Bundle contents: Advocacy

Support provided by a third party including professional advocacy, citizen advocacy, family advocacy and peer advocacy. An advocate helps someone with health and social care needs to express their needs and wishes, and to weigh up and take decisions about options available to them. Advocates can help people find services, make sure correct procedures are followed and challenge decisions made by councils or other organisations.The advocate is there to represent the person’s interests, which they can do by supporting them to speak, or by speaking on their behalf.


An Analysis of the Economic Impacts of the British Red Cross Support at Home Service
Dixon J, Winterbourne S, Lombard D, et al Personal Social Services Research Unit, London. 2015

This British Red Cross volunteer-based scheme offers short-term (4-12 week) practical and emotional support at home for older people recently discharged from hospital. Using data from the British Red Cross internal evaluation (n=52 individuals; Joy et al., 2013), savings from needing less help with daily activities and improvements in subjective well-being averaged £884 per person. This covered savings up until 6 months following the intervention and included reduced use of paid homecare workers (£167), unpaid care valued at minimum wage (£411) and general help (£75), as well as reduced healthcare costs for treatment associated with falls (£153), malnutrition (£74) and depressive symptoms (£4). The internal British Red Cross evaluation could not identify a control group and no adequate external comparison group could be identified for our economic evaluation. However, we estimated that the intervention costs an average £169 per person, including volunteer time valued at minimum wage. The scheme would need to be responsible for 19 per cent of the estimated savings to be considered cost-saving. Qualitative research, conducted as part of the British Red Cross evaluation, indicated that there were also wider benefits, including enabling safe discharge, supporting carers, enabling patient advocacy and quality of life benefits that could not be included in the economic analysis. More detailed results are available.

Building Community Capacity: Making an Economic Case
Knapp M, Bauer A, Perkins M Personal Social Services Research Unit, London. 2010

Our aim in this small study was to develop simple ‘models’ of interventions that can contribute
to local community development programmes by examining some of the possible impacts. We
could not look at all impacts because of data limitations. These are necessarily simplified
representations of reality, because of the availability of evidence. But this is a pragmatic
approach, using published, unpublished and experiential evidence, and working closely with local experts, and was the most helpful way to go forward given time constraints. We
calculated the costs of three particular community initiatives – time banks, befriending and
community navigators for people with debt or benefits problems – and found that each
generated net economic benefits in quite a short time period. Each of those calculations was
conservative in that we only attached a monetary value to a subset of the potential benefits.

Circles of support and personalisation: exploring the economic case
Gerald W, Perkins M, Knapp M, et al Journal of Intellectual Disabilities, 20, 2, 194-207. 2016

Circles of Support aim to enable people with learning disabilities (and others) to live
full lives as part of their communities. As part of a wider study of the economic case
for community capacity building conducted from 2012-2014, we conducted a mixed
methods study of five Circles in North West England. Members of these Circles were
supporting adults with moderate to profound learning disabilities and provided
accounts of success in enabling the core member to live more independent lives
with improved social care outcomes within cost envelopes that appeared to be less
than more traditional types of support. The Circles also reported success in
harnessing community resources to promote social inclusion and improve
wellbeing. This very small scale study can only offer tentative evidence but does
appear to justify more rigorous research into the potential of Circles to secure cost
effective means of providing support to people with learning disabilities than the
alternative, which in most cases would have been a long-term residential care

Investing in Advocacy for Parents with Learning Disabilities: What is the Economic Argument?
Bauer A, Wistow G, Dixon J, et al British Journal of Learning Disabilities, 43, 66-74. 2014

Advocacy services may be called upon at the beginning of, or in the course of, child safeguarding processes. Without this support, parents with learning disabilities often find it difficult to participate effectively. We worked with four advocacy services, which together provided information on seventeen case studies. Costs of service provision were calculated for each case based on budget and activity information. Economic consequences of reduced child safeguarding activities were derived for cases in which there was evidence that the involvement of advocacy had changed the outcome. Incremental costs were calculated by comparing this against a vignette, developed from previous research, of a typical child safeguarding process that ends with the child being removed from the parental home.
On average, an advocacy intervention consisted of 95 hours of client-related work and cost £3,040. Potential savings included net benefits of £720 over the course of the intervention (average 9 months) to councils’ social services departments from reduced safeguarding activities, care proceedings and care provision, as well as potential longer-term net benefits of £3,130 due to increased access to interventions such as parenting programmes, benefits (debt) advice, counselling, support for alcohol problems and victim support. There may also be economic impacts for children in their later lives that were not included in our analyses, such as improved school performance. (For example, the cost of a child leaving without school qualifications has been projected to be £58,000.) Full details have been published.

National Evaluation of Partnerships for Older People Projects: Final Report
Windle K, Wagland R, Forder J, et al Personal Social Services Research Unit, Kent. 2009

The Partnership for Older People Projects (POPP) were funded by the Department of Health to
develop services for older people, aimed at promoting their health, well‐being and independence
and preventing or delaying their need for higher intensity or institutional care. The evaluation found
that a wide range of projects resulted in improved quality of life for participants and considerable
savings, as well as better local working relationships.
 Twenty‐nine local authorities were involved as pilot sites, working with health and voluntary
sector partners to develop services, with funding of £60m
 Those projects developed ranged from low level services, such as lunch‐clubs, to more formal
preventive initiatives, such as hospital discharge and rapid response services
 Over a quarter of a million people (264,637) used one or more of these services
 The reduction in hospital emergency bed days resulted in considerable savings, to the extent
that for every extra £1 spent on the POPP services, there has been approximately a £1.20
additional benefit in savings on emergency bed days. This is the headline estimate drawn from a
statistically valid range of £0.80 to £1.60 saving on emergency bed days for every extra £1 spent
on the projects.
 Overnight hospital stays were seemingly reduced by 47% and use of Accident & Emergency
departments by 29%. Reductions were also seen in physiotherapy/occupational therapy and
clinic or outpatient appointments with a total cost reduction of £2,166 per person
 A practical example of what works is pro‐active case coordination services, where visits to A&E
departments fell by 60%, hospital overnight stays were reduced by 48%, phone calls to GPs fell
by 28%, visits to practice nurses reduced by 25% and GP appointments reduced by 10%
 Efficiency gains in health service use appear to have been achieved without any adverse impact
on the use of social care resources
 The overwhelming majority of the POPP projects have been sustained, with only 3% being closed
– either because they did not deliver the intended outcomes or because local strategic priorities
had changed
 PCTs have contributed to the sustainability of the POPP projects within all 29 pilot sites.
Moreover, within almost half of the sites, one or more of the projects are being entirely
sustained through PCT funding – a total of 20% of POPP projects. There are a further 14% of
projects for which PCTs are providing at least half of the necessary ongoing funding
 POPP services appear to have improved users’ quality of life, varying with the nature of
individual projects; those providing services to individuals with complex needs were particularly
successful, but low‐level preventive projects also had an impact
 All local projects involved older people in their design and management, although to varying
degrees, including as members of steering or programme boards, in staff recruitment panels, as
volunteers or in the evaluation
 Improved relationships with health agencies and the voluntary sector in the locality were
generally reported as a result of partnership working, although there were some difficulties
securing the involvement of GPs

Taking Stock: Assessing the Value of Preventative Support
New Economics Foundation and British Red Cross British Red Cross, London. 2012

The aim of this report is to illustrate how British Red Cross preventative services providing time-limited practical and emotional support deliver savings for public sector partners including the NHS and local authorities. It presents brief case studies of 5 people who received personalised support from British Red Cross staff and volunteers to help them live independently in their communities. In each case it describes the action taken and the impact of the services and support provided. It includes an independent economic analysis of each case study assessing the costs which could have been incurred by statutory services in delivering care in the absence of the British Red Cross services. It reports that savings of between £700 and over £10,000 were delivered per person, and that this reflects a minimum return on investment of over 3.5 times the cost of the British Red Cross service provided.

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