Integrated care for older people or people living with frailty and waiting times/lists – a mixed methods rapid review

Background 

The NHS faces the problem of an aging population - for example, it is expected that 30% of the Welsh population will be 60 or over by 2026.  Those over 65 years old are more likely to be affected by frailty and health problems. While the population is getting older, NHS health and social care waiting times are getting longer. The process of joining up different health and social care services is known as ‘integrated care’, which may have the potential to deliver care in a more efficient way, as well as helping to improve waiting times. However, it is not well-known how effective these methods may be, so this rapid review looked to see if there was any evidence of whether this type of joined-up, ‘integrated’ care could improve waiting times. This question was requested to help inform the work of the Bevan Commission, and the Cardiff and Vale University Health Board.

Methods

The researchers did a review of published research to see if any evidence could be found around whether integrated care interventions might be useful in improving waiting times. They looked for evidence published between January 2015 and June 2025.

Findings

• The review team identified 61 studies from over 14 countries. 30 studies included various integrated care interventions that were used across two or more services (e.g. GP, hospital, community or social care). Interventions included multidisciplinary team (MDT) working, development of pathways and protocols, and coordinating care. The studies included older people with multiple health conditions and/or care needs.
• The review team found some weak evidence from multiple studies suggesting that integrated care interventions including MDT, pathways/protocols and/ or care coordination may help to reduce waiting times. The evidence was judged to be weak due to weak study designs, low study quality, and inconsistencies in the findings.
• The review team also found some strong evidence from two studies showing that a multidisciplinary assessment for older people who came into hospital emergency departments for various reasons, was effective in reducing time spent there.
• Some studies focused on exploring what healthcare professionals and older people thought about integrated care and whether it improved waiting times. Healthcare professionals working in different areas found that integrated care may help improving waiting times. One study explored older people’s and their relatives’ experiences regarding an integrated emergency department avoidance service. The findings suggest this service may help reduce emergency department waiting times for older people with urgent but non-emergency needs.

Further research needs

• There is a need for more high-quality research looking at the effect of integrated care on waiting times. There is also a need for good research that explores older and frail people’s perspectives and experiences of waiting times and integrated care.
• Policy and Practice Implications 

There is some evidence that interventions may improve inpatient waiting times to surgery, and emergency waiting times in an emergency department. Therefore, initiatives supporting the development and use of integrated care interventions is crucial.  

Lay Summary Author: Bob Hall, Public Partnership Group Member

To see the full report, click here.