Integrated care in Herefordshire: a case study.

Purpose The paper draws on the experience of the health and social care system in Herefordshire to answer what, when and how improvements in cost and quality can be realised through service integration. Design/methodology/approach - The three stages in the evolution of integrated health and social care services within the county and the establishment of Wye Valley NHS Trust are described. An overview of the new model of integrated care is provided. Findings The baseline performance of the health and social care system in 2010/2011 is compared with the projected future performance in 2014/2015 and the current performance in 2012/2013. Reasons for underperformance of the new model of care are listed. It is concluded that integration will improve the effectiveness of care and the patient experience but is unlikely to deliver material savings. Service integration requires pump priming monies and short-term double running costs, the close involvement of GPs and a robust change management approach. Practical implications - The implication of these conclusions is that the current emphasis on the cost benefits of service integration have been overstated and the difficulties of maximising cost and quality benefits underestimated. Originality/value - The paper provides a "real world" contribution to what remains a live debate amongst NHS clinicians and managers, and those with an interest in policy development and analysis. [ABSTRACT FROM AUTHOR]