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.

Dementia care costs and outcomes: a systematic review
Knapp M, Iemmi V, Romeo R International Journal of Geriatric Psychiatry, 28:, 551-556. 2013

Abstract
OBJECTIVE:
We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia.

METHODS:
We performed a systematic review of available literature on economic evaluations of dementia care, searching key databases and websites in medicine, social care and economics. Literature reviews were privileged, and other study designs were included only to fill gaps in the evidence base. Narrative analysis was used to synthesise the results.

RESULTS:
We identified 56 literature reviews and 29 single studies offering economic evidence on dementia care. There is more cost-effectiveness evidence on pharmacological therapies than other interventions. Acetylcholinesterase inhibitors for mild-to-moderate disease and memantine for moderate-to-severe disease were found to be cost-effective. Regarding non-pharmacological treatments, cognitive stimulation therapy, tailored activity programme and occupational therapy were found to be more cost-effective than usual care. There was some evidence to suggest that respite care in day settings and psychosocial interventions for carers could be cost-effective. Coordinated care management and personal budgets held by carers have also demonstrated cost-effectiveness in some studies.

CONCLUSION:
Five barriers to achieving better value for money in dementia care were identified: the scarcity and low methodological quality of available studies, the difficulty of generalising from available evidence, the narrowness of cost measures, a reluctance to implement evidence and the poor coordination of health and social care provision and financing.

Evaluation of Direct Payments in Residential Care Trailblazers
Stefanie Ettelt, Raphael Wittenberg, Lorraine Williams, Jackie Damant, Daniel Lombard, Margaret Perkins and Nicholas Mays Evaluation of Direct Payments in Residential Care Trailblazers 2017

Evaluation of Integrated Personal Commissioning (IPC)
Thom G SQW Limited, London. 2018

The Department of Health has commissioned a summative evaluation of the Integrated Personal Commissioning (IPC) programme. The evaluation will be carried out by a consortium led by SQW, in partnership with Bryson Purdon Social Research (BPSR), Social Care Institute for Excellence (SCIE), the Social Policy Research Unit (SPRU) and the Centre for Health Economics (CHE) both at the University of York, and Mott MacDonald.

Integrated Personal Commissioning (IPC) was launched in April 2015. It is a partnership between NHS England and the Local Government Association.

IPC is an approach to joining up health and social care, and other services where appropriate. The purpose is to enable people, with help from carers and families, to combine the resources available to them in order to control their care. This is achieved through personalised care planning and personal budgets. IPC also aims to support people to develop the skills and confidence needed to self-manage their care in partnership with carers, the voluntary, community and social enterprise (VCSE) sector, community capacity and peer support.

Evidence and Initiatives for Integrating Personal Budgets for People with Mental Health Problems
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2014

Because integrating personal budgets is a relatively new initiative, evidence is still emerging about the impact they might have on people’s health and wellbeing.

However, evidence suggests that people with mental health problems can benefit significantly from having increased choice and control over their care, because their needs tend to cross boundaries between health and social care.

This section discusses some of the evidence from a recent evaluation of personal health budgets. It also describes some recent initiatives by government to promote the integration of services around an individual’s needs.

IMPROVING OUTCOMES FOR PEOPLE WITH LONG-TERM CARE NEEDS THROUGH PERSONALISATION
Lorraine Frisina Doetter, Francesco Barbabella, Montserrat Guillen, Blanche Le Bihan, Joanna Marczak, Ricardo Rodrigues, Heinz Rothgang, Miguel Santolino, Alis Sopadzhiyan, Agnieszka Sowa-Kofta and Raphael Wittenberg IMPROVING OUTCOMES FOR PEOPLE WITH LONG-TERM CARE NEEDS THROUGH PERSONALISATION 2019

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.

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.

Personalisation, Productivity and Efficiency
Carr S Social Care Institute for Excellence, London. 2010

This report focuses on the potential for personalisation, particularly self-directed support and personal budgets, to result in cost-efficiencies and improved productivity as well as improved care and support. The overall result of this is greater independence and better outcomes for people’s lives. The report provides an overview of some emerging evidence for efficiency from the implementation of personalisation so far, to inform the next stage of delivery.

Reform of social care and personalisation is part of the coalition agreement, which states that:

we understand the urgency of reforming the system of social care to provide much more control to individuals and their carers
we will break down barriers between health and social care funding to incentivise preventative action
we will extend the greater roll-out of personal budgets to give people and their carers more control and purchasing powers.

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 -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 Implementation of Individual Budget Schemes in Adult Social Care. SCIE Research Briefing 20
Carr S, Robbins D Social Care Institute for Excellence, London. 2009

Introduction

This briefing examines some of the recent UK and international literature relating to the development of personal budget schemes for adults eligible for support from social care services. These include older people, people with physical or sensory disabilities, people with learning disabilities and people with mental health problems

The briefing is an update of Research briefing 20: Choice, control and individual budgets: emerging themes (2007) and incorporates some new findings from research published between 2006 and 2008. It includes highlights from the In Control evaluation, the UK Direct Payments survey and the Department of Health Individual Budgets pilot.

The briefing is intended to provide an outline of – and signpost to – some of the most recent research for all those interested in the role of individual budget schemes for the development of personalised adult social care in England. The findings presented here are not comprehensive or conclusive, but give a brief indication of how personal or individual budgets have been working to date.
Key messages

The international evidence to date is based on many relatively small examples, but given the right level of support, user views are very positive and they report improvements.
All schemes are still working to balance safeguarding and registration of the workforce with individual choice and control. There are emerging risks to be overcome at the level of the organisation and the individual.
There are both advantages and disadvantages for carers and families. Support arrangements are needed to ensure successful implementation.
Older people and people with complex needs may need greater time and support to help them get the most from individual budget schemes, particularly the cash direct payment option.
Brokerage and support is needed but the support infrastructure is not yet sufficiently well developed in the UK. Emerging evidence indicates that support is more successful when it is independent of the service system. Support brokers should provide a task-focused service and be trained and regulated.
Early studies of personal assistants (PAs) paint a mixed picture of poorer pay and conditions but higher job satisfaction.
Most schemes share the same goals of improving freedom of choice, independence and autonomy and using public funds more efficiently.
Schemes still vary to take account of national context, but central government leadership is always a vital component.
All schemes have taken time to embed and have needed strong local leadership and investment in targeted training and support for frontline staff.
In the UK, IBSEN claims that individual budgets have ‘the potential’ to be more cost effective and there is improved satisfaction for people who use services.
Reliable evidence on the long-term social care cost implications is not yet available. This is an area which needs urgent attention to sustain confidence. There is emerging international evidence that self-directed care can lead to health gains and consequent efficiency gains

The Long Term Care Revolution
Housing Learning and Improvement Network Housing Learning and Improvement Network, London. 2013

This Housing LIN Report comprehensively outlines the case for a revolution in long term care and captures some of the supporting material that has aided the development of the TSB’s Assisted Living Innovation Platform’s, ‘Long Term Care Revolution’ programme.

It sets out a vision for an alternative to institutional care, drawing on substantial evidence about the views of older people and their carers in the UK, lessons from abroad, the implications for industry/providers and makes recommendations to government and industry leaders on key factors for revolutionizing long term care for older people, including mainstream and specialist living environments.