Alternative Solutions – South Cheshire and Vale Royal Social Prescribing Programme (national and international model of best practice)

Evaluation by external Health Economist 65% of those attaching to Alternative Solutions (A/S) were female, with 32% over the age of 70 By far the most common primary health condition at attachment was mental health issues, prevalent in 37.8% of females and 43.8% of males In 86% of cases, respondents self-rated quality of life was LOWER than would be expected for persons of their age representative of the UK general population. Those with COPD, musculoskeletal conditions and mental health disorders reported a quality-of- life 61%, 58% and 44% lower than would be expected for individuals of their age respectively. The average contact time for all respondents was 4.6 hours, varying from 3.9 hours (COPD) to 7.3 hours (sensory impairment) Regardless of underlying health condition, depression and anxiety was the single most common and exacerbated symptom present in respondents, improving by 24% post-attachment. Those with COPD (0.14, n=13) and mental health concerns (0.13, n=63) demonstrated the most significant improvement in quality-of life following attachment to A/S. The average quality-adjusted life year gain per person was 0.07, with a corresponding monetary equivalent of £1,400 per user, based on the NICE willingness-to-pay of £20,000 per QALY.

Patient Reported Impact of the Service at discharge Number of GP appointments following support from Alternative Solutions (Patient reported) Fewer Appointments 50.6% Same 26.9% More Appointments 5.2% Unsure 17.3%   Change in overall health following support from Alternative Solutions (Patient reported) Improved 62.5% Worsened 11.7% No Change 25.8% Has the support you gained through Alternative Solutions helped you? Yes 88.1% No 3.5% 8.4%

Client Needs Cohort 4 referrals (185 clients Aug 2018) Identified main social condition upon referral (Multiple areas may be recorded per patient)   Health Promotion & Lifestyle 70 Wellbeing and self-care (particularly diabets/pre-diabetes support, increasing activation levels, mental wellbeing 31 Managing Symptoms of long-term health condition 36 Employment Support (in-work or out-of-work) volunteering, education and training, 33 Financial (including Benefits Advice) Housing including cold homes, threats of eviction, fuel poverty 29 Social Isolation or Loneliness including disability advice and community safety, meaningful activity 61 Support feeling positive 98 Frequent Faller (or at Risk) 27 Support provided includes disability support, home adaptations, mobility/transport, community safety, carer support, healthy eating, pain management, condition management, support following abuse/discrimination,

Client Journey Discharge summary plan shared with referrer and client Confirmation to GP that the client has engaged (input on EMIS) GP referral with client consent (co-location practices MOU in place, website, nhs email address from EMIS template Eligibility check - ensure meets basic criteria for accessing the services and wishes to take part in the service Assessment (EQ5D and outcome star) within 10 working days and action plan Case management and support service offer Reassessment and review

Case study Patient AS is a 58 year old male. He was referred to Alternative Solutions as he was due a PIP assessment following being rejected for ESA. He was concerned about this and his anxiety was causing flare ups of his Chrohn’s. He originally applied for ESA as he was unable to work at the time, and the financial pressures were starting to have further implications to his physical and mental health, as he was starting to worry about how he was going to cope. Following his initial assessment, there was a time pressure as his PIP assessment was coming up shortly. Service signposted him to a local support organisation who were able to help with preparing for his assessment. On review of his bills, services supported him to get a water meter to manage his bills. He had a mortgage and was also concerned that his home may have been at risk, but after encouraging him to contact his mortgage provider, it transpired that he was paying too much on his mortgage, so the payments were reduced. Service provided skills review and employment support including CV development and interview preparation. His PIP assessment went well, but prior to receiving the benefit, he withdrew his claim as he successfully applied for and secured a full time role in an engineering company who were understanding of his medical condition and were able to work with him to ensure that he maintained his position. Upon his discharge, he reported that had it not been for our service and sign posting for help, he probably wouldn't have done anything about his situation, and the encouragement he got from his case worker helped him to see that a return to work would be possible.

Opportunities for efficiencies Confirmation to GP that the client has engaged (input on EMIS template agreed including read codes) Discharge summary plan shared with referrer and client GP referral with client consent (co-location practices MOU in place, website, nhs email address from EMIS template Eligibility check - ensure meets basic criteria for accessing the services and wishes to take part in the service Assessment (EQ5D and outcome star) within 10 working days (purpose of assessment for full service to measure outcome, purpose of assessment for advice service to tailor service) and action plan Assessment and advice service Case management and support service offer discharge Reassessment and review

Increasing capacity opportunities Existing model 400 cases @ £250 per case = £100,000 Our data shows 86% of clients have lower than expected health status activation levels low - don’t naturally engage with prevention, passive recipients, overwhelmed, lack knowledge/skills . These require full service 14% need support/resilience impacted in face of stressors Revised model Assessment and action plan for those who at assessment have skills/knowledge but need support to identify services/their resilience has been impacted upon in face of stressors followed by discharge Full service for those with low activation levels New Financial Model 344 clients @£250 = £86,000 140 clients @£100 = £14,000 Total cases 484 cases = £100,000