Read the full case study for 'Cognitive stimulation therapy: economic evidence' here (PDF)
Annette Bauer, Martin Knapp, Adelina Comas-Herrera, Danielle Guy 2019

KEY POINTS

• Cognitive stimulation therapy (CST) helps memory and cognition of people with dementia. It involves structured group therapy sessions with themed activities. Those are typically provided over 14 sessions in seven weeks.
• Maintenance CST involves 24 additional sessions after the initial seven weeks that follow the same principles as regular cognitive stimulation therapy sessions.
• People using CST are likely to experience improvements in memory, cognition, and overall quality of life (although improvements in quality of life are less easy to establish).
• Both (standard) CST and maintenance CST for people with mild-to-moderate dementia can be cost-effective; this is particular so when offered in combination with dementia medication.
• Whilst provision of CST is recommended by NICE, and rolled out more widely, current provision remains patchy.

Read the full case study for 'Help-at-home: economic evidence' here (PDF)
Annette Bauer, Michela Tinelli, Danielle Guy 2019

KEY POINTS

• Help-at-home schemes provide older people with access to a range of highly-valued support and can lead to health and wellbeing benefits.
• Help-at-home schemes appear to save local government and the NHS around £1500 per person per year, owing to:
  • people remaining longer in their homes, rather than moving to care homes;
  • fewer GP appointments;
  • fewer hospital admissions.
• Benefits of help-at-home schemes might also accrue to volunteers providing support (who are more likely to find jobs after gaining skills through volunteering with the schemes).
• Findings from the economic evaluation summarised here are the first to demonstrate that help-at-home schemes also have the potential to offer value for money
• Despite the support provided by help-at-home schemes some older people continue to experience loneliness, financial worries and personal care.
• Despite economic evidence that help-at-home schemes can be good value for money, many benefits are likely to depend on local infrastructures and how such schemes are run, making it hard to generalise their value.

Read the full case study for 'Interventions beyond medicine for dementia: economic evidence' here (PDF)
Michela Tinelli, Martin Knapp, Adelina Comas-Herrera, Danielle Guy 2019

KEY POINTS

• A series of interventions ‘beyond medicine’ are available for people living with dementia. The effectiveness in relation to cognition, independence, wellbeing and other outcomes varies across these interventions.
• The National Institute for Health and Care Excellence (NICE) developed economic models to simulate the cost-effectiveness for an average person receiving each intervention of interest, compared with usual care. The effectiveness measure was (health-related) quality-adjusted life years (QALYs).
• Individual cognitive stimulation therapy is the only cost-effective intervention for dementia. However, group cognitive stimulation therapy and group reminiscence therapy are interventions to consider for people living with mild-to-moderate dementia. Additionally, cognitive rehabilitation or occupational therapy are interventions to consider for supporting functional ability in people living with mild-to-moderate dementia.
• For other interventions the NICE committee agreed that people should be offered access to a range of activities that should be tailored to their individual preferences.

A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation
Harrington R, Taylor G, Hollinghurst S, et al Clinical Rehabiliation, 24, 3-15. 2010

Abstract
OBJECTIVE:

The evaluation of a community-based exercise and education scheme for stroke survivors.
DESIGN:

A single blind parallel group randomized controlled trial.
SETTING:

Leisure and community centres in the south-west of England.
SUBJECTS:

Stroke survivors (median (IQR) time post stroke 10.3 (5.4-17.1) months). 243 participants were randomized to standard care (124) or the intervention (119).
INTERVENTION:

Exercise and education schemes held twice weekly for eight weeks, facilitated by volunteers and qualified exercise instructors (supported by a physiotherapist), each with nine participants plus carers or family members.
METHOD:

Participants were assessed by a blinded independent assessor at two weeks before the start of the scheme, nine weeks and six months. One-year follow-up was by postal assessment.
MAIN MEASURES:

PRIMARY OUTCOMES:

Subjective Index of Physical and Social Outcome (SIPSO); Frenchay Activities Index; Rivermead Mobility Index. NHS, social care and personal costs. Secondary outcomes included WHOQoL-Bref.
ANALYSIS:

Intention-to-treat basis, using non-parametric analysis to investigate change from baseline. Economic costs were compared in a cost-consequences analysis.
RESULTS:

There were significant between-group changes in SIPSO physical at nine weeks (median (95% confidence interval (CI)), 1 (0, 2): P = 0.022) and at one year (0 (-1, 2): P = 0.024). (WHOQol-Bref psychological (6.2 (-0.1, 9.1): P = 0.011) at six months. Mean cost per patient was higher in the intervention group. The difference, excluding inpatient care, was pound296 (95% CI: – pound321 to pound913).
CONCLUSION:

The community scheme for stroke survivors was a low-cost intervention successful in improving physical integration, maintained at one year, when compared with standard care.

Adult Day Program services for seniors with dementia: An innovative model of community-college partnership (Innovative Practice)
Mirou Jaana Adult Day Program services for seniors with dementia: An innovative model of community-college partnership (Innovative Practice) 2020

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.

An Independent Review of Shared Lives for Older People and People Living with Dementia
PPL, Cordis Bright, Social Finance PPL, London. 2018

Shared Lives is based around a Shared Lives carer sharing their home with an adult in need of care, to encourage meaningful relationships, independent living skills and community integration. This review explores how Shared Lives’ respite service for older people and people with dementia compare to ‘traditional’ forms of care for across three areas: outcomes for service users, carer and care commissioners; direct care costs to commissioners; and impact on the broader health system, such as a reduced usage. The review found that Shared Lives model provides positive outcomes for both service users and carers. It found that Shared Lives arrangements were able to reduce social isolation experience by carers and help increase their general wellbeing. Shared Lives also resulted in increased independence, wellbeing and choice for service users. In addition, the study found that the costs Shared Lives approach are similar to ‘traditional’ respite provision and provide an important option for commissioners. Appendices include details of calculations of the cost of providing Shared Lives respite care and day services; the results of a rapid evidence assessment on outcomes of ‘traditional’ respite care; and details of Healthcare service usage modelling.

Assessing the impact of Person-centered Planning on the Community Integration of Adults with an Intellectural Disability
Darren McCausland, Esther Murphy, Philip McCallion, Mary McCarron Assessing the impact of Person-centered Planning on the Community Integration of Adults with an Intellectural Disability 2019

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.

Building community capital in social care: is there an economic case?
Knapp M, Bauer A, Perkins M, et al Community Development Journal, 48, 313-331. 2013

ABSTRACT
Current debates in many countries about the sustainability of public commitments include
discussion of the adequacy and affordability of collective health and social care responses to the
rapidly growing needs of ageing communities. A recurrent theme in England is whether
communities can play greater roles in preventing the emergence of social care needs and/or in
helping to meet them. A number of approaches have been suggested, employing a range of
concepts and terms, including community development, community capacity-building and
creating social capital. We investigated whether initiatives of this kind generate cost-savings to the
public purse and more broadly to society. We used a cost-benefit approach and decisionmodelling techniques to demonstrate potential costs and economic consequences in a context
where evidence is limited and there is little opportunity to collect primary data. We found that
there could be sizable savings to the public purse when investing in community capital-building
initiatives at relatively low cost. We discuss the limitations of our analysis and recommend
collection of better outcome data.

Building Wellbeing and Resilience - Living Well
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2016

The Living Well scheme aims to improve prevention and resilience amongst older people with multiple long-term conditions by providing low-level support to day-to-day living and utilising asset-based resources to promote empowerment and wellbeing.

The process begins with a conversation between the person and the voluntary sector coordinator, who helps them to identify their goals and coordinate a management plan. Trained volunteers provide support to build social networks around the individual to help them become better connected to their community, be more physically and socially active and subsequently have better health outcomes. Practical support, navigation and coordination are provided in order to boost self-confidence and self-reliance, leading to reduced adult social care spend and primary/community health benefits.

Care and Health Improvement Programme: Efficiency Project
Local Government Association Local Government Association, London. 2018

This report provides practice examples from ten councils who took part in the Care and Health Improvement Programme during 2016/17. It describes the innovative approaches they took to achieve greater efficiencies from their adult social care budgets and draws conclusions as to what other councils might learn from them. The examples cover three main areas: managing demand for social care by offering residents a different type of service; more effectively using the capacity in communities to help find new care solutions; and working closer with partners in the NHS to reduce pressures in the care and health system. They highlight the importance of councils dealing with people effectively at their first point of contact; the benefits of using strength-based approaches; that developing social enterprises can be a cost effective way of meeting demand and reducing shortage of supply; and the potential of collaboration between councils to reduce costs and demand for services. The 10 councils are: Bristol City Council, Poole Borough Council, Swindon and Wiltshire Councils; Norfolk County Council; Waltham Forest Council; Somerset Council; Newcastle City Council; Nottingham City Council; and Nottinghamshire County Council.

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
placement

Clinical and cost effectiveness of services for early diagnosis and intervention in dementia
Banerjee S and Wittenberg R International ournal of Geriatric Psychiatry, 24, 748-754. 2009

Abstract
BACKGROUND:
This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia.

METHOD:
A model was developed to examine potential public and private savings associated with delayed admissions to care homes in England as a result of the commissioning of memory services.

FINDINGS:
The new services would cost around pound sterling 220 million extra per year nationally in England. The estimated savings if 10% of care home admissions were prevented would by year 10 be around pound sterling 120 million in public expenditure (social care) and pound sterling 125 million in private expenditure (service users and their families), a total of pound sterling 245 million. Under a 20% reduction, the annual cost would within around 6 years be offset by the savings to public funds alone. In 10 years all people with dementia will have had the chance to be seen by the new services. A gain of between 0.01 and 0.02 QALYs per person year would be sufficient to render the service cost-effective (in terms of positive net present value). These relatively small improvements seem very likely to be achievable.

INTERPRETATION:
These analyses suggest that the service need only achieve a modest increase in average quality of life of people with dementia, plus a 10% diversion of people with dementia from residential care, to be cost-effective. The net increase in public expenditure would then, on the assumptions discussed and from a societal perspective, be justified by the expected benefits. This modelling presents for debate support for the development of nationwide services for the early identification and treatment of dementia in terms of quality of life and overall cost-effectiveness.

Community Development in Health: A Literature Review
Fisher B Health Empowerment Leverage Project, London. 2016

This literature review offers a brief background to the current state of play in the NHS and statutory services, and ideas that services more flexible, place-based services are likely to offer more effective and efficient outcomes. It then provides an overview of the nature of community development, its relationship to community health and to enhancing the responsiveness of commissioning of services. It brings together evidence which shows how communities can be supported to develop their own strengths and their own trajectories of development. It also examines the health benefits of community engagement, and identifies the limitations of some studies and where evidence that suggests poor outcomes or risks. It looks developing a business case, and what is already known of costs and benefits of community development. It finds that although it is difficult to express costs and benefits of community development in monetary terms, some effective techniques do exist. The evidence shows that community development helps to strengthen and increase social networks and therefore build up social capital. Evidence shows that they to contribute significantly to individual and to community health and resilience. Existing data also suggests that community development in health is cost-effective and provides good value for money. The review includes definitions of community development and key related concepts, including as asset-based approaches, co-production, social networks, social capital, and community capital.

Dementia: Assessment, Management and Support for People Living with Dementia and their Carers [NG97]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2018

This guideline covers diagnosing and managing dementia (including Alzheimer’s disease). It aims to improve care by making recommendations on training staff and helping carers to support people living with dementia.

Recommendations
This guideline includes recommendations on:
• involving people living with dementia in decisions about their care
• assessment and diagnosis
• interventions to promote cognition, independence and wellbeing
• pharmacological interventions
• managing non-cognitive symptoms
• supporting carers
• staff training and education

Who is it for?
• Healthcare and social care professionals caring for and supporting people living with dementia
• Commissioners and providers of dementia health and social care services
• Housing associations, private and voluntary organisations contracted by the NHS or social services to provide care for people living with dementia
• People living with dementia, their families and carers

Related NICE guideline:
Appendix J:Health Economics Authors not listed

Economic Analysis of the Health Champions Scheme in Hammersmith and Fulham
Bauer A and Fernandez JL Personal Social Service Research Unit, London. 2012

This study assesses costs and economic benefits of the Health Champions scheme under the Well London programme. As part of their volunteering role, health champions and other volunteers signposted
individuals to services and – after receiving additional training – provided health promotion advice and supported the delivery of activities on a broad range of topics including physical activity, healthy eating, smoking cessation and mental wellbeing. At the same time as the health champion scheme was set up, the Well London programme ran locally providing a wide range of (mental) health promotion
activities which health champions and volunteers referred to. The analysis showed that it was not possible to derive a single economic value that could be attributed to the Scheme.

Economic Evaluation of an "Experts by Experience" Model in Basildon District
Bauer A, et al Personal Social Services Research Unit, London. 2011

The aim of the project was the development of a business case based on economic evaluation
methods which supports local commissioners in Basildon in the reconfiguration of services, following
the implementation of Turning Point’s Connected Care community led audit and recommendations
for commissioning and provision of services in the communities of SE Pitsea and Vange. One of the
recommendations made by the Connected Care Community researchers was for a community led
and delivered service, Experts by Experience (EbE). The business case examined likely costs and
outcomes of a community navigator programme, (EbE), which targets high-risk individuals and those
with complex or multiple needs in the deprived neighbourhoods of SE Pitsea and Vange in Basildon
district. The service design was developed by members of the community, commissioners and other
stakeholders, based on the audit of local needs carried out by local people. The economic evaluation
explored, from a societal and total public budget perspective, the short-term (1 year) likely costs and
benefits of a hypothetical implementation of the EbE programme. An interactive toolkit was
developed to illustrate the contributions of different service pathways to the costs and benefits of
the EbE programme

Economic impact of social care services. Assessment of the outcomes for disabled adults with moderate care needs
Deloitte Deloitte, London. 2013

This report provides evidence on the costs and benefits of providing care to working aged disabled adults with with moderate care needs

Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: randomised controlled trial
Coulton S, Clift S, Skingley A, et al British Journal of Psychiatry, 207, 250-255. 2015

Abstract
BACKGROUND:
As the population ages, older people account for a greater proportion of the health and social care budget. Whereas some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people.

AIMS:
To evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England.

METHOD:
A pilot pragmatic individual randomised controlled trial comparing group singing with usual activities in those aged 60 years or more.

RESULTS:
A total of 258 participants were recruited across five centres in East Kent. At 6 months post-randomisation, significant differences were observed in terms of mental health-related quality of life measured using the SF12 (mean difference = 2.35; 95% CI = 0.06-4.76) in favour of group singing. In addition, the intervention was found to be marginally more cost-effective than usual activities. At 3 months, significant differences were observed for the mental health components of quality of life (mean difference = 4.77; 2.53-7.01), anxiety (mean difference = -1.78; -2.5 to -1.06) and depression (mean difference = -1.52; -2.13 to -0.92).

CONCLUSIONS:
Community group singing appears to have a significant effect on mental health-related quality of life, anxiety and depression, and it may be a useful intervention to maintain and enhance the mental health of older people.

Effectiveness of Day Services: Summary of Research Evidence
Age UK Age UK, London. 2011

This briefing updates the research evidence on the effectiveness of day services featured in the publication ‘Day services for older people. Quality and effectiveness: a resource for providers and commissioners’ (2008). After outlining the range of services and activities covered by the term ‘day services’, the briefing summarises the key points and outlines the methodology used for the review. The review which involved literature searches on a number of databases, journal archives, websites in July and August 2011. These searches supplement the original literature search which was carried out in December 2007. The findings and summaries of research evidence are then presented, listing each report in turn. Due to the lack of evidence focusing on day services, research is also included on activities to reduce isolation and loneliness. The few studies that specifically evaluated the impact of day services found that older people and their carers benefitted from them. The review also identified the different types of day services that can address older people’s need for social contact, exercise, to engage in and make contributions to society.

Evaluation of Redcar and Cleveland Community Agents Project: Outputs and Outcomes Summary Report
Watson P and Shucksmith J Social Care Institute for Excellence, London. 2015

The Community Agents Project, a programme jointly funded through health and adult social care services, is an innovative approach to meeting the social needs of the elderly and vulnerable population. Community agents act as a one-stop shop, signposting people to the appropriate service that meets their needs. This could be an organisation or voluntary group that can help with shopping, arrange transport to the GP surgery or hospital appointments, help to complete forms, offer encouragement to maintain a care plan, organise a befriender, accompany to a local social activity or signposting to other agencies. The project has received a total of 486 referrals across the borough of Redcar & Cleveland for the period September 2014-September 2015, generating positive outcomes in the following areas: maintaining independence; faster discharge from hospital; reducing admissions to hospital; reducing isolation; improved financial status; appropriate use of health and social services; cost saving; and increases in community capacity. The report estimates a social return on investment of £3.29 for every £1 invested in the Community Agents Project

Evaluation of the Cambridgeshire Timebanks
Gemma B Cambridge Centre for Housing and Planning Research, Cambridge. 2014

The research suggested that the timebanks were developing successfully, with increasing numbers of members and exchanges. There was evidence of a range of benefits to the members who are involved and evidence of positive outcomes, including reduced social isolation.
This research evaluated the development of a timebanking project in Cambridgeshire for Cambridgeshire County Council and the CHS Group. Timebanking is a community scheme which enables local people to exchange skills and support in a structured way around the swapping of units of their time. It can help to build social capital in local communities, but may also have the potential to generate cost savings.

Growing Innovative Models of Health, Care and Support for Adults
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2018

Key Messages: Innovation is needed more than ever as our challenges grow. Innovation does not only mean technological breakthroughs or large restructures. New and better ways of delivering relationship-based care are needed, and already exist, but are inconsistently implemented or poorly scaled.
For innovation to flourish, we need to find better ways to help people bring good ideas from the margins into core business. The keys to success are:
a shared ambition to ‘embed person- and community-centred ways of working across the system, using the best available tools and evidence’
co-production: planning with the people who have the greatest stake in our services from the beginning
a new model of leadership which is collaborative and convening
investment and commissioning approaches which transfer resources from low quality, low outcomes into approaches which work effectively
effective outcomes monitoring and use of data to drive change
a willingness to learn from experience.

How can Local Authorities with Less Money Support Better Outcomes for Older People?
Centre for Policy on Ageing Joseph Rowntree Foundation, York. 2011

Research shows that older people want and value low-level support – ‘that bit of help’ – but the benefits of investing in this are realised over many years, making it harder to prove impact and protect funding in the face of severe pressure on spending.

This ‘Solutions’ published by Joseph Rowntree Foundation provides examples of imaginative, affordable and effective ways of supporting older people’s health, well-being, social engagement and independence. It highlights projects with some local authority involvement whether as lead commissioner, subsidiary partner, or through small grants or seed-funding.

The projects demonstrate the importance of:

involving people who use support and services in shaping them;
investing in collective solutions, small grants or seed-funding for self-help groups, and developing local markets to provide the support people want and value;
greater emphasis on the assistance that older people need and choose, and their experiences rather than on conventional social care and/or services;
developing place-based approaches that reflect the whole of people’s lives, and delivering value for money, for example by including transport

Implementing Active Support in disability day services: A 6-month prospective study on engagement and behaviours of concern among adults with intellectual disability
Jiayong Lin, Vimallan Manokara, Jesselyn S Ng, Sivananda Penchaliah Implementing Active Support in disability day services: A 6-month prospective study on engagement and behaviours of concern among adults with intellectual disability 2020

Intermediate Care Including Reablement [NG74]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2017

This guideline covers referral and assessment for intermediate care and how to deliver the service. Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions to hospitals and residential care.
Recommendations

This guideline includes recommendations on:

core principles of intermediate care, including reablement
supporting infrastructure
assessment of need for intermediate care
referral into intermediate care and entering the service
delivering intermediate care
transition from intermediate care
training and development

Who is it for?

Health and social care practitioners who deliver intermediate care and reablement in the community and in bed-based settings
Other practitioners who work in voluntary and community services, including home care, general practice and housing
Health and social care practitioners in acute inpatient settings
Commissioners and providers
Adults using intermediate care and reablement services, and their families and carers

Related NICE guideline:
Appendix C3: Economic report Intermediate care Bauer A and Fernandez JL

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.

Investing in Recovery: Making the Business Case for Effective Interventions for People with Schizophrenia and Psychosis
Knapp M, Andrew A, McDaid D, et al Rethink Mental Illness, London. 2014

This study provides economic evidence to support the case for investing in effective, recovery-focused services for people with schizophrenia and psychosis. Drawing on a wide range of data, it sets out the evidence for the cost-effectiveness for a range of interventions and service. Those discussed are: Early Detection (ED) services; Early Intervention (EI) teams; Individual Placement and Support (IPS); Family therapy; Criminal justice liaison and diversion; Physical health promotion, including health behaviours; Supported housing; Crisis Resolution and Home Treatment (CRHT) teams; Crisis houses; Peer support; Self-management; Cognitive Behavioural Therapy (CBT); Anti-stigma and discrimination campaigns; Personal Budgets (PBs); and Welfare advice. For each intervention the report provides information on the context, the nature of the intervention, the evidence on effectiveness and cost-effectiveness, and the policy and practice implications. The report finds evidence to suggest that all of the interventions contribute to recovery outcomes, reduced costs and/or better value for money. Examples of the savings incurred through particular interventions are also included. The study was undertaken by a team from the Personal Social Services Research Unit (PSSRU), at the London School of Economics and Political Science (LSE), the Centre for Mental Health, and the Centre for the Economics of Mental and Physical Health (CEMPH) at King’s College London.

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England
Wilberforce M, Tucker S, Brand C, et al International Journal of Geriatric Psychiatry, 31, 11, 1208-1216. 2016

Objectives:To evaluate the association between the degree of integration in community mental healthteams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and carehome admission.Methods:An observational study of service use and admissions to institutional care was undertaken for aprospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to repre-sent‘high’or‘low’levels of integrated working practice and patients were followed-up for seven months.General linear models were used to estimate service costs and the likelihood of institutional admission.Results:Patients supported by high integration teams received services costing an estimated 44% morethan comparable patients in low integration teams. However, after controlling for case mix, no signif-icant differences were found in the likelihood of admission to mental health inpatient wards or carehomes between team types.Conclusions:Integrated mental health and social care teams appeared to facilitate greater access tocommunity care services, but no consequent association was found with community tenure. Furtherresearch is required to identify the necessary and sufficient components of integrated community men-tal health care, and its effect on a wider range of outcomes using patient-reported measures.

Living Well for Longer: The Economic Argument for Investing in the Health and Wellbeing of Older People in Wales
Edwards RT, Spencer LH, Bryning L, et al Centre for Health Economics and Medicines Evaluation, Bangor. 2018

This report by the University of Bangor makes the economic argument for investing in prevention at different stages of the life course, in particular, older people.

Commissioned by Public Health Wales, it brings together robust international and UK evidence on the relative cost-effectiveness and return on investment of devoting public sector resources to programmes and practices supporting older people.

In relation to housing, it notes that the Welsh Government spends around £50 million per year on adapting the homes of older and disabled people, helping them to live safely and independently.

For every £1 invested in Care & Repair there is £7.50 savings to the taxpayer. It comes to the conclusion that it is cost-effective to improve housing by providing heating and insulation for high risk groups of over 65s.

Local Community Initiatives in Western Bay: Formative Evaluation Summary Report
Swansea University Swansea University, Swansea. 2016

An evaluation of the early implementation of Local Area Coordination (LAC) and Local Community Coordination (LCC) in Neath Port Talbot and Swansea, covering recruitment and initial delivery activities between July 2015 and April 2016. The initiative used both LAC and LCC coordinators to help communities to develop local relationships and support, reduce dependence on services and create conditions for long-term resilience. The evaluation identifies positive outcomes for people, communities and local finances; highlights factors which help create the conditions for good outcomes; and provides recommendations for the development and improvement of LAC. The report also contains case study examples to show how the initiative was able to help individuals. The results of the evaluation found good progress in both LAC and LCC areas, including community engagement, identifying community assets and individuals for support. It also found LAC helped development of strong and sustained personal networks for individuals and communities, reducing isolation and helping to build local resilience. The LAC implementation in Swansea demonstrated cost benefits of £800k – £1.2m, with expected benefits to rise when LAC is embedded more fully within communities. Findings and recommendations are listed across a number of key themes, including: strategy, funding, shared learning, leadership, information recording, recruitment and roles, cost benefits.

Maintenance Cognitive Stimulation Therapy (CST) for dementia: a single-blind, multi-centre, randomized controlled trial of Maintenance CST vs. CST for dementia
Aguirre E, Spector A, Hoe J, et al Trials, 11, 46-46. 2010

Background: Psychological treatments for dementia are widely used in the UK and internationally, but only rarely have they been standardised, adequately evaluated or systematically implemented. There is increasing recognition that psychosocial interventions may have similar levels of effectiveness to medication, and both can be used in combination. Cognitive Stimulation Therapy (CST) is a 7-week cognitive-based approach for dementia that has been shown to be beneficial for cognition and quality of life and is cost-effective, but there is less conclusive evidence for the effects of CST over an extended period.; Methods/design: This multi-centre, pragmatic randomised controlled trial (RCT) to assess the effectiveness and cost-effectiveness of Maintenance CST groups for dementia compares a intervention group who receive CST for 7 weeks followed by the Maintenance CST programme once a week for 24 weeks with the control group who receive CST for 7 weeks, followed by treatment as usual for 24 weeks.The primary outcome measures are quality of life of people with dementia assessed by the QoL-AD and cognition assessed by the ADAS-Cog. Secondary outcomes include the person with dementia’s mood, behaviour, activities of daily living, ability to communicate and costs; as well as caregiver health-related quality of life. Using a 5% significance level, comparison of 230 participants will yield 80% power to detect a standardised difference of 0.39 on the ADAS-Cog between the groups. The trial includes a cost-effectiveness analysis from a public sector perspective.; Discussion: A pilot study of longer-term Maintenance CST, offering 16 weekly sessions of maintenance following the initial CST programme, previously found a significant improvement in cognitive function (MMSE) for those on the intervention group. The study identified the need for a large-scale, multi-centre RCT to define the potential longer-term benefits of continuing the therapy. This study aims to provide definitive evidence of the potential efficacy of maintenance CST and establish how far the long-term benefits can be compared with antidementia drugs such as cholinesterase inhibitors.

Maintenance cognitive stimulation therapy: an economic evaluation within a randomized controlled trial.
D’Amico F, Rehill A, Knapp M Journal of the American Medical Directors Association, 16, 63-70. 2015

BACKGROUND:
Cognitive Stimulation Therapy (CST) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks.

AIMS:
To examine whether longer-term (maintenance) CST is cost-effective when added to usual care.

METHODS:
Cost-effectiveness analysis within multicenter, single-blind, pragmatic randomized controlled trial; subgroup analysis for people taking acetylcholinesterase inhibitors (ACHEIs). A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks. They were randomized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks.

RESULTS:
Although outcome gains were modest over 6 months, maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome, and cognition (MMSE) and proxy-rated quality-adjusted life years as secondary outcomes. CST in combination with ACHEIs offered cost-effectiveness gains when outcome was measured as cognition.

CONCLUSIONS:
Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia.

Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Making the Case for Investing in Actions to Prevent and/or Tackle Loneliness: A Systematic Review. A Briefing Paper
McDaid D, Bauer A, Park A Personal Social Services Research Unit, London. 2017

Summarises findings from a systematic review on the available economic evidence on the cost effectiveness of loneliness interventions for older people. The review found mixed evidence for the cost effectiveness of befriending interventions and the benefits of participation in social activities, ranging from cost saving to cost ineffective interventions. Recent evidence identified suggests that signposting and navigation services have the potential to be cost effective, with a saving of up to £3 of health costs for every £1 invested. The paper also makes suggestions for strengthening the evidence based on the cost effectiveness of interventions to address loneliness.

Money Matters: Reviews of Cost-effective Initiatives
Institute of Public Care The Institute for Research and Innovation in Social Services, Glasgow. 2011

This set of eight case studies, produced by the Institute of Public Care on behalf of IRISS (the Institute for Research and Innovation in Social Services), provides detailed analysis of the cost-effectiveness of a series of recent social care initiatives, ranging from nationwide and relatively high-profile schemes such as individual budgets to those thus far unique to one country, city or local authority area in the UK.

In each case, the report provides an overview of the initiative – its origins, including previous variants of the scheme, who it is intended to help, and how it works in practice – before justifying claims of cost-effectiveness by reference to detailed comparative costings, using one illustrative implementation of the scheme where the initiative is nationwide. Based on the analysis, the report sets out the initiative’s applicability to other settings as well as potential impediments to broader implementation.

The eight initiatives scrutinised are:

A study of Shared Lives schemes in south east England for providing care in the carer’s own home for individuals placed there by the local authority.
An extra-care housing scheme completed in Bradford.
Health in mind – social inclusion support for people with mental health needs in Bradford based round a series of mental health “well-being cafes”.
LinkAge Plus – analysis of nationwide DWP-funded pilot schemes for an holistic approach to provision of services for older people.
The Rapid Response Adaptations Programme – a Welsh initiative for providing adaptations such as ramps to let people return to their own homes.
A project in north west England to guide older people with low-level needs through a self-assessment process.
Analysis of various pilot sites taking different approaches to individual budgets, based on a broader evaluation conducted in 2008.
A project in two acute trusts in London to reconfigure hospital discharge procedures to emphasise rehabilitation.

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

Older People: Independence and Mental Wellbeing [NG32]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2015

This guideline covers interventions to maintain and improve the mental wellbeing and independence of people aged 65 or older and how to identify those most at risk of a decline.

Recommendations
The guideline includes recommendations on:

principles of good practice
group-based activities
one-to-one activities
volunteering
identifying people most at risk of a decline
Who is it for?
Local authorities working in partnership with organisations in the public, private, voluntary and community sectors that come into contact with older people
The NHS and other service providers with a remit for older people
It may also be of interest to older people, their families and carers
Commissioners of services for older people should ensure any service specifications take into account the recommendations in this guideline.

Related NICE guideline:
Independence and mental wellbeing (including social and emotional wellbeing) for older people Economic analysis Mallender J, Pritchard C, Tierney R, et al

Positive behavioural support for adults with intellectual disabilities and behaviour that challenges: an initial exploration of the economic case
Iemmi V, Knapp M, Saville M, et al International Journal of Positive Behavioural Support, 5, 16-25. 2015

Caroline Reid and colleagues have previously shown that the PBS service in Ealing reduced emotional and behavioural difficulties and improved carers’ ability to cope. We collected further data on education, health and social care service use for ten children supported by PBS in Ealing. In Bristol we collected data for twelve children on behaviours that challenge, positive developmental skills before and after the intervention, and use of education, health and social care service by individuals with behaviours that challenge and carers. In Halton we collected service use data for five adults and information on behaviours that challenge, engagement in meaningful activities and community participation.
PBS service costs varied across the three sites from less than £200 per participant per week to around £700. Outcomes improved in all three samples. The total cost of health and social care services (and education for children) during the intervention averaged between £1500 and £2300 per week. Most children and adults supported with PBS were able to avoid residential placements or to be transferred to more service-intensive residential care.
In the absence of a comparator we conducted a Delphi exercise using six ‘case vignettes’. The aim was to estimate the cost of current packages of care that support people with learning disabilities and behaviours that challenge in England. Detail findings from this Delphi study will be published soon. They provided a benchmark for comparisons in the three local studies of PBS (and will be of interest more broadly). We concluded that although there is an initial increase in cost during the period when PBS is provided, avoiding residential placements or transfer to more expensive residential care has the potential to substantially reduce care costs over the longer term. Findings from this multi-faceted study are now being published , but have already informed analyses underpinning recent NICE guidelines.

Prevention. A Shared Commitment: Making the Case for a Prevention Transformation Fund
Local Government Association Local Government Association, London. 2015

This document identifies and collates key pieces of evidence about the cost effectiveness of prevention in order to make the case for greater investment in prevention interventions. The report recommends that the Government should introduce a Prevention Transformation Fund, worth at least £2 billion annually. This would enable some double running of new investment in preventative services alongside ‘business as usual’ in the current system, until savings can be realised and reinvested into the system – as part of wider local prevention strategies. Based on the analysis of an extensive range of intervention case studies that have provided a net cost benefit, the report suggests that investment in prevention could yield a net return of 90 per cent.

Six Innovations in Social Care
Think Local Act Personal Think Local Act Personal, London. 2018

A group of innovators in social care have produced a summary of six innovations.
The innovations covered are:

Community Catalysts
Community Circles
Local Area Coordination
Shared Lives
Homeshare UK
Wellbeing Teams

Each innovation is presented as a one- page summary which cover:

the problem they are aiming to solve
the solution they have created
their evidence base and expected impact
the stage they are at currently
what else is needed to support it
and what would stop the innovation from happening successfully

This document is useful for anyone who is interested in new models of care and support, and would like to find out about different innovations that are being developed across the UK

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.

Technical Guide: Building a Business Case for Prevention
Social Finance Social Finance, London. 2014

This guide sets out the issues that need to be considered when developing a business case to invest in preventive services and to ensure that any decision are based on robust and reliable data. The guide focuses on the following arguments: the importance of ‘investing to save’, arguing that prevention is cheaper in the long term; promotion of service innovation; placing the focus of commissioning on outcomes rather than outputs; and managing a shift in spending from acute to prevention to reduce demand over time. The guide outlines key four activities required to build a business case: understanding needs; understanding current costs; assessing possible interventions; and deciding how to measure the value and outcome of the interventions. It also provides a summary business case for prevention and using a Social Impact Bond (SBI) to finance a business case for prevention. An example case study of making a business case for prevention services in early years services in Greater Manchester is included.

The Community In-reach Rehabilitation and Care Transition (CIRACT) clinical and cost-effectiveness randomisation controlled trial in older people admitted to hospital as an acute medical emergency
Sahota O, Pulikottil-Jacob R, Marshall F, et al Age and Ageing, 46, 26-32. 2017

Objective: to compare the clinical and cost-effectiveness of a Community In-reach Rehabilitation and Care Transition (CIRACT) service with the traditional hospital-based rehabilitation (THB-Rehab) service. Design: pragmatic randomised controlled trial with an integral health economic study. Settings: large UK teaching hospital, with community follow-up. Subjects: frail older people aged 70 years and older admitted to hospital as an acute medical emergency. Measurements: Primary outcome: hospital length of stay; secondary outcomes: readmission, day 91-super spell bed days, functional ability, co-morbidity and health-related quality of life; cost-effectiveness analysis. Results: a total of 250 participants were randomised. There was no significant difference in length of stay between the CIRACT and THB-Rehab service (median 8 versus 9 days; geometric mean 7.8 versus 8.7 days, mean ratio 0.90, 95% confidence interval (CI) 0.74–1.10). Of the participants who were discharged from hospital, 17% and 13% were readmitted within 28 days from the CIRACT and THB-Rehab services, respectively (risk difference 3.8%, 95% CI −5.8% to 13.4%). There were no other significant differences in any of the other secondary outcomes between the two groups. The mean costs (including NHS and personal social service) of the CIRACT and THB-Rehab service were £3,744 and £3,603, respectively (mean cost difference £144; 95% CI −1,645 to 1,934). Conclusion: the CIRACT service does not reduce major hospital length of stay nor reduce short-term readmission rates, compared to the standard THB-Rehab service; however, a modest (<2.3 days) effect cannot be excluded. Further studies are necessary powered with larger sample sizes and cluster randomisation.

The Economic Value of the Adult Social Care sector -England
Kearney J and White A Skills for Care, Leeds. 2018

Key findings

Sector characteristics

An estimated 45,000 sites were involved in providing adult social care in the UK in 2016. Most of these sites provided residential care. A further 72,000 individuals receive direct payments and employ Personal Assistants (PAs);
There were an estimated 1.6 million jobs in the adult social care sector in the UK in 2016. Most of these jobs were involved in providing domiciliary care. There were a further 151,300 jobs due to individuals employing PAs, meaning there were a total of 1.8 million jobs in the adult social care sector in 2016;
There were an estimated 1.2 million Full-Time Equivalents (FTEs) in the adult social care sector in the UK, and a further 69,500 FTEs employed as PAs;
Most of the adult social care workforce providing regulated services were employed at sites run by private sector providers (845,200);
The level of employment in the adult social care sector represents 6% of total employment in the UK; and
The average earnings in the adult social care sector in the UK was estimated to be £17,300.

Economic value of the sector

It was estimated that in 2016, adult social care sector GVA was £23.6 billion (using the income approach). Most of this was estimated to be in domiciliary care (£7.0 billion, 30%);
This represents 1.4% of total GVA in the UK; and
It was estimated that the average level of productivity (GVA generated per FTE) in the adult social care sector was £19,200.

Indirect and induced value of the sector

The indirect effect of the adult social care sector (resulting from the purchase of intermediate goods and services by the adult social care sector in delivering its services) was estimated to contribute a further 603,500 jobs (424,800 FTEs) and £10.8 billion of GVA to the UK economy;
The induced effect of the adult social care sector (resulting from purchases made by those directly and indirectly employed in the adult social care sector) was estimated to contribute a further 251,300 jobs (176,100 FTEs) and £11.1 billion of GVA to the UK economy
The total direct, indirect and induced value of the adult social care sector in the UK was estimated to be 2.6 million jobs (1.8 million FTEs) and £46.2 billion.

The Economic Value of the Adult Social Care sector -UK
Kearney J and White A Skills for Care, Leeds. 2018

Key FindingsSector characteristics■An estimated 45,000sites were involved in providing adult social care in the UKin 2016. Most of these sitesprovided residentialcare. A further 72,000 individuals receive direct payments and employ Personal Assistants (PAs);■There were an estimated 1.6 millionjobs in the adult social care sector in the UKin 2016. Most of these jobs were involved in providing domiciliarycare. There were a further 151,300jobs due to individuals employing PAs, meaning there were a total of 1.8 millionjobs in the adult social care sector in 2016;■There were an estimated 1.2 millionFull-Time Equivalents (FTEs) in the adult social care sector in the UK, and a further 69,500FTEs employed as PAs;■Most of the adult social care workforce providing regulated services were employed at sites run by private sector providers (846,600);■The level of employment in the adult social care sector represents 6% of total employment in the UK; and■The average earnings in the adult social care sector in the UK was estimated to be £17,300.Economic value of the sector(using the income approach)■It was estimated that in 2016, adult social care sector GVA was £24.3billion. Most of this was estimated to be in domiciliarycare (£7.6billion, 31%);■This represents 1.4% of total GVA in the UK;and■It was estimated that the average level of productivity (GVA generated per FTE) in the adult social care sector was £19,700.Indirect and induced value of the sector(using the income approach)■The indirect effect of the adult social care sector (resulting from the purchase of intermediate goods and services by the adult social care sector in delivering its services) was estimated to contribute a further 603,500 jobs (424,800FTEs) and £10.8billion of GVA to the UKeconomy;■The induced effect of the adult social care sector (resulting from purchases made by those directly and indirectly employed in the adult social care sector) was estimated to contribute a further 251,300jobs (176,100FTEs) and £11.1billion of GVA to the UKeconomy; and■The total direct, indirect and induced value of the adult social care sector in the UKwas estimated to be 2.6million jobs (1.8 millionFTEs) and £46.2billion in 2016.

The Economic Value of the Adult Social Care sector -Wales
Kearney J and White A Skills for Care, Leeds. 2018

Key FindingsSector characteristics■An estimated 2,070sites were involved in providing adult social care in Walesin 2016.Most of these sites were provided nursing care.A further 1,700 individuals receive direct payments and employ Personal Assistants (PAs);■There were an estimated 79,800jobs in the adult social care sector in Walesin 2016.Most of these jobs were involved in providing residential care.There were afurther 3,600 jobs due to individuals employing PAs,meaning there were a total of 83,400 jobs in the adult social care sector in 2016;■There were an estimated 60,000 Full-Time Equivalents (FTEs) in the adult social care sector in Wales,and a further 1,600 FTEs employed as PAs;■Most of the adult social care workforce providing regulated services wereemployed at sites run by private sector providers (44,500);■The level of employment in the adult social care sector represents 6% of total employment in Wales; and■The average earnings in the adult social care sector in Wales was estimated to be £16,900.Economic value of the sector(using the income approach)■It was estimated that in 2016, adult social care sector GVA was £1.2billion. Most of this was estimated to be in residential care (£328 million, 28%);■This represents 1.9% of total GVA in Wales;■It was estimated that the average level of productivity (GVA generated per FTE) in the adult social care sector was £18,700; and■The estimated GVA in the adult social care sector in Wales is estimated to be higher than the Agriculture, forestry andfishing, Arts, entertainment andrecreationand Water supply; sewerage andwaste managementsectors.Indirect and induced value of the sector(using the income approach)■The indirect effect of the adult social care sector (resulting from the purchase of intermediate goods and services by the adult social care sector in delivering its services) wasestimated to contribute a further 31,200 jobs (23,000 FTEs) and £554million of GVA to the Welsh economy;■The induced effect of the adult social care sector (resulting from purchases made by those directly and indirectly employed in the adult social care sector) wasestimated to contribute a further 12,200 jobs (9,000 FTEs) and £543 million of GVA to the Welsh economy;and■The total direct, indirect and induced value of the adult social care sector inWales was estimated to be 126,800 jobs (93,600 FTEs) and £2.2 billion in 2016.

The Economic Value of the Adult Social Care Sector in England
ICF GHK Skills for Care, Leeds. 2013

Skills for Care is part of the Sector SkillsCouncil, Skills for Care and Development. It is responsible for improving qualifications, training and development for alladult social care workers in England. Skills for Care had identified a need to establish the economic contribution of the activitiesprovided by the sector, measured as the economic value of the sector. However, the adult social care sector in England has historically been difficult to assess in terms of its economic value, as distinct from the children’s workforce and the wider UK workforce.Skills for Care has recently generated estimates of the number of employers, enterprises and employees in the sector, through its work on the National Minimum Dataset for Adult Social Care (NMDS-SC). ICF GHK was commissioned by Skills for Care to build on this work and to assess the economic significance of the adult social care sector in England to the wider economy.This study was commissioned in support of further policy development towards the sector including consideration of a broader case for investment in skills in the sector. The purpose of the study was to establish the economic contribution of adult social care servicesin England(defined in terms consistentwith the UK national accounts)and provide estimates of:■the annual GDP andGVAgenerated directly by the adult social care sector in England (including the public sector activities within the sector as well as the independent sector) (direct impact);■productivity -GVA per worker for the adult social care sector in England;■the supply chain multiplier for the adult social care sector in England (indirect impact);■the wage multiplier for the adult social care sector in England (induced impact)

Total Transformation of Care and Support: Creating the Five Year Forward View for Social Care
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2017

Adult social care has repeatedly demonstrated its capacity for transformation: pioneering de-institutionalisation, personal budgets and more recently, asset-based approaches.Health and care systems will not provide good services that meet rising demand without realigning around people and communities.There are five areas where transformation needs to take place: 1Helping all people and families to stay well, connected to others and resilient when facing health or care needs.2Supporting people and families who need help to carry on living well at home.3Enabling people with support needs to do enjoyable and meaningful things during the day, or look for work.4Developing new models of care for adults and older people who need support and a home in their community.5Equipping people to regain independence following hospital or other forms of health care. If the sector scales up promising practice, economic modelling shows that outcomes can be improved and costs reduced.The sector needs to have difficult, challenging and creative local conversations involving people who use services and others, which create space to move forward together. Further research and economic modelling is needed on the promising practices to build a business case for proper and effective investment in truly integrated care and health.

Transition Between Inpatient Hospital Settings and Community or Care Home Settings for Adults with Social Care Needs [NG27]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2015

This guideline covers the transition between inpatient hospital settings and community or care homes for adults with social care needs. It aims to improve people’s experience of admission to, and discharge from, hospital by better coordination of health and social care services.

The Care Quality Commission uses NICE guidelines as evidence to inform the inspection process.

Recommendations
The guideline includes recommendations on:

person-centred care and communication and information sharing
before admission to hospital including developing a care plan and explaining what type of care the person might receive
admission to hospital including the establishment of a hospital-based multi-disciplinary team
during hospital stay including recording medicines and assessments and regularly reviewing and updating the person’s progress towards discharge
discharge from hospital including the role of the discharge coordinator
supporting infrastructure
training and development for people involved in the hospital discharge process.
Who is it for?
The guideline is for health and social care practitioners; health and social care providers; commissioners; service users and their carers (including people who purchase their own care).

Related NICE guideline:
Appendix C3 Bauer A and Fernandez JL

Transition Between Inpatient Mental Health Settings and Community or Care Home Settings [NG53]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2016

This guideline covers the period before, during and after a person is admitted to, and discharged from, a mental health hospital. It aims to help people who use mental health services, and their families and carers, to have a better experience of transition by improving the way it’s planned and carried out.

The Care Quality Commission uses NICE guidelines as evidence to inform the inspection process.

Recommendations
This guideline includes recommendations on:

overarching principles for good transition
planning for admission and discharge
out-of-area admissions
support for families and carers
Who is it for?
Providers of care and support in inpatient and community mental health and social care services
Front-line practitioners and managers in inpatient and community mental health and social care services
Commissioners of mental health services
People who use inpatient and community mental health services, their families and carers

Related NICE guideline:
Economics, economic modelling, appendix C3.2 Cost–utility analysis of a 2-year multi-staged psychological intervention for bipolar I patients with their first, second or third hospitalisation vs Generic outpatient treatment of bipolar affective disorders (active treatment as usual) Trachtenberg M and Knapp M

What Role Can Local and National Supportive Services Play in Supporting Independent and Healthy Living in Individuals 65 and Over?
WIindle K Government Office for Science, London. 2015

This report explores the evidence base around effective and cost-effective preventative services and the role that they can play in supporting older people’s independence, health and wellbeing. It looks at the available evidence to support the benefits of preventative services in mitigating social inclusion and loneliness and improving physical health. It also highlights evidence on the effectiveness of information, advice and signposting in helping people access preventative services and the benefits of providing practical interventions such as minor housing repairs. It considers a wide range of primary and secondary preventative services, including: health screening, vaccinations, day services, reablement, and care coordination and management. It then outlines two teritary prevention services which aim to prevent imminent admission to acute health settings. These are community based rapid response services and ambulatory emergency care units, which operation within the secondary care environment. The report then highlights gaps in the evidence base and and looks at what is needed to develop preventative services to achieve health and independent ageing by 2013. It looks at the changes needed in service funding and commissioning, the balance between individual responsibility and organisational support, and how preventative services should be implemented.

What Works in Community Led Support?
Bown H, Carrier J, Hayden C National Development Team for Inclusion, Bath. 2017

This report has been written to share the findings, learning and examples of impact identified from working with 9 authorities across England, Wales and Scotland who are working differently to improve the lives and support of local people.

It is essentially an evaluation report on the authorities’ progress towards the outcomes and longer-term aims of community led support over the last 18 months, but we believe it is more than that.

We hope the learning shared here will help demonstrate what’s possible when applying core principles associated with asset based approaches at the same time as tackling hard systemic and cultural issues around speed of response, ease of access, changing the nature of ‘assessment’, reducing waiting times and lists, turning eligibility criteria on their heads and making the best use of local resources for people with a wide range of support needs.