Evaluating the role of community-based multi-disciplinary teams in integrated health and social care in England: Overview of findings from the Pioneer evaluation and their implications for health and social care integration.

Abstract

ObjectivesThis paper synthesises the findings of an evaluation of community-based multi-disciplinary teams (MDTs), primarily serving older people with long-term conditions, undertaken as part of a wider evaluation (2015-2022) of the Integrated Care and Support Pioneer Programme (2013-2018) in England. The MDT evaluation was undertaken in two contrasting Pioneers with 11 MDTs covering four models of MDT functioning.MethodsThe synthesis, set against our conceptual framework of MDT functioning, draws principally on the findings of semi-structured interviews with local strategic level health and care leaders, frontline MDT staff, and patients and their informal carers, observations of MDT meetings, and an online survey of MDT staff.ResultsMDTs were seen as an essential means of working towards local health and care integration. While local contexts shaped the precise aims, structure, composition and ways of working of the different MDT models studied, there were strong similarities across the teams in how staff viewed the nature and benefits of MDT working. MDTs were perceived as having the potential to provide more holistic care to patients, speed up access to care, improve access to a wider range of services and enhance care at home. Benefits to staff included better information sharing; reduced duplication of tasks; enhanced collective responsibility and problem-solving, which enriched decision-making; opportunities to learn from, and about, the remits of other professional groups and services; and the erosion of traditional professional hierarchies. However, barriers to MDT working, including the absence of shared patient records, inadequate infrastructure and resources, and concerns about the ability to measure and demonstrate the value of MDT working, were also identified. Patients and their informal carers reported valuing good communication with their health and care providers but often appeared unaware of an MDT's involvement in planning their care. This suggests there is some distance to travel in terms of how MDTs communicate their roles to those they serve.ConclusionsAt the service delivery level, our findings' implications for policy and practice include the need for greater integration across patient records and data systems, and greater investment in specialist services (e.g., housing) currently absent from MDTs. However, our research also highlighted challenges to evaluating the outcomes of 'integration' both as a concept and at the service delivery level. Changes to both the research environment and the approach to evaluation are also warranted.