The views of older people on community-based multi-disciplinary team caseloads and informal carers about health and care services in two Integrated Care Pioneer sites in England.

Abstract

Objectives: Community-based multi-disciplinary teams (MDTs) were among the most widely reported health and care integration initiatives in the Integrated Care Pioneers in England. Such MDTs bring together staff from different sectors to co-ordinate and plan care for patients, who are often older, have multiple long-term conditions and risk hospital admission. As part of our evaluation of MDTs in two contrasting Pioneers, we explored MDT patients' and informal carers' perspectives on health and care services. As the COVID-19 pandemic started during data collection, we also wanted to understand its impact on patients' access to services. Methods: We conducted qualitative interviews with 44 patients aged 60 or over, with long-term conditions, and on the caseload of one of 11 participating MDTs. We also undertook qualitative interviews with 15 carers. Interviews took place between November 2019 and March 2021. Interview transcripts were coded in NVivo-12 and analysed thematically. Results: In addition to formal services, patients often relied on informal care. Valued aspects of care included equipment and home modifications that supported independence, timely access to and continuity in care, effective information-sharing, professionals who made them feel that their needs mattered, and having a named contact. Where challenges were experienced (e.g. with accessing professionals, communication, and care quality), patients and carers sometimes felt abandoned. While some patients mentioned being on an MDT caseload, few reported having a care plan. The impacts of caring on informal carers were sometimes considerable. COVID-19 affected patient and carer wellbeing, but the new ways of accessing care generated by the pandemic were valued by some participants. Conclusions: As long as challenges remain, patients and carers are unlikely to perceive care as joined-up and patient-centred. If truly integrated and holistic care is to be provided, barriers (such as the lack of shared patient records) must be addressed. Even where MDTs function primarily to co-ordinate rather than deliver care, they could better communicate their co-ordinating role, and MDT discussion outcomes, including care decisions, to patients. Informal carers' needs also require greater attention by MDTs.