by Jill Carman

Health and social care: the need for change

Health and social care in the UK is fragmented. An ageing population makes this an increasingly pressing problem – people are living longer, presenting with multiple long-term conditions that need coordinated management. We need our health and social care services to adapt accordingly. Better coordinating these sectors will lead to better patient outcomes, and will help address the pressures on our hospitals and social care services.

But national efforts to better integrate health and social care across the country have been slow. As the National Audit Office reports, there are significant challenges to overcome, including misaligned financial incentives, restrictive information-sharing rules, and workforce issues.

Many communities are developing their own solutions to better link up health and social care, particularly to improve care for specific cohorts such as older people, who extensively use health and social care services. Age UK has helped lead the charge with its personalised integrated care programme, which puts the needs of older people at the centre of a coordinated response from health and social care services. Now Age UK, like many others, is exploring the potential of outcomes based contracting for this programme. We believe that with good planning, outcomes-based contracting can help deliver care that is better integrated, achieving better results for patients and value for money for commissioners.

Spotlight on Age UK’s Personalised Integrated Care programme

Age UK’s programme is a good example of how coordinating care across sectors can improve results for all. The programme unites a multi-disciplinary team to support older people with multiple long-term conditions who have experienced avoidable hospital admissions. It has achieved promising early results in many local sites – for example, Age UK South Gloucestershire found its programme achieved a significant reduction in unplanned hospital admissions (compared to a comparative cohort), as well as reducing the number of community care visits. The self-rated wellbeing of older people also improved greatly.

Aleron worked with Age UK nationally to help it understand the feasibility of using social investment to fund the programme in key local Age UK sites. Reflecting on our experience, we believe that outcomes-based contracting presents some strong opportunities for personalised integrated care programmes, though there are implementation challenges to be overcome.

The promise of outcomes-based contracting for integrated care

Intelligent contracting structures can help to solve several of the key challenges in integrating health and social care. For example, setting outcomes lets commissioners incentivise quality integrated pathways for joined-up care, ensuring better value for money as commissioners pay for ‘what works.’ It provides a mechanism to bring health and social care funders together, creating structures of joint accountability and potentially joint funding pools too. Furthermore, outcomes based contracting here also recognises that there is often a special role for a central coordinating body to ensure successful integration, which needs to be appropriately supported.

While the trends are promising, we are moving here into a less-explored space. Outcomes-based contracting, particularly in the form of social impact bonds, is not yet mainstream practice in the UK. Perhaps the best-known example is the Ways to Wellness social impact bond, which launched in 2015 as the UK’s first healthcare social impact bond. Others are fast following suit. Last month, Age UK South Gloucestershire, in partnership with Age UK national, was one of a number of organisations awarded funding from the UK Government’s Life Chances Fund, to support the development of a social impact bond model in this space.
Based on our experience, Aleron has identified five key preconditions for success for outcomes-based contracting of integrated care.

  • Guaranteeing referral pathways – achieving sufficient referrals of eligible clients is key for the sustainability of an outcomes-based contract. Guaranteeing sufficient referrals from health and social care partners is a key dependency and needs to be carefully managed. For example, Age UK is trying to enable programme participants to proactively target and manage referrals using predictive risk stratification.
  • Costing the benefits for commissioners – achieving a return on health and social care outcomes is long-term, and requires detailed modelling. Be prepared to work with long time horizons to realise savings.
  • Joint governance and accountability – integration requires all parties to be working together to common objectives, and this needs to be developed into a well-codified model governing how parties will work together.
  • Strong data systems – across all delivery partners, to support effective capture and validation of outcomes.
  • Involvement of broad range of stakeholders early on – outcomes-based contracts for integrated care will achieve greatest success if contracting is designed to take into account the benefits accruing to a wide range of stakeholders, spanning both local authorities and CCGs. Invest early on in building these relationships across institutional lines.

Want to find out more? Check out our further reading below, or get in touch with us to start up a conversation.

Further reading
Age UK Personalised Integrated Care programme
Evaluation of AUK South Gloucestershire’s programme
Life Chances Fund
Ways to Wellness SIB evaluation
NAO review of health and social care integration