The ESSENCE project aimed to:
We examined whether there is an economic case for each of a range of adult social care interventions.
We have aimed to communicate the evidence in accessible form and discuss it with as many stakeholders as possible. These stakeholders have included local commissioners, providers, central government officials, individual service users and carers, and researchers: evidence of different kinds will be relevant to different stakeholders.
We have produced a comprehensive collection of everything that can be found (previous research that is relevant) and new analyses (new evidence that we assemble, mainly through modelling), and ‘tools’ that would enable localisation of evidence by illustrating its implications for local levels of needs, service configurations, unit costs and so on.
The aims of this proposed new study are:
We used a broad definition of adult social care, aiming to include interventions across a range of (adult) service user groups, carers and settings. We worked with a range of experts in the area (including other researchers, provider organisations and umbrella bodies) to finalise the selection of interventions to be examined.
Children’s social care refers to all forms of personal care and other practical assistance for children, young people and families who need extra support.
We have adapted the Children’s Social Care toolkit to the framework proposed by What Works Children’s for Social Care (now known as What Works for Early Intervention and Children’s Social Care). The toolkit examines children’s social care practices and cost-effectiveness in the UK. It is categorised by 5 levels of socio-ecological interventions: family, child (interpersonal), community, organisation, and policy, which can operate across a single or multiple socio-ecological domains.
By ‘economic case’ we mean whether an intervention is cost-effective and affordable, paying particular attention to the spread of costs and outcomes (across budgets, sectors or systems) and over different time periods. We sought to identify direct (immediate or longer-term) cashable and non-cashable savings to various public budgets, cashable and non-cashable savings to other stakeholders (e.g. to employers, people using services or families) and cost-effectiveness gains where there are no savings as such, but the additional costs are seen by decision-makers to be justified by the improved outcomes.
The evaluations in this project have shown the costs (and potentially also the savings) alongside these outcomes so that decision-makers have more information to help them choose between the different options available to them, or perhaps help them choose to invest in new options that appear to make better use of resources.
We covered as many different social care interventions as possible. We have summarised the economic evidence where there has already been good research. Where there was no such evidence during our project we tried to generate new findings using a range of ‘modelling’ techniques that aim to simulate what the cost and outcome consequences would be from (say) partial previous evaluations or using data held by local authorities.
We have summarised the findings for each intervention in ways that make the findings understandable to a wide range of people. In due course, we will also produce some simple interactive ‘tools’ so that local decision-makers can explore what the implications would be in their own local contexts (given that needs differ from one locality to another, as does the availability of services and their costs).
There are never enough resources to meet every need or to satisfy every want. This applies as much to social care as it does to any other area or system in any society across the world. Consequently, difficult choices have to be made about how to use the resources that are available (such as social workers, care home places, home care hours, etc.). Decision-makers in local authorities, provider organisations, fieldwork teams – and in fact also individual service users and carers (especially those with personal budgets or who are self-funders) – therefore have to weigh up the pros and cons of different ways of using their resources or spending their budgets.
Those decision-makers will want to think through a number of considerations when deciding how to allocate their personal or organisational resources. One of those considerations is how to achieve the greatest beneficial outcomes from a given level of resources. For example, a local authority commissioner may want to meet as many needs as possible or to support as many people as possible to achieve independence or (in some sense) to improve overall wellbeing in the community as much as possible.
Well-conducted economic evaluations can provide decision-makers will information that can help them face up to the difficulty of not having sufficient resources to meet needs. These evaluations show the costs of two or more different interventions (such as two or more different services or preventive strategies) and the relative outcomes that will result. Those outcomes could include improved well-being for individuals with social care needs or their carers, greater independence in the activities of daily living (washing, dressing, meals preparation etc.), more choice and control over the services received (which services, when delivered, who by, and so on), and better support so that people can contribute to their families and to society in ways that are important to them.
NIHR School for
Social Care Research