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

2. 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.

3. 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%

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,

5. 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 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

6. 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.

7. 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 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

8. 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 = £86,000
140 = £14,000
Total cases 484 cases = £100,000