THE ESSENCE PROJECT

Continuing healthcare

Evidence

Get Well Soon
Studdert J, Stopforth S, Parker S, et al New Local Government Network, London. 2016

This report from New Local Government Network (and supported by Midland Heart) argues that the health service in its current form is not sustainable, and sets out a new plan for shifting the system to focus on preventing illness, shorten stays in hospitals and help people live independently for longer.

It makes a number of references to housing interventions and the care efficiencies that can be achieved and recommends that any new resources for health announced by government should be designated to support a transition to place-based health and a renewed focus on people’s wellbeing to drive a reduction in health inequalities.

In addition, with devolution in mind, it calls for metro mayors and council leaders to be in charge of pooled budgets and other financial models that ensures places rather than institutions are held to account for health.

Personal Budgets and Health: A Review of the Evidence
Wirrmann Gadsby E Policy Research Unit in Commissioning and the Healthcare System, Centre for Health Services Studies, Kent. 2013

The UK Government has committed to expanding the use of personal health budgets for health service users following the evaluation of the pilot programme which ran from 2009-2012. This is part of a wider ‘personalisation’ agenda, which has become a central theme in the reform of health and social care in England, and also features increasingly prominently in the policies of other UK governments, in addition to governments of many other developed countries around the world. A number of other countries around the world have experimented with various forms of personal budgets, although predominantly for the purchasing of care that, in the UK, would be described as social rather than health care. Programmes – and their contexts – vary enormously. There is no programme elsewhere that is directly comparable to personal health budgets in England. There is therefore no directly relevant evidence from which we might extrapolate. However, this review collates evidence on those various programmes in order to examine the case for investing further in personal health budgets. It incorporates the findings of the recently published final report of the evaluation of the personal health budget pilot in England

Personalization in the health care system: Do personal health budgets impact on outcomes and cost?
Jones K, Forder J, Caiels J et al Journal of Health Services Research and Policy, 18, 59-67. 2013

Objectives: In England’s National Health Service, personal health budgets are part of a growing trend to give patients more choice and control over how health care services are managed and delivered. The personal health budget programme was launched by the Department of Health in 2009, and a three-year independent evaluation was commissioned with the aim of identifying whether the initiative ensured better health- and care-related outcomes and at what cost when compared to conventional service delivery. Methods: The evaluation used a pragmatic controlled trial design to compare the outcomes and costs of patients selected to receive a personal health budget with those continuing with conventional support arrangements (control group). Just over 1000 individuals were recruited into the personal health budget group and 1000 into the control group in order to ensure sufficient statistical power, and followed for 12 months. Results: The use of personal health budgets was associated with significant improvement in patients’ care-related quality of life and psychological wellbeing at 12 months. Personal health budgets did not appear to have an impact on health status, mortality rates, health-related quality of life or costs over the same period. With net benefits measured in terms of care-related quality of life on the adult social care outcome toolkit measure, personal health budgets were cost-effective: that is, budget holders experienced greater benefits than people receiving conventional services, and the budgets were worth the cost. Conclusion: The evaluation provides support for the planned wider roll-out of personal health budgets in the English NHS after 2014 in so far as the localities in the pilot sample are representative of the whole country.

What Works in Community Led Support? Findings and Lessons from Local Approaches and Solutions for Transforming Adult Social Care (and Health) Services
Brown H, et al National Development Team for Inclusion, Bath. 2017

The first evaluation report of the Community Led Support (CLS) programme, which supported nine authorities across England, Wales and Scotland to develop and implement a new model of delivering community based care and support. The findings show what can be achieved when applying core principles associated with asset based approaches. CLS involves local authorities working collaboratively with their communities, partner organisations and staff to design a health and social care service that works for everyone. Its core principles include co-production; a focus on communities; preventing crises by enabling people to get support and advice when they need it; a culture based on trust and empowerment; and treating people as equals, and building on their strengths. The evaluation found evidence that CLS resulted in better experiences and outcomes for local people, improved access to services; greater efficiencies in services; reduced waiting times and lists; increased signposting and resolution through community services; improvement in staff morale; and a potential for cost savings. Sites achieved these changes by adopting a variety of approaches to implementing CLS – from implementing CLS across an entire authority area at the same time, to implementing in one innovation site and encouraging others to adopt aspects of the service. The report identifies six priority areas for action to further develop and embed community led support over the next 12-18 months.

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