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 evaluation of peer-led self-management training for people with severe psychiatric diagnoses
Cyhlarova E, Crepaz-Keay D, Reeves R, et al Journal of Mental Health Training, Education and Practice, 10, 3-13. 2015

This Mental Health Foundation intervention runs for nine-months and involves workshops and peer-group meetings in which participants learn goal-setting and problem-solving techniques and have an opportunity to socialise and share experiences. Well-being, functional living skills, absences from work and use of health, social care and criminal justice services were measured for 262 participants at baseline, six months and three months post-intervention. The cost of the intervention was calculated to be £894 per person. We were unable to identify a suitable comparison group. For the intervention group, well-being and functional living skills improved over time. Costs associated with use of services over the first 6 months were on average £20 per week higher than at baseline. However, at three months post-intervention these were £62 per week lower than at baseline. If the intervention was responsible for 27 per cent of these identified savings, and if individuals using the service would not have experienced changes without it, then peer-led self-management could be considered cost-effective. Detailed findings have been published.

Befriending of Older Adults
Bauer A, Knapp M, Perkins M Personal Social Services Research Unit, London. 2011

Befriending initiatives, often delivered by volunteers, provide an‘upstream’ intervention that is potentially of
value both to the person being befriended and the ‘befriender’. For those receiving the intervention,
particularly older people, it promotes social inclusion and reduces loneliness;
for the befriender, there is the personal satisfaction of contributing to the local community by offering support and skills. Specific potential
benefits include the improved mental well­being of the person receiving the intervention, a reduced risk of
depression, and associated savings in health care costs.

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.

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.

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.

Cost effectiveness of a manual based coping strategy programme in promoting the mental health of family carers of people with dementia (the START (STrAtegies for RelaTives) study): a pragmatic randomised controlled trial.
Knapp M, King D, Romeo R, et al British Medical Journal, 347, f6342. 2013

Objective To assess whether the START (STrAtegies for RelatTives) intervention added to treatment as usual is cost effective compared with usual treatment alone.

Design Cost effectiveness analysis nested within a pragmatic randomised controlled trial.

Setting Three mental health and one neurological outpatient dementia service in London and Essex, UK.

Participants Family carers of people with dementia.

Intervention Eight session, manual based, coping intervention delivered by supervised psychology graduates to family carers of people with dementia added to usual treatment, compared with usual treatment alone.

Primary outcome measures Costs measured from a health and social care perspective were analysed alongside the Hospital Anxiety and Depression Scale total score (HADS-T) of affective symptoms and quality adjusted life years (QALYs) in cost effectiveness analyses over eight months from baseline.

Results Of the 260 participants recruited to the study, 173 were randomised to the START intervention, and 87 to usual treatment alone. Mean HADS-T scores were lower in the intervention group than the usual treatment group over the 8 month evaluation period (mean difference −1.79 (95% CI −3.32 to −0.33)), indicating better outcomes associated with the START intervention. There was a small improvement in health related quality of life as measured by QALYs (0.03 (−0.01 to 0.08)). Costs were no different between the intervention and usual treatment groups (£252 (−28 to 565) higher for START group). The cost effectiveness calculations suggested that START had a greater than 99% chance of being cost effective compared with usual treatment alone at a willingness to pay threshold of £30 000 per QALY gained, and a high probability of cost effectiveness on the HADS-T measure.

Conclusions The manual based coping intervention START, when added to treatment as usual, was cost effective compared with treatment as usual alone by reference to both outcome measures (affective symptoms for family carers, and carer based QALYs).

Cost-effectiveness of an Integrated Care Home Support Service in Oxfordshire, England.
Tsiachristas A, et al International Journal of Integrated Care, 17, 1-8. 2017

Background: Multi-morbidity is an increasing threat to population health and healthcare systems. A high proportion of people living in care homes have dementia, mental illness and/or physical frailty. Thus, this population has high and complex care needs, which require substantial healthcare expenditure.

Intervention: An Integrated Care Home Support Service (CHSS) in Oxfordshire, England, combined two evidence based approaches to deliver a stepped care and treatment to meet both physical and mental health needs, called the BRIghTER DAWN programme. These evidenced based approaches trained staff to deliver Dementia Assessment of Wellbeing and Needs (DAWN) and/or a personalised intervention focusing on Building Relationships and Individually Tailored Evaluation and Responses (BRIghTER).

Methods: Different data sources and methods were combined in this observational study to perform an economic evaluation of the CHSS. Individual patient data (IPD) on two-year community care utilisation and time alive since admission to a care home were used to calculate community care costs and Life Years (LYs) per patient. Mahalanobis one-to-one propensity score matching (PSM) was used to match 443 residents who received DAWN and/or BrighTER with residents from a control cohort of 5,339 residents with respect to community care costs at baseline, date admitted to a care home, date of birth, mental health cluster codes, gender, and care home. Multiple imputation by predictive mean matching was used to impute missing observations in community care cost at baseline. To reduce remaining confounding, 5,000 bootstrapped samples were generated from the paired dataset and for each one, Generalised Linear Models were specified to estimate incremental community care costs and incremental Lys adjusting for confounders. Difference-in-differences analysis supplemented with inverse probability weighting for propensity score matching was performed to estimate incremental non-elective hospital costs based. A decision model was built to combine the incremental costs and effects from the two different analyses to estimate costs per LY gained and to perform probabilistic sensitivity analysis. Uncertainty was displayed in cost-effectiveness acceptability curves.

Results: The CHSS resulted to £575 higher costs and 0.04 more Lys than usual care resulting to an ICER of £13,886, which is considered to be cost-effective under conventional NICE thresholds (i.e. £20,000-£30,000). Looking at the interventions separately, DAWN was even more cost-effective (ICER=£2,081), while DAWN was less cost-effective (ICER=14,837) but still under NICE’s threshold. The probability of the interventions to be cost-effective at £20.000 ceiling ration was more than 80%.

Discussion: This study demonstrated a series of methods to be used by health economists when dealing with Murphy’s law in the economic evaluation of complex interventions.

Conclusion: The Integrated Care Home Support Service implemented in Oxfordshire was very likely to be cost-effective.

Lessons learned: Evidence-based, integrated, and in-reach care home services improve health outcomes at reasonable costs. These value-for-money interventions can improve efficiency in elderly care and meet the complex needs of an rapidly increasing part of the population.

Limitations: The impact of the CHSS on quality of life is not included in the economic evaluation.

Suggestions for future research: Investigate whether the cost-effectiveness results are sustainable in time and replicable in other settings.

Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial
Henderson C, Knapp M, Fernandez JL, et al Age and Ageing, 43, 794-800. 2014

Purpose of the study: to examine the costs and cost-effectiveness of ‘second-generation’ telecare, in addition to standard support and care that could include ‘first-generation’ forms of telecare, compared with standard support and care that could include ‘first-generation’ forms of telecare.

Design and methods: a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas. In the Whole Systems Demonstrator Telecare Questionnaire Study, 550 participants were randomised to intervention and 639 to control. Participants who were offered the telecare intervention received a package of equipment and monitoring services for 12 months, additional to their standard health and social care services. The control group received usual health and social care.

Primary outcome measure: incremental cost per quality-adjusted life year (QALY) gained. The analyses took a health and social care perspective.

Results: cost per additional QALY was £297,000. Cost-effectiveness acceptability curves indicated that the probability of cost-effectiveness at a willingness-to-pay of £30,000 per QALY gained was only 16%. Sensitivity analyses combining variations in equipment price and support cost parameters yielded a cost-effectiveness ratio of £161,000 per QALY.

Implications: while QALY gain in the intervention group was similar to that for controls, social and health services costs were higher. Second-generation telecare did not appear to be a cost-effective addition to usual care, assuming a commonly accepted willingness to pay for QALYs.

Cost-effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial
Henderson C, Knapp M, Fernandez JL, et al British Medical Journal, 346, f1035. 2014

OBJECTIVE:

To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment.
DESIGN:

Economic evaluation nested in a pragmatic, cluster randomised controlled trial.
SETTING:

Community based telehealth intervention in three local authority areas in England.
PARTICIPANTS:

3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care.
INTERVENTIONS:

Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care.
MAIN OUTCOME MEASURE:

Primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained.
RESULTS:

We undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). The adjusted mean difference in QALY gain between groups at 12 months was 0.012. Total health and social care costs (including direct costs of the intervention) for the three months before 12 month interview were £1390 (€1610; $2150) and £1596 for the usual care and telehealth groups, respectively. Cost effectiveness acceptability curves were generated to examine decision uncertainty in the analysis surrounding the value of the cost effectiveness threshold. The incremental cost per QALY of telehealth when added to usual care was £92 000. With this amount, the probability of cost effectiveness was low (11% at willingness to pay threshold of £30 000; >50% only if the threshold exceeded about £90 000). In sensitivity analyses, telehealth costs remained slightly (non-significantly) higher than usual care costs, even after assuming that equipment prices fell by 80% or telehealth services operated at maximum capacity. However, the most optimistic scenario (combining reduced equipment prices with maximum operating capacity) eliminated this group difference (cost effectiveness ratio £12 000 per QALY).
CONCLUSIONS:

The QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment.

Costs and economic consequences of a help-at-home scheme for older people in England
Bauer A, Knapp M, Wistow G Health and Social Care in the Community, 25, 780-789. 2017

Abstract
Solutions to support older people to live independently and reduce the cost of an ageing population are high on the political agenda of most developed countries. Help-at-home schemes offer a mix of community support with the aim to address a range of well-being needs. However, not much is currently known about the costs, outcomes and economic consequences of such schemes. Understanding their impact on individuals’ well-being and the economic consequences for local and central government can contribute to decisions about sustainable long-term care financing. This article presents results from a mixed-methods study of a voluntary sector-provided help-at-home scheme in England for people of 55 years and older. The study followed a participatory approach, which involved staff and volunteers. Data were collected during 2012 and 2013. Social care-related quality of life was measured with the Adult Social Care Outcomes Toolkit for 24 service users (59% response rate) when they started using the scheme and 4-6 months later. A customised questionnaire that captured resource use and well-being information was sent to 1064 service users (63% response rate). The same tool was used in assessment with service users who started using the scheme between November 2012 and April 2013 (100% response rate). Costs of the scheme were established from local budget and activity data. The scheme was likely to achieve a mean net benefit of £1568 per person from a local government and National Health Service (NHS) perspective and £3766 from the perspective of the individual. An expenditure of £2851 per person accrued to central government for the additional redistribution of benefit payments to older people. This article highlights the potential contribution of voluntary sector-run help-at-home schemes to an affordable welfare system for ageing societies.

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.

Early intervention for first‐episode psychosis: broadening the scope of economic estimates
Park A, McCrone P, Knapp M Early Intervention in Psychiatry, 10, 144-151. 2016

AIM:

To explore the economic impacts of early intervention in England on outcomes and costs for people with first-episode psychosis.
METHODS:

Three decision analytical models were constructed to compare treatment by early intervention for first-episode psychosis with standard care in relation to employment, education, homicide and suicide. Data on effectiveness and costs were taken from previous studies and expert opinion. Sensitivity analyses tested the robustness of assumptions.
RESULTS:

Our models indicate that early intervention demonstrates savings of £2087 per person over 3 years from improved employment and education outcomes. In addition, the annual costs over 10 years related to homicide after early intervention were £80 lower than for standard care. There were also annual savings of £957 per person for early intervention over 4 years compared to standard care as a result of suicides averted.
CONCLUSIONS:

Not only can investment in early intervention help reduce some of the long-term costs and consequences of mental disorders to the health-care system. In addition, there are broader economic benefits that strengthen the potential cost savings to society.

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

Effective Interventions in Schizophrenia: The Economic Case
Andrew A, Knapp M, McCrone P Personal Social Services Research Unit, London. 2012

Making the business case for effective interventions for people with schizophrenia and psychosis

Effectiveness and Cost-effectiveness of 'Usual Care' versus 'Specialist Integrated Care': A Comparative Study of Hospital Discharge Arrangements for Homeless People in England
Cornes M Forthcoming.

Purpose
To explore specialist services set up to improve homeless people’s experiences of leaving hospital. It is investigating different types of services; for example, some put patients in touch with a specially trained GP, others might employ a housing support worker to ensure people do not return to living on the streets after hospital discharge. We want to know what homeless people think of specialist services, how they help them tackle the range of problems they may have, and if this support prevents them returning to hospital. To compare effectiveness and costs we will also study hospital discharge arrangements where no specialist support for homeless people is in place.

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

Improving the quality of life of care home residents with dementia: cost-effectiveness of an optimized intervention for residents with clinically significant agitation in dementia
Romeo R, Zala D, Knapp M, et al Alzheimer's and Dementia, 15, 282-229. 2019

Introduction
To examine whether an optimized intervention is a more cost-effective option than treatment as usual (TAU) for improving agitation and quality of life in nursing home residents with clinically significant agitation and dementia.

Methods
A cost-effectiveness analysis within a cluster-randomized factorial study in 69 care homes with 549 residents was conducted. Each cluster was randomized to receive either the Well-being and Health for people with Dementia (WHELD) intervention or TAU for nine months. Health and social care costs, agitation, and quality of life outcomes were evaluated.

Results
Improvements in agitation and quality of life were evident in residents allocated to the WHELD intervention group. The additional cost of the WHELD intervention was offset by the higher health and social care costs incurred by TAU group residents (mean difference, £2103; 95% confidence interval, −13 to 4219).

Discussion
The WHELD intervention has clinical and economic benefits when used in residents with clinically significant agitation.

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 Personal Social Services Research Unit and Centre for Mental Health, London. 2014

The health service spent £2.0 billion on services for people with psychosis in
2012/13. Over half (54%) of this total was devoted to inpatient care. This means
that spending is currently skewed towards the more expensive parts of the
system, at £350 average cost per day for inpatient care compared with £13
average cost per day in community settings.

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

Learning from International Models of Advance Care Planning to Inform Evolving Practice
Dixon J Personal Social Services Research Unit, London. 2017

Reform of end of life care in England has been a priority for some time, with a desire, amongst other things, to ensure that more people can have a ‘good death’ in line with their wishes for what this would be and where this might happen. Advance care planning (ACP) is a key element in this end-of-life care in England. An economic perspective policy, with an important role for social care envisaged. The complex interventions that research suggests are most effective and the social care role within them are, however, under-developed. While research evidence suggests that ACP interventions are associated with improved quality outcomes and potential acute-care cost savings, interventions are poorly described in the literature, and information on costs and cost drivers is almost entirely lacking. This project addresses these gaps, identifying and interrogating the activities and resources needed to deliver complex ACP interventions, drawing on the experiences of ACP programmes in the US and Australia, including Respecting Choices and four programmes adapting this approach. These programmes use (or, in Australia, are considering use of) social workers, allied professionals and volunteers as facilitators. We will use quantitative and in-depth qualitative methods to produce detailed descriptions of the programmes and their practices, develop a method for costing them, collect and compare cost data, and explore the main cost drivers and sources of cost variation. We shall also review the literature to identify, and ideally model, the likely economic and quality outcomes of such interventions in England. We will work with an expert advisory panel and facilitate a stakeholder workshop to comprehensively consider transferability into an English context.

Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomized, controlled trial
Livingston G, Barber J, Rapaport P Lancet Psychiatry, 1, 539-548. 2014

Background Two-thirds of people with dementia live at home supported mainly by family carers. These carers
frequently develop clinical depression or anxiety, which predicts care breakdown. We aimed to assess the clinical
eff ectiveness (long-term reduction of depression and anxiety symptoms in family carers) and cost-eff ectiveness of a
psychological intervention called START (STrAtegies for RelaTives).
Methods We did a randomised, parallel-group trial with masked outcome assessments in three UK mental-health
services and one neurological-outpatient dementia service. We included self-identifi ed family carers of people with
dementia who had been referred in the previous year and gave support at least once per week to the person with
dementia. We randomly assigned these carers, via an online computer-generated randomisation system from an
independent clinical trials unit, to either START, an 8-session, manual-based coping intervention delivered by
supervised psychology graduates, or treatment as usual (TAU). The primary long-term outcomes were aff ective
symptoms (Hospital Anxiety and Depression Scale total score [HADS-T]) 2 years after randomisation and costeff ectiveness (health and social care perspectives) over 24 months. Analysis was by intention to treat, excluding
carers with data missing at both 12 and 24 months. This trial is registered ISCTRN70017938.
Findings From November 4, 2009, to June 8, 2011, we recruited 260 carers. 173 carers were randomly assigned to
START and 87 to TAU. Of these 260 participants, 209 (80%) were included in the clinical effi cacy analysis
(140 START, 69 TAU). At 24 months, compared with TAU the START group was signifi cantly better for HADS-T
(mean diff erence –2·58 points, 95% CI –4·26 to –0·90; p=0·003). The intervention is cost eff ective for both carers
and patients (67% probability of cost-eff ectiveness at the £20 000 per QALY willingness-to-pay threshold, and 70%
at the £30 000 threshold).
Interpretation START is clinically eff ective, improving carer mood and anxiety levels for 2 years. Carers in the
control TAU group were seven times more likely to have clinically signifi cant depression than those receiving
START. START is cost eff ective with respect to carer and patient outcomes, and National Institute for Health and
Care Excellence (NICE) thresholds. The number of people with dementia is rapidly growing, and policy
frameworks assume that their families will remain the frontline providers of (unpaid) support. This cost-neutral
intervention, which substantially improves family-carers’ mental health and quality of life, should therefore be
widely available.

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.

Making the Long-Term Economic Case for Investing in Mental Health to Contribute to Sustainability
McDaid D European Union, Brussels. 2011

Poor mental health has a significant economic impact on the health system and the wider economy
in Europe, with implications for the potential achievement of the Europe 2020 strategy on economic
growth. This brief primer considers what is known about the potential short, mid and longer term
economic benefits of actions across the life course focused on mental health promotion, mental
disorder prevention and early intervention. Actions that can be undertaken both within and external
to the mental health system are highlighted, drawing on recent economic analyses prepared in a UK
context, supplemented by data from other parts of Europe and elsewhere.
There is considerable variation in the strength of the evidence base and in the time period required
to achieve a return on investment. The most attractive actions include early actions in childhood
which can have substantial benefits that last well into adulthood, as well as interventions to promote
health in workplaces. Improved job retention rates reduce the need to pay social welfare payments
related to employment and disability. Workplace health promotion activities might also reduce the
risk of early retirement due to poor mental health.
Economic restructuring is not just associated with the current economic climate it is a constant
activity; there may also be interest in interventions to strengthen the mental health and resilience of
those who have been made unemployed or are at risk of unemployment or enforced change of role
at work. Loss of job, or downsizing of role have been associated with a reduction in mental health;
again early actions can reduce the risks of these events and their resource consequences for health
care systems.
Other activities examined here include tackling post natal depression, reducing the risk of suicide,
early identification of psychosis, promoting the mental health of older people, the use of debt and
financial advice services, tackling chronic co-morbid physical and mental health problems, and
addressing the issue of medically unexplained systems.

Mental Health Promotion and Mental Illness Prevention: The Economic Case
Knapp M, McDaid D, Parsonage M Personal Social Services Research Unit, London. 2011

Mental ill health is the largest single cause of disability in the UK, contributing almost 23% of the overall burden of disease compared to about 16% each for cancer and cardiovascular disease. The economic and social costs of mental health problems in England are estimated at around £105 billion each year.

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 in Mental Health Care: Is it Good Value for Money?
Trachtenberg M, Parsonage M, Shepherd G Centre for Mental Health, London. 2013

Peer support workers – people with their own lived experience of mental illness – provide mutually supportive relationships in secondary mental health services. Increasing numbers are being employed, both in this country and elsewhere.

This paper makes a first attempt at assessing whether peer support provides value for money, looking specifically at whether peer support workers can reduce psychiatric inpatient bed use. Because of the very high cost of inpatient care, the savings that result from even small changes in bed use may be sufficient to outweigh the costs of employing peer workers.

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.

Promoting Health, Preventing Disease: Is There an Economic Case?
Merkur S, Sassi F, McDaid D European Observatory on Health Systems and Policies, Denmark. 2013

A core question for policy-makers will be the extent to which investments
in preventive actions that address some of the social determinants of health
represent an effi cient option to help promote and protect population health.
Can they reduce the level of ill health in the population? How strong is the
evidence base on their effectiveness and, from an economic perspective,
how do they stack up against investment in the treatment of health problems?
Are there potential gains to be made by reducing or delaying the need for the
consumption of future health care resources? Will they limit some of the wider
costs of poor health to society, such as absenteeism from work, poorer levels of
educational attainment, higher rates of violence and crime and early retirement
from the labour force due to sickness and disability?
This policy summary provides an overview of what is known about the economic
case for investing in a number of different areas of health promotion and
non-communicable disease prevention. It focuses predominantly on addressing
some of the risk factors for health: tobacco and alcohol consumption, impacts
of dietary behaviour and patterns of physical activity, exposure to environmental
harm, risks to mental health and well-being, as well as risks of injury on
our roads.
It highlights that there is an evidence base from controlled trials and welldesigned observational studies on the effectiveness of a wide range of health
promotion and disease prevention interventions that address risk factors to
health. Moreover, the cost–effectiveness of a number of health promotion and
disease prevention interventions has been shown in multiple studies. Some of
these interventions will be cost-saving, but

Review of the international evidence on support for unpaid carers
Brimblecombe N, Fernandez JL, Knapp M, et al Journal of Long-Term Care, September, 25-40. 2018

Abstract Globally and locally, ongoing demographic, socio-cultural and economic changes have implications for unpaid carers. For those who provide unpaid care, particularly at higher intensities, there is substantial evidence of negative effects on employment, health and wellbeing, with associated individual and soci-etal costs. For these reasons, there is increasing policy emphasis on supporting unpaid care in the UK, mirrored, and in some cases exceeded, internationally. This paper aims to provide an overview of the interna-tional evidence on effective support for unpaid carers. This evidence synthesis finds an extensive literature on a wide range of potentially effective interventions to support unpaid carers under the broad categories of indirect support (services for the care-recipient), direct support (such as psychological therapies), work condi-tions, and combinations of these. However, there are significant gaps in the evidence base with regards to interventions, outcomes and types of caring situation studied, with a dearth of evidence on cost-effectiveness and few evaluations of key recent policy initiatives. Evidence is strongest and most consistent for formal care services for people with care needs (so-called ‘replacement’ or ‘substitution’ care); flexible working conditions; psychological therapy, training and educa-tion interventions; and support groups. In many cases it may be that a combination of interventions is most effective. These findings have implications for social care policy and practice which aims to support carers, particularly in the context of the changing landscape of global macro-level processes and recent policy, legislative and funding changes for local authority and voluntary sector providers of support and services for carers in the UK.Keywords: unpaid care, support for unpaid carers, social care services, work conditions, cash benefits, review.

Supported employment: cost-effectiveness across six European sites
Knapp M, Patel A, Curran C, et al World Psychiatry, 12, 1, 60-68. 2013

A high proportion of people with severe mental health problems are unemployed but would like to work. Individual Placement and Support (IPS) offers a promising approach to establishing people in paid employment. In a randomized controlled trial across six European countries, we investigated the economic case for IPS for people with severe mental health problems compared to standard vocational rehabilitation. Individuals (n=312) were randomized to receive either IPS or standard vocational services and followed for 18 months. Service use and outcome data were collected. Cost-effectiveness analysis was conducted with two primary outcomes: additional days worked in competitive settings and additional percentage of individuals who worked at least 1 day. Analyses distinguished country effects. A partial cost-benefit analysis was also conducted. IPS produced better outcomes than alternative vocational services at lower cost overall to the health and social care systems. This pattern also held in disaggregated analyses for five of the six European sites. The inclusion of imputed values for missing cost data supported these findings. IPS would be viewed as more cost-effective than standard vocational services. Further analysis demonstrated cost-benefit arguments for IPS. Compared to standard vocational rehabilitation services, IPS is, therefore, probably cost-saving and almost certainly more cost-effective as a way to help people with severe mental health problems into competitive employment.

The Autism Dividend: The Report
Iemmi V, Knapp M, Ragan I National Autism Project, London. 2017

In 2007, research led by Professor Martin
Knapp from the London School of Economics
and Political Science demonstrated that the
economic consequences of autism in the
UK totalled £28 billion per annum. The study,
financed by The Shirley Foundation, stimulated
other work such as the National Audit Office
report in 2009, Supporting People with Autism
through Adulthood, which showed that
effective support could substantially reduce
costs. The Autism Act (2009) aimed to improve
diagnosis and support for autistic adults in
England, while in Wales the first ever national
strategy for autism was published in 2008, and
other political initiatives followed in Scotland
(the Scottish Strategy for Autism launched in
2011) and Northern Ireland (the wide-ranging
Autism Act (NI) 2011). These initiatives in
all four nations led to further development
of action plans, revised strategies and new
guidance. It looked as though a new era of
more effective recognition and support for
autistic people was beginning. Yet nearly
a decade on, the needs of autistic people
are still unmet and the expected economic
dividend never materialised. When the LSE
revisited the figures for 2014 using more
accurate information the total came to £32
billion. Something is clearly not working.

The Economic Case for a Befriending and Practical At-Home Support Scheme for Older People in Shropshire, England
Bauer A, Knapp M, Perkins M, et al LSE PSSRU and NIHR SSCR Research Findings, Personal Social Services Research Unit, London. 2014

Abstract
Our aim for this particular case study was to examine the economic case for a help-at-home scheme focused on supporting older people to live more independently in their homes. For this purpose we sought to evaluate the costs of the scheme and the outcomes it achieved, including those linked to cost savings. While the focus was on assessing whether the scheme was able to achieve potential cost savings from a public sector perspective, and in particular an adult social care perspective, we also evaluated additional social benefits, including those to the individual older people (including in their role as carers for their spouse in some cases) and volunteers. We also wanted to explore the capacity of the project to engage with a process of economic analysis and to present our economic evidence in the wider context of qualitative data about, for example, service user satisfaction.

The Role of Adult Social Care in Improving Outcomes for Young People Who Provide Unpaid Care
Brimblecombe N Personal Social Services Research Unit, London. Due to complete 2019

There is increasing emphasis in social care policy and practice in England on the provision of formal support and services for the care-recipient to meet needs and improve outcomes for unpaid carers. This includes young adult carers for whom there are negative short and long-term outcomes in education, employment, mental and physical health, with associated individual and societal costs. Despite this, little is known about the role of social care services in alleviating young people’s need to provide unpaid care and improving outcomes, nor about the extent of services needed and the cost of providing them. This study aims to fill these gaps through analysis of large, nationally representative datasets and collection of primary questionnaire data from young carers and the adult they support. The study aims to investigate associations between outcomes for young adult carers aged 16 to 25 in England and provision of social care services for the adult they care for, needs for such services and costs of providing them. Young carers and adult social care users, practitioners and policy makers will be involved in the study design, implementation and knowledge exchange activities to keep the project policy and practice relevant and facilitate impact.

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