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

This 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 25 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. The 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. MDTs 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 (e.g., poor wifi connections during meetings, absence of key professional groups and services) 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. While this may reflect the largely ‘behind-the-scenes’ co-ordinating role of many of the participating MDTs, it also suggests that there is some distance to travel before care is fully patient-centred. At 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. More broadly, the evaluation findings echo those of other national integration pilots in that staff were positive about working in more integrated ways at the service delivery level, while the impacts on patients and their informal carers were more difficult to ascertain definitively. However, our research also highlighted challenges to evaluating the outcomes of ‘integration’ both as a concept and at the service delivery level. We conclude that changes to both the research environment and to the focus and approach to evaluation are warranted.