Evaluation of the Integrated Personal Commissioning (IPC) Programme
Client: Department of Health and Social Care
Integrated Personal Commissioning (IPC) is an approach to joining up health and social care, and other services where appropriate. The purpose is to enable service users, with help from carers and families, to combine and direct the resources available to them and control their care. This is achieved through personalised care and support planning, and personal budgets. The testing of IPC began in April 2015. In total 17 local areas were involved in the process. It was focussed on four user groups with complex needs:
- children and young people with complex needs, including those eligible for Education, Health and Care plans
- people with multiple long-term conditions, particularly older people with frailty
- people with learning difficulties with high support needs, including those who are in institutional settings or at risk of being placed in these settings
- people with significant mental health needs, such as those eligible for the Care Programme Approach, or those who use high levels of unplanned care.
The Department of Health and Social Care commissioned an independent evaluation of IPC. The evaluation was carried out by a consortium led by SQW, in partnership with Bryson Purdon Social Research (BPSR), Social Care Institute for Excellence (SCIE), the Social Policy Research Unit (SPRU) and the Centre for Health Economics (CHE) both at the University of York, and Mott MacDonald. The evaluation ran between November 2016 and May 2019 and comprised three strands of work: process, impact and economic.
The evaluation key findings were:
- Sites made good progress in developing and establishing new governance arrangements and a ‘system culture change’ with greater progress being made where there were pre-existing relationships, which were more amenable for the change. A key challenge identified was the engagement of middle managers as change agents. Maintaining momentum for change was a key challenge.
- Progress in the delivery of IPC was mixed across the sites. The majority made slow progress at the beginning, recruiting only small numbers of service users to IPC (with some sites not recruiting any people at all), while they were developing the local model and strategy. However, by March 2018 sites had moved forward, making progress in embedding the new models and beginning to deliver personalised care and support planning sessions.
- Service users’ and carers’ experience of IPC was mixed with service users having different desires or abilities to exercise choice. Some service users and carers particularly good or particularly poor experiences of choice and control appeared to be related to the actions and accessibility of key professionals. It appeared that in order to gain the most choice and control, service users needed to be pro-active and push hard within the system to get the results they wanted.
- Overall, service users were positive about their experiences of IPC. A quarter felt that their new personalised care and support plan gave them a lot more support than before and 31 per cent felt it gave them a little more support.
- The findings from the economic evaluation suggest that IPC was slightly costlier than standard care. The additional cost of running IPC compared to standard care was driven by the greater number of appointments and contacts between staff members.
- Survey responses and feedback from service users suggested that for a good number the new personalised care and support plans provided them with more support than before. This suggests that IPC was also associated with increased resources in the personalised care and support plans.
- The impact evaluation found that there was a significant improvement in the social care related wellbeing outcomes (measured through ASCOT). However, there was no statistically significant improvement in health outcomes (measured through EQ5D) and in general wellbeing outcomes (measured through WEMWBS). Sub-group analysis found statistically significant changes in ASCOT scores for people with mental health issues, those who had a personalised care and support plan, those who had a personal budget, males and people aged under 65.
- The statistically significant improvements between baseline and follow-up should not automatically be interpreted as evidence of an IPC impact. However, the changes in ASCOT scores (especially) and EQ5D for IPC are in line with those found for PHB evaluation. This is encouraging for IPC, as the PHB study focussed on a similar client group and found no real change in the comparison group scores. Therefore, the impact evaluation, although limited by relatively small numbers, does present some encouraging findings around the impact of IPC.
The learning from IPC has already informed the development of the comprehensive model for personalised care. This model, which is one of five major practical changes of the NHS outlined in the Long Term Plan, is now being rolled out across the country to ensure personalised care becomes business as usual.
The final report of the evaluation can be found here. It provides a full description of the findings from the three strands of the evaluation. The report concludes with a series of supporting annexes including the findings from the service users and carers qualitative interviews and three thematic case studies covering:
- Personalised care and support planning process
- Development of the local market
- Sustainability and scalability.