Accountability for health: a scoping paper for the LGA health commission

This paper for the Local Government Association Health Commission aims to scope the main issues surrounding the accountability of health services in England in the context of the Commission’s terms of reference. These require the Commission to consider, against a background of what is referred to as a ‘new consensus’ about localism, how local councils might work best with National Health Service and other partners to engage local people in decision-making and empower them to hold the health care commissioning and delivery system to account. In this paper, the authors seek to clarify the different ways in which accountability has been understood and expressed in relation to the NHS, and to offer a framework for assessing both current mechanisms and new proposals

Early evaluation: hurdles in the road for Pioneer health and social care integration programme

The final report from the ‘early evaluation of the Integrated Care and Support Pioneer programme’s first 18 months suggests the 14 English areas comprising its original cohort have been making some headway (11 others joined them last year). But many are finding the going tough in terms of progress towards the initiative’s goal of ‘whole system’ integration organised around the needs of individuals and their carers

National evaluation of Partnerships for Older People Projects

Executive Summary The Partnership for Older People Projects (POPP) were funded by the Department of Health to develop services for older people, aimed at promoting their health, well-being and independence and preventing or delaying their need for higher intensity or institutional care. The evaluation found that a wide range of projects resulted in improved quality of life for participants and considerable savings, as well as better local working relationships. • Twenty-nine local authorities were involved as pilot sites, working with health and voluntary sector partners to develop services, with funding of £60m • Those projects developed ranged from low level services, such as lunch-clubs, to more formal preventive initiatives, such as hospital discharge and rapid response services • Over a quarter of a million people (264,637) used one or more of these services • 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. This is the headline estimate drawn from a statistically valid range of £0.80 to £1.60 saving on emergency bed days for every extra £1 spent on the projects. • Overnight hospital stays were seemingly reduced by 47% and use of Accident & Emergency departments by 29%. Reductions were also seen in physiotherapy/occupational therapy and clinic or outpatient appointments with a total cost reduction of £2,166 per person • A practical example of what works is pro-active case coordination services, where visits to A&E departments fell by 60%, hospital overnight stays were reduced by 48%, phone calls to GPs fell by 28%, visits to practice nurses reduced by 25% and GP appointments reduced by 10% • Efficiency gains in health service use appear to have been achieved without any adverse impact on the use of social care resources • The overwhelming majority of the POPP projects have been sustained, with only 3% being closed – either because they did not deliver the intended outcomes or because local strategic priorities had changed • PCTs have contributed to the sustainability of the POPP projects within all 29 pilot sites. Moreover, within almost half of the sites, one or more of the projects are being entirely sustained through PCT funding – a total of 20% of POPP projects. There are a further 14% of projects for which PCTs are providing at least half of the necessary ongoing funding • POPP services appear to have improved users’ quality of life, varying with the nature of individual projects; those providing services to individuals with complex needs were particularly successful, but low-level preventive projects also had an impact • All local projects involved older people in their design and management, although to varying degrees, including as members of steering or programme boards, in staff recruitment panels, as volunteers or in the evaluation • Improved relationships with health agencies and the voluntary sector in the locality were generally reported as a result of partnership working, although there were some difficulties securing the involvement of GP

Evaluating social care prevention in England: challenges and opportunities

Context: The Care Act 2014 placed a statutory duty on adult social care (ASC) to prevent and delay the development of needs for care and support. There is little clarity about how to translate this national obligation into effective local practice. Objectives: This exploratory study sought to lay the foundations for understanding approaches to this new duty by identifying: emerging local understandings of prevention; associated implementation strate­gies; and the potential for designing evaluation frameworks. Methods: Local perspectives were secured through: in-depth interviews in six English local authorities; reviews of local strategy, implementation documents and reviews of data sources; and methods for evaluating local initiatives in sampled authorities. Findings: Our findings indicate important differences between and within local authorities in conceptuali­sations of prevention. Although willingness to commission services was strongly linked to the availability of evidence on what works in prevention, council conducted limited local evaluations. We also found limited collaboration between ASC and Health in developing joint prevention approaches, in part due to differ­ences in conceptualisation and also constraints arising from different priorities and information systems. Limitations: The exploratory nature of the study and the small sample size limits the generalisability of its findings. Overall, the number of local authorities and respondents allowed us to explore a range of local views, opinions and practices related to the prevention agenda in a variety of contexts, however the findings are not generalisable to all English local authorities. Implications: Our study suggests that the limited local evidence about prevention, combined with finan­cial austerity, may lead to disproportionate investment in a small number of interventions where existing evidence suggests cost-savings potential, which, in turn, may impact authorities’ ability to fulfil their statutory duties related to preventing and delaying the needs for care and support. In this connection, we highlight the potential for developing local evaluation strategies utilising existing but largely unexploited local administrative data collections

Circles of support and personalisation: exploring the economic case

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

Costs and economic consequences of a help-at-home scheme for older people in England

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 wellbeing needs. However, not much is currently known about the costs, outcomes and economic consequences of such schemes. Understanding their impact on individuals’ wellbeing 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 (ASCOT) for 24 service users (59% response rate) when they started using the scheme and 4 to 6 months later. A customised questionnaire that captured resource use and wellbeing information was sent to 1,064 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 £1,568 per person from a local government and NHS perspective and £3,766 from the perspective of the individual. An expenditure of £2,851 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

Using vignettes to examine preferences for paying for long-term social care in online and interview surveys

A novel approach using ‘vignettes’ to elicit public attitudes towards paying for long-term social care for older people was administered in two surveys: 1) for people aged 18-75, a web survey using an online volunteer panel; and 2) for older people aged 65+, a face-to-face interview was included within a national random location omnibus survey. Given the different sampling approaches and modes of data collection, we examined whether our key results differed between the two surveys by comparing responses for the 65-75 age group that was included in both. While responses to the vignettes were significantly different in the two surveys, after adjusting for differences in socio-demographic characteristics, the vignette results were comparable. The variations in response between the surveys thus appear to be due to differences in sample profile rather than to measurement differences due to survey mode