Results for 'costs'
Results 1 - 10 of 21
MACKINTOSH Shelia, et al
This review, commissioned by the Department of Health and Social Care, looks at how the Disabled Facilities Grant (DFG) currently operates and makes evidence based recommendations for how it should change in the future. It review aims to develop more effective ways of supporting more people to live in suitable housing so they can stay independent for longer and makes the case for more joint working across housing, health and social care. The focus of the review is on how the disabled or older person can be put at the centre of service provision and what would make it easier for them to access services. It also looks at the role of DFG in prevention and how it can deliver this more effectively. It draws on a range of evidence, including: analysis of data from LOGASnet returns; consultation events attended by local authorities and home improvement agencies; interviews with staff from selected local authorities; and a short review of the academic, policy and practice literature. The conclusions and recommendations include: renaming the grant to reflect that it is part of a broader set interventions to help people remain independent; improved integration of services; better partnership working between health and care and different professions; raising the upper limit of the grant; and changes to the current formula for allocating funding; and updating of the existing means testing regulations. The review also identifies additional research to be carried out.
OLIJ Branko F., et al
Objectives: To provide a comprehensive overview of economic evaluations of falls prevention programs and to evaluate the methodology and quality of these studies. Design: Systematic review of economic evaluations on falls prevention programs. Setting: Studies (N=31) of community‐dwelling older adults (n=25), of older adults living in residential care facilities (n=3), and of both populations (n=3) published before May 2017. Participants: Adults aged 60 and older. Measurements: Information on study characteristics and health economics was collected. Study quality was appraised using the 20‐item Consensus on Health Economic Criteria. Results: Economic evaluations of falls prevention through exercise (n = 9), home assessment (n = 6), medication adjustment (n = 4), multifactorial programs (n = 11), and various other programs (n = 13) were identified. Approximately two‐thirds of all reported incremental cost‐effectiveness ratios (ICERs) with quality‐adjusted life‐years (QALYs) as outcome were below the willingness‐to‐pay threshold of $50,000 per QALY. All studies on home assessment and medication adjustment programs reported favorable ICERs, whereas the results of studies on exercise and multifactorial programs were inconsistent. The overall methodological quality of the studies was good, although there was variation between studies. Conclusion: The majority of the reported ICERs indicated that falls prevention programs were cost‐effective, but methodological differences between studies hampered direct comparison of the cost‐effectiveness of program types. The results imply that investing in falls prevention programs for adults aged 60 and older is cost‐effective. Home assessment programs (ICERs < $40,000/QALY) were the most cost‐effective type of program for community‐dwelling older adults, and medication adjustment programs (ICERs < $13,000/QALY) were the most cost‐effective type of program for older adults living in a residential care facility.
TRAVERSE, MACMILLAN Tarran, et al
The final evaluation report of Homeshare pilots programme (HSP), which looks at what works to develop a sustainable Homeshare scheme. Homeshare schemes bring together older people who need support to stay in their homes, with young people who provide companionship and low level support in return for an affordable place to live. The evaluation, commissioned by SCIE and conducted by Traverse, identifies which approaches and activities work best, barriers to successful schemes, cost and benefits, and identifies factors that to be used by commissioners to assess bids for Homeshare schemes. It draws on qualitative interviews with pilot leads and staff, local authority stakeholders, referral agencies and with householders and homesharers from the first matches achieved in three HSP sites. It covers experiences of living in a Homeshare, operating a sustainable Homeshare scheme, referral and sustainability, and highlights broader learning for the social care and housing sectors. The results show how that Homeshare can reduce loneliness and improve wellbeing by offering companionship and facilitating inter-generational relationships, as well as addressing the lack of affordable housing options. The report concludes that the programme has been successful in supporting the development of Homeshare sites and provided learning in what works in supporting innovation within delivery of social and housing support.
WILLIS Elizabeth, SEMPLE Amy C., de WAAL Hugo
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.
This paper describes work undertaken with Age UK Herefordshire and Worcestershire to design a service that addresses loneliness, particularly among older people. The first half of the paper examines the potential costs of loneliness and the potential value to the public sector of reducing loneliness. The second half of the paper describes the outcomes-based model used in Worcestershire and sets out initial findings of the service. The service uses a model of commissioning services through a Social Impact Bond (SIB), a contract in which commissioners commit to pay investors for an improvement in social outcomes. The paper sets out some of the benefits of using social investment to fund the upfront cost of delivering a service to reduce loneliness. It also discusses the following elements of the model: measuring loneliness and additional outcomes, delivering support to the population most at risk, considering social investment and agreeing a payment mechanism.
BICKERDIKE Liz, et al
Objectives: Social prescribing is a way of linking patients in primary care with sources of support within the community to help improve their health and well-being. Social prescribing programmes are being widely promoted and adopted in the UK National Health Service and this systematic review aims to assess the evidence for their effectiveness.
Setting/data sources: Nine databases were searched from 2000 to January 2016 for studies conducted in the UK. Relevant reports and guidelines, websites and reference lists of retrieved articles were scanned to identify additional studies. All the searches were restricted to English language only.
Participants: Systematic reviews and any published evaluation of programmes where patient referral was made from a primary care setting to a link worker or facilitator of social prescribing were eligible for inclusion. Risk of bias for included studies was undertaken independently by two reviewers and a narrative synthesis was performed.
Primary and secondary outcome measures: Primary outcomes of interest were any measures of health and well-being and/or usage of health services.
Results: A total of 15 evaluations of social prescribing programmes were included. Most were small scale and limited by poor design and reporting. All were rated as a having a high risk of bias. Common design issues included a lack of comparative controls, short follow-up durations, a lack of standardised and validated measuring tools, missing data and a failure to consider potential confounding factors. Despite clear methodological shortcomings, most evaluations presented positive conclusions.
Conclusions: Social prescribing is being widely advocated and implemented but current evidence fails to provide sufficient detail to judge either success or value for money. If social prescribing is to realise its potential, future evaluations must be comparative by design and consider when, by whom, for whom, how well and at what cost.
Drawing on the findings from a review of evidence on the impact of sheltered housing for older people, this briefing paper provides estimates of the cost savings sheltered housing can achieve for health and social care. The paper gives a conservative estimate of a social value saving made by sheltered housing of nearly half a billion pounds. This figure takes into account costs saved through a reduction in the number of falls by older people, the time spent in hospital, combating loneliness, as well as fewer unnecessary call-outs to emergency services. The paper was commissioned to help Anchor, Hanover and Housing & Care 21 consider the future of sheltered housing.
CAPER Kathleen, PLUNKETT James
Drawing on the results of interviews with 824 general practitioners (GPs) in England carried out in 2015, this briefing looks at the amount of time and money GPs spend dealing with non-health issues. GPs responding to the survey report spending almost a fifth of their time on social issues that are not principally about health, including relationship problems, housing, unemployment and social isolation. This time has an implied cost to the health service of almost £400 million a year. Although approximately half the GPs surveyed said that time spent on non-health issues helped them understand their local community, this can leave less time for other patients' health care needs. In addition, many issues raised with GPs, require specialist knowledge that many GPs do not have. Whist the report acknowledges that discussion of non-health issues can be helpful in developing GP-patient relationships, it concludes that finding other ways to meet some of the non-health demand facing GPs would free up time and money to be reinvested in patient care. Possible suggestions put forward include the co-locating of non-health services and advice services in GP surgeries and ensuring GPs know how to best signpost patients to other local services in the community.
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.
Results 1 - 10 of 21