Title: Evaluation of the Integrated Care and Support Pioneers Programme in the Context of New Funding Arrangements for Integrated Care in England
Funder: Department of Health and Social Care

Abstract: Background In November 2013, 14 Integrated Care and Support Pioneers were launched to drive change at scale and pace from which the rest of the country could benefit. Ten more will start in 2015. Also in 2013, the Government announced the Better Care Fund (BCF), a pooled budget system designed to provide strong incentives for joint working between NHS, social care and other services to make better use of scarce resources while improving outcomes. Pioneers are to provide examples of best practice in relation to both initiatives. This 5-year evaluation aims to assess the extent to which Pioneers in the context of the BCF are successful in improving patient/user experience and outcomes in a cost effective way. In particular, it recognises that the cost-effectiveness of particular initiatives may depend on the whole systems within which they are located as well as the characteristics of individual initiatives, themselves. Aims The evaluation consists of three interdependent work packages (WPs). WP1 aims to: understand the service changes implemented and the experiences of those working in and with Pioneers, in particular, to identify facilitators and barriers to integrating services and how barriers are overcome; examine changes in key indicators of the extent of care coordination and its consequences at Pioneer level compared with non-Pioneers; ascertain whether Pioneer approaches to integration that are most similar to those in the NHS Five year forward view appear to perform better or worse than others. WP2 aims to: undertake cost-effectiveness (C-E) evaluations of specific integrated care initiatives identified in WP1; understand how and why these initiatives impacts are affected by different contexts. WP3 aims to: synthesise the findings from WPs 1 and 2 by assessing the extent to which the performance of integration initiatives (WP2) can be related to the approach taken at a higher level by the host Pioneer l (WP1) and the contribution of initiatives to the overall performance of the Pioneer; derive and spread practical insights from WPs 1 and 2 that will lead to better integrated care. Research plan and methods WP1 consists of: identifying aggregate indicators of integrated care and its consequences using administrative datasets (including in relation to the BCF) and comparing Pioneers with matched areas; a panel of staff and stakeholders from all 24 Pioneers, surveyed through a mix of interviews and web surveys, depending on topic. WP2 consists of: selecting specific service developments within Pioneers for detailed C-E evaluation, using a range of designs depending on circumstances; an integral qualitative component in each of the C-E analyses to understand the facilitators and barriers encountered compared with the experience of similar initiatives provided by other Pioneers in different contexts. WP3 consists of: workshops (following each WP1 survey) aimed at a mix of Pioneer stakeholders (including the WP1 panellists), policy-makers, international and domestic experts, and patients/users; blogs, podcasts, articles in the professional press and peer-reviewed journals, reports for individual Pioneers, etc. Research team The team already successfully collaborates in the Policy Innovation Research Unit (PIRU). All bar one of the team are also involved in the early evaluation of the integrated care Pioneers (January 2014-June 2015). The team has extensive experience of evaluating integrated care programmes in England (e.g. POPP, Integrated Care Pilots, NW London Integrated Care Pilot, Virtual Wards, Whole Systems Demonstrators) and overseas (e.g. in New Zealand). Anticipated impact of this research With regular reporting and workshops highlighting the development of the Pioneers, along with analysis of the factors that enable or inhibit progress towards integration and its contribution to better outcomes, the evaluation will identify the factors that facilitate whole system and cost-effective integrated care in different contexts.

Lay abstract: Better coordination within and between the NHS, local government and other services, should lead to more personalised care and more efficient services that will improve individuals experiences and outcomes. This is now one of the priorities of the English health and social care system. In 2013, person-centred, coordinated care was accepted as the national definition of integrated care. Fourteen areas were initially selected as Pioneers (with ten more areas expected in 2015) to experiment with new ways of coordinating health and social care over a five year period. The Pioneers are being supported by a number of national partners and other experts. Another initiative, the Better Care Fund (BCF), provided &pound;3.8bn for pooled NHS and local authority budgets to promote better joint working between health and social care services in all English local authorities. Over the past 50 years, there have been many schemes promoting integration, but there is not much evidence that they have had the improvements hoped for, for example, by reducing unplanned hospital admissions or saving costs. However, many of the previous evaluations did not continue for long enough to draw conclusions about how well they might work over time. With the Pioneer evaluation programme lasting for five years, we have a unique opportunity to examine not only whether they do result in providing better coordinated care in a cost-effective way, but also whether the benefits and savings continue over time or are only temporary. Our evaluation will examine whether significant changes can be found within the Pioneer areas over five years. We will also examine specific schemes within the Pioneers which look promising in terms of providing cost-effective integrated care. The results will help national and local partners deliver better integrated care. Our team has extensive experience of evaluation of integrated care initiatives in England and overseas.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE