1. Cost effectiveness in adult social care Jennifer Francis, Research Analyst Age NI and SCIE seminar ‘Prevention: the way forward’ 21 March 2012

2. Overview  Why prevention? – the context  The importance of cost effectiveness data  Economics fit for social care  What the research says about reablement  What the research says about preventing loneliness  Can we ‘invest to save’?

3. Why prevention?  Demographic shifts  People living longer  Decrease in informal support  Savings drive  Economic climate  Public opinion

4. The importance of cost effectiveness data  Rationally reduce expenditure  Improve people’s wellbeing

5. What’s involved in economic evaluation?  Analysis of cost and benefits  Comparison with a control (often the usual intervention or service)  Measurement and valuation of effects vary

6. Economics fit for social care  The complexity of social care requires a broad analytic perspective  Outcomes should include the perspective of service users and their families  The costs of un-paid care should always be included  Methods can be applied which address the lack of evidence in social work and social care  Costs and benefits should be analysed for different sub groups of the population

7. The importance of costs and outcomes “...there was no statistically significant difference in the costs of all the services used by the reablement and comparison group over the 12 month study period.” “... the study has established a high probability of cost- effectiveness...”

8. Outcome measures PP erceived health PP erceived quality of life HH ealth related quality of life (EQ-5D) SS ocial care outcomes (ASCOT)

9. The spectrum of prevention Wellbeing interventions Maintaining independence Primary Early intervention Screening/ case finding Secondary Minimising disability Maximising functioning Tertiary

10. Preventing loneliness and social isolation “Primary prevention is generally designed for people with few health or social care needs or symptoms of illness”

11. Services included One to one interventions Befriending Mentoring Group services Day centre Social groups Wider community engagement Volunteer schemes Outreach programmes

12. How effective?  Reducing loneliness  Community navigator, befriending.  Improving health and well-being  Befriending, community activities.  Health service use  Cultural programmes.

13. How cost-effective?  Befriending  Estimated savings, £300 per person, per year  Community Navigators  Economic benefit, approx £900 (year one)  Social activity groups  Estimated saving of €62

14. Can we ‘invest to save’ in prevention?  Evidence of acceptability  Some good evidence of effective interventions  Limited evidence of cost effectiveness