East Durham Trust Annual Conference

11 November 2015

Martin Knapp & A-La ParkPersonal Social Services Research Unit,

London School of Economics and Political Science

The true value of community

interventions

The true value of community

interventions

• The roles of community interventions

• Economic questions

• Example 1: social care

• Example 2: Connected Communities

• Final thoughts

StructureStructure

Person in need

A person with health / social care needs…A person with health / social care needs…

Family

Person in need

… supported by their family …… supported by their family …

Care staff

Family

Person in need

… with skilled help from professionals …… with skilled help from professionals …

Care setting (eg care home)

Care staff

Family

Person in need

… working in a care / treatment setting …… working in a care / treatment setting …

Local / nationalprovider (eg local charity)

Care setting (eg care home)

Care staff

Family

Person in need

… managed by a local provider …… managed by a local provider …

Context: comm’y, culture,

environ’t etc.

Local / nationalprovider

Care setting (eg care home)

Care staff

Family

Person in need

… within a particular community, cultural, environmental (etc.) context…

… within a particular community, cultural, environmental (etc.) context…

Context: comm’y, culture,

environ’t etc.

Local /national provider

Care setting (eg care home)

Care staff

Family

Person in need

Commissioning bodies;

purchasers

… whose services are commissioned …… whose services are commissioned …

Local / national provider

Care setting (eg care home)

Care staff

Family

Person in need

Regulatory bodies

Advocacy bodies Policy-making

bodies (EU, national,

regional, local)

Commissioning bodies;

purchasers

Context: comm’y, culture,

environ’t etc.

… within strategic policy, regulatory, advocacy contexts…

… within strategic policy, regulatory, advocacy contexts…

Local / national provider

Care setting (eg care home)

Care staff

Family

Person in need

Regulatory bodies

Advocacy bodies Policy-making

bodies (EU, national,

regional, local)

Commissioning bodies;

purchasers

Context: comm’y, culture,

environ’t etc.

Bombarded by many external influencesBombarded by many external influences

Economic conditions

Labour marketsHousing policyCriminal justice

Education policyMigration Environmental

policyWelfare benefits

Local / national provider

Care setting (eg care home)

Care staff

Family

Person in need

Regulatory bodies

Advocacy bodies Policy-making

bodies (EU, national,

regional, local)

Commissioning bodies;

purchasers

Context: comm’y, culture,

environ’t etc.

Roles for community interventions?Roles for community interventions?

Economic conditions

Labour marketsHousing policyCriminal justice

Education policyMigration Environmental

policyWelfare benefits

Local / national provider

Care setting (eg care home)

Care staff

Family

Person in need

Regulatory bodies

Advocacy bodies Policy-making

bodies (EU, national,

regional, local)

Commissioning bodies;

purchasers

Context: comm’y, culture,

environ’t etc.

How good are those interventions?How good are those interventions?

Economic conditions

Labour marketsHousing policyCriminal justice

Education policyMigration Environmental

policyWelfare benefits

Why?

•Resources are ALWAYS scarce.

•So we – society - cannot meet every need, or agree to every request, or accommodate every preference.

•And so we – society - must choose how to get the best out of our available resources.

Consequently …

•… any new service or ‘intervention’ is looked at very carefully: Is it effective? Is it affordable? And is it cost-effective?

Decision-makers need economic evidence

Decision-makers need economic evidence

If the outcome question is:

‘Does this intervention work?’

Then the economic question is:

‘Is it worth it?’

By ‘works’ we mean …

Does it achieve its aims; i.e. does it have good outcomes for the people on which it is targeted?

By ‘worth it’ we mean …

Is the cost that has to be paid to achieve those good outcomes justified because the outcomes are so good?

The cost-effectiveness questionThe cost-effectiveness question

Building community capital in social care, Community Development Jnl 2012

Building community capital in social care, Community Development Jnl 2012

Exploratory economic evidence - building community capacity

•Three examples

•Based on local studies

•Simple decision models

•Very cautious assumptions about economic pay-offs

E.g. Modelling befriending pathwaysE.g. Modelling befriending pathways

Time banks

o Cost per time bank member = £607 p.a.

o Economic pay-offs = c.£1300 per member

o … of which £187 = short-term cashable to govt.

Knapp, Bauer, Perkins, Snell, Community Development Journal 2013

Befriending

o Cost per older person = £90 over 12 weeks

o Economic pay-offs = £490 including QOL gains

o … of which £38 = short-term cashable to govt.

Community navigators (benefit & debt advice)

o Cost per ‘hard-to-reach’ person = £611

o Economic pay-offs = £360 (or £1200 including QOL gains)

Findings from the three economic modelsFindings from the three economic models

Implications of this building community capital / capacity study?

Implications of this building community capital / capacity study?

Three very simple models, each built on very limited, local data.Despite their limitations, these models showed that there is a strong likelihood of an economic case for investment.Provided sufficient reassurance for national (DH) & local initiativesBut only a small proportion of each pay-off is short-term cashable to the public sector.Needs long-term commitment.

The ‘economic dividend’a.Participation & economic engagementb.Health & wellbeingc.Personalisation & empowermentd.Good & bad costse.Cost-effectiveness

Community Capital: The value of connected communities (2015)

Community Capital: The value of connected communities (2015)

RSA, UCLAN, LSE

Murton MamsMurton Mams

A co-produced social group for single parents. Single parents in the village were found to be particularly at risk of isolation and low wellbeingA focus-group of single mothers worked with the East Durham Trust to design a club that would be accessible and enjoyable to those who needed it.

Community interventions can support / encourage / facilitate: •participation in activities & services already available in communities,•develop / lead new activities •volunteer. Potential economic benefits by altering:•patterns of employment •engagement with education & training•benefit take-up•service utilisation •empowerment •wellbeingAnd also by helping to keep community facilities open Each generates an immediate or latent ‘economic dividend’.

Participation & economic engagementParticipation & economic engagement

Volunteering England report - review of evidence on links between volunteering and health. Positive health outcomes include: •improved disease management; •reduced depression and anxiety; •improved cognitive function; •increased uptake and duration of breastfeeding; •more childhood immunisations; •improved mental health of children; •better parenting skills; •improved physical health and functioning; •increased levels of physical activity; •improved diet; •compliance with medication and clinic attendance; •fewer hospital visits; •improved relationships between patients & health professionals.

Health & wellbeingHealth & wellbeing

Personalisation & empowerment

Personalisation & empowerment

Many roots and manifestations:•Political philosophy that encourages personal responsibility & accountability …•… and a rather different political philosophy that encourages social inclusion & personal rights.•Long-standing social work commitment to independent living & self-determination …•… and emphasis on personal strengths & assets.•Encourage personal responsibility for health through lifestyle changes …•… and slow spread of ‘precision medicine’.

Policy emphasis person-centred responses to needs & preferences.

Good and bad costsGood and bad costsCommunity interventions could increase ‘good costs’: make people aware of their needsand availability of services & their entitlements to thembuild self-confidence & breaking down barriers to useAnd at the same time reduce the ‘bad costs’: avoid need for some services altogether (e.g. social care support or mental health treatments) through good preventive strategiesand avert crises (from late identification of need) Aims in the long-run are to shift balance from ‘bad’ to ‘good’, and ideally to bring total cost down.

Cost-effectiveness?Cost-effectiveness?Cost-effectiveness is intrinsically hard to gauge for community interventions:achievements are often wide-ranging & not easily or sensibly reduced to quantitative measuresmany economic impacts are not seen in the short-termmany community projects are not (yet?) operating at most efficient scale (e.g. 20% of Murton budget went on identifying local needs & how to address them)ambiguous nature of many (short-term?) costs – they are all genuine resource impacts, but are they bad or good?

Final thoughtsFinal thoughts

Community interventions:•have multiple aims and purposes;•are increasingly going to be judged by economic as well as other criteria; and•have the potential to generate many economic benefits.But - not always easy to show cost-effectiveness in the short term.So commissioners will need to think long when deciding what they can & should support.

Thank you

m.knapp@lse.ac.uk