Economic and evaluation focus within Resolving Chaos
Hertfordshire – evaluation of Adults with Complex Needs service
The Resolving Chaos model of identifying high cost individuals with multiple needs and poor outcomes is being adopted within Hertfordshire, specifically the Three Rivers and Hertsmere areas.
The You Can team has been formed and will be working with 60 individuals with multiple needs, supported by an innovative partnership of Resolving Chaos and South London and Maudsley NHS Trust (SLaM), a leading NHS provider of mental health and substance misuse services.
Resolving Chaos is undertaking an evaluation of service user outcomes and the economic impact of the team’s work. This will include comparing the participants’ use of crisis and support services, both before and during their time supported by the project. Independent evaluation will also take place.
The findings of our outcomes, in particular the economic impact of the work of the You Can team, will be reported regularly to Hertfordshire’s Adults with Complex Needs Sponsorship Group and will play an important role in future commissioning decisions.
Psychology in Hostels
Resolving Chaos is working with Thames Reach to build a clear and relevant business case for the Psychologically Informed Environments (PIE) that operate in Lambeth hostels. PIE uses a psychological approach to key-working people with long histories of multiple and un-resolved problems.
We are working with Thames Reach over a three year period to quantify the savings directly resulting from this approach. We will identify to whom and how much the savings are; to describe whether they are ‘cashable’ and use the findings to demonstrate the impact of a larger scale intervention. This will be used to inform a local case for investment.
The process includes:
- Identification of 15 ‘archetypes’ who, collectively represent the caseload of people that the hostel team are working with.
- The construction of detailed service use inventories for those people. Crucial to the process is an agreement on the counter-factual (what would have happened in the absence of the service).
- The application of costs to the service used by our archetypes to construct the business case which shows where the service avoids costs and which of those savings can be cashed, monitoring how the costs change over the 3 year period.
- This process works alongside the University of Southampton, who are assessing the qualitative service-user experience of living within and receiving support through the PIE model.
Big Lottery Fund Fulfilling Lives programme – 4 Area Evaluation
Resolving Chaos has been commissioned by the Big Lottery Fund to undertake an economic evaluation of the impact of four Fulfilling Lives projects. These evaluations are taking place in the following areas:
- Camden & Islington
- Lambeth, Southwark and Lewisham
The aim of the evaluation is to demonstrate the cost savings made by the projects in each area, as a result of fewer crisis services being used by beneficiaries.
We will work with the four areas throughout the life of the Fulfilling Lives programme 2014-2021, to determine the costs of agreed “archetypal” clients before, during and after the Fulfilling Lives interventions.
In the longer term, as well as providing the business case information required to change investment, we also hope that the ‘archetype’ model can be mainstreamed as a valuable and cost efficient way for charities and social enterprises to demonstrate the savings they achieve. By tracking a limited but representative number of beneficiaries, identified through a demonstrably robust process, this model can become a powerful tool for organisations to show their impact.
This is a project that is researching Early Intervention in Psychosis within Lambeth, Southwark and Lewisham, from both a qualitative and economic viewpoint. The project is comprised of membership from NHS Lambeth, Lambeth CCG commissioning, SLaM, Certitude, McPin consulting and Resolving Chaos. This work is ongoing and the Resolving Chaos input will be focused during Autumn 2016.
Examples of past project work
Mental Health Crisis Concordat
During 2015 we were commissioned by both Hertfordshire CCG and Barnet, Enfield and Haringey CCG to assist their preparations for Mental Health Crisis Care Concordats. In both projects the work involved undertaking fieldwork to understand current crisis pathways and suggest recommendations to shift response from crisis to prevention; to provide economic data on case examples and the cost of current responses across local agencies; and to produce an action plan that can be used locally and adapted for submission to Department of Health.
In both projects resolving Chaos led the contract and managed a project team involving contractors from Kaleidoscope and Confluence Consulting.
Hertfordshire Feasibility Study
We are delighted that our Feasibility Study within Hertfordshire 2012-14, which researched the issue of people with multiple needs in two Districts of Hertfordshire, has been used as a basis to pool budgets and introduce a new intervention to work with 60 people to improve their personal situation, as well as their community – we believe this will determine if better outcomes can be achieved for less money.
The Feasibility Study involved working in the Three Rivers and Hertsmere Districts, gathering stakeholders to identify individuals known to many current services, studying their basic profiles, use of services and the costs these incurred. We reported on anonymised service audit data, collected for 35 people between the two areas. For the ‘Top 20’, the cost per week to public services is £14,081 a week, every week. This figure does not include benefits or rent, which would add considerably to the total. Every two years, just twenty people cost £1.46m and, crucially, this money is not resulting in them leading happy, fulfilling lives of stability and joy. These costs have been analysed according to the budget they fall within and were used by Hertfordshire commissioners to plan contributions to the 2016-17 Adults with Complex Needs Project.
Evaluating the economic benefits of the Single Homelessness Project’s Camden Drug and Alcohol Aftercare Service
Resolving Chaos evaluated the main economic benefits of SHP’s Camden Drug and Alcohol Aftercare Service, as shown to accrue through the outcomes achieved by its service users.
The analysis was commissioned by SHP, a charity that supports homeless and vulnerable people in London. SHP deliver the Aftercare Service and wanted to quantify the outcomes of the scheme, to demonstrate its value to commissioners and policy makers.
Through study of data for the service from 2012/13 and 2013/14 we were able to report outcomes achieved by people using the Camden Drug and Alcohol Aftercare Service are very positive. Employment outcomes are particularly strong with large numbers of people securing employment, work placements or volunteering. The Service’s work to help people into volunteering opportunities is an estimated worth of £125,000 over two years, with its Work Placement achievements estimated at £36,000 over the same period.
The report also examines the role of the service in preventing relapse into addiction. Using a small scale, scenario test, it calculates what could happen to overall client group costs in the absence of the service.
Lankelley Chase – Membership of the Promoting Change Network
Resolving Chaos were included in the Promoting Change Network (PCN) which enabled us access the knowledge and intellectual rigour to develop our model and share our expertise. The membership allowed us to participate in the PCN’s aim of exchange ideas, and creating a strong evidence base to work within and bring system change for people with multiple needs. In short, inclusion in the PCN enabled Resolving Chaos to do the ‘big thinking’ in conjunction with other members, which shaped our local work into a national vision.
Brent Mind- Nucleus and Horizons
Resolving Chaos worked with Brent Mind between 2012-14. We established the financial benefits which accrue from two of their services - Nucleus and Horizons. For Horizons, we conducted a break even analysis, scenario tested the costs of support that would be required in the absence of the project and calculated the cost per unit of their services. For Nucleus, we have developed costed case-studies to demonstrate the financial impact of their work, and produced statistical data for reporting to their principle funder, the Big Lottery Fund.
St Mungos – Investigating the health needs of homeless people
In 2013 Resolving Chaos worked with St Mungos on a shared project that evolved from our joint concern for improved health outcomes for homeless people. We worked to better understand the complex subject of health needs of homeless people, to recommend means of meeting these and prevent their escalation to chronic needs.
We welcome the publication of our study into the "Acute healthcare needs of rough sleepers" and the cost of responding to these needs. The report highlights that there is significant variance in the cost per person of acute healthcare use within the sample. Our studies confirmed that over a two year period, the ‘top 5%’ cost an average of almost £27,000 per person while the ‘bottom 10%’ cost under £300 per person. These costs do not include medication, rather the cost of healthcare whether in community or hospital
The report’s recommendations include:
- Providing health care services that can work effectively with the needs of this population and can make significant financial savings by tackling healthcare problems earlier, to prevent escalating health problems and associated treatment in later years.
- It would be financially prudent to identify the ‘top 10%’ users of healthcare to learn if alternative, possibly cheaper healthcare can meet their needs; to understand whether their escalating costs could have been prevented; and to understand the causes of high-cost service use within this client group
- To gather data on the use, need and cost of health care for rough sleepers and other disadvantaged groups in order to influence new commissioning structures Resolving Chaos completed an investment review for the London Borough of Brent. The review tested the extent to which the Council’s Supporting People investment has contributed to the organisation’s ‘One Council’ priorities. As part of this review, Resolving Chaos examined existing front line services in terms of current outcomes and effectiveness. They also quantified the service’s impact on individuals and communities focusing on homelessness prevention and access to costly statutory services. Where gaps in outcome data were identified, Resolving Chaos suggested specific data measures. Resolving Chaos led the NHS London and DH Social Exclusion Pilots, where 14 different localities worked with people who have multiple and complex needs across London. We pioneered the approach of linking outcomes to cost reduction of services for the multiple needs client group, in order to make a business case for sustained investment in services. Two-thirds secured sustained funding as a result of the investment case we made.
- Resolving Chaos' key successes within NHS London commissioned projects were:
- Resolving Chaos, NHS LONDON commissioned projects
- Key success: The review concluded with a value for money assessment (cost benefit analysis) and a number of recommendations for future investment opportunities to maximise the outcomes and financial benefit for local communities. The Council accepted the financial recommendations.
- Investment Review of Supporting People investment in Brent, London Borough of Brent
- This report follows Health and Homelessness published in 2013 in which we analysed the economic impact of current healthcare services for homeless people.
- Two-thirds of the pilots were sustained with local funding, as a result of the business case and outcomes monitoring RC provided.
- Resolving Chaos successfully applied its cost-measurement system across 14 diverse services to create a business case which then secured Cabinet Office funding for marketing this approach.
- Resolving Chaos shared learning across London through a Learning Network which identified best practice and what works.Resolving Chaos worked within the six Olympic Boroughs, specifically collaborating with the boroughs of Greenwich and Hackney, to identify their core client group of people with complex and multiple needs, experiencing repeat crises and poor outcomes, to calculate the cost of their service use over the last 12 months.This information was then used to make the economic case for an Investment Options paper where Local Authorities formulated potential options for future reinvestment of services to improve outcomes for the target cohort. A pilot scheme in Greenwich Council was funded as a result and we worked with the authority to evaluate its outcomes and construct a business case for further investment.
- Key Success
- The Olympic Project, Olympic Boroughs