Plugging the gaps: new cost-effectiveness guidance for charities

Plugging the gaps: new cost-effectiveness guidance for charities
What Works Wellbeing 17 September 2020

• A seven-step approach to assess the wellbeing cost-effectiveness of a charitable intervention. This guide provides a solution for those who seek to measure their wellbeing cost effectiveness, but who have not yet directly measured wellbeing using the ONS measure of Life satisfaction.

Health economics: a guide for public health teams

Health economics: a guide for public health teams
PHE updated 18 June 2020

• Links to tools and reports that can help you:
• assess which interventions provide the best value for money, by calculating their costs, benefits and ROI
• make the most of your budget by deciding how to split resources across different public health programmes
• compare costs, savings and clinical outcomes
• assess the available economic evidence in different public health topic areas
• Covers a range of health conditions including LTCs and public health concerns (eg falls) plus wider decision support.
• ROI tools include:
• colorectal cancer ROI tool
• end of life care economic tool
• NHS Diabetes Prevention Programme ROI tool

Value for Money Profiles

Value for Money Profiles
LGA updates

• An overview of individual LA spend on services (2013-2019) expressed per head of total population - including adult social care, children and young people, and public health services.

Estimates of the impact of English public health grant on mortality and morbidity

Is an ounce of prevention worth a pound of cure? Estimates of the impact of English public health grant on mortality and morbidity
Centre for Health Economics 9 July 2019

• This paper exploits the introduction of a ‘funding formula’ for the English public health grant in 2013/14 to to investigate the relationship between both treatment (healthcare through CCGs) and prevention (public health) expenditure and mortality. It also convert these mortality effects into broader quality-adjusted life year (QALY) effects for both healthcare and public health interventions.
• Cost per QALY calculations reveal that public health expenditure, at about £3,800 per QALY, appears to be about three to four times more productive at the margin than healthcare expenditure (which costs about £13,500 per QALY).

Evaluating preventative investments in public health in England

Evaluating preventative investments in public health in England
CIPFA 1 May 2019

• In this report, PHE and CIPFA argue that a culture change in the way local organisations evaluate long-term investment in prevention is key to making the most of the proposed shift to Integrated Care Systems by 2021. The overall ambition is to change the way that prevention is considered – it should be viewed and treated as an investment, and properly reported as such. Moving forward, PHE and CIPFA are interested in supporting and challenging finance professionals to pick up these ideas and integrate them into everyday practice.
• The report identifies existing tools and resources which could be utilised across different types of intervention, across different organisations and at local, regional or national levels to evaluate preventative investment. 
• The report concludes that:
• 1. Use of cost-benefit analysis (CBA) methodology can provide a balanced evaluation of the financial and conomic costs and benefits of preventative investment.
• 2. The Green Book/New Economy model is well-suited to judging the comparative merits of such investments and allows a whole-system view to facilitate decisions on a place-based basis.
• 3. Using International Public Sector Accounting Standards Board (IPSASB) guidance and the principles of the Prudential Code2 would allow for consideration of the impact of such investment, particularly on long-term financial sustainability, and would enable comparative assessment of investment across time and place.

NHS efficiency map updated

NHS efficiency map updated
HFMA, NHS Improvement and NHS England, updated 12 April 2019

• The NHS Efficiency map is a tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) and quality, innovation, production and prevention (QIPP) schemes in the NHS. The map contains links to a range of tools and guidance to help NHS bodies improve their efficiency. 
• Includes case studies on Theatres reporting and utilisation and Aligned incentive contract.

Methods for the economic evaluation of changes to the organisation and delivery of health services

Methods for the economic evaluation of changes to the organisation and delivery of health services: principal challenges and recommendations
Health Econ Policy Law. 2019 Jan;14(1):119-134

• This paper discusses the principal challenges faced when performing economic evaluations of changes to the organisation and delivery of health services and provides recommendations for overcoming them.

Abstract

Developing new care models through NHS vanguards

Developing new care models through NHS vanguards
National Audit Office 29 June 2018

• This report examines whether the NHS is well placed to get value for money from its investment in developing new care models through vanguards. In particular, it focuses on:
• set up and management of the vanguard programme (Part One);
• national support and evaluation (Part Two);
• progress made by the vanguards (Part Three); and
• readiness for the spread of these new care models (Part Four). 
• The report focuses primarily on the two types of vanguards which were designed to test integrated models of health and social care for a local population: integrated primary and acute care systems (PACs) and multispecialty community providers (MCPs)

Report conclusions

The five essential components of value-based approaches to health and care

Taking the value-based agenda forward: The five essential components of value-based approaches to health and care
NHS Confederation 14 June 2018

• This paper explores how to spread the adoption of value-based healthcare across all parts of the health and care system and maximise the benefits for those who use NHS and wider services.
• This paper explores key characteristics/factors:
• Learning and adapting through the adoption of innovation
• Managing risk
• Making best use of data
• Thinking about pathways across the whole system
• Listening to patients.

Economic evaluations of eHealth technologies: A systematic review

Economic evaluations of eHealth technologies: A systematic review
PLoS ONE 13(6): e0198112. 13 June 2018

• A systematic review identified only 11 studies which evaluated eHealth technologies (including computerised decision support system, a web-based physical activity intervention, internet-delivered cognitive behavioural therapy, telecare, and telehealth). 
• Consistent across studies was a lack of reporting on the feasibility of adopting these technologies based on economic and organizational factors.

Realising the Value - economic modelling tool

Realising the Value economic modelling tool
NESTA 15 November 2016

• The Realising the Value economic modelling tool allows commissioners to assess the potential impact of commissioning person- and community-centred approaches in their local area.

A review of the evidence assessing impact of social prescribing

A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications.
University of Westminster June 2017

• It is estimated that around 20% of patients consult their GP for what is primarily a social problem. It has been suggested that referral to a social prescribing service could reduce this pressure. This systematic review critically appraises the current evidence as to whether social prescribing reduces the demand for health services and is cost effective. 
• Fourteen papers were examined. 
• Seven looked at the ffect on demand for general practice, reporting an average 28% reduction in demand for GP services.
• Five studies looked at the effect on A&E attendances and reported an average fall of 24% in attendance
• Five studies looked at demand on other secondary care services and reported significant reductsion in demand. 
• Value for money assessments in eight studies were methodologically unsatisfactory.
• Anaysis of Social Return on Investment in four studies suggest SROI was £2.3 per £1 invested in the first year.
• Poor quality of data means all results have to be interpreted with caution.

Towards affordable healthcare: Why effective innovation is key

Towards affordable healthcare: Why effective innovation is key
ILC-UK (International Longevity Centre), EY, 1 June 2017

• This report explores how health care innovations currently employed in the UK and abroad could increase productivity and reduce costs. 
• It showcases seven global and UK-based innovations with a strong evidence base of demonstrable success, and calculates the savings that could be achieved by implementing them across the UK. All case studies relate to out of hospital care.
• Analysis of these innovations indicate that, whilst the UK is well placed to innovate to improve health outcomes and reduce costs, the UK is often not doing enough with the tools at its disposal.

The effects of environmental factors on the efficiency of CCGs

The Effects of Environmental Factors on the Efficiency of Clinical Commissioning Groups in England: A Data Envelopment Analysis
Journal of Medical Systems 2017, 41:97

• The performance of CCGs may also be confounded by environmental factors such as deprivation, population size and burden of disease. This study estimates the technical efficiency of 208 CCGs in England using Data Envelopment Analysis (DEA), a linear programming technique that can be used to measure the relative efficiency of a given set of organisations. 
• The inputs and outputs used include budget allocation, number of general practitioners, mortality rates, patient satisfaction and QOF scores. 
• Three environmental factors were statistically significant predictors of efficiency: CCGs with smaller population sizes were more efficient than those with larger ones, while high unemployment rates and a high prevalence of chronic obstructive pulmonary disease led to a decrease in efficiency scores. 
• Comparative deprivation was not a significant predictor of efficiency.

Better Care Fund financial outcomes

Health and social care integration
National Audit Office 8 February 2017

• The Better Care Fund has not achieved the expected value for money, in terms of savings, outcomes for patients or hospital activity.
• The National Audit Office warns that progress with integration of health and social care has, to date, been slower and less successful than envisaged and has not delivered all of the expected benefits for patients, the NHS or local authorities. As a result, the government’s plan for integrated health and social care services across England by 2020 is at significant risk.
• The report acknowledges what has been achieved so far, including that 90 per cent of local areas agreed that the Fund has improved joint working and acknowledges good examples of integration at a local level. 
• The report sets out a number of recommendations for Government and NHS England to improve the case for integration and address some of the barriers to achieving this.

Evaluation of Doncaster Social Prescribing Service: understanding outcomes and impact

Evaluation of Doncaster Social Prescribing Service: understanding outcomes and impact
December 2016

• In Doncaster the Social Prescribing Service is delivered through a partnership between South Yorkshire Housing Association (SYHA) and Doncaster CVS. The Service's Advisors receive client referrals from GPs, community nurses and pharmacists and provide them with support to access a range of voluntary, community and statutory services that meet their needs. 
• It is funded through the Better Care Fund and is a key feature of local health and social care integration and transformation programmes.
• In health terms the Social Prescribing Service is estimated to have led to an additional 91.7 Quality Adjusted Life Years (QALYs) in the 3-6 months following engagement. This provides a cost per QALY of £1,963; much lower than the NHS cost-effectiveness threshold of £20,000-£30,000. This QALY gain equates to health benefits worth £1,834,000 and means that for every £1 of health and social care funding spent supporting vulnerable people, the Social Prescribing Service produced more than £10 of benefits in terms of better health, at least in the short term. In addition to quantifiable health benefits the Service created a range of wider social and economic benefits in the areas of volunteering, employment, and leveraged funding.

Doncaster Social Prescribing website

Realising the Value - delivering community centred health and wellbeing

Realising the Value    (www.realisingthevalue.org)

Health Foundation, Nesta 15 November 2016
This programme examined the evidence on what good person and community-centred care looks like and the potentially wide-reaching benefits then developed and tested ways to embed these approaches, creating a set of tools to allow these to have national and local impact.

The value of community pharmacy

The value of community pharmacy
PwC for Pharmaceutical Services Negotiating Committee,7 September 2016

• An analysis of the value to the NHS, to patients and to wider society of 12 specific services provided by community pharmacy in England in 2015, focusing on public health services; support for self-care; and medicine support services, which include enhancing access to medicines and delivering patient management service.

Realising the financial value of sustainable development

Securing healthy returns report: Realising the financial value of sustainable development.
Sustainable Development Unit, June 2016

• This document provides an insight into the financial savings for projects which deliver financial, social and environmental benefit beyond the areas of estates and facilities.
• There are a number of accompanying online tools which are designed to help decision makers better understand what different interventions can deliver for their organisation.
• This report is primarily intended to aid finance professionals and those managers and decision makers working with finance colleagues, to realise these benefits.

Best Possible Value - practical tools to support NHS finance

Best Possible Value
Future-Focused Finance programme

• A toolkit for commissioning and providing organisations using a value-based approach
• As part of the Future-Focused Finance programme, this work-stream provides practical tools and resources to support NHS finance business partners and NHS organisations in delivering the Best Possible Value for patients and the public.
• The website provides details of the Best Possible Value process and is also a repository of value-oriented tools, data sources and case studies including a Practice Guidebook which is suitable for commissioning and providing organisations and contains: 
•  a definition and overview of value in health systems, 
•  practical tools and techniques that enable the delivery of value, 
•  links to more value resources and the NHS value community.