THE ESSENCE PROJECT

Information and advice

Case studies

Read the full case study for 'Providing debt advice: economic evidence' here (PDF)
Michela Tinelli, David McDaid, Martin Knapp, Danielle Guy 2019

KEY POINTS

  • Debt advice helps people manage and repay money owed or make arrangements with creditors where debt cannot be fully repaid.
  • While debt advice helps individuals get back control of their finances, it can improve mental and physical wellbeing as well as overall quality of life. Wider societal benefits include lower incidence of stress-related illness and smaller likelihood of family breakdown.
  • According to economic modelling, over five years, society can gain at least £2.60 from every £1 invested in face-to-face debt advice services. In addition, avoiding an episode of depression or anxiety would have an impact of additional social costs avoided up to £24–£52 million annually. The benefit in terms of reduced mental health care costs due to debt advice is between £50 and £93 million annually in UK.
  • Economic modelling on debt advice includes a number of assumptions based on limited data. As such, attribution of impacts to debt advice should be considered with caution.
  • Debt advice services are provided across the UK and are regulated by the Financial Conduct Authority.

Read the full case study for 'Signposting and navigation services for older people: economic evidence' here (PDF)
Annette Bauer, David McDaid, Michela Tinelli, Danielle Guy 2019

KEY POINTS

Health, social care and other local government services can help ‘signpost’ or facilitate links to community and voluntary organisations that can help address social isolation and loneliness.

  • Signposting and navigation services are available in many areas, and may be found in GP surgeries, shopping centres and libraries. Some services even proactively identify and liaise with potentially isolated older individuals.
  • Signposting and navigation services can increase access to a range of statutory and voluntary sector activities and support. They can benefit the mental wellbeing and independence of older people.
  • Economic studies suggest that signposting and navigation services have the potential to achieve positive return on investments.
  • However, evidence is restricted to a few small-scale studies and modelling. Further research is needed to test those findings, particularly as findings are likely to vary between different populations and subgroups of older people.

Evidence

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

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

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

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

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 Support of People Growing Older with Learning Disabilities [NG96]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2018

This guideline covers care and support for adults with learning disabilities as they grow older. It covers identifying changing needs, planning for the future, and delivering services including health, social care and housing. It aims to support people to access the services they need as they get older.

We have produced an EasyRead version and video to explain this guideline, which are available from information for the public.

Recommendations
This guideline includes recommendations on:

overarching principles
organising and delivering services
identifying and assessing care and support needs
planning and reviewing care and support
identifying and managing health needs
end of life care
staff skills and expertise
Who is it for?
Providers of social care, health and housing support for people growing older with learning disabilities
Practitioners in social care, health and housing who work with people growing older with learning disabilities and their families and carers
Commissioners and people with a strategic role in assessing and planning local services
Practitioners in other related services, including older people’s services, adult learning disability services, employment, education and criminal justice services
People with learning disabilities, their families, carers and advocates

Related NICE guideline:
Appendix C2: Economic report Bauer A and Knapp M

Commissioning Befriending: A Guide for Adult Social Care Commissioners
Association of Directors of Adult Social Services Association of Directors of Adult Social Services, London. 2014

A guide developed to inform commissioners of adult social care about how befriending services are being delivered across the South West and how to effectively commissioning high quality befriending services. It describes what befriending is; the different ways it can be delivered; and the positive benefits it can have through improving health, well being and increasing independence. It also explains how people and communities can be involved in delivering and developing services through volunteering. Case study examples of current befriending practice are used throughout. The guide also draws upon materials and guidance produced by the Mentoring and Befriending Foundation (MBF) and feedback from commissioners and befriending providers through a series of consultations undertaken by the MBF.

Commissioning Cost-Effective Services for Promotion of Mental Health and Wellbeing and Prevention of Mental Ill-Health
McDaid D, Park A, Knapp M Public Health England, London. 2017

A return on investment resource to support local commissioners in designing and implementing mental health and wellbeing support services.

Connecting with Health and Care
Foundations and Housing Learning and Improvement Network, London. 2009

In Autumn 2007 Foundations, the National Body for home improvement agencies, was commissioned by Communities and Local Government to carry out research and produce a report examining the options for the future delivery of home improvement agency (HIA) services. The report draws on examples from within and outside the HIA sector to highlight possible areas for development. It does not present a ‘one-size-fits-all’ model, but a series of options that may be appropriate depending on the identified needs of the local population, taking account of other services already in place.

Cost-effectiveness of a pilot social care service for UK military veterans
Clarkson P Journal of Care Services Management, 7, 95-106. 2014

This paper investigates the cost-effectiveness of a pilot social care service for military veterans, a group relatively ill-served by traditional forms of social and health care. The service involved caseworkers signposting veterans, experiencing multiple difficulties, to sources of advice designed to assist with issues such as employment and training, education, debt, legal problems, and housing. Routinely generated data were collected on 202 veterans, concerning their characteristics, types of problem, and resources identified, and on a sub-set (n = 21) of these, regarding their outcomes in terms of well-being, measured by routine administration of the General Health Questionnaire. Costs, in terms of caseworkers’ time commitments, were modelled across this sample of veterans. The additional costs as against the additional effects of the service, against usual care (the standard primary care response to this population), were modelled in terms of the Incremental Cost Effectiveness Ratio. There was a statistically significant reduction in symptoms after receipt of the service at an average cost of £155 per unit improvement in well-being. Analysis of uncertainty revealed a high probability of cost-effectiveness when set against a benchmark value of standard social care for adults. These findings are discussed in terms of the future priority given to the after-care of veterans, in particular regarding social care interventions, which remain under-evaluated.

Decision-making and Mental Capacity [NG018]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2018

This guideline covers decision-making in people 16 years and over who may lack capacity now or in the future. It aims to help health and social care practitioners support people to make their own decisions where they have the capacity to do so. It also helps practitioners to keep people who lack capacity at the centre of the decision-making process.

This guideline should be read in conjunction with the Mental Capacity Act 2005. It is not a substitute for the law or relevant Codes of Practice.

It does not cover Deprivation of Liberty Safeguards processes.

Recommendations
This guideline includes recommendations on:

supporting decision-making
advance care planning
assessing mental capacity to make specific decisions at a particular time
best interests decision-making
Who is it for?
Health and social care practitioners working with people who may (now or in the future) lack mental capacity to make specific decisions.
Independent advocates, with statutory and non-statutory roles.
Practitioners working in services (including housing, education, employment, police and criminal justice) who may come into contact with people who lack mental capacity.
People using health and social care services who may (now or in the future) lack mental capacity to make specific decisions, as well as their families, friends, carers and other interested parties.

Related NICE guideline:
Appendix C3: Economic report. DECISION-MAKING AND MENTALCAPACITY Bauer A and Knapp M

Dementia, Disability and Frailty in Later Life – Mid-life Approaches to Delay or Prevent Onset [NG16]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2015

This guideline covers mid-life approaches to delay or prevent the onset of dementia, disability and frailty in later life. The guideline aims to increase the amount of time that people can be independent, healthy and active in later life.

Who is it for?
Commissioners, managers and practitioners with public health as part of their remit, working in the public, private and third sector
The public.

Related NICE guideline:
Costs and benefits of increasing physical activity to prevent the onset of dementia: a modelling analysis van Baal P and Hoogendoorn M

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

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

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

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

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

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

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.

Health Begins at Home
Family Mosaic Family Mosaic, London. 2013

This new pamphlet provides interim results at 6 months from a fascinating Family Mosaic research project being undertaken by the London School of Economics. It seeks to measure and test out the impact of their services, both as a social landlord and as a provider of housing-related care and support services, and ways in which they can improve the health and wellbeing of older residents whilst at the same time help reduce NHS costs in the areas they operate in. Initial findings suggest an annual saving of £860,000 to local health economies for the 597 participants alone. With a range of useful information and examples of prevention and reablement at work, read below.

Home Care: Delivering Personal Care and Practical Support to Older People Living in their Own Homes [NG21]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2015

This guideline covers the planning and delivery of person-centred care for older people living in their own homes (known as home care or domiciliary care). It aims to promote older people’s independence and to ensure safe and consistently high quality home care services.

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

Recommendations
The guideline includes recommendations on:

ensuring care is person centred
providing information about care and support options
planning and reviewing home care and support
delivering home care, including recommendations on the length home care visits
joint working between health and social care
ensuring safety and safeguarding people using home care services
recruiting, training and supporting home care workers
Who is it for?
Health and social care practitioners
Home care provider organisations
Home care managers and workers
Older people using or planning to use home care services, and their carers
Commissioners of home care services should ensure any service specifications take into account the recommendations in this guideline.

Related NICE guideline:
APPENDIX C3 – Economics Report Bauer A, King D, Knapp M

Home from Hospital: How Housing Services are Relieving Pressures on the NHS
Copeman I, Edwards M, Porteus J National Housing Federation, London. 2017

This report shows how housing services are helping to relieve pressure on the NHS by reducing delays in discharging people from hospital and preventing unnecessary hospital admissions. It features 12 case studies to show the positive impact these services have on people’s lives and the cost benefit to the NHS. The case studies highlight services that will benefit people most at risk of delayed discharge, such as older people, people with mental health problems and people experiencing homelessness. The case studies also demonstrate a diversity of housing and health services including: ‘step down’ bed services for people coming out of hospital who cannot return to their own home immediately; hospital discharge support and housing adaptation services to enable timely and appropriate transfers out of hospital and back to patients’ existing homes; providing a new home for people whose existing home or lack of housing mean that they have nowhere suitable to be discharged to; and Home from Hospital services to keeping people well at home who would otherwise be at risk of being admitted or readmitted to hospital. The report also considers the impact and additional savings that could be made by housing providers if this work were to be scaled up.

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.

Learning Disabilities and Behaviour That Challenges: Service Design and Delivery [NG93]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2018

This guideline covers services for children, young people and adults with a learning disability (or autism and a learning disability) and behaviour that challenges. It aims to promote a lifelong approach to supporting people and their families and carers, focusing on prevention and early intervention and minimising inpatient admissions.

This guideline should be read alongside the NICE guideline on challenging behaviour and learning disabilities: prevention and interventions.

We have produced an EasyRead version and video to explain this guidance, which are available from information for the public.

Recommendations
This guideline includes recommendations on:

strategic planning and infrastructure
enabling person-centred care and support
early intervention and support for families and carers
services in the community
housing and related support
services for children and young people
carers’ breaks services
making the right use of inpatient services
staff skills and values
Who is it for?
Commissioners and providers of health and social care services for children, young people and adults with a learning disability and behaviour that challenges
Health and social care practitioners working with children, young people and adults with a learning disability and behaviour that challenges
Providers of related services, including housing, education, employment and criminal justice services
Practitioners working with children, young people and adults with a learning disability and behaviour that challenges in other services or settings, including education, housing, voluntary and community services, employment and criminal justice services
Children, young people and adults with a learning disability and behaviour that challenges and their families and carers, including people who pay for their own care

Related NICE guideline:
Service models guidance: individuals with intellectual disabilities and behaviour that challenges Trachtenberg M and Knapp M

LinkAge Bristol
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2012

An independent evaluation of LinkAge by the University of the West of England concluded that: LinkAge meets the agendas established by the Marmot Review–Fair Society Healthy Lives. Its outreach work draws people in that may feel isolated in their community. Through activities LinkAge helps people feel more socially connected, improves wellbeing and happiness (on the ONS Happiness Index) and increases physical activity.

In 2012 a Social Return on Investment Calculation was completed on the Whitehall and St. George LinkAge hub and found that for every £1 invested there was a SROI of at least £1.20. LinkAge believes this represents a substantial underestimate as, since 2012, the organisation has increased its public profile, expanded its referral network and is now drawing in more lonely
and isolated individuals – supporting them with befriending and through the ACE project.

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.

Loneliness and Social Isolation Among Older People in North Yorkshire
Bernard SM Research Report. SPRU Working Paper, WP 256 . Social Policy Research Unit, York. 2013

This report was commissioned by the Loneliness Task Group of the North Yorkshire
Older People‟s Partnership Board (NYOPPB). Its purpose was to build on the
findings from the „Voice of Ripon‟ loneliness survey carried out in 2009 on behalf of
NYOPPB(1) . The report aims to provide a review of current literature that brings
together knowledge about the extent and nature of loneliness among older people.
This will help to clarify current thinking about what a „good practice‟ or service looks
like and start to identify likely models of good practice in North Yorkshire.
The report looks at how loneliness and social isolation are understood in the
literature, why they should be important concerns of local strategic organisations,
such as health and wellbeing boards, and what might be done. This evidence is set
in the context of the geography and demography of North Yorkshire and suggestions
for future work are made.

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.

Making the Case for Public Health Interventions: Public Health Spending and Return on Investment
King's Fund, Local Government Association King's Fund and Local Government Association, London. 2014

These infographics from the King’s Fund and the Local Government Association set out key facts about the public health system and the return on investment for some public health interventions. They show the changing demographics with a growing ageing population and the impact of social and behavioural determinants on people’s health. The document also highlights the costs of key health and social services and estimates the potential returns on investment on preventative interventions. For instance, Birmingham’s Be Active programme of free use of leisure centres and other initiatives returned an estimated £23 in quality of life, reduced NHS use and other gains for every £1 spent. Every £1 spent on improving homes saves the NHS £70 over 10 years. Befriending services have been estimated to pay back around £3.75 in reduced mental health service spending and improvements in health for every £1 spent. Every £1 spent on drugs treatment saves society £2.50 in reduced NHS and social care costs and reduced crime.

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 and Social Isolation: A Review of the Evidence
Kinsella S Wirral Council Business & Public Health Intelligence Team, Wirral. 2015

Reducing social isolation is likely to have positive effects on health and mortality:
Greater benefits were observed (in reducing mortality) from improving levels of social
isolation, compared to reducing loneliness.
Targeting has the greatest impact: Focussing public health intervention efforts on
those most at risk, e.g those who live alone, are on low incomes, have poorer health,
been recently bereaved or are carers – rather than all older people – is more effective.
There is still considerable stigma attached to being lonely: and initiatives should
bear this in mind. For example, their marketing materials, should not use the ‘L’ word (as
Age UK call loneliness), particularly if they wish to attract more men
Initiatives based on evidence were more effective than those that were not: 87% of
interventions based on evidence reported beneficial effects compared to 59% of
interventions which were not. Studies aiming to achieve and maintain characteristics
essential for positive mental health (e.g people realising their own abilities, having a
purpose in life, a sense of belonging and support) appeared to be most effective.
Group activities achieve good outcomes: 79% of group based interventions reported
at least one improved outcome, compared to 55% of one-to-one interventions.
Group activities which have an arts, educational learning or social focus are
particularly beneficial: A systematic review supported this finding that group
interventions involving some form of educational, training, arts or social activity that
target specific groups of people are the most effective.
Participatory initiatives are most beneficial: Positive effects are reported in 80% of
initiatives which were participatory, compared to 44% of non-participatory initiatives.
One-to-one initiatives (e.g befriending) only appears to be effective in certain
circumstances: Namely, when the befriender and recipient have enough in common to
build a genuine relationship. They do not appear to reduce use of health services, but
can result in reductions in depression and improvements in quality of life. One-to-one
interventions targeted at specific groups of older people (e.g the recently bereaved, or
recently discharged from hospital), may offer more benefit than trying to reach to all
older people. Currently, there is little evidence of benefit for mentoring support.
The impact of new technologies is inconclusive: The evidence is often contradictory
on the subject of new technologies, but there is some evidence of benefit for training on
the use of computers, the internet, Skype (particularly for specific groups such as carers)
Real and practical barriers to reducing isolation should be the focus of joint
efforts by all agencies concerned with the wellbeing of older people: particularly
those relating to transport, toilets, continence issues and long term health conditions

Older People with Social Care Needs and Multiple Long-term Conditions [NG22]
The National Institute for Health and Care Excellence (NICE) National Institute for Health and Care Excellence, London. 2015

This guideline covers planning and delivering social care and support for older people who have multiple long-term conditions. It promotes an integrated and person-centred approach to delivering effective health and social care services.

Recommendations
The guideline includes recommendations on:

identifying and assessing social care needs
care planning, including the role of the named care coordinator
supporting carers
integrating health and social care planning
delivering care
preventing social isolation
training health and social care practitioners

Who is it for?
Health and social care practitioners
Providers of care and support in health and social care services
Older people with social care needs and multiple long-term conditions (including both physical and mental health conditions), and their carers.
Commissioners should ensure any service specifications take into account the recommendations in this guideline.

Related NICE guideline:
Appendix C3: Cost-consequence and cost-utility analysis of an outpatient geriatric multidisciplinary assessment and case management intervention: the ‘GRACE’ model of care Trachtenberg M and Fernandez JL

Peer Support for People with Dementia: A Social Return on Investment (SROI) Study
Semple A, Willis E, de Waal H Health Innovation Network, London. 2015

Reports on a study using Social Return on Investment (SROI) analysis to examine the impact and social value of peer support groups as an intervention for people with dementia. Three peer support groups in South London participated in the study. A separate SROI analysis was carried out for each individual group to find out what people valued about the groups and how they helped them. The report presents the outcomes for each group, the indicators for evidencing these outcomes and the quality and duration of outcomes experienced. It then provides detail on the methodology used to calculate the impact and the social return on investment. Overall, the study found that peer support groups provide positive outcomes for people with dementia, their carers and the volunteers who support the groups. The benefits of participating in peer support groups included: reduced isolation and loneliness; increased stimulation, including mental stimulation; and increased wellbeing. Carers experienced a reduction in carer stress, carer burden and reduction in the feeling of loneliness. Volunteers had an increased sense of wellbeing through their engagement with the group, improved knowledge of dementia and gained transferrable skills. Overall the study found that for every pound (£) of investment the social value created by the three groups evaluated ranged from £1.17 to £5.18.

People Powered Recovery: Social Action and Complex Needs. Findings from a Call for Evidence
Turning Point All-Party Parliamentary Group on Complex Needs and Dual Diagnosis, London. 2018

The UK All-Party Parliamentary Group (APPG) on complex needs and dual diagnosis was established in 2007 in recognition of the fact that people seeking help often have a number of over-lapping needs including problems around access to housing, social care, unemployment services, mental health provision or substance misuse support. This report sets out the findings from a call for evidence on how social action can improve outcomes and develop more responsive services for people with complex needs or a dual diagnosis. Social action is about people coming together to tackle an issue, support others or improve their local area, by sharing their time and expertise through volunteering, peer-led groups and community projects. The report provides examples of how social action can support recovery, self-worth and confidence, boost employment prospects and skills, reduce stigma, better shape services to meet people’s needs, contribute to better health and wellbeing and save money. It also looks at how to overcome some of the challenges and barriers to developing social action focused around complex needs. These include resources, stigma, procedural issues, leadership, commissioning structures and demonstrating benefits.

Preventing Loneliness and Social Isolation: Interventions and Outcomes. SCIE Research Briefing 39
Windle K, Francis J, Coomber C Social Care Institute for Excellence, London. 2011

This is one in a series of research briefings about preventive care and support for adults.

Prevention is broadly defined to include a wide range of services that:

promote independence
prevent or delay the deterioration of wellbeing resulting from ageing, illness or disability
delay the need for more costly and intensive services.

Preventive services represent a continuum of support ranging from the most intensive, ‘tertiary services’ such as intermediate care or reablement, down to ‘secondary’ or early intervention, and finally, ‘primary prevention’ aimed at promoting wellbeing. Primary prevention is generally designed for people with few social care needs or symptoms of illness. The focus therefore is on maintaining independence and good health and promoting wellbeing. The range of these ‘wellbeing’ interventions includes activities to reduce social isolation, practical help with tasks like shopping or gardening, universal healthy living advice, intergenerational activities and transport, and other ways of helping people get out and about.

Just as the range of wellbeing services is extensive, so too is the available literature examining how well they work. For this research briefing, the focus has been narrowed to the effectiveness and cost-effectiveness of services aimed at preventing social isolation and loneliness. Our review question was: ‘To what extent does investment in services that prevent social isolation improve people’s wellbeing and reduce the need for ongoing care and support?’

While ‘social isolation’ and ‘loneliness’ are often used interchangeably, one paper examined the distinct meanings that people attach to each concept. ‘Loneliness’ was reported as being a subjective, negative feeling associated with loss (e.g. loss of a partner or children relocating), while ‘social isolation’ was described as imposed isolation from normal social networks caused by loss of mobility or deteriorating health. This briefing focuses on services aimed at reducing the effects of both loneliness and social isolation. Although the terms might have slightly different meanings, the experience of both is generally negative and the resulting impacts are undesirable at the individual, community and societal levels.
Key messages

Older people are particularly vulnerable to social isolation or loneliness owing to loss of friends and family, mobility or income.
Social isolation and loneliness impact upon individuals’ quality of life and wellbeing, adversely affecting health and increasing their use of health and social care services.
The interventions to tackle social isolation or loneliness include: befriending, mentoring, Community Navigators, social group schemes.
People who use befriending or Community Navigator services reported that they were less lonely and socially isolated following the intervention.
The outcomes from mentoring services are less clear; one study reported improvements in mental and physical health, another that no difference was found.
Where longitudinal studies recorded survival rates, older people who were part of a social group intervention had a greater chance of survival than those who had not received such a service.
Users report high satisfaction with services, benefiting from such interventions by increasing their social interaction and community involvement, taking up or going back to hobbies and participating in wider community activities.
Users argued for flexibility and adaptation of services. One-to-one services could be more flexible, while enjoyment of group activities would be greater if these could be tailored to users’ preferences.
When planning services to reduce social isolation or loneliness, strong partnership arrangements need to be in place between organisations to ensure developed services can be sustained.
We need to invest in proven projects. Community Navigator interventions have been shown to be effective in identifying those individuals who are socially isolated. Befriending services can be effective in reducing depression and cost-effective.
Research needs to be carried out on interventions that include different genders, populations and localities.
There is an urgent need for more longitudinal, randomised controlled trials that incorporate standardised quality-of-life and cost measures.

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.

Quantifying the benefits of peer support for people with dementia: a social return on investment (SROI) study
Willis E, Semple A, de Waal H International Journal of Social Research and Practice, 17, 266–278. 2018

Objective: Peer support for people with dementia and carers is routinely advocated in national strategies and policy as a post-diagnostic intervention. However there is limited evidence to demonstrate the value these groups offer. This study looked at three dementia peer support groups in South London to evaluate what outcomes they produce and how much social value they create in relation to the cost of investment. Methods: A Social Return on Investment (SROI) analysis was undertaken, which involves collecting data on the inputs, outputs and outcomes of an intervention, which are put into a formula, the end result being a SROI ratio showing how much social value is created per £1 of investment. Results: Findings showed the three groups created social value ranging from £1.17 to £5.18 for every pound (£) of investment, dependent on the design and structure of the group. Key outcomes for people with dementia were mental stimulation and a reduction in loneliness and isolation. Carers reported a reduction in stress and burden of care. Volunteers cited an increased knowledge of dementia. Conclusions: This study has shown that peer groups for people with dementia produce a social value greater than the cost of investment which provides encouraging evidence for those looking to commission, invest, set up or evaluate peer support groups for people with dementia and carers. Beyond the SROI ratio, this study has shown these groups create beneficial outcomes not only for the group members but also more widely for their carers and the group volunteers.

Rotherham Social Prescribing Scheme
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2017

An evaluation conducted by the Centre for Regional Economic and Social Research (CRESR) at Sheffield Hallam University of the pilot phase of the service found that the service had positive social and economic impacts. The service uses a specially developed health and wellbeing tool to measure social outcomes for people referred to the service. Its 8 measures cover different aspects of self-management and wellbeing, such as lifestyle and managing symptoms, to work and volunteering, to friends and family, and people are asked to use a 5 point scale to rate their progress. 17 qualitative interviews were also held with participants and their carers, who were referred to 5 of the 31 service providers.

During the pilot phase of the project, of the 280 participants who had their wellbeing measures followed up after 3-4 months, 83 per cent of people experienced positive change in at least one social outcome area. The biggest changes were seen for patients who scored the least at baseline (work, volunteering etc., and feeling positive); and a majority of low scoring participants (two points or less at baseline) made progress- among them 54% improved their score in work & volunteering area, while 61% improved their score in the feeling positive area. Among the case studies (those interviewed), the positive outcomes described using four broad themes of increased well-being, reduced social isolation and loneliness, increased independence, and access to wider welfare benefits.

There were also significant benefits to the NHS, with inpatient admissions reduced by 21 per cent; Accident and Emergency attendances reduced by as much as 20 per cent; and outpatient appointments reduced by as much as 21 per cent, These increases were calculated looking at patient-level Hospital Episode Statistics provided by the Commissioning Support Unit (CSU), of a cohort of 108 participants who had 12-months of post-referral data available, after being referred between September and December 2012.

Shared Lives Costs and Effectiveness (SLiCE)
Brookes N Personal Social Services Research Unit, Kent. 2018

In the Shared Lives model, an adult who needs support and/or accommodation moves in with or regularly visits an approved Shared Lives carer after they have been matched for compatibility. At present there is a limited evidence base for Shared Lives. The proposed research will mean that a thorough exploration of how successful the model is and whether it represents a good investment can be explored. An outcome evaluation will include: collection of data including service user characteristics, risks and needs, case management information, service use, quality of life and well-being measures; data collection from a comparison group of Shared Lives-suitable, non-participating service users; interviews with service users and Shared Lives carers focusing on outcomes; and use of other administrative and survey data.

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

Social Value of Local Area Coordination in Derby
Marsh H Kingfishers (Project Management) Ltd, Manchester. 2016

A Social Return on Investment Analysis for Derby City Council (SROI) has found that for a three year forecast period with 10 Local Area Coordinators, £4.00 of social value would be earned for every £1.00 invested. The report was commissioned by Think Local Act Personal and developed from our work with a number of health and wellbeing boards to embed our earlier ‘Strong and Inclusive Communities Framework'”.

The analysis was initially completed for Thurrock Council based on nine Local Area Coordinators (LAC) in July 2015. Then followed by an analysis for Derby based on ten LAC in November 2015.

The findings our available in two reports: Social Value of Local Area Coordination in Derby – Social Return on Investment (SROI) Analysis, and the Learning Outcomes from Thurrock Council & Derby City Council SROI Analyses.

Social Value of Local Area Coordination. Learning Outcomes from Thurrock Council and Derby City Council SROI Analyses
Kingfishers (Project Management) Ltd Kingfishers (Project Management) Ltd, Manchester. 2016

The aim of Local Area Coordination is to support residents in the local community to ‘get a life, not a service’, empowering individuals to find community based solutions instead of relying on traditional services.Thurrock Council and Derby City Council both implemented Local Area Coordination as part of a driver for wider change to deliver community based person focussed services. The service has proved successful in both of the unitary authorities and has since expanded to nine wards in Thurrock and ten wards in Derby over the past few years.A forecast Social Return on Investment Analysis was commissioned by each Council independently to better understand and start to quantify the impact of the service together with demonstrating how Local Area Coordination is effecting real change in the community. The analyses completed for Thurrock and Derby demonstrate that Local Area Coordination is delivering significant benefit to the local community and other stakeholders with up to £4 forecast for every £1 invested. Furthermore, the service has the potential to influence wider cultural change and a shift to community based services longer term; decreasing the reliance on traditional services.Although the specific calculations are not directly comparable due to the differing quantities, recording methods and assumptions made in each, the overall recommendations and approaches of each Council to delivering Local Area Coordination – both at a strategic and operational level – can inform learning to further enhance the service in both authorities. This report summarises the two analyses and recommendations from both to share best practice and optimise the social value delivered in Thurrock and Derby, ultimately to the benefit of the individuals receiving the service.The key outcomes are comparable between Thurrock and Derby demonstrating how Local Area Coordination across two differing authorities is having a similar impact. This highlights how the principles of Local Area Coordination can effectively be applied across areas. The understanding and upholding of the principles driven by strong leadership is critical to enabling this and is being achieved in both Thurrock and Derby.

The analysis was initially completed for Thurrock Council based on nine Local Area Coordinators (LAC) in July 2015. Then followed by an analysis for Derby based on ten LAC in November 2015.

The findings our available in two reports: Social Value of Local Area Coordination in Derby – Social Return on Investment (SROI) Analysis, and the Learning Outcomes from Thurrock Council & Derby City Council SROI Analyses.

Tackling Loneliness and Social Isolation: The Role of Commissioners
Social Care Institute for Excellence Social Care Institute for Excellence, London. 2018

With one million people aged 65 and over in the UK reporting they are often or always lonely, few would refute the need to tackle this issue. (1)
However, loneliness and social isolation are conditions that are difficult to identify, complex to address and hard to resolve. The evidence base for interventions to address the problems of loneliness and social isolation is emerging but inconclusive at this stage.

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.

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.

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.

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