Purpose Integrating health and social care is a priority in England, although there is little evidence that previous initiatives have reduced hospital admissions or costs. In total, 25 Integrated Care Pioneers have been established to drive change “at scale and pace”. The early phases of the evaluation (April 2014-June 2016) aimed to identify their objectives, plans and activities, and to assess the extent to which they have overcome barriers to integration. In the longer term, the authors will assess whether integrated care leads to improved outcomes and quality of care and at what cost. The paper aims to discuss these issues. Design/methodology/approach Mixed methods involving documentary analysis, qualitative interviews and an online key informant survey. Findings Over time, there was a narrowing of the integration agenda in most Pioneers. The predominant approach was to establish community-based multi-disciplinary teams focussed on (older) people with multiple long-term conditions with extensive needs. Moving from design to delivery proved difficult, as many barriers are outside the control of local actors. There was limited evidence of service change. Research limitations/implications Because the findings relate to the early stage of the 5+ years of the Pioneer programme (2014-2019), it is not yet possible to detect changes in services or in user experiences and outcomes. Practical implications The persistence of many barriers to integration highlights the need for greater national support to remove them. Originality/value The evaluation demonstrates that implementing integrated health and social care is not a short-term process and cannot be achieved without national support in tackling persistent barriers.