DEMONSTRATING IMPACT IN HEALTH AND SOCIAL CARE: HOSPITAL AFTERCARE SERVICE

Lesley Dabell, CEO Age UK Rotherham,

November 2012

Introduction• Demands on VCS now to ‘prove it’ – evidence base

needed for funders/ commissioners etc.• Example of trying to measure impact in the ‘real world’• NOT an EXPERT – we are all still learning as this is a

brave new world• Started with our Hospital Aftercare Service (HAS)• Now trying to roll this out in other areas of work e.g.

befriending service• This morning:

• Describe what we did• Opportunities and challenges this presented

Hospital Aftercare Service: BackgroundContract with NHSR 2 year pilot basis from April 2009 to offer wider range of support on discharge from hospital on time limited basis in order to:

1. Assist service users to return home as soon as medically fit;

2. Reduce risk of readmission in early stages when most vulnerable;

3. Facilitate early discharge to reduce average length of stay;

4. Promote independence through provision of short term care packages with focus on re-ablement – help regain confidence and day to day independent living skills.

What the Service provides• Provides service 7 days per week, 365 days per year

between 8.30am and 8.30pm• Discharge - help with transport home, collect and deliver

medication from Hospital Pharmacy• Settle client back in own environment – ensure initial

safety and comfort• Assessment within 48 hours - non clinical needs and offer

support and help over 30 days (sometimes more)• Refer to appropriate agencies and other forms of support• Check that they are receiving all benefits and other

entitlements• Offer carer support - many are older carers

Who does the Service support?

• Older people in Rotherham Borough – whichever hospital.

• 1470 older people in 30 months • Majority 75 + and increasingly 85+• Priority – referral criteria:

• Non FAC’s – most at ‘moderate’ level of need; no other care package in place

• No appropriate family carer• Living alone and with no family support

• Carers – many of whom are older people themselves

Measuring impact of HAS: Starting out

We wanted to know WHAT OUTCOME IMPACT WE COULD DEMONSTRATE IN TERMS OF 2 KEY STAKHOLDER GROUPS

1. Older people using the service and their carers2. The NHS/ Social care ‘system’ – our commissioners

We wanted to be able to QUANTIFY SOFT OUTCOMES so we could build up an overview of impact on outcomes for service users AS A GROUP

We wanted to be able to DEMONSTRATE SOCIAL RETURN ON INVESTMENT or at least show that public sector investment in our service generated some ‘savings’

Measuring impact: What we did

Outcomes for SERVICE USERS were measured using an ‘outcomes star’ developed by us - based on user set short term goals which were grouped into 5 key headings:

• Motivation• Mobility• Confidence• Independence• Finances

Used as part of assessment and review process (i.e. not a separate evaluation) benchmarked at outset and progress measured at end of use of service.

Impact Map: Service UsersNature of benefits

(i.e. economic or social outcome)

Measure Indicator Evidence

Social:

Improvement in well-being following discharge from hospital

Increased confidence post discharge

Proportion of clients reporting increased confidence post discharge

ACR have developed a new outcome tool which measures client's progress against personal goals across five well-being categories

Increased motivation post discharge

Proportion of clients reporting increased motivation post discharge

Increased mobility post discharge

Proportion of clients reporting increased mobility post discharge

Improved financial situation post discharge

Proportion of clients reporting increased improved financial situation post discharge

Increased independence post discharge

Proportion of clients reporting increased independence post discharge

Economic:

Improvement in financial situation following discharge from hospital

Increased personal income through claimed benefits entitlements

Total value of new benefits claimed

ACR monitor this for each client supported

Outcomes for Service Users

Based on 2010/11: Piloted ‘Outcomes star’ to monitor effectiveness against user’s set goals

Service User Impact

Improvements in client's financial situation:Support to claim benefits entitlements:

• A total of £73,300 in extra benefits claimed each year• Net benefits worth £342 thousand after five years and

£575 thousand after 10 years

Additionality caveat: • What proportion of HAS clients would have gone on to

claim these benefits by themselves or with the support of others, and how long it would have taken them?

CRESR, 2011

CRESR Key Findings: Service User ImpactSocial Benefits•HAS measures changes in client's self-reported well-being over the period of the intervention in terms of improvements in confidence, motivation, mobility, financial situation, independence.•The evidence demonstrates in 91% of cases users demonstrate average improvements of over 3 points (on 5 point scale) towards goals in all areas

CRESR, 2011

Public Sector Impact

Nature of benefits(i.e. economic or social

outcome)

Measure Indicator Evidence

Economic:

Demonstrable savings to the public purse as a result of service provided

Reduction in number of bed days used

Cost saving per bed ACR monitor number of bed days saved per ward

Reduction in transport costs

Cost saving through not using hospital transport

ACR monitor no of people taken home per ward

Reduction in readmissions and use of other health services

Cost saving associated with fewer admissions

ACR do not monitor data on number of readmissions prevented but this can be estimated using secondary evidence

Public sector impact

Public sector cost savings:•Reduction in the number of bed days required by Rotherham General Hospital:

• 296 bed days saved per year• Between £46,768 and £74,000 saved each year

•Reduction in hospital transport costs:• 228 journeys saved each year• Between £9,120 and £18,240 saved each year

•Reduction in readmissions and other health services:• Reductions in hospital stays, A&E visits, GP visits, physiotherapy• Savings of £277 per client over 3 months• Estimated savings of £179,300 if sustained for 3 months• Estimated savings of £716,900 if sustained for 1 year

CRESR, 2011

Public Sector Impact

Public sector cost savings:Overall savings (low estimate):

• HAS saves the public sector at least £235,000 per year • Return on investment of £1.50 for every £1 invested by the public

sector each year• Net savings after five years will be at least £1.1 million and after 10

years will be £2 million

Overall savings (high estimate)• HAS could be saving the public sector up to £988 thousand each year • Return on investment of £6.30 for every £1 invested by the public

sector each year • Net savings of £4.6 million after five years and £8.5 million after 10

years CRESR, 2011

Critical Success Factors• ‘Action Research’ model enables continuous improvements

in service quality and effectiveness to be delivered – requires flexibility from commissioner as well as provider

• Robust monitoring and evaluation processes are in place from the start to enable evidence base to be developed and used in service delivery and review.

• Key relationships built between partners – trust, understanding and information sharing enables effective provision (appropriate referrals) and evaluation (data sharing).

• Intelligent commissioning – close working and flexibility between commissioner and provider increases effectiveness and enables further developments to support this work e.g. befriending service.

Critical success factors• Effectiveness of service has been increased by close

collaboration with commissioner and by freedom to change the service to meet the needs of the users, rather than restrictive service specification.

• Evidence produced as a result of CRESR Study has been invaluable in proving case for further funding – would it have been as effective if not external, academic evaluation?

• ‘Toolkits’ would be great but may not be possible….