National Evaluation of POPP: The Evidence Base Report authors and core team: Karen Windle, Richard Wagland, Julien Forder, Francesco D’Amico, Dirk Janssen, Gerald Wistow Wider national evaluation team: Roger Beech, Ann Bowling, Angela Dickinson, Kate Ellis, Catherine Henderson, Emily Knapp, Martin Knapp, Kathryn Lord, Brenda Roe

POPP Programme £60 million ring-fenced funding for council-based partnerships to lead locally innovative pilot projects for older people. Overall aim was to improve the health, well-being and independence of older people through: Provide person centred and integrated responses for older people Encourage investment in approaches that promote health, well-being and independence for older people and Prevent or delay the need for high intensity or institutionalised care. 19 pilot sites funded May 2006 – further pilot sites May 2007 – 2009

The National Evaluation Research Questions Process Did the POPP programme change partnership working and practice across the sites? What was the level of older people’s involvement across the programme? Outcome Did the interventions improve users quality of life? Did the POPP programme reduce use of high intensity- services? Measurement Interviews and focus groups (operational staff, users and users outside of the POPP programme) Structured questionnaire to key informants Standardised user questionnaire completed at two time points (before and after intervention); EQ-5D, service change, demographic data ‘Difference in Difference’ Analysis (Emergency Bed Days) Financial/ Activity data 03/09/20153

4 POPP Interventions Primary Prevention (n=49,34%) Secondary Prevention (n=40, 27%) Tertiary Prevention (n=35, 24%) Gardening/ handyperson/ befriending/ learning/leisure Gardening/ handyperson/ befriending/ learning/leisure Holistic assessments/ Hospital aftercare/Falls Prevention/ Peer Monitoring and support/Falls follow-ups Rapid Response Teams/ Hospital at Home/ Intensive support teams/ Case Management/ Proactive Case Finding 146 core projects, 530 upstream projects

Users within the interventions Total of 264,637 users either contacted or were referred to the POPP interventions 77% of the population aged 70 and over, with a third (32%) aged 85 and over One-third was married (33%), the remainder widowed, divorced, separated or single. 81% lived in their own homes, but almost a fifth lived in sheltered housing, residential and nursing care Fewer men were using services that address lower-level needs (1:3) than those focused toward secondary or tertiary support (1:1) The age at which respondents use services differs with levels of deprivation Weekly income (where reported) was £100 less per week than the median income for general population (Age Concern 2008) 03/09/20155

Outcomes & Impact: Measuring changes in health-related quality of life 03/09/20156  Standardised user questionnaire -before the POPP intervention and up to six months after the project (62 projects; n=1,529)  EQ-5D, Health-related quality of life  Measured on mobility, self-care, usual activities, pain/discomfort, Anxiety/Depression  Used quasi-comparison group (British Household Panel Survey) to benchmark the outcomes Age range of participantOverall populationPOPP sample Aged Aged Aged

Outcomes & Impact: Health Related QoL: POPP & Quasi-Comparison group 03/09/20157

Outcomes & Impact: HRQoL: Categories of Projects 03/09/20158

Outcomes and Impact: Overall Emergency Bed-Days 03/09/20159 Effect of…Management Overhead Effect size Effect on…Lower CI Upper CI +£1 spend on POPP project per month in POPP PCT (at POPP time) 30%-£1.00Cost per month per PCT of bed- days -£1.30-£ %-£1.10-£1.50-£ %-£1.20-£1.60-£0.80 0%-£1.30-£1.70-£0.90

Outcomes & Impact: EBDs;Secondary/Tertiary and Primary Prevention Secondary and Tertiary prevention PCTs: headline saving of -£1.40 on EBDs for £1 extra POPP spend, with a range of -£1.00 to -£1.90. Primary prevention PCTs: headline saving of -£0.70 for £1 extra POPP spend, with a range of £0.10 to -£ /09/201510

Outcomes and impact: Overall programme cost-effectiveness 03/09/201511

Outcomes and Impact: Overall change in service use & costs 03/09/ Service usePre-intervention (t1) mean cost Post- intervention (t2) mean cost Mean cost change per person Physiotherapy£14.23£9.67£4.56 A & E£80.59£79.43£1.16 Hospital overnight £188.46£115.87£72.59 Outpatient£182.48£137.71£44.77 Totals£465.76£ £328.05

Outcomes and Impact: Categories; change in service use & costs 03/09/ Project CategoryTotal Saving per person Well-Being – Emotional/ Social Isolation-£30.16 Well-Being – Physical Health-£ Specialist Falls-£25.45 Proactive Case Coordination-£ Hospital Discharge Total-£

HRQoL and/ or efficiencies? 03/09/ Project Category % Increase in HRQoL (standardised) Efficiency Savings from individual use (per person) Well-Being Practical13%£0 Well-Being Emotional Social-3%-£30.16 Well-Being - Physical Health12%-£ Well-Being -Community4%£0 Information, Signposting and Access0.20%£0 Specialist Falls4%-£25.45 Proactive Case Coordination4%-£ Long-Term Conditions - Hospital Discharge -2% HE = 0.70p per extra £ HE = £1.40 per extra £

Summary Good data enables analysis of effectiveness Good data respects the participants voice Good data enables analysis of quality Good data ensures the work that the enormously hard work and effort that you have carried out is not compromised Good data ensures we can build on the evidence base, changing policy and practice 03/09/201515