The long-term impacts of New Care Models on hospital use: An evaluation of the Integrated Care Transformation Programme in Mid Nottinghamshire

Abstract

This report presents the findings of an evaluation of the long-term impacts of the Mid-Nottinghamshire Better Together Integrated Care Transformation Programme (ICTP) over a 6-year period from its launch in April 2013 until March 2019. The programme was established by Mansfield and Ashfield clinical commissioning group (CCG) and Newark and Sherwood CCG, together with local partners. In March 2015, the Mid-Nottinghamshire Better Together programme achieved vanguard status as an integrated primary and acute care systems provider, one of the first of the new care models announced in the Five year forward view. 1The long-term impacts of new care models on hospital use 2 * www.nhs.uk/Services/Trusts/GPs/DefaultView.aspx?id=89801 and www.nhs.uk/services/trusts/gps/defaultview. aspx?id=89804 † ONS March 2018 Mid-year estimate.The long-term impacts of new care models on hospital use 4In April 2013, the Mid-Nottinghamshire Better Together ICTP was launched in partnership with M&A CCG, N&S CCG, Nottinghamshire County Council, Sherwood Forest Hospitals NHS Trust and other partners to develop a joined-up way of working for better health and social care outcomes for the population of Mid-Nottinghamshire.In March 2015, the Mid-Nottinghamshire Better Together programme achieved vanguard status as an integrated primary and acute care systems (PACS) provider, one of the first of the new care models vanguards announced in the Five year forward view. 1 The aim of PACS was 'to join up services to allow better decision-making and more sustainable use of resources, with a greater focus on prevention and integrated community based care, and less reliance on hospital care'. 9 The vanguard funding was used to support the ongoing ICTP in delivering new models of health and social care to transform the delivery of health and social care and drive system-wide financial benefits. An alliance contract * was agreed from April 2016 entering the partners into a contractual joint venture for a 3-year period until March 2019. The Mid-Nottinghamshire Alliance now operates as an Integrated Care Partnership as part of the Nottingham and Nottinghamshire Integrated Care System (ICS). Successful elements of the ICTP are now a key part of the changes being rolled out more widely to support the overarching ICS priorities.The ICTP was launched in April 2013 and comprised four main work programmes. 10 The Proactive and Urgent Care programme comprised interventions focused on long-term conditions, emergencies and urgent health problems. The Elective Care programme comprised a collection of approaches designed to improve elective referrals and processes. * An Alliance contract is a contractual arrangement between commissioners and an alliance of partners who deliver the services. See www.kingsfund.org.uk/sites/default/files/media/linda-hutchinson-alliancecontracting-27.03.14_0.pdf for more details. * Hereafter we refer to M&A and N&S CCGs as the Mid-Nottinghamshire CCGs; the GP practices in the Mid-Nottinghamshire CCGs as the treated group; the region covere...

Integrated Care in England – what can we Learn from a Decade of National Pilot Programmes?

“…Table 2 Comparison of significant pilot experiences and outcomes (extracted from publications of the national evaluation teams and selected studies) [1][2][3][4][5][6][7][8][9][10][11][12].…”

“…It is also notable that a longer-term evaluation of one Vanguard site found that a lower rate of increase in a range of measures of unplanned hospital care towards the end of a six-year period of pilot operation. The evaluators hypothesised that they may have captured the impact of sustained improvements to community care on hospital usage which may be missed in shorter periods of analysis [12].…”

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Investigating the nature and quality of locally commissioned evaluations of the NHS Vanguard programme: an evidence synthesis

“…Future evaluations of large-scale service change should continue to consider such a multifaceted approach but perhaps with less prescription of what should be explored in depth at the local level. In the evaluation of the New Models of Care Vanguard programme, the ability to deliver robust counterfactual analysis has been limited to the national-level evaluation teams [ 24 – 26 ]. Given the apparent challenges faced by local evaluation teams in trying to deliver counterfactuals (under resource constraints and limited time horizons), there is an argument that local analysis should focus on providing causal explanations for impact in a given context.…”

The future of the NHS hospital payment system in England

“…It may take time for changes to the system to translate into improvements for patients. For instance, a recent study into an integrated care transformation programme 32 shows that despite an initial increase of hospital activity, it took 6 years for the integrated care initiative to deliver a reduction of both A&E attendances and emergency admissions.…”