Start Date:  December 2008   End Date:  May 2009   Status: Completed

The treatment of patients with long-term conditions (LTCs) is the key challenge to health care systems today.  In England long-term illnesses affect the lives of one in three people. The burden of disease is particularly severe among older people. LTCs have a significant impact on the NHS, Patients with chronic conditions account for 65% of all outpatient activity. The available evidence suggests that integrated care provided by multidisciplinary teams using common patient databases and risk assessment may lead to more efficient delivery of services, higher levels of patient satisfaction and improvements in patient quality of life. Havering has a rapidly ageing population. Older people constitute 17.5% of the population, which is significantly higher than the averages for London and England. By 2023 the population of over 65s is predicted to grow by about a quarter. Older people with complex chronic conditions are intensive users of health and social care services. Over 65s with long term conditions in Havering account for around 4,300 emergency hospital admissions, which cost about £13.8 million a year.


To produce information and intelligence to inform the development of a pilot integrated case management programme for people with complex LTCs aged 65 years and over in Havering.

The work included

  • a review of the background documents on LTCs and models of Integrated care and Integrated Case Management;
  • an analysis of the key socio-demographic and health indicators related to LTCs in Havering;
  • developing two assessment instruments and conducting interviews with purposefully selected providers and service users;
  • a review of the use of the Patient at Risk of Re-Admission (PARR2) Assessment Tool and Patients Related Outcome Measures (PROMS) for LTCs;
  • constructing a matrix and a geographical map of services participating in the review;
  • a Stakeholder workshop; and
  • recommendations for the pilot ICM programme.


The review has been based on the principles of the whole system approach and used multiple data collection methods including:

  • semi-structured interviews with service providers
  • in-depth interviews with service users
  • documentary analysis
  • GIS mapping.

Stakeholder organisations (service providers) were selected by purposive sampling using a range of local and regional databases. In total, 79 of 123 informants selected from these organisations agreed to participate (response rate 64.2%). The interviewees represented NHS Havering, the Autonomous Provider Organisation, GP practices, social services, care homes and domiciliary agencies, Voluntary Sector Organisation, hospital trusts, mental health services, Ambulance service and pharmacies.

Ten service users were selected by convenience sample and provided a broad cross section of men and women over 65 with differing ages, health conditions and living arrangements. Six of the interviewees were male. The median age was 73 years (range 65-88 years). Two informants were carers. All service user interviews were recorded on audio tape and transcribed verbatim for thematic analysis.

Main Findings


The project results have been presented to the Havering Steering Committee on Integrated Care and to the Commissioners' Forum. The recommendations formed the basis of a pilot of an integrated case management project, which will be implemented in the next five years as an innovative approach to the delivery of care for over 65s. If successful, the new approach can significantly improve the relationship between different service providers, lead to a more efficient use of resources and improve patients' quality of life.

Contact us

Project Lead: Dr Elena Schmidt

Project Team:  Dr Elena Schmidt (Principal Investigator), Dr Patrick Tobi  (Co-Investigator), Shahana Lais, Dr Jurgen Schmidt, Dr. Amber Siddiqui, Hena Wali Haque, Dr Usman Siddiqui

Funder: Havering Primary Care Trust

Report: London Borough of Havering Overview and Scrutiny Committee report (PDF) 

For more information, contact: Patrick Tobi

Elena Schmidt

You may also be interested in...