The complex challenges facing the health and social care sector in Wales, including increasing numbers of people with long-term health conditions, health inequalities, and workforce and hospital pressures, point to the need for greater integration of health and social care, with a stronger focus on prevention and early intervention. To address this, the 2021-2026 Welsh Government established its Integrated Community Care System (ICCS), which sets out a framework for Regional Partnership Boards (RPBs) to develop more integrated, preventative health and social care services across Wales.

Despite a clear legal and policy framework to deliver preventative and integrated health and social care in Wales, set out in the Social Service and Wellbeing (Wales) Act 2014 and the Wellbeing of Future Generations (Wales) Act 2015, measuring the impact of preventative and integrated approaches remains challenging due to a lack of robust measurement tools and frameworks.

To address this, the 2021-2026 Welsh Government asked the Wales Centre for Public Policy (WCPP) to provide evidence on the extent to which existing measurement tools and frameworks can effectively evaluate the impact of integrated prevention and early intervention services, to support wider policy ambitions to strengthen early intervention, prevention and integration across health and social care.

To deliver this research, WCPP commissioned the Centre for Health Promotion Research to conduct a review into the following research questions:

1. How have measurement tools for assessing the preventative impact of integrated prevention and early intervention services and interventions in health and social care services been developed elsewhere?
2. How are measurement tools and frameworks being used in the UK and internationally to evaluate the impact of prevention and early intervention in integrated health and social care? Which of these show promise in supporting an integrated approach to measuring the impact of prevention and early intervention in health and social care?
3. How could existing evaluation tools, methods and approaches support the development of shared measurement frameworks for integrated prevention and early intervention in health and social care in Wales?

A rapid review of academic evidence and a series of focus groups and interviews with stakeholders across Wales and the UK was conducted to explore the practical challenges and opportunities associated with measuring prevention in complex systems.  The key findings from this work are:

• There is no single approach to measuring impact that can be applied universally. Definitions of ‘prevention’ and ‘integration’ vary significantly across services and sectors. Measurement approaches must be carefully tailored to reflect these differences.
• It is important to identify both long-term preventative outcomes, and the mechanisms and intermediate outcomes that lead to these impacts. Given the complexity of prevention, early signals of success may need to be captured through interim measures, at both person-centred and system levels.
• The service user voice should be central to measurement. Person-centred outcomes, including wellbeing, quality of life, and experience of care, were seen as critical components of any framework.
• Careful consideration needs to be given to the practical challenges associated with implementing measurement frameworks in this area. These include the burden on staff and services of data collection, limitations in data sharing infrastructure, and disparities in capacity and resources across organisations, particularly within the third sector. There was a strong preference amongst practitioners for using a small number of measures, rather than large, complex frameworks that can be difficult to implement consistently.

The conclusion reached by this work is that measurement frameworks should be designed with flexibility in mind. A ‘one size fits all’ approach is unlikely to be effective, and there is a need to allow for adaptation at service and local system level, within an agreed national framework. Supporting capacity for evaluation, improving data infrastructure, and ensuring alignment between measurement and policy objectives will also be critical to successful implementation.