Taking Stock: Assessing the Value of Preventative Support

British Red Cross 44 Moorfields London EC2Y 9AL Tel: 020 7877 7284 Fax: 020 7562 2000 redcross.org.uk Published 2012 The British Red Cross Society, incorporated by Royal Charter 1908, is a charity registered in England and Wales (220949) and Scotland (SC037738)

This report tells the stories of five people who have recently been supported by British Red Cross staff and volunteers. They show the value of time-limited practical and emotional support which responds to people’s individual needs and wishes at times of transition and vulnerability. This personalised support has helped all of these people live independently and with dignity in their communities. While the outcomes for individuals speak for themselves, it is increasingly important to be able to show how preventative services such as ours deliver savings for statutory partners. To support us in evaluating these savings, we asked nef consulting (new economics foundation) to carry out an independent economic analysis of our work with these people. They have assessed the costs which could have been incurred by the state to treat and deliver care to these 1 five people had our services not been there. They have estimated that our support delivered savings of between £700 and £10,430 per person. This reflects a minimum return on investment of over three and a half times 2 the cost of our service , and in most cases significantly more. We know how valuable our services are to the people we support, their families and their carers. This report shows the value they also deliver every day to a range of statutory services, bridging gaps between professionals and saving money. 1. The challenges of varying service provision and access criteria should be acknowledged. It is possible that these people may not have been able to access every service that they could have benefited from, and where appropriate, we have distinguished between projected and potential additional savings. The photographs used in this publication are of models and there is no intention to associate any of them with any of the 2. Costs depend on the length and frequency of support provided by each service. In these case studies, costs range from £90 conditions or circumstances referred to in this publication. Names have been changed to protect anonymity. to £330 per service user. 1

Avoided state costs £3,262 – £5,776 £2,514 Outcome Prevented ambulance call out and Mr Bradley unnecessary hospital admission Assumption One ambulance transfer and inpatient hospital stay (average length) Mr Bradley was referred to the nurse, linking him into a local Impact of our support Mr Bradley, 50, lives British Red Cross as he could not befriending service, and organising cope alone and particularly needed a meeting with the Citizens Advice alone, suffers from help with paperwork, which he was Bureau, who helped him get in touch 2 finding overwhelming. with a solicitor to discuss his house Providing practical and emotional cent of the total NHS budget . The agoraphobia and and children. We were also support to Mr Bradley saved the annual cost of treating diabetes and 3 depression, and is From an initial visit to Mr Bradley, able to organise support for Mr Bradley state money in two ways: complications is £2,944 per person. we found that he was extremely from Age UK. Complications with the condition type one diabetic. depressed and lonely. He was account for around 35 per cent of 4 His relationship with not eating or drinking much, often After a period of intensive support, We prevented Mr Bradley’s this (or £1,035) . It is possible that going for days with no food. This we continued to visit Mr Bradley depression worsening without our intervention this would his long-term partner was particularly concerning given and help him set up longer-term Ongoing and worsening depression have led to a hospital admission, his diabetes and regular insulin solutions. He now has a befriending including ambulance transfer (£1805) recently broke down, can increase the likelihood of a 6 injections. He was also very worried volunteer, a counsellor, regular suicide attempt or a long recovery and inpatient stay (£2,334 ). and he has had no about his finances as his ex-partner appointments with the diabetic period. It is likely that without our £1,035 £3,262 contact with her or his had dealt with money issues. nurse and better control of his health support Mr Bradley’s depression Overall, the support we We visited Mr Bradley once a day and personal care. He also has would have worsened, to the extent delivered to Mr Bradley Outcome three children since. and offered practical and emotional a better outlook on life and feels he would have required some at- Prevented diabetic He has no other family support to help him get back on he has the support to cope with home medical assessment and care. represents total avoided complication his feet. We helped him with his day-to-day life and start regaining costs to the state of Assumption and only one close paperwork, and in the course of this his independence. It is likely Mr Bradley would have between £3,262 and £5,776. Cost of treating required a residential GP visit to diabetic complication friend in the area. support we discovered he had bank Our support allowed (35 per cent of total accounts in his name that he was assess his mental health, and cost) for one year unaware of, and that his ex-partner Mr Bradley to start would have then needed support £2,227 had taken both his passport and regaining his from social services home care. A Outcome birth certificate with her. residential GP visit costs, on average, Prevented GP visit independence and £121 and home care support for and home care support We alerted the safeguarding rebuilding his confidence service users with mental health 1. PSSRU (2011), Unit costs of health and Assumption 1 social care 2011, The University of Kent officer to Mr Bradley’s financial while learning new ways problems costs £162 per week . It is One GP visit and concerns. We helped him fill out likely that social care support would publications. £21 represents the cost of a home care support to cope. community nurse, per visit (pages 106-108, for 13 weeks forms to declare his passport and be needed weekly for three months taken from: Community Care Packages for birth certificate as lost or stolen (13 weeks) at a cost of £2,227. Older People). We assume this is a low bound He said the support he received figure representing the fact that Mr Bradley was and helped him complete and send from the British Red Cross gave him unable to cope with daily necessities himself, his benefits forms. We also fed e.g. food preparation. back to Mr Bradley’s GP our fantastic emotional support at his We prevented Mr Bradley’s 2. Diabetes in the UK (2004), a report from lowest point and helped him to Diabetes UK available at www.diabetes.org. concerns about his diet, and diabetes worsening and causing uk/Professionals/Publications-reports-and- organised regular deliveries of start taking back control of his life. complications resources/Reports-statistics-and-case-studies/ Reports/Diabetes_in_the_UK_2004/ prepared meals to ensure that he Mr Bradley was not providing for 3. Ibid. would be eating properly. 4. Ibid. his own basic needs, which could 5. National Audit Office (2011), Transforming the NHS We then put Mr Bradley in touch with have had very harmful effects ambulance services: presentation to the House of Commons. www.connectingforhealth.nhs.uk/ various other forms of help, including alongside his diabetic condition. systemsandservices/pathways/news/fullreport. arranging a visit from his diabetic The cost of treating diabetes and pdf. The unit cost for ambulance services ranges from £144 to £216, i.e. a mean unit cost for this is its associated complications is £180 per call. significant, comprising around 5 per 6. PSSRU (2011). Projected savings Potential additional savings 2 3

Impact of our support Avoided state costs wheelchair. A Red Cross volunteer Preventing Mr Bains’ depression have needed a two-year course of £7,310 – visited Mr Bains weekly for three worsening saved the state money anti-depressants at a cost of £292. months and provided him with in several ways: £10,430 emotional support, as well as practical help like finding computer We prevented Mr Bains from classes at his local library, which We kept Mr Bains out of hospital needing cognitive behavioural £3,120 helped him continue his interest in or care therapy (CBT) Outcome bird watching. Prevented further Worsening depression can increase Given the advanced stage of psychological Our volunteer referred Mr Bains to the likelihood of a suicide attempt. Mr Bains’ condition and his suicidal support (mid-term) other support services, including the It can also undermine people’s thoughts, it is probable that he Assumption MS Society which provided a home willingness and ability to provide for would have required CBT or another One session of visitor, and the NHS expert patient counselling per their own basic needs, such as food, therapeutic treatment. The cost of week for one year programme to help him learn more clothing and heating. If Mr Bains’ a CBT session is £1065. If Mr Bains about how to manage his condition. depression worsened, he would had needed one session a week for We also gave Mr Bains information have had to be admitted to hospital 24 weeks, it would have cost the about community transport services, and then provided with social care state £2,544. local buses with wheelchair access support in his home. He might have and information on accessible days even risked or damaged his health, out locally. for example through self-harm, We prevented Mr Bains from Mr Bains was invited to our local which would have meant longer- needing counselling services £2,544 £7,310 service user forum and offered help term support in the form of sheltered While Mr Bains would already have with transport to it. Despite his initial housing, day, residential or nursing received support in the form of Outcome reluctance to attend, Mr Bains found home care. Prevented talking social services home care and CBT, therapy (short-term) the opportunity to meet other service One hospital inpatient admission he may also have been referred for Assumption users, socialise with them, and hear (for an elderly individual with mental further counselling due to his MS One CBT session their stories hugely beneficial. 1 per week for almost Mr Bains health problems) costs on average and associated difficulties. Mean six months He told us: £293 per day and it is likely he costs of public psychotherapy would have required a minimum of counselling services are £60 per “Meeting those people a two-day stay. It is also likely that session6. If Mr Bains had needed Mr Bains would have then needed one session a week for a year, it Outcome who were so depressed social services support, provided by would have cost the state £3,120. Prevented and had no-one made me prescription of the local authority. The average cost medication realise just how lucky of delivering home care to a service Assumption user with mental health problems Overall, the support we £292 Average cost of a Mr Bains is 68 years old and lives alone in a small I was to have friends 2 course of anti- and family. It made me is £162 per week . We assume this delivered to Mr Bains depressants over town in a rural area. He is divorced and has two support would have been required represents total avoided £4,474 two years realise I must make the for 24 weeks at a cost of £3,8883. costs to the state of Outcome sons, one of whom lives nearby. Prevented most of my time, and between £10,310 and worsening of Mr Having worked as a painter and decorator for how silly I was to feel £10,729. Bains’ depression We prevented Mr Bains from Assumption many years, he was well known in the town so embarrassed.” needing anti-depressants Hospital admission and subsequent and led an active social life including enjoying a Overcoming his fear and The average cost to the NHS of social care support administering anti-depressants for 24 weeks. number of hobbies from bird watching to whist. embarrassment of being seen in a across the UK is £1464 per patient, wheelchair, Mr Bains went out with his per annum. Due to the severity of his son shortly after the forum and bought condition, Mr Bains would probably Sadly, Mr Bains was diagnosed with on wheels for him. However, he was an electric scooter which enabled multiple sclerosis which affects his referred to the British Red Cross him to get around town again and mobility and means that while he after becoming very depressed and reconnect with the community. is able to walk carefully around his withdrawn, and choosing not to Our support helped Mr Bains own home with a walking frame, he leave his house, even though he through this very difficult time of 1. PSSRU (2011), Unit costs of health and social care 2011, The University of Kent publications. needs a wheelchair to go outside. had the opportunity. change, grief and acceptance of his 2. Ibid. illness, back to a full and fulfilling life. 3. This would be until the end of Mr Bains’ cognitive behavioural therapy (CBT) course (24 weeks). Initially, Mr Bains was supported by He told us he felt suicidal and 4. McCrone et al (2008), Paying the price: The cost of mental health care in England to 2026, a social worker who arranged for couldn’t bear the thought of people The King’s Fund publications and Thomas and Morris (2003) “Cost of depression among adults in England in 2000”: The British Journal of Psychiatry Vol. 183. Unit costs range from £41.10 to £250.60. carers to visit and organised meals around the town seeing him in a 5. PSSRU (2011). 6. Ibid. Projected savings Potential additional savings 4 5

Impact of our support Avoided state costs Providing Mrs Jones with practical £729 and emotional support saved the state money in two ways: We prevented Mrs Jones from needing an ambulance £549 Outcome Our volunteer’s support in Prevented reminding Mrs Jones to take unnecessary her medication over a three-day hospital admission period, along with liaising with her Assumption Inpatient stay social services team for one night to remind her to take her medication promptly, meant her infection was successfully treated and an ambulance transfer due to medication non-compliance was avoided. The unit cost for 1 this is £180 . We prevented Mrs Jones from needing readmission to hospital It is likely that, due to Mrs Jones’ dementia and the fact she was found collapsed, she would have required a hospital stay. We estimate that the length of Mrs Jones Mrs Jones’ hospital stay on readmission would be one night, 2 for which the unit cost is £549 . Overall, the support we delivered to Mrs Jones represents Mrs Jones was diagnosed with to provide her with face-to-face at this difficult time, our volunteer total avoided costs Mrs Jones is a a urinary tract infection and was medication prompting until the also gently encouraged Mrs Jones to to the state of £729. widow in her mid-80s, prescribed tablets for three days. As completion of her treatment. We also participate in some of the communal she suffers from dementia, hospital encouraged Mrs Jones to read the activities offered within the sheltered living in sheltered staff were concerned she would not instructions on the dosette box to accommodation premises. remember to take her medication reduce her anxiety and put her more At the end of this short period of £180 accommodation. and requested assistance from at ease as she could not remember support, Mrs Jones had successfully Outcome the British Red Cross to support being in hospital, or why she was Prevented ambulance She was admitted Mrs Jones in the days following supposed to take the medication. completed her three-day course of call out to hospital after she her discharge from hospital. medication. This effectively dealt Assumption was found collapsed During this period our volunteer with her infection and meant she One transfer A British Red Cross volunteer visited established contact with Mrs Jones’ avoided readmission to hospital. Mrs Jones on the ward to introduce social services team to discuss Our support also gave Mrs Jones 1. National Audit Office (2011), Transforming on the floor. herself, explain the service we were the need for her morning carer to the confidence to consider engaging the NHS ambulance services: presentation to the House of Commons. able to offer, and identify any further prompt her timely medication intake, in some group activities, resulting in www.connectingforhealth.nhs.uk/ needs she may have which we could which they agreed to do. improvements to both her physical systemsandservices/pathways/news/ fullreport.pdf. The unit cost for ambulance support her in addressing. and mental health. services ranges from £144 to £216, i.e. a Through establishing a good mean unit cost of £180 per call. Our volunteer then visited Mrs Jones relationship with Mrs Jones and 2. PSSRU (2011) Unit costs of health and at home every day for three days providing her with emotional support social care 2011, The University of Kent publications. 6 7

Impact of our support Avoided state costs Providing Mrs Khan with practical £3,474 and emotional support saved the state money in two ways: We prevented social services from needing £2,514 to get involved earlier Outcome Prevented ambulance Our involvement and support call out and unnecessary hospital ensured Mrs Khan’s needs were admission identified sooner than would Assumption otherwise have been the case, Ambulance transfer preventing or reducing the need and inpatient hospital stay for social services to be involved in the early stages of the case. We assume that Mrs Khan would have required intensive home care for at least one week. Given Mrs Khan’s circumstances, we assume she would have received intensive support totalling 30 hours a week, at a 1 Mrs Khan cost to social services of £960 . We prevented Mrs Khan from needing an ambulance and hospital stay Given that Mrs Khan was unable to look after herself, it is likely that our support also avoided the cost of an ambulance transfer and hospital inpatient stay We agreed to do Mrs Khan’s shopping However, Mrs Khan continued to was assessed and sectioned by resulting from a serious injury or at short notice on the first day of telephone the service for support statutory services. illness. The cost of an ambulance 2 Mrs Khan, 63, referral and a volunteer was able to at short notice over the next few transfer is £180 per instance , contacted the deliver it to her. Our volunteer then days, and seemed to be increasingly The flexibility of our while the cost of an inpatient stay spent some time with Mrs Khan and distressed, leading to concerns for service ensured Mrs Khan (based on an average number of British Red Cross explained what support the British her wellbeing. We contacted social days in hospital) is £2,334. for urgent support Red Cross could offer, but she services to enquire whether Mrs received the support she with shopping as refused ongoing support. Khan was known to them and, at needed during a period Overall, the support we Mrs Khan phoned again the following the duty social worker’s request, the when she was becoming delivered to Mrs Khan £960 she had run out of day asking for help with housework, volunteer encouraged Mrs Khan to increasingly unwell. represents total avoided Outcome more shopping and transport to a refer herself for more support. Prevented initial food and was suffering Our role in keeping in touch with costs to the state of social services from an inflamed knee hospital appointment. When the A few days later, our volunteer visited £3,474. involvement volunteer arrived, an ambulance was Mrs Khan by arrangement and was social services and Mrs Khan’s Assumption which prevented her outside the house, and the crew unable to find her at home. We then daughter meant there was a quick 30 hours support suggested Mrs Khan might need to contacted her daughter and a short response when her mental capacity over the course of from getting to her was compromised, and we were 1 week be admitted to hospital. However, while later we were informed that 1. PSSRU (2011), Unit costs of health and local shops. she remained at home and phoned Mrs Khan had been found in town in able to greatly minimise the length social care 2011, The University of Kent the following day, again requesting her night clothes, confused and very of time that she was at risk from publications. immediate help with shopping and unwell. Her daughter was hugely her own actions as well as her 2. National Audit Office (2011), Transforming daughter’s anxiety. the NHS ambulance services: prescription collection. A volunteer grateful to have been alerted to her presentation to the House of Commons. provided the support and agreed a mother’s absence and was able to www.connectingforhealth.nhs.uk/ systemsandservices/pathways/news/ weekly programme of help with her. provide her with support while she fullreport.pdf. The unit cost for ambulance services ranges from £144 to £216, i.e. a mean unit cost for this is £180 per call. 8 9

Impact of our support Avoided state costs As a result, he was bed-bound and Providing Mr Hughes with practical costs to the healthcare system having difficulty with his speech. and emotional support saved the as well as indirect costs, such as £3,787 Mrs Hughes was finding it increasingly state money in several ways: health complications resulting from difficult to care for him, and he was malnutrition and related costs to other refusing to drink or co-operate public health services. with her. We prevented Mr Hughes from £1,152 His GP referred him to the British Red requiring a GP residential visit Outcome We prevented Mrs Hughes’ stress Prevented home Cross on a Friday to see if we could Our support avoided the need for a and anxiety from worsening visits from a nurse help with his fluid intake. The GP GP visit in the home, costing £121 Assumption 1. Assumed four said he would review the situation on per visit Without our support, Mrs Hughes visits per day, initially, Monday, but would have to admit him may also have required some sort reducing over a to hospital if he had not improved. of medical or emotional support period of We prevented Mr Hughes from in the midterm. The direct costs for three weeks We arranged to visit Mr Hughes at needing another admission to of depression and anxiety cost least four times a day to encourage hospital the state around £22 billion a year him to take fluids, fitting in between through lost productivity, inability to visits from his existing carers in the The unit cost of a non-elective commence or return to employment, morning and evening. inpatient stay for more than one health facility usage and medication Mr Hughes happily drank for our night (based on the average number costs8. This represents an annual 2 volunteers every time they visited over of days stayed) is £2,334 . Mr cost of £7,875 per case. Around 35 the weekend, and we helped Mrs Hughes would also have required per cent of mental health treatments Hughes create a fluid diary to keep an ambulance transfer to hospital deal with people experiencing anxiety £2,514 Outcome 3 Prevented ambulance (£180) resulting in a total cost of 9 track of his intake. We also liaised with £2,514 for the admission. disorders . Applying this proportion call out and his carers to ensure Mr Hughes drank suggests avoided costs around unnecessary hospital as much as possible. £2,620 per year, per person. admission We also helped him cut up his food, We prevented Mr Hughes from Assumption Average length as his hands were very shaky due to needing further health or social of stay and one his Parkinson’s. care home visits from statutory Overall, the support we ambulance transfer services delivered to Mr Hughes His health began to improve and by represents total avoided Sunday evening he was out of bed The cost of a home visit from a costs to the state of £3,787. 4 and watching TV in the living room nurse is £64 an hour . We assume with his wife. From Monday we agreed visits would be required four times with Mr and Mrs Hughes to visit a day, in line with what we provided. only twice a day, which decreased Assuming each appointment lasted Mr Hughes shortly afterwards to one visit, until around 30 minutes, daily costs 1. PSSRU (2011), Unit costs of health and social our assistance was no longer needed would have been around £1285. care 2011, The University of Kent publications. around three weeks later. These visits would be required 2. Ibid. 3. National Audit Office (2011), Transforming During the course of our visits we for three weeks, in line with what the NHS ambulance services: presentation we provided at a cost of £1,152. to the House of Commons. http:// reported back on Mr Hughes’ situation www.connectingforhealth.nhs.uk/ to his GP. systemsandservices/pathways/news/fullreport. pdf Additional benefits 4. PSSRU (2011). Our support meant 5. PSSRU (2011). Mr Hughes was able to We prevented Mr Hughes from 6. Elia (Chairman & Editor) Stratton, Russell, developing longer-term health Green, Pan; (2005); “The cost of disease- stay at home with his wife related malnutrition in the UK and economic problems considerations for the use of oral nutritional and avoid a readmission supplements (ONS) in adults”. British Without our support, Mr Hughes may Association for Parenteral & Enteral Nutrition. Mr Hughes, 81, suffers from Parkinson’s disease to hospital. have suffered longer-term problems http://www.teespublichealth.nhs.uk/document. aspx?id=3202&siteID=1012 and lives with his wife, his main carer. After as a result of malnutrition. 7. McKinlay (2008) “Malnutrition: the spectre at It also gave Mrs Hughes the the feast”, Journal of College Physicians of recently being discharged from hospital, he The overall costs of malnutrition Edinburgh 38:317–21 Outcome confidence to arrange for extra carers across the UK amount to around 8. Layard (2005), “Mental health: Britain’s largest Prevented residential became mildly dehydrated and had a possible to visit to relieve some of the pressure social problems?”, Paper presented at the GP visit 6 No. 10 Strategy Unit Seminar on Mental Health on her in the long term and ensure £7.3 billion per annum , affecting Assumption urinary tract infection. 5 per cent of the British population (or 20 January 2005 One GP visit to Mr that they were both better able to 7 9. Hallam (2008), “The social costs of anxiety £121 Hughes’ home cope with their situation. 2.9 million people) . This represents disorders”, Congresso Istituto Tolman: a cost of around £2,483 per person, Psicoterapia competenti per la communita: I per year. This figure includes direct percorsi, gli ostacoli, le soluzioni. Palermo, 3 Dec, 2006. 10 11

This report captures the stories of just five of our recent service users. In 2011, we helped over 45,500 people across the UK regain their independence at home, working through 161 contracts with local authority and NHS commissioners across the UK. If you would like to find out more about our services, please phone us on 020 7877 7284 or visit our website redcross.org.uk Photos Cover: © Patrick Harrison/BRC. Page 2-3: © iStock. Page 4: © iStock. Page 6-7: © Patrick Harrison/BRC. Page 8-9: © Crispin Hughes/BRC. Page 10 © Shutterstock. 12 13