National Evaluation Interim Report of Progress - October 2007 Briefing
National Evaluation Interim Report of Progress - October 2007 Briefing Paper
Background
The Department of Health's Older People and Disability Division is leading a project 'Partnerships for Older People Projects' (POPP). The strategic aim of the project is to test and evaluate (through pilots established during 2006/07 and 2007/08) innovative approaches that sustain prevention work in order to improve outcomes for older people.
The underlying aim of the 29 pilot projects making up the POPP programme is to create a sustainable shift in resources and culture away from the focus on institutionalised and hospital-based crisis care towards earlier and better targeted interventions for older people within community settings.
The Department of Health has commissioned a national evaluation of the POPP programme to assess to what extent this aim is being met and to enable learning to be shared across the country with non-pilot areas.
In the longer term the findings from the national evaluation will help to develop the existing evidence base on the effectiveness of initiatives aimed at promoting independence and prevention as highlighted in the Health and Social Care White Paper 'Our Health, Our Care, Our Say: A new direction for community services' (2006).
The national evaluation is being carried out by a partnership of the University of Hertfordshire, Personal Social Services Research Unit, University of Keele, John Moores University and University College London.
The Department of Health published an interim report of progress providing early findings and key lessons learnt on the 11 th October 2007. The evaluation is ongoing and further findings are due to be reported in October 2008.
This briefing paper summarises Key Messages from the interim report in respect of:
- Early Findings
- Cost-Effectiveness
- Sustainability
Finally, the briefing note compares the interim findings from the national evaluation with the early experience over the first 5 months of Tameside's POPP – the Opening Doors for Older People project.
The full interim progress report 
and a companion paper on cost-effectiveness and measuring the effects on emergency bed-day use is available here.
Further information about Tameside's Opening Doors for Older People project can be obtained at http://www.tameside.gov.uk/popps
Key Messages
Early Findings
Early findings from the interim progress report include the following:
- There are early indications that POPP pilot sites are having a significant effect on reducing hospital emergency bed-day use when compared with non-POPP sites.
- Pilot sites are reporting improved access for excluded groups through proactive case finding, greater publicity and links with the voluntary sector.
- Services are being re-branded away from 'welfare' to health and well-being.
- Increased recognition across the community and public sectors of the need for low-level, universal and preventative services to sit within a whole system approach to health, independence and well-being.
- Partnerships between statutory organisations and the community and voluntary sectors have improved if compared with the perceived quality of partnerships prior to the initiation of POPP.
- Some of the key challenges that have been reported within the local partnership structures include: Defining and setting roles and responsibilities of partner agencies; negotiating different 'cultures' within the partnerships; the lack of involvement of GPs in some areas; the difficulty of engaging with PCTs in a period of reconfiguration and building the necessary trust and confidence between the different partners.
- Pilot sites are reporting that older people's involvement has increased within steering groups, commissioning, recruitment, provision and evaluation.
- Older people's health (including mental health) and well-being needs are becoming better integrated within the wider strategic agenda.
Cost-Effectiveness
Although the interim progress report emphasises that judgments about cost-effectiveness are of necessity tentative at this stage - early findings from POPP sites are:
- When compared with non-POPP sites, there are indications that POPP pilot sites appear to have a significant effect on hospital emergency bed-day use.
- The results show reductions against trend that would produce an average potential cost - saving in the order of; for every £1 spent on POPP, £1 will be saved on hospital bed-days.
Despite such savings, the challenge for the POPP pilot sites will be in extracting or removing such savings from the secondary care contracts.
Admission reduction can in principle release cash to PCTs. But hospital beds do not stay empty for long. Reducing emergency admissions often leads to an increase in elective and planned activity. Indeed, hospital cost savings generally only occur when beds are actually closed. Overall, then unless PCTs can control non-emergency demand (or, more specifically, non-POPP related demand of all kinds), most of the savings would appear to accrue to providers. Only if excess demand is exhausted would commissioners really see significant benefits, or if commissioners could agree with providers to share the savings.
As part of the national evaluation future cost analysis will explore older people's reported levels of quality of life alongside any data on overarching cost-effectiveness. This will ensure that any benefits to individuals resulting from their involvement in the POPP programme are captured.
Sustainability
Within the interim progress report pilot sites have reported a number of ways that they are aiming to promote sustainability at the end of grant funding:
- The majority of sites identified using National policy mechanisms (e.g. Practice Based Commissioning, Payment by Results and the Health Act flexibilities) to ensure projects are sustainable.
- Local Area Agreements have been identified as a central mechanism to continue project development and sustainability.
- Some pilot sites are concentrating on empowering older people and the wider community to set up and take forward specific projects through Social Enterprise models.
- Of the 245 projects running within the POPP programme in July 2007 it was reported that 161 (66%) will be 'mainstream' funded following the end of the POPP grant.
All the pilot sites emphasise the importance of negotiating with commissioners and partner organisations at a very early stage in any project evolution if sustainability is to be achieved.
Comparison Tameside's POPP Project - Opening Doors for Older People
Tameside's Opening Doors for Older People project commenced in May 2007 and runs until March 2009.
Whilst it is clearly too early to locally evidence any reduction in hospital emergency bed-day use or to quantify the cost-effectiveness of the project within such a short space of time, experience within Tameside is consistent with many of early findings contained within the interim progress report, particularly in terms of improved access from excluded groups through assertive out-reach & case finding; the emphasis on positive ageing, health, independence and well-being which underpins the project; partnership working across statutory, community and voluntary sector organisations; older people involvement and the value and need for a whole system, borough-wide approach.
Tameside's local evaluation of the Opening Doors for Older People project in partnership with the Institute for Public Health at Oxfords Brookes University will provide evidence of what outcomes the project has for older people as well as progressively providing information on cost-effectiveness, the project's impact on hospital emergency bed-day use and admissions to institutional care.
Work is currently ongoing to try and pilot approaches to Practice Based Commissioning with a number of primary care practices within the borough.
A preliminary report on sustainability of Tameside's project at the end of the grant funding period (March 2009) has already been presented to the Health Partnership Board.
The project is closely aligned with a number of targets within Tameside's recently agreed Local Area Agreement, for example in respect of use of 'sub-threshold' services and volunteering.
John Dunne
15th October 2007