© Nuffield Trust Can the voluntary sector help to prevent hospital admissions? Theo Georghiou & the Nuffield Research team 22 June 2015

© Nuffield Trust Social action to prevent admissions Cabinet Office Reducing winter pressures fund (£3m). (also match-funding by local commissioners) Seven funded organisations Age UKs, British Red Cross, Westbank (Exeter), Royal Voluntary Service. Explicit aim to reduce emergency admissions (+other) over 2014/15 winter, using volunteers Required to work with Nuffield Trust as independent evaluators (collect and transfer data as necessary)

© Nuffield Trust Main types of service Home from hospital Inpatient wards, and A&E Upstream prevention Referrals from GPs, wards, local integrated H&SC teams, community Signposting Referring to other voluntary or statutory orgs ‘Active’ support Transporting, befriending, shopping, meals, …

© Nuffield Trust Story so far and to come Since October ,900 people supported (500 to 2,270) 470 volunteers recruited (4 to 140) 62 staff in place (5 to 12) Extension to September 2015 (…9,500 people supported?) Analysis (this autumn): Matched control evaluation (Cono Ariti, this morning) Link local voluntary sector admin data to hospital data

© Nuffield Trust Data from voluntary sector organisations Personal identifiers Info about person and/or service provided Mrs Louise Smith F DOB 13/12/40 … Day 54 - Referred; Consent , Assessed Day 56 - Driven home, shopping (3 hr volunteer time) Day 60 - Visited (1 hr volunteer time) … Might include Referrals [dates, route..] Assessments [Recorded needs, plans, wellbeing surveys…] Services provided [what, dates, volunteer or staff, time spent…]

© Nuffield Trust Data from voluntary sector organisations Personal identifiers Info about person and/or service provided Hospital data Mrs Louise Smith F DOB 13/12/40 … Day 54 - Referred; Consent , Assessed Day 56 - Driven home, shopping (3 hr volunteer time) Day 60 - Visited (1 hr volunteer time) … Day 52 - Emergency admission (Diagnosis of COPD, …, … ) Day 56 - Discharged home Day 83 - AE visit, not admitted …. Might include Referrals [dates, route..] Assessments [Recorded needs, plans, wellbeing surveys…] Services provided [what, dates, volunteer or staff, time spent…]

© Nuffield Trust Data from voluntary sector organisations linked to hospital data for evaluation Info about person and/or service provided Hospital data … Day 52 - Emergency hospital admission; Diagnosis of COPD, …, … ; Day 54 - Referred to scheme; Consent , Assessed Day 56 - Discharged home Day 56 - Driven home, shopping (3 hr volunteer time) Day 60 - Visited (1 hr volunteer time) … Day 83 - AE visit, not admitted … Linkage to to hospital data via HSCIC (consent issues) Analysis data are pseudonymous

© Nuffield Trust Varied status of the different schemes Seven different schemes - mix of situations: Well established intervention, advanced data collection (and data sharing) locally New intervention and databases put together from scratch Others somewhere in the middle – adapted existing interventions, and modified data collection with our advice Some are collecting a lot of data …

© Nuffield Trust Age UK South Lakelands – assessment data HealthWellbeing - over last two weeksAbout your home Hospital stays last 18 months?Little interest or pleasure in doing thingsLive with someone? A&E Not Admitted last 18 months?Feeling down, depressed, or hopelessYour accomodation - class Emergency Treatment at Home last 18 monthsTrouble falling or staying asleep, or sleepingType of home Doc/Nurse last 3 months?Feeling tired or having little energyType of heating How many Medicines?Poor appetite or overeatingInsulation Diabetes?Feeling bad about yourselfNeed repairs? Controlled by diet/insulin/etc?Trouble concentrating on thingsMoving around home safely? Angina?Moving or speaking so slowly that other peopleAids and adaptations in home ok? Spray/Tabs times per week?Thoughts that you would be better off dead orWorking smoke detector? Respiratory?Feeling nervous, anxious or on edgePersonal alarm? Inhaler times per week?Not being able to stop or control worryingFeel safe now? Stroke?Worrying too much about different thingsSafe in future? How many months ago?Trouble relaxing Your money Infect/UTI'sBeing so restless that it is hard to sit stillState pension(s), total £ Number last 18 months?Becoming easily annoyed or irritableOccupational Pensions, total £ Arthritis/Osteoporosis?Feeling afraid as if something awful might happenPension Credit, £ Falls? Social life Other earnings, £ Fractures?Social visitors - how often?Attendance Allowance Health impact on daily living?Family contact - how often?DLA mobility Hot meals number per week?Get out for engagements - how often?DLA care Weight changing?What transport do you use?PIP mobility Appetite changing?Have Telephone/Mobile?PIP care Smoke? Per DayHave internet?ESA amount, £ Drinks? Per WeekUse internet?Housing benefit, £ Physical Activities number per week?Confident internet?CT Reduct., £ Current health (Very good to poor)Social changed over last 3 years?Fuel costs, £ per month Knowledge of Conditions (very confident to not)If care for someone - how impact?Manage now? Future health management (very confident to not)Lifestyle or culture affects social life?Manage in the future? Difficulty with Activities? (no diff to impossible)Unplanned costs? Shortness of breath? (rest to no problems) Walking aids? Get up in the night number of times Statutory care or support? Lifestyle or culture affect access to health?

© Nuffield Trust Follow all 7,900 people’s hospital history before, and after: Data needed – minimum Two most important things from each area: Good quality personal identifiers > Data linkage to HES A start date for service > Reference date ? ?

© Nuffield Trust Good quality personal identifiers Illustration of ‘minimum’ necessary (2013 study) N% of initial N Initial Cohort3,946 Dropped from analysis No linkage to HES1,24031% Link to HES, but not found in hospital72718% Other - analytical reasons40610% Final analysis cohort1,57340%

© Nuffield Trust Good quality personal identifiers A start date for service – almost the only data we had… Illustration of ‘minimum’ necessary (2013 study) N% of initial N Initial Cohort3,946 Dropped from analysis No linkage to HES1,24031% Link to HES, but not found in hospital72718% Other - analytical reasons40610% Final analysis cohort1,57340% Risk of future emergency admission High risk Low risk

© Nuffield Trust We’d (all) like to know more From HES data - client characteristics multiple long terms conditions, previous admissions, age, deprivation, … But what about the interventions themselves? Home from hospital vs community Signposting vs ‘active’ Light vs intensive support Volunteer vs staff delivered Short vs long term follow up > Who best to target? And how?

© Nuffield Trust Final thoughts Cabinet office social action study – part of a suite of work on voluntary sector’s impact on health Past and current work – it’s possible to use voluntary sector person level data and link to hospital data Data quality and completeness - limits what you can do Homogeneous interventions (and data), more likely to make nuanced (and useful?) evaluation findings

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