The importance of patience before judging the success of complex change: the need to think long term when implementing and evaluating integrated care programmes



  • Geraldine Clarke (Principal Analyst, Improvement Analytics Unit, The Health Foundation)


  • Stephen O'Neill (Associate Professor, The London School of Hygiene & Tropical Medicine)
  • Paul Seamer (Analytics Manager, The Strategy Unit, Midlands and Lancashire CSU)
  • Daniel Alton (GP, Population Health Management Clinical Lead, Berkshire West CCG, National PHM Clinical Advisor NHSE/I)

Over the years, the NHS has implemented various initiatives in England with the aim to integrate delivery of care at various levels of the system, including the Integrated Care Pioneers, the New Care Model Vanguards and, more recently, Integrated Care Systems. However, evidence of effectiveness of these interventions particularly in reducing hospital use is mixed, possibly due to their complex and multi-faceted nature, barriers to implementation and / or unrealistic expectations, either in terms of time taken for discernible impact to materialise or its magnitude. This workshop explores the hypothesis that integrated care interventions need time to embed in and adapt to the context they are delivered into for the intended change in hospital activity trends to occur. The structure of the workshop is as follows: a brief outline of findings from an evaluation of the Integrated Care Transformation Programme in Mid-Nottinghamshire will set the scene around the hypothesis being investigated, followed by an overview of the statistical approach adopted in this and subsequent population-level evaluations (the Generalised Synthetic Control method). Background to and results from three evaluations of integrated care programmes rolled out as NHS Vanguards in the North East Hampshire and Farnham, Blackpool and Fylde and Wyre CCGs will then be provided. Drawing from the reviewed body of evidence and from the experience of contributing panellists, the workshop will conclude with a round-table discussion. This will include the views and experience of a GP and PHM lead to contextualise the findings and conclusions, as well as a discussion of the policy implications for planning and implementing integrated care programmes. The audience will have the opportunity to feed into the discussion, which will also touch upon the role of evaluation, including relative merits of short-term and longer-term evaluations.


Click here to join this session at 1230hrs on 7 July.