Results for 'costs'
DAMERY Sarah, FLANAGAN Sarah, COMBES Gill
Objective: To summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity.
Design: Umbrella review of systematic reviews and meta-analyses.
Setting: Interventions must have delivered care crossing the boundary between at least two health and/or social care settings.
Participants: Adult patients with one or more chronic diseases.
Data sources: MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (HTA database,DARE, Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, HEED, manual screening of references.
Outcome measures: Any measure of hospital admission or readmission, length of stay (LoS), accident and emergency use, healthcare costs.
Results: 50 reviews were included. Interventions focused on case management (n=8), chronic care model (CCM) (n=9), discharge management (n=15), complex interventions (n=3), multidisciplinary teams (MDT) (n=10) and self-management (n=5). 29 reviews
reported statistically significant improvements in at least one outcome. 11/21 reviews reported significantly reduced emergency admissions (15–50%); 11/24 showed significant reductions in all-cause (10–30%) or condition-specific (15–50%) readmissions; 9/16 reported LoS reductions of 1–7 days and 4/9 showed significantly lower A&E use (30–40%). 10/25 reviews reported significant cost reductions but provided little
robust evidence. Effective interventions included discharge management with post-discharge support, MDT care with teams that include condition-specific expertise, specialist nurses and/or pharmacists and self-management as an adjunct to broader
interventions. Interventions were most effective when targeting single conditions such as heart failure, and when care was provided in patients’ homes.
Conclusions: Although all outcomes showed some significant reductions, and a number of potentially effective interventions were found, interventions rarely demonstrated unequivocally positive effects. Despite the centrality of integrated care to current policy,
questions remain about whether the magnitude of potentially achievable gains is enough to satisfy national targets for reductions in hospital activity.
UNITED KINGDOM HOMECARE ASSOCIATION
Drawing on data obtained from freedom of information requests, this report analyses average prices paid by councils for home care services across all four administrations of the United Kingdom. It also provides a breakdown by England’s nine government regions. The data were obtained during a sample week in April 2016 following the introduction of the new National Living Wage. The analysis found that only one in ten authorities paid an average price at or above UKHCA’s minimum price of £16.70 per hour. It also found that seven authorities paid average prices which the UKHCA believe are unlikely even to cover care workers’ wages and on-costs of £11.94 per hour. Only 24 councils had completed calculations for the costs of home care. The report highlights the low rates that many councils are paying independent and voluntary homecare providers. It argues that this underfunding is a root cause of the instability of local homecare markets and the low pay and conditions of the homecare workforce. The analysis also exposes the level of risk that councils place on a system intended to support older and disabled people. The report makes a number of recommendations, which include the need for local authorities to provide calculations of their costs of homecare.
Implementation plan which outlines a roadmap for delivering the commitments made in the Five Year Forward View for Mental Health to people who use services and the public in order to improve care. It prioritises objectives for delivery by 2020/21 and is intended as a blueprint for the changes that NHS staff, other organisations and other parts of the system can make. Key principles of the plan include co-production, working in partnership with local public, private and voluntary sector organisations; early interventions and delivering person-centred care. The plan also gives a clear indication to the public and people who use services what they can expect from the NHS, and when. It also outlines future funding commitments, shows how the workforce requirements will be delivered in these priority areas, and how data and payment will support transparency. Separate sections cover: children and young people’s mental health; perinatal mental health; adult mental health – including community, acute, crisis care and secure care; mental health and justice, and suicide prevention. These individual chapters set out national-level objectives, costs and planning assumptions. Chapters also describe cross-cutting work to help sustain transformation, including testing new models of care and ensuring the health and wellbeing of the NHS workforce.
HARFLETT Naomi, et al
An economic analysis of three schemes from Dorset Partnership for Older People Projects (POPP), focusing on their value and effectiveness in preventing malnutrition and preventing fire related injuries. Dorset POPP schemes use a community led preventative approach and aim to improve the quality of life of older people and to save money by preventing ineffective use of publicly funded services. The report uses published figures of the costs of malnutrition and the economic value of preventing fire injuries and applies the figure to contact monitoring and costs data from three of the Dorset POPP projects to provide an estimate of the potential economic value. The schemes are: the Wayfinder Programme, which provides signposting and support on services such as welfare benefits and pensions, retaining independent living, social activities, telecare and lunch clubs; the Community Initiatives Commissioning Fund (CICF), which funds initiatives identified by local people such as lunch clubs, social clubs, and neighbourcare schemes; and Safe And Independent Living (SAIL) multi-agency referral scheme, which provides a multi-agency referral approach to enabling access to signposting, support, and services. For all of the interventions included in the analysis, just a very small proportion (often less than one per cent) of the contacts or referrals made would be needed to prevent malnutrition or fire related injuries, in order to save money.
KING'S FUND, LOCAL GOVERNMENT ASSOCIATION
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.
HOLLAND Carol, et al
Report presenting findings from a longitudinal study to evaluate whether the ExtraCare Charitable Trust housing approach provides positive outcomes for healthy ageing which also results in health and social care cost savings. For the study 162 volunteer new residents were assessed prior to moving into ExtraCare accommodation in the 14 locations on their health, illness, well-being and level of activity. They were then assessed on the same measures at 6, 12 and 18 months after entry. Residents were compared against 39 control participants. The main focuse was to measure health, illness, well-being, activity and personal perceptions .Qualitative data were also collected through focus groups, interviews, and case studies to gather residents views and perceptions. Statistical modelling was used to identify the most important factors in predicting outcome measures of cost. Key findings identified: significant saving for NHS budgets, with total NHS costs reducing by 38% over a 12-month period for residents in the sample; a reduction in the duration of unplanned hospital stays; potential savings in the cost of social care; improvements in residents who were designated as in a 'pre-frail' state on entry to ExtraCare housing; and improvements in residents psychological wellbeing, memory and social interaction.
DIXON Josie, et al
This independent economic evaluation of the British Red Cross Support at Home service focuses on four services which were found to improve outcomes in an earlier British Red Cross evaluation. The services all aim to help people to build their confidence and regain their independence during times of particular difficulty.Those evaluated were 'Next Steps', where volunteers provide home visits and monitor how people are coping following hospital discharge; 'Care in the Home' services delivered by staff and volunteers providing social visits, support and help with household tasks; and a Neighbourhood/Community service in Scotland which focused on linking people to existing services and volunteer-led services such as befriending. The final sample for this analysis consisted of a total of 52 people, the majority of who were over 65. Two outcomes were used in the economic analysis: an increased ability to manage daily activities and improved wellbeing. The evaluation identified cost savings that were related to a reduced need for formal/ informal care and general help around the home; a reduced risk of falls and malnutrition, particularly amongst those with unmet care needs; and, to a lesser degree, a reduced need for treatment of depressive symptoms. The total savings identified amounted to more than five times the cost of the service. The average cost of the intervention was £169 per person (based on the services and sample data in the Red Cross evaluation) and the identified savings came to £880 per person.
SKILLS FOR CARE
This online tool outlines the key steps of planning and implementing the impact assessment of assisted living technologies (ALT) and assistive living services (ALT). It includes practical tips, links to other sources of guidance and areas to discuss with partners. The toolkit covers designing an evaluation framework; assigning impact measures; establishing a sample of people to assess impact; establishing unit costs; developing data capture research tools; measuring return on investment; quality control; and using the findings to inform future delivery. The tool should be used in conjunction with two accompanying reports: 'Supporting commissioners of assisted living Services: stage 1: research report' and 'Commissioning assisted living technologies: guidance'.
This guide sets out the issues that need to be considered when developing a business case to invest in preventive services and to ensure that any decision are based on robust and reliable data. The guide focuses on the following arguments: the importance of 'investing to save', arguing that prevention is cheaper in the long term; promotion of service innovation; placing the focus of commissioning on outcomes rather than outputs; and managing a shift in spending from acute to prevention to reduce demand over time. The guide outlines key four activities required to build a business case: understanding needs; understanding current costs; assessing possible interventions; and deciding how to measure the value and outcome of the interventions. It also provides a summary business case for prevention and using a Social Impact Bond (SBI) to finance a business case for prevention. An example case study of making a business case for prevention services in early years services in Greater Manchester is included.
UNIVERSITY OF YORK. Social Policy Research Unit
This report provides final findings of a study conducted with ten participating councils to investigate the benefits of homecare re-ablement. The study aimed to identify features of an effective and cost efficient services; maximise outcome and duration of benefits; and to understand and reduce the demands on other formal care, including other social services. The study comprised of three groups of councils: intervention sites which were enablement staff led; intervention sites with mixed staff teams; and comparison sites where service users had not undergone a phase of home care re-ablement. The previous interim study reflected on initial findings from the intervention sites. This report also adds findings from the comparison sites and long term impact from the follow up review stage. Main findings are discussed in the areas of assessment arrangements; discharge and onward referral arrangements; key features of re-ablement services; team skill mix; staff commitment, attitude, knowledge and skill; service users and carer views; and a strong vision of the service.