A mixed methods evaluation of the Integrated Care Pilot in North-West London

The North-West London Integrated Care Pilot (ICP), originally launched for one year in July 2011 and later extended for a further year, is a large-scale change programme involving two hospitals, two mental health providers, three community health care service providers, five municipal providers of social care, two non-governmental organisations and (by April 2012) 103 general practitioners. Its aims are to improve health outcomes and reduce unnecessary admissions to hospital by pro-actively managing people living with diabetes and/or those aged 75+ through creating better access to more integrated care outside hospital and by enabling effective working of professionals across organisations.  In a paper published in the International Journal of Integrated Care, researchers from Imperial College London and the Nuffield Trust describe the results of the evaluation of the first year of the programme. The evaluation was funded by the Imperial College Healthcare NHS Trust Charity and the NIHR CLAHRC for NW London.

We found that the pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence during the first year of the pilot of a significant reductions in emergency admissions. However, there was some evidence of changes in care processes. We concluded that although the pilot has demonstrated the beginnings of large-scale change, it remains in the early stages and faces significant challenges as it seeks to become sustainable for the longer term. The pilot also showed the importance of National Health Service managers and clinicians having realistic expectations of what can be achieved in a relatively short period of time when implementing major changes in local health services. The evaluation contributed to our understanding of the process and mechanisms of establishing a large-scale integrated care project within health and social care in the National Health Service (See Box 1). It has clearly highlighted the challenges and tensions involved in such a pilot and underlined the need for thorough evaluation and research over a long period of time in order to detect impact.