Report 37: Personalisation, productivity and efficiency

Preventing admissions

'The use of personalisation and 'community-based approaches' can result in crisis prevention and avoiding admission to hospital or residential care' (21)

Personalised and 'low level' community-based approaches to integrated adult social care and support can result in crisis prevention and avoiding admission to hospital or residential care, particularly for older people. (21, 22, 23) This can result in improvements to productivity in adult social care. The way people use personal budgets can be preventative, particularly in mental health, (24, 25) thereby reducing health crises or hospital admissions that can result in savings to health. However, cost savings to health are not necessarily registered by or shared with local authorities. (26, 14, 27)

The following extract from 'SCIE Research briefing 20: The implementation of Individual Budget schemes in adult social care' (27) makes some key points on savings gained by health from some of the research up until 2008 (this also includes research on direct payments):

What research indicates is that personal budget schemes from social care funding may have the potential to produce savings for health, but that it can be challenging for social care to achieve the flexibility with health funding necessary to meet the support needs of individuals, particularly Continuing Healthcare for those with complex needs. If this is the case, action may be needed to ensure that funding structures and budgets reflect this dynamic. Central government may have a strategic role to play here.

The IBSEN study, the In Control evaluation and the Commission for Social Care Inspection have revealed that there were significant challenges in aligning and integrating funding streams within existing regulatory frameworks. Particular barriers were identified for NHS funding. This is found to impact especially on people with mental health problems and may also have implications for older people. In Control reported that 'a disparity of funding levels [between health and social care] …prevented three people [with learning disabilities living in a hospital setting] from moving into the community'. (27)

• Case study: Partnerships for Older People Projects (POPPs)Open

  A major piece of research that demonstrated some cost savings and improved productivity as part of a broader approach to transformation and personalisation was the two-year National Evaluation of Partnerships for Older People Projects (POPPs). This provides evidence about how integrated person-centred services can promote the independence and health of older people as well as prevent or delay the need for hospital admission, higher intensity or institutional care. The focus was on a wide range of local projects, from low level voluntary sector community-based services to formal hospital discharge schemes in 29 local authorities:

  • The reduction in hospital emergency bed days resulted in considerable savings, to the extent that for every extra £1 spent on the POPP services, there has been approximately a £1.20 additional benefit in savings on emergency bed days.
  • Overnight hospital stays were reduced by 47 per cent and use of A&E [Accident and Emergency] by 29 per cent. Reductions were also seen in physiotherapy/occupational therapy and clinic and outpatient appointments with a total cost reduction of £2,166 per person.
  • One operational example concerns those projects focused on improving wellbeing through the provision of practical help, small housing repairs, gardening, limited assistive technology or shopping [all of which could be purchased using a personal budget]. For an extra spend of £5,000 per person – £96.15 per week – these is a 98 per cent probability that such projects are cost effective compared with “usual care”. (22)

  The POPPs research recommendations include a health and social care financial system reform so that cashable savings from prevention and early intervention can be realised:

  … their cost effectiveness cannot be fully realised unless cashable savings can be released and re-invested in such projects ... some degree of financial systems reform is likely to be necessary to support the decommissioning of services in one part of health and local government alongside the re-investment of resources elsewhere. (22)

  This is consistent with recommendations about the cost-effectiveness and efficiency gains from joint financing and resource sharing between health and social care from elsewhere. (26, 2)