Older people: Early intervention schemes lead to better health

Save money and improve lives? The NHS and councils’ early intervention scheme has, reports Jeremy Dunning

Saving public funds while keeping older people at home and independent is a major ambition for the NHS and local government.

And now evidence has emerged that councils and primary care trusts can achieve both goals through investment in prevention and early intervention.

Last month’s evaluation report of the Department of Health’s Partnerships for Older People Projects (Popp) showed care spending on service users fell by £2,166 per person per year after using preventive services, while users reported better outcomes.

For every £1 spent on Popp services, £1.20 was saved in spending on emergency hospital beds. The scheme, funded from 2006-8, supported 470 projects in 29 areas and benefited more than 250,000 people.

Maintain independence

More than 70% provided low-level services to help older people maintain independence, such as handyman schemes, with the rest providing targeted support to those at risk of hospital admission, including falls avoidance schemes. Just 3% of the schemes were closed after funding ceased; commissioners continued to fund the vast majority.

The NHS Confederation and the Association of Directors of Adult Social Services both back a wider roll-out of Popp-style schemes. The question is what will drive this process since health secretary Andy Burnham has said commissioners will not be directed to do so by the DH.

Resourcing a roll-out of Popp-style schemes will require money to be reinvested from decommissioned services, which will in turn require a reform of financial systems across local government and the NHS.

However, Jo Webber, deputy policy director at the NHS Confederation, is confident that a roll-out of Popps can take place “quite quickly” by, for example, using pooled budgets across councils and PCTs.

With both the NHS and councils expected to make savings from 2011-14, financial necessity may ensure change happens.

More information from www.communitycare.co.uk/popps

Bradford: “We can help people stay in their home”

Bradford Council received £2.3m in Popps funding during 2006-8 which has funded the Health in Mind project, to support older people with mental health problems and their carers.

This has included the establishment of two intensive support teams to provide short-term support and reablement care to people at risk of admission to acute or institutional care and to facilitate early discharge. They also respond to crises and assist carers.

Roland and Joan Ackroyd benefit from a team run by Methodist Homes for the Aged (MHA), operating out of its extra-care housing scheme called Rowanberries.

Staff including Sarah Green help Mr Ackroyd, 82, who suffers from leg ulcers and general infirmity, in getting changed every morning and night.

At the same time this takes some pressure off Mrs Ackroyd, 83. This support means they can continue to look after each other without having to move into residential care.

Senior case worker Ann Creed says the project is designed to motivate and enable people to stay independent through a variety of means, including helping with life-skills, with shopping and getting back out into the community.

She says: “It could be they’ve had a deterioration in health and that’s had a knock-on effect in well-being in the home. We go out with social services or we will go out and do an assessment and tell them what we can put in and do. The team would then go out and enable the client to go out and become independent. Sometimes it doesn’t always come off but often it does.”

After Popp funding finished, Bradford Council and Bradford and Airedale Teaching Primary Care Trust decided to sustain the project by mainstreaming the funding.

The evidence indicates the project has diverted people from hospitalisation and emergency care. Though this has generated savings at the acute care end rather than in social care, the council’s strategic director for adult and community services, Moira Wilson, says:

“We totally agreed with the PCT that this is a whole-system approach rather than health or social care funding and this will become more important as council budgets get squeezed.”

“It’s shown that with the right care and support we can help people stay at home through a crisis situation,” she says.

Wilson says the plan now was for a “broader strategic development” for older people with mental health needs, which went “all the way” from early intervention to specialist services using the experience gained from Popp.

 www.bradfordhealthinmind.nhs.uk

Tameside opens doors to a life of independence

Jean Sutcliffe is a testament to the success of Popps. She believes that Tameside Council’s Opening Doors for Older People project has turned her life around.

The council was awarded £1.15m from the Department of Health to develop the project in the second round of Popp funding in May 2007.

The project was designed to reduce or delay older people’s need for hospital, residential or intensive home care through personalised information, advice and support at home.

It has provided support for more than 3,000 people so far. Although the Popp grant ran out in March 2009, the council and Tameside and Glossop PCT decided to extend funding for a further two years.

Until Sutcliffe, 78, came across the project she had considered herself a disabled person after developing peripheral neuropathy, which involves damage to the nervous system and has affected her mobility.

Now she sees herself as “enabled” because of the mobility aids that have been fitted in her house. “Everything done by them has improved my life,” she says. “They’ve made my home safe for me and given me confidence to use tri-walkers.”

Now Sutcliffe sees her job as encouraging other people to find out more about the project to ensure no one loses out.

She was identified as someone at risk of losing her independence and was invited to a meeting of an older people’s network set up by the council called the Really Important Questions network.

This project has two strands. The first involves identifying and contacting older people and their carers who are most at risk of losing their independence but who do not yet require residential care, hospital, or intensive care at home.

Once contacted they will be offered a free “community options for remaining active” (Cora) check and support visit, to assess support needs.

After the visit the client will be given information and advice including directing or “signposting” to services or other sources of help.

Second strand

The second strand involves using the Cora visits to get the views of older people and their carers on the type of community services they need to support their independence and well-being.

This has been used to develop local social enterprises and re-shape community-based services, using funding obtained from the Popp grant and elsewhere within the local health, social care and other services.

Programme manager John Dunne says it was difficult to quantify savings or reduced hospital admissions over a relatively short timeframe.

But he adds: “What we are finding is a general trend in terms of a reduction in nursing and residential care home use but it’s difficult to know if it’s Popp or another early intervention, such as telecare. But it’s a trend in the right direction.”

It had been so successful that it had been expanded to all adult client groups. Part of the work with Tameside and Glossop PCT also involves looking at social prescribing – offering GPs a fast-track route for patients to the check and support service. This should help reduce the PCT’s costs.

Dunne added: “We are very clear that we will be sustaining the focus of the early intervention. We’ve identified reduced demand at the statutory front door and that was sufficient to give the commissioners confidence.”

Find out more at www.tameside.gov.uk/popps

This article is published in the 4 February issue of Community Care magazine under the heading Early intervention prevents crises