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As one of the 16 pilots in the Department of Health Integrated Care Organisation (ICO) programme, Norfolk is exploring ways of integrating primary, community and social care services in six localities. Progress in the first few months is assessed within the framework of the six laws of integration developed by Leutz. The initiative has a high degree of support across the County, and local practitioners are taking the opportunity of being within a national programme to redesign their services for the benefit of patients and carers. There is work to do at every level to align the strategy, policy, management and operation of the service to facilitate integrated working for the benefit of patients and carers. The Norfolk approach is to build on existing knowledge of good practice, identify champions by inviting volunteers to work on the pilot, and share experience through a network for the six localities in preparation for rolling out and replicating the model. Progress is being monitored nationally as well as locally.

In Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.

Engaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.

Three themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.

Study findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.

The purpose of this paper is to explore the outcomes identified by the evaluation of the national programme of integrated care pilots (ICPs) in England in the context of wider policies designed to deliver integrated care and to consider the challenges presented to policy makers and evaluators in distilling usable insights to promote effective policy.

This is a review of the ICP evaluation findings and the findings of a number of systematic reviews into aspects of integrated care. This paper shows the contextual analysis of these findings in relation to health policy in England.

The evaluation of ICPs in 2012 produced mixed results with some potentially useful findings for policy makers. However, numerous integrated care initiatives succeeded the ICPs suggesting that insights from evaluation are of limited usefulness to policy makers or are difficult to implement. A shift in macro policy within the English NHS may support integrated care by aligning objectives of clinical teams with those of the wider systems within which they operate.

This review has not been based on a systematic review of the evidence on integrated care and reflects the personal experiences and views of the authors who have been active in this field of research for many years.

This paper considers why evaluation findings appear limited in their impact on policy in the field of integrated care. Views as to how evaluation might be undertaken so that it generates actionable insights are advanced.

This paper aims to demonstrate the approach taken in Norfolk, UK, to engage patients and staff to develop and improve services by stimulating improvements in integrated working. The two year programme focused on making specific improvements that patients said they wanted to see by working with staff who volunteered to take part in the programme.

The “Integrating Care in Norfolk” pilot (ICN) was one of 16 national pilots. GPs from 32 practices worked with local community staff to redesign services to meet “patient pledges”. The impact of changes on patients, staff and services were evaluated locally using questionnaires and by analysing data combined in a performance dashboard. The ICN was subject to both national and local evaluations, which provided a basis for comparison.

The local evaluation showed that progress had been made towards meeting objectives, including patients and staff satisfaction and reducing unplanned admissions. GPs recorded improvements to joint working, and all staff concerned chose to continue the project beyond the pilot period.

The findings of the local evaluation contrasted with those of the national evaluation. The Norfolk study demonstrated the positive impact of integrating care on patients, staff and services. The national study concluded that there were minimal or negative impacts of integrating care, although the study amalgamated all 16 pilots, with very different clients, services and objectives.

The ICN was novel in the way that patients and staff were engaged. Patients were invited to set an agenda for change, and provided a mandate to staff from each organisation to redesign their services. This approach may provide a solution to sustainable integrated working. The ICN was evaluated locally as well as nationally as part of the DH ICP programme, enabling respective findings to be compared and validated.

The purpose of this paper is to report on the findings of the first stage of a project seeking to evaluate and overcome inter-professional barriers between health and social care staff within a single, co-located, integrated community team. The project seeks to answer the following questions: first, Do inter-professional barriers to integrated working exist between health and social care staff at the interface of care delivery? Second, If inter-professional barriers exist, can joint health and social care assessments help to overcome them? The paper develops the current evidence base through findings from a staff questionnaire and the initial findings of a pilot study of joint health and social care assessments aimed at overcoming inter-professional barriers to integration.

The first stage of the project involved running an anonymous, online questionnaire with health and social care staff within a single, co-located community adult health and social care team. The questionnaire aimed to explore staffs’ perceptions of inter-professional collaboration when assessing the health and care needs of service users with a high degree of complexity of need. The second element of the study presents the initial findings of a small pilot of joint health and social care assessments. A second staff survey was used in order to provide a “before and after” comparative analysis and to demonstrate the effect of joint assessments on staffs’ perceptions of inter-professional collaboration at the interface of care delivery.

Health and social care staff value joint working as a means of improving quality of care. However, they also felt that inter-professional collaboration did not occur routinely due to organisational limitations. Staff members who participated in the pilot of joint assessments believed that this collaborative approach improved their understanding of other professional roles, was an effective means of enabling others to understand their own roles and helped to better identify the health and care needs of the most complex service users on their caseloads. Initial findings suggest that joint assessments may be a practical means of overcoming inter-professional barriers related to a lack of communication and lack of understanding of job roles.

The questionnaires highlighted the need for integration strategies that are aimed at facilitating collaborative working between staff of different professions, in order to achieve the aims of integration, such as a reduction in duplication of work and hand-offs between services.

To date, few studies have explored either staff perceptions of collaborative working or the effectiveness of joint assessments as a means of overcoming inter-professional barriers. This paper adds new data to an important area of integration that legislators and researchers increasingly agree requires more focus. Although the findings are limited due to the small scale of the initial pilot, they provide interesting and original data that will provide insight into future workforce integration strategies.

This paper reviews the evidence base for vertical integration in health care. We describe its impact on organisational structures, on how services are provided, and on such outcomes as cost, clinical outcomes and patient experience. We also outline conditions that support successful integration.

This article will outline the work being carried out in Torbay to provide more seamless services for people aged 65 and over. Torbay Care Trust is one of 16 DH pilot sites for integrated care and is using its already established strong partnerships with Torbay Council, South Devon Healthcare NHS Foundation Trust and Devon Partnership Trust to progress towards a form of vertical integration for older people's care.

This paper aims to demonstrate the approach taken in Norfolk to improve the health and welfare of young people. Local practitioners in Thetford want to address teenage pregnancy rates as a priority issue for their community; they have volunteered to be part of a national pilot to test integrated working in a service that involves many agencies and services.

This health promotion service was a particular challenge for integration as it involved building partnerships between children's and adults’ services, health and social care, education and care services, and voluntary and statutory services. The service also covered the counties of Norfolk and Suffolk. A local core group, chaired by a GP, planned four phases of work: design, information gathering, service redesign and evaluation. This paper sets out an analysis of progress and achievements.

The group recognised the multiple factors affecting young people and their lives and lifestyles in this area of social deprivation and the benefits of partnership working. Improvements to date include better coordination, improved access to services and an enhancement of services.

The impact will not be measurable within the timescale of the pilot project in respect of reducing pregnancy rates; the work is ongoing.

Implications of the study include how partnership working can lead to targeting resources and to improving access to contraception and services.

This study is a local initiative within the national programme for integrating care, demonstrating the benefits of working together to target resources and working in a more coordinated way.

This paper results from experience gained while developing and delivering the South Devon Integrated Care Network (ICN) and from more recent experience as an Integrated Care Pilot (ICP) organisation. It demonstrates that by taking an integrated approach a hospital can develop and prosper, and that it is possible to reduce the use of beds and manage care in the community within the levels of funding currently available. The paper focuses on integration at organisation level and proposes a model of key system drivers and controls necessary to manage an integrated health and social care system. The next level of integration is at individual customer level, and the paper discusses the enablers for this.

Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach.

Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information.

While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations.

Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.