26 / 02 / 2019
Age UK’s Personalised Integrated Care Programme: Evaluation of impact on hospital activity
Nuffield Trust, January 2019
In this report
commissioned by Age UK, Theo Georgiou and Eilìs Keeble of the Nuffield Trust set out to determine whether Age UK’s ‘Personalised Integrated Care Programme’ (PICP) managed to reduce the overall amount of hospital use amongst those older people who were referred the scheme.
Age UK’s PICP is geared improving the health and wellbeing of older people, through bringing about “a transformation in the way that parts of the health and care system work together locally”, and those referred to the scheme are older people who are at risk of an emergency admission to hospital.
The programme begins for each PICP client with a “guided conversation”, during which a series of health goals, that the client would like to achieve, are identified. A “primary care-based multidisciplinary team” then tracks the progress of the client, for a period of approximately three months, while they receive a support plan that is tailored to their identified goals and general health condition.
As pointed out by Georgiou and Keeble, a key element of the programme is the way that it attempts to act as a “catalyst” to greater local integration, by introducing systems of shared financial responsibilities and joint performance monitoring across local providers of health and social care services.
On the date that Age UK’s programme began within different areas of England, the Nuffield Trust’s researchers carefully selected a control individual for each one of the 1,996 PICP clients. The control individuals were drawn from those areas where the programme was not currently in place, and they were selected based on their similarity to corresponding PICP clients by considering factors such as age, sex, risk of future admission and extant health conditions.
Once the 1,996 PICP clients were each matched with non-PICP control individuals, the Nuffield Trust’s researchers were able to examine the impact of Age UK’s programme on hospital activity.
Over the nine months (and 16 months for a larger subset of PICP clients) following the start of the programme’s start, the researchers examined whether there was, on average, a difference in the amount of hospital activity generated by PICP clients and their matched control individuals. To determine the impact of the programme on hospital activity, the researchers analysed PICP clients’ and control individuals’ use of emergency and non-emergency patient care, and their use of A&E and outpatient services.
Disappointingly, Georgiou and Keeble found that PICP clients generated greater levels of hospital activity than those within the control group.
As Georgiou and Keeble summarise,
“… in the first nine months after the start of the service there were at least a third more A&E visits and admissions in the PICP group, and nearly a quarter more outpatient attendances. This was equivalent to two additional emergency admissions, between two and three additional A&E visits and nine additional outpatient attendances for every 10 people who received a service from PICP.”
The researchers found that the total cost to commissioners resulting from the additional hospital activity of the PICP group was equivalent to £906 per client – 37% more than the costs generated by the control group.
The findings of the Nuffield Trust’s study on Age UK’s programme may dent the popular argument that improved social care, and greater integration between health and social care sectors, would alleviate pressures on the NHS and improve service finances. However, it should be noted that this study did not set out to examine the difference in health outcomes between the PICP and control groups.
As Georgiou and Keeble postulate, it may be that the greater levels of care provided by the scheme result in the identification of unmet need, which in turn, results in increased hospital activity.