This document summarizes the aims and agenda for a workshop on accelerating integration in the NHS. The workshop aims to understand experiences with integration, present preliminary findings from Nuffield Trust work, and test those findings. The document reviews the long history and overlapping terminology around integration efforts in the UK. Evidence suggests payer-provider and provider integration can improve partnerships and capacity but has mixed effects on outcomes and costs. Networks show improved communication and care provision but little evidence of improved outcomes or reduced costs. Large organized medical groups in the US achieve higher quality and lower mortality. The document outlines assumptions that integration and integrated care are distinct, that current initiatives share common goals, and that progress requires adapting to organizational and local contexts.

1. Integrated care: Accelerating the pace
of change
Setting the context
Dr Rebecca Rosen
September 16 2009

2. Aims of the workshop
To understand your experiences of integration and the
opportunities and barriers that influence progress
To present preliminary findings from Nuffield Trust work on
integration and explore their relevance to you
To test out early findings from the above work, and consider
their relevance and feasibility in NHS settings

3. A long history of overlapping policy & terminology
Acute / community trust Horizontal
mergers (& demergers) Integration
Networking
Health/social care mergers Micro Vertical
& partnerships
Mental health reform Integrated care
Pathways
Long term conditions
Functional
policy
Our Health Our Care Our Partnership
Selves Structural working Care
Coordination
Social care white paper
Wellbeing and choice Integrated
care Meso
Next stage review High performance
ICO pilots Macro health systems

4. Evidence base for integration
Limited but growing evidence base:
• 16 Dept of Health pilots under evaluation
• Review of evidence by Fulop:
• Payer-provider integration: improved partnerships, more case Mx and use of
IT, some increases in capacity, mixed evidence on admissions, LOS and cost
• Provider integration:some improved partnership, improved governance and
use of guidelines; little impact on outcomes limited information on costs
• Networks: Mixed evidence – some re better communication between teams/
with patients some re resistance to change. Some evidence on improvements in
care provision. Little evidence of improvements in outcomes or costs
• Growing body of evidence from US on organised health systems:
• Shortell review: VA and Kaiser achieving higher quality of care and reductions
in mortality; larger organised medical groups with more infastructure perform
better re chronic disease and safety
• Cassalio review: Large medical groups more likely to use EMR, score higher
on process measures and more use of care management processes.

5. Assumptions for the day (1)
We will distinguish between integration and integrated care
Integration Integrated care
• Structures • Integrated Care Pathways
– IDS’s,merged orgs, networks • Integrated services (eg cancer
• Processes networks)
– Use of data and information • Multidisciplinary teams
– Governance systems
• Care coordination services
– Leadership arrangements
– Skill mix changes • Other ad hoc developments

6. Assumptions for the day (2)
All current integration Initiatives are linked by common goals
• Good clinical and Exemplars of integration can take
care outcomes many different forms and deliver
different types of integrated care
Innovative MD teams
• Better patient
Networked services
experience Care pathways
Integrated delivery systems
• Efficient care delivery High performance organisations
Integration as a means to an end not a starting point for redesign

7. Assumptions for the day (3)
Progress with integration is inextricably linked to context and proposals for
improving integration must be context specific
3 tiers of contextual influences:
– External: Politicial/policy/financial/regulatory
– Organisational
– Teams and individuals
Global solutions unlikely to work
Adapting integration to local context is key

8. Outline of the day
Session 1: Your experiences of integration
Sessions 2/3: Presentations on NT work
Conceptual framework – clarifying the
terminology
Key findings and recommendations from
case studies
Session 4: Feedback/discussion on relevance
Session 5: Small group work: next steps
towards timely and effective integration
Session 6: Key messages and take-aways

9. www.nuffieldtrust.org.uk