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: Background Contract 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 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 carers 2. 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 Users Nature of benefits (i.e. economic or social outcome) MeasureIndicatorEvidence 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 Impact Social 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) MeasureIndicatorEvidence Economic: Demonstrable savings to the public purse as a result of service provided Reduction in number of bed days used Cost saving per bedACR 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 yearsCRESR, 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….