The Public Services (Social Value) Act 2012 here requires those who commission public services to think about how they can secure wider social, economic and environmental benefits from the services they procure. What do they cost to provide, and what ‘value’ of outcome do they give in return? And can their value be measured in pure ‘cash’ terms, or in other less tangible ways? There is a rapidly growing army of social value indicators that can be found by a quick search of the internet.
The Housing Associations Charitable Trust (HACT) is an avid proponent of measuring social value and has produced a Social Value Bank here. Foundations are currently working with HACT and a number of HIA providers to establish a methodology for measuring the social value of the aids and adaptations that they deliver to clients. A final version of the tool being developed will be made available via our website.
In the meantime the cost-effectiveness of a DFG can be based on three main areas:
- removing or reducing the need for residential or community care;
- savings to the NHS through prevention; and
- non-cash benefits in the form of improvements to quality of life.
Benefits to Social Care
There are benefits through helping to prevent admissions to residential care and reducing the need for domiciliary care. By providing adaptations it enables people who would otherwise require residential care to stay living in their own home. A survey of 150 people who received a DFG adaptation showed that 1 in 10 would have gone into residential care without the intervention (Heywood, 2001). Preventing one person from being admitted into residential care can save on average £30,000 per person per year. The saving is greater for working age adults with physical disabilities at £42,700 per year. In the analysis it is assumed that the majority of DFG recipients of working age, are those with physical disabilities.
According to the most recent wave of the Personal Social Services (PSS) Survey of Adults receiving community equipment and minor adaptations (2009/10), 25% of a sample of 65,000 users of equipment and adaptations reported that they needed less help from others following receipt of their equipment or minor adaptation, and 18% that no help was needed from others.
Benefits to NHS
The Department of Health (2009) provided an estimate of the treatment pathways and diagnoses that follow falls. According to their estimates, of 15,500 who will fall in a given year, 2,200 will attend A&E and a similar number will call an ambulance. 360 older people are likely to have sustained a hip fracture and 890 will have sustained other types of fracture. As a consequence, prevention through reducing a proportion of falls results in savings to the NHS.
The provision of suitable aids and adaptations will not prevent all falls from occurring. However, it is important to note that additional reductions in the demand for services can still be accrued where equipment-based interventions are in place. Care and Repair Cymru (2006, in Heywood and Turner 2007) suggest that the average length of stay in hospital following a fall or critical incident may be reduced by up to a week when the necessary equipment is in place at home, potentially avoiding over £1,400 in extra costs due to delayed discharge. Some evidence suggests that following an adaptation disabled people needed to visit their GP less often and it was also reported that the adaptation had had a positive effect on health.
Benefits to the Individual and Carer
Quality of Life Benefits of £1,522 per person per year is based on modelling by PSSRU (2012). Included in the calculation are the combined effects of additional deaths, acute care episodes, increased levels of institutionalisation, disability, increased fear of falls and decreased independence in cases with unmet equipment and adaptation needs. The figure of £1,522 is the mid-range estimate provided by PSSRU.
Carers are likely to be another group who benefit from adaptations through reductions in rates of injury and quality of life improvements as the adaptations may reduce the number of physical tasks which they assist. A survey of carers conducted by Henwood (1998) found that 51% of carers had suffered a physical injury such as a strained back since they began to care.
We will update this resource page as and when further information on this subject becomes available.