Innovation for Evidence: Integrating service design, evaluation and research in a collaborative a strategy to improve person centred coordinated care (PCCC) in the south west of the UK.
Many individuals, particularly older people with multi-morbidity, have complex bio-psycho-social needs and often receive fragmented and uncoordinated care across the NHS and social care system. Integrated care is perceived as the answer but has yet to be proven as the solution. Knowledge generated by traditional health services research takes many years to come to fruition and is often outdated by the time it reaches journal print as policy and service redesign has moved to the next challenge or crisis. Meanwhile locally driven solutions involving enhanced general practice, multi-professional locality teams and other innovations are moving on apace alongside policy driven initiatives such as GP care plans, Vanguards and Pioneers. This paper describes a whole system collaborative methodological innovation to address this mismatch in time frames and priorities for outputs and hence enable evidence based service change, development of practical theory and a receptive context for longer term externally funded research.
The South West Peninsula CLAHRC and the Academic Health Science Network (SW AHSN) responded to local stakeholder interest in integrated care by developing an interlinked programme of service redesign, evaluation and research. Stakeholder engagement involved understanding grass roots challenges, and defining evaluation needs and providing advice about evidence. A whole system approach to metrics has been developed taking account of outcomes of importance to patients, practitioners and health systems. A linked evaluation framework allows selection of measures for specific projects, alongside use of qualitative interviews and observational data.
Rather than integration, the brand Person Centred Coordinated Care (PCCC) was chosen to emphasise both individual people and organisational behaviour. Gaps identified in the whole system metric framework required adaptation of a measure for individual experience (Modified Long Term Conditions Questionnaire(MLTC)) and development of an organisational change tool (P3C-OCT). We are engaged with three health systems to carry out seven funded evaluations using this framework. Research funding bids have been awarded for projects examining: Integrated Personal Commissioning; how multiple initiatives in a system can co-ordinate to be person centred; metrics for person centeredness (a portfolio of intelligence); and Multi-speciality Community Providers (review).
We have been successful in moving towards mutual trust between stakeholders and hence bringing research and evaluation closer together. There are promising signs that managers and practitioners are becoming more receptive to research approaches while researchers have been willing to be flexible to fit in with NHS time frames. Our next challenges include validation of the new measures, demonstrating impact on service change and using mixed methods approaches to use data from across the evaluations to build practical theory in relation to key questions such as role of general practice, new locality teams and how to actually do ‘care planning’.