How we reduce costs and change lives
People with multiple needs often lead chaotic lives, which can be costly to the state. At Resolving Chaos we frequently work with commissioners and providers to identify individuals with a history of poor outcomes and work to develop a social and economic case for commissioning services differently.
Below are examples that highlight our approach and provide a flavour of some of the work we have been involved in. The case example of George, plus two examples of action-research we have undertaken, establish how services can be provided to have strong positive impact on individuals and their communities, as well as reducing the cycle of repeated crises and reliance on emergency services.
George, 38, lives alone in South London. He’s agoraphobic, so he won’t willingly leave his flat. He’s a chronic alcoholic – two bottles of fortified wine a day, as well as whiskey mixed with the codeine he’s also addicted to. Unsurprisingly, he has liver damage, with fluid on the lungs, which leads to him needing a two-week hospital admission on a monthly basis. He has painful fungal infections.
George doesn’t receive any social care support – he doesn’t meet their criteria. He has been ‘red-flagged’ by the local Clinical Commissioning Group, meaning he is not able to use their services due to his aggressive/abusive behaviour. So, he has no GP and he’s banned from respite care.
George rings an ambulance two or three times a week. The police have to accompany the ambulance crew when they attend his house. He has attacked ambulance staff, police and taxi drivers, leading to arrest, court appearances and fines. No local taxis will take him to A&E, so the ambulance is his main method of transport. He has a wide range of medication for his conditions, but does not take them. His condition deteriorates until he requires re-admission.
George’s behaviour costs the tax payer an estimated £71,000 a year.
How we can help reduce these costs
At Resolving Chaos we are creating shared services across London that are not only more cost effective but which deliver better outcomes for people like George.
Hertfordshire You Can Project
Following our work to develop a Feasibility study which made a business case for the joint commissioning of a service to holistically support individuals with complex and multiple needs, Resolving Chaos led a two-year action research pilot of the You Can project in the Three Rivers and Hertsmere areas of Hertfordshire. The project was run by Resolving Chaos through an innovative partnership with South London and Maudsley NHS Trust (SLaM), a leading NHS provider of mental health and substance misuse services.
Based on the Resolving Chaos model of identifying individuals with multiple needs who experience poor outcomes, which incur high cost, a team was put in place to work in two districts. The project worked with 55 participants until July 2017, commissioned by Hertfordshire County Council with the backing of a partnership of statutory and voluntary sector services including Three Rivers District Council, Hertsmere Borough Council, Hertfordshire’s Police and Crime Commissioner, the local NHS and several key local Housing Associations.
How we worked
The project aimed to demonstrate that by giving the right support and more control to people, real improvements are possible. The team comprised a manager and six project workers from a variety of disciplines including homelessness, drug and alcohol, mental health, and worked with ex-offenders. Our approach was based on:
- Putting people at the centre of what we do, supporting them to take control of their life
- Building people’s confidence and enabling them to make choices for themselves
- Working with local partners to look at different ways of supporting individuals with multiple needs
- Using learning from the project to improve how services work together to deliver better outcomes for people.
Economic evaluation was undertaken by Resolving Chaos in partnership with the London School of Economics’ Personal Social Services Research Unit. The Resolving Chaos economic analysis reported across participants an average of £232k of costs were reduced per annum, this equates to a 29% cost reduction of services used. Particular decreases were noted for reducing demand in emergency and crisis services for mental health, reduced costs of prison and court costs, housing management and temporary accommodation. It is important to note that the team worked to engage participants into appropriate support services, which was evidenced by increased costs of engaging with community drug and alcohol services.
Evaluation of outcomes were recorded and analysed throughout the project. Key findings were improvement for mental health, housing, fewer incidences of crisis requiring Police call-out and reduced drug and alcohol use. We are pleased that the service was shortlisted for a prestigious award through the Local Government Chronicle (LGC) Awards.
The pilot service has ended in July 2017, with a legacy of improved joint working and co-ordination when agencies are supporting people with multiple needs. Future commissioning will work to embed joint working and provision of support for people with complex and multiple needs. Please contact us to learn further details of this project.
You First – Lambeth, Southwark & Lewisham Fulfilling Lives project
The Improving Lives, Saving Money local evaluation report highlights the service both improved outcomes for people with multiple needs and delivered a 34% cost saving, through reduced crises.
In a partnership led by Resolving Chaos, You First works with people with multiple needs including mental illness, homelessness, substance misuse and offending in Lambeth, Southwark and Lewisham. The people You First works with were all known to have very high service costs and yet consistently achieved poor outcomes as they typically moved from hospital bed to police cell, crisis mental health service to homeless hostel.
Since the programme began beneficiary outcomes have improved, alongside the cost of the service use, which has reduced by over a third, 34%. Most cost reduction has been a consequence of fewer incidences of crisis, alongside greater engagement in community support services.
The report found that You First engagement led to reduced demand for mental health assessments, less ambulance use, reduce A+E attendance and fewer hospital in-patient stays. There has also been a reduction in nights spent in prison, with fewer prosecutions for criminal behaviour orders, arrests and police call-outs.
As well as a cost benefit there have been overall improvements in beneficiaries’ outcomes, measured by both Outcomes Stars and New Directions Team assessments.
The report, approved by a partnership including all three local authorities, South London and the Maudsley NHS Trust, Thames Reach, Certitude and the Lambeth Clinical Commissioning Group, said: ‘You First is achieving the aims set out in its original business plan of improving lives and saving money through making better use of resources.’