“We will do more to support people manage their own health – staying healthy, making informed choices of treatment, managing conditions and avoiding complications”[i]. This statement from Chapter 2 of the Five Year Forward View encapsulates the feeling that NHS England considers a new way of operating as crucial to the future quality and sustainability of our country’s health and care system. It is a future that NHS England see as encompassing “a new relationship with patients and communities”i.
Approaches to help achieve this are known as person- and community-centred approaches, and include self-management education, peer support, health coaching, asset based activities, and group based activities. Widely regarded as ‘the right thing to do’, we still know relatively little about what works and how such approaches are generating tangible impact both in terms of quality and sustainability. As a result, many commissioners still do not have the information they need to invest.
Building the investment case for person- and community-centred approaches
The Realising the Value programme helps address that. Led by Nesta and the Health Foundation and sponsored by NHS England, the programme has over the past 18 months developed the field of person- and community-centred approaches to health and wellbeing by drawing together the evidence base, establishing new networks and creating practical resources for system leaders, commissioners and practitioners.
As part of this work, PPL has developed a toolkit, which enables commissioners to assess the costs and benefits of a number of person and community centred approaches. It builds on a wealth of data, wider evidence and expert assessment of impact in relation to:
- Mental and physical health and wellbeing – Person- and community-centred approaches have been shown to increase people’s self-efficacy and confidence to manage their health and care, improve health outcomes and experience, and reduce social isolation and loneliness
- Financial sustainability – including reducing demand on formal, particularly acute health services, as well as achieving savings for local authority care budgets. Person- and community-centred approaches can impact how people use health and care services and can lead to reduced demand on services, particularly emergency admissions and A&E visits, freeing up staff time. Modelling undertaken as part of the programme suggests that implementing peer support and self-management approaches for people with a subset of particular long-term conditions could equate to net savings to the health commissioner of around £2,000 per person reached per year, achievable within the first year of implementation.
- Wider social value – including more resilient communities and greater social connections, as well as wider societal benefits from supporting people to return to work and reducing demand on other public services. Person- and community-centred approaches can lead to a wide range of social outcomes, from improving employment prospects and school attendance to increasing volunteering. They may also contribute to reducing health inequalities for individuals and communities.
The economic modelling tool has already been used by NHS England for planning and strategy purposes. The tool offers a quick way of developing an investment case for person- and community centred approaches which has demonstrable benefits to people, communities and the health and care system as a whole. We expect local commissioners and STP prevention teams to use this to develop business cases and inform priority setting.
Building the investment case in other areas
PPL’s analytics team is also building investment cases in other areas. Most recently, we have built an economic model that enabled analysis of economic impact of transformation initiatives in adult social care. Working with the Social Care Institute for Excellence, Shared Lives and Birmingham City Council we identified a range of new models of care where there is a strong emerging evidence base around impact (both to the person and to the sustainability of the health system).
We then built an economic model to assess the potential economic impact of scaling up three key new models of care across the whole of Birmingham, taking into account what has already been done in this area and what the cost and timescales for implementation might be. Estimated savings from these three schemes alone represent approximately 2.5% of Birmingham’s 2014/15 Adult Social Care net expenditure, cashable net savings within second year of implementation.
This blog was written by Toby Irving, Senior Consultant at PPL
To download the Realising the Value economic model, please visit http://www.nesta.org.uk/publications/impact-and-cost-economic-modelling-tool-commissioners
For more information on the Realising the Value programme, please visit http://www.nesta.org.uk/project/realising-value
For more information about the Birmingham Total Transformation work, see a paper published by the Social Care Institute for Excellence, which includes the modelling work we undertook (http://www.scie.org.uk/future-of-care/total-transformation)”
To contact the PPL team who worked on these programmes please contact Toby Irving (firstname.lastname@example.org)
[i] The Five Year Forward View. NHS England. 2014. https://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf