Report 37: Personalisation, productivity and efficiency
Other strategic approaches
'Councils with developed forecasts expect savings to come from other areas of Putting People First, such as prevention, early intervention and enablement, rather than from personal budgets' (14)
The Audit Commission report on financial aspects of personal budgets showed that local authorities that were further along the process of personal budget implementation recognised the fact that savings could come from wider strategic and efficient integrated working.
Studies are showing the potential of telecare, reablement, assistive technology and adaptations and equipment to result in cost-effectiveness, to promote independent living and better outcomes for people who use services and carers (28, 29, 23, 11), although the aim of cost saving needs to be balanced with quality and determined by user outcomes (30). As discussed in the previous section, the POPPs evaluation demonstrated the potential savings gained from an integrated, preventative approach to health and independent living for older people that included the use of assistive technology and reablement (22).
Case study: TelecareOpen
CSED's evaluation of implementing an integrated telecare model to achieve efficiencies concluded that it could deliver benefits in terms of cost and outcomes if integrated across the whole of a council's adult care system. The CSED report (31) gives the following best practice examples that show cost savings:
North Yorkshire County Council [NYCC]
- NYCC has introduced telecare support for everybody needing Adult and Community Services support, as part of the range of mainstream personalised solutions designed to suit each individual's circumstances.
- In Sept 2008, analysis of 132 new users of telecare highlighted an average efficiency of £3,600 per person per year, a 38 per cent reduction in care costs.
- In the first year of the programme, NYCC saved over £1 million that would otherwise have been spent on domiciliary or residential care.
- In August 2009, NYCC had 12,265 telecare users.
Essex County Council
- Essex County Council has allocated £4m to telecare equipment and support in its budget for 2009-2010.
- The council offers new users aged 85 and older a completely free telecare service for one year, covering installation, equipment and a careline connection.
- The service is being made available to these older residents without reference to other eligibility criteria, and a full evaluation of its impact is planned.
- Initial indications show for every £1 spent on telecare, £3.82 has been saved on traditional care. (31)
Case study: Home care reablementOpen
A 2007 CSED and SPRU retrospective longitudinal study of home care reablement for older people provides some emerging data concerning the efficiency and effectiveness of this type of support (32). The findings showed that in three of the four schemes:
- 53 per cent–68 per cent left reablement, requiring no immediate home care package
- 36 per cent–48 per cent continued to require no home care package two years after reablement
- In the fourth service, that operated on a selective basis, the results were significantly higher. Of those who required a home care package within the two years after reablement:
- 34 per cent–54 per cent had maintained or reduced their home care package two years after reablement
- In the fourth service, that operated on a selective basis, the results were higher. Of those aged under 65 years who required a home care package within two years after reablement:
- In three of the four schemes the number who had reduced their package was higher after 24 months than after three months
- This was even more noticeable in two of the schemes for those aged over 85.
Case study: Adaptations and equipmentOpen
An evidence review commissioned by the ODI on implications for health and social care budgets of investment in housing adaptations, improvements and equipment showed that savings could be made in several ways: saving the cost of residential care; reducing the cost of home care; saving through prevention of waste; and saving through better outcomes for the same expenditure: (28)
- For a seriously disabled wheelchair user, the cost of residential care is £700-£800 a week – £400,000 in 10 years. The provision of adaptation and equipment that enables someone to move out of a residential placement produces direct savings, normally within the first year. Home modifications can also help to prevent or defer entry into residential care for older people. One year's delay will save £26,000 per person, less the cost of the adaptation (average £6,000).
- A social services authority, by spending £37,000 on equipment, was able to achieve savings of £4,900 per week in respect of residential care for 10 people. The expenditure was made back in less than eight weeks.
- Adaptations that remove or reduce the need for daily visits pay for themselves in a time span ranging from a few months to three years and then produce annual savings. In the cases reviewed, annual savings varied from £1,200 to £29,000 a year.
- Delay was leading to more costly options. One person received 4.5 additional home care hours a week for 32 weeks at total cost of £1,440, when a door-widening adaptation costing £300 was delayed for seven months for lack of funding.
- One local authority spent £89,000 in one year on adaptations for applicants who, because of long delays, died before they could obtain any real benefit from them.
- The average cost of a disabled facilities grant (£6,000) pays for a stair-lift and level-access shower, a common package for older applicants. These items will last at least five years. The same expenditure would be enough to purchase the average home care package (6.5 hours per week) for just one year and three months. (28)