What value does low-level preventative support have for society and what does it cost?
The Scottish Finance Committee is currently conducting an inquiry into exactly this. Its aim:
"To consider and report on how public spending can best be focused over the longer term on trying to prevent, rather than deal with, negative social outcomes."
This is exactly the sort of approach we need for the longer term. Whatever public money there is, let’s make sure it is used wisely. Let’s talk about how to save public money without false economies, and without diminishing social justice or quality of life.
For older people, most services are focused on the highest needs of the frailest people, mainly funded from health and social care budgets. Yet these services are not what many older people want – they value supportive interventions, often at an earlier stage, and ‘that bit of help’.
When JRF’s Older People’s Inquiry explored this further, it found many examples already in existence of the kind of help older people want. Importantly, many were provided by volunteer services, often with support from local authority grants.
In the current climate of budget cuts, any investment must be justified by its social return on investment, if not clear evidence of cost savings. Seemingly unproven prevention schemes may be viewed as a luxury.
But some preventative work is hard to quantify. For example, we may know that unsafe and unsuitable housing can be a trigger for admissions into hospital or residential care (falls are a major cause). But it is notoriously difficult for schemes like this to quantify any direct impact on future costs to housing, health or social care budgets.
The effectiveness of preventative spending in later life has been most clearly demonstrated by the national evaluation of POPPs (Partnership of Older People Pilots) – a point highlighted in a Policy Exchange report, Careless.
Policy Exchange advocates continued investment in low-level preventative support to older people, in part to help keep down the costs (to individuals, state and society) of funding long-term care, and to increase the quality of later life.
POPPs offered a range of services to promote health, well-being and independence, to understand how this might prevent or delay the need for higher intensity (and more expensive) care. The evaluation found that overnight hospital stays were reduced by 47% and use of A&E departments by 29%. The result: for every extra £1 spent on the POPP services, there was approximately a £1.20 additional benefit.
When you scale that up to a rapidly growing population of older people, we are talking about significant savings to public spending.
More recently, JRF funded an evaluation of three pilots which trained care staff in residential care homes with basic clinical and nursing skills. This produced clear evidence of benefits and cost savings, preventing between 81 and 197 potential hospital admissions over the first two years, as well as facilitating 20 early discharges. There was an overall saving of £36.90 per resident per week, from avoiding hospital admissions and transfers to nursing homes.
But the depressing reality is that pressure on public spending on health and care is likely to incentivise fire-fighting approaches as well as salami-slicing. The onus will be on dealing with the most critical cases, not prevention. Many preventative services rely heavily on user charges and increasing these will undoubtedly restrict access. They also need volunteers, who are often older people themselves. Stimulating and sustaining volunteer-based support will be essential.
It is vital we exploit what we know to face the challenges that the comprehensive spending review will bring. That is why JRF and Centre for Policy on Ageing are working together to gather evidence for empowering and effective solutions that lend themselves to these cash-strapped times.
So this is where I want to shout 'hurrah' for the Scottish Financial Committee for looking at the potential of preventative spending. Justifying something that may initially raise costs is going to be increasingly difficult...and incredibly important.