Nuffield Trust, Health Foundation 17 January 2019
- QualityWatch is assessing what impact the policy to join up services across GPs, hospitals, community services, social care and patients themselves has had on the quality of care in recent years, and whether patients and the public are likely to notice any difference.
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Extract:
What do our indicators tell us about the state of integrated care?"Since 2012, patients report feeling less supported to manage their own care, find it more difficult to see their preferred GP when they want to, and there has been no improvement in how involved people feel in their GP care. Patients with developmental disabilities, learning disabilities or a mental health condition feel the least supported to manage their condition. The proportion of people who are able to see or speak to their preferred GP varies between patient groups, and involvement in decisions about care is lower for community mental health service users and adult inpatients than for maternity and children and young people’s service users. There has also been a marked decline in carer quality of life, and in how well supported informal carers feel.
We also looked at how well the NHS is preventing people from being admitted to hospital unnecessarily. Rates of admissions in ambulatory care sensitive conditions (where effective care from GPs, community services and outpatient clinics can prevent the need for hospital admission) and urgent care sensitive conditions (where a care system should aim to treat and manage acute exacerbations of ongoing conditions as close to home as possible) have remained stable over time. This is arguably a good result, given that the total number of emergency admissions has risen dramatically.
Furthermore, we looked at what happens when people leave hospital. Between 2014 and 2016, the number of people who were still in hospital even though they were ready for discharge increased substantially. Better discharge planning for patients has now reversed that trend, although the number of people delayed is still higher than in 2014. Many of these delays are due to people waiting for home care packages as well as further non-acute NHS care, indicating that NHS services need to be joined-up better, just as effectively as health and social care.
Finally, the proportion of people who are able to die at home has increased over time, reflecting a long-standing policy to provide better support for people outside of hospital at the end of life.
Alongside the indicators we have selected, additional measures in QualityWatch are also relevant, such as patient experience of out of hours GP services, the quality of care for community mental health service users, and rehabilitation services for older people. These measures all show stable or fluctuating trends over the time period."
We also looked at how well the NHS is preventing people from being admitted to hospital unnecessarily. Rates of admissions in ambulatory care sensitive conditions (where effective care from GPs, community services and outpatient clinics can prevent the need for hospital admission) and urgent care sensitive conditions (where a care system should aim to treat and manage acute exacerbations of ongoing conditions as close to home as possible) have remained stable over time. This is arguably a good result, given that the total number of emergency admissions has risen dramatically.
Furthermore, we looked at what happens when people leave hospital. Between 2014 and 2016, the number of people who were still in hospital even though they were ready for discharge increased substantially. Better discharge planning for patients has now reversed that trend, although the number of people delayed is still higher than in 2014. Many of these delays are due to people waiting for home care packages as well as further non-acute NHS care, indicating that NHS services need to be joined-up better, just as effectively as health and social care.
Finally, the proportion of people who are able to die at home has increased over time, reflecting a long-standing policy to provide better support for people outside of hospital at the end of life.
Alongside the indicators we have selected, additional measures in QualityWatch are also relevant, such as patient experience of out of hours GP services, the quality of care for community mental health service users, and rehabilitation services for older people. These measures all show stable or fluctuating trends over the time period."
