Evidence from the UK suggests that the greatest financial benefit lies in developing integrated early intervention initiatives. The central theme to emerge from the review is the importance of early intervention. Those services that are designed to enable people to retain their independence and quality of life can deliver cost savings through the prevention of hospital admissions and residential placements. This leads to savings for both the NHS and social care services. Studies have illustrated that integrated early intervention programmes can generate resource savings of between £1.20 and £2.65 for every £1 spent.

Early intervention through housing related support is highly cost effective. Programmes that focus upon supporting people to live independently in the community and in their own homes can reduce health and social care costs for local authorities and primary care trusts in the UK. Housing related support that includes giving advice on benefits, how to pay bills and home improvements can prevent future health and social care needs. For example, the Supporting People programme provided net financial benefits of £3.41 billion per annum.

Structural integration

Whilst the business case for greater integration is strongest for preventative, low-level support health and social care services, it is also clear that structural integration, on a range of scales, can realise financial benefits.

Case management is highly effective at reducing hospital admissions and delaying residential care placements among older people and people with long term conditions. For example, one study in Italy concluded that case management for older people led to savings of £1125 per person per year.

In addition to this, integrated care teams that include co-located social workers, care staff and health professionals can reduce GP risks and in turn, costs. Integrated care teams can also be helpful in supporting people with complex needs. For example, the Denver Housing First Collaborative, in addition to illustrating the benefits of housing related support, resulted in savings to the criminal justice system of $4,475 per person.

Integrated processes

As well as examining evidence for early intervention and structural integration, Turning Point also looked closely at integrated processes. However, there is very little evidence for the financial benefits of administrative restructuring. This is due to the fact that there have been no economic evaluations that have measured the costs of such processes.

Conclusion

Integration enables thejoining up and more efficient use of resources to better meet people’s needs. Our research indicates that integration in health and social care can take a variety of forms. It might include practical support, schemes, shared buildings, integrated teams, case management that coordinates the support provided by a range of agencies, joint commissioning structures or single assessment processes.

Turning Point’s review demonstrates that meeting people’s needs with a preventative and integrated approach to health and social care can create efficiencies and savings. The report also shows that whilst structural integration can bring a number of benefits, the evidence shows that structural integration does not necessarily lead to service integration and it is possible to achieve service integration in the absence of structural integration through effective local leadership and a commitment to involve the patient or service user in its design. Moreover, whilst you can integrate all services it is essential to target intervention where it is most needed in order to bring about cost efficiencies.

The biggest challenge, however, is capturing the long-term financial benefits of integration. Most evaluations have focussed on changes up to two years after the introduction of the scheme. However, many of the benefits of integration will accrue as individuals remain independent well into the future. Turning Point would argue that if we are to achieve greater integration of health and social care, more comprehensive and large-scale evaluations, which consider the long-term financial benefits, are required.

Richard Kramer is director of Turning Point’s Connected Care programme which integrates health, housing and social care service delivery where communities are central to the design and delivery of those services