National evaluation of partnerships for older people projects (popps):  Second interim report of progress october 2008

Briefing Paper

Contents:

Introduction

The second interim report of progress was published on 22nd October 2008 and provides a summary of key findings from the National Evaluation of the Department of Health’s POPP Programme.

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 summary findings making up the second interim report on progress are based on data collected and analysed over the period from April 2006 to March 2008 and has been made available to support emerging learning around prevention and early intervention.

As many of pilot sites still have one year to run a final report of the national evaluation will be published in Autumn 2009. All of the issues and evidence on which these findings are based will be made available in the final report.

This briefing paper summarises key messages from the second interim report in respect of:

1. Main Messages
2. Key Achievements
3. Learning Points to Date

The full interim progress report and a range of other resources on making a strategic shift to prevention and early intervention based on learning from POPP and Linkage Plus is available at www.networks.csip.org.uk/Prevention/  

1. Main Messages

• 99,988 individuals had received, or were receiving, a service within the POPP programme across 470 projects and within 29 pilot site areas as of March 2008. Of those people receiving a service almost a third (30%) are aged 85 or over, with almost two-thirds (63%) aged 75 and over.
  
• 71% of projects are focused toward Universal Services, (e.g., Handyperson schemes, Gardening, Shopping and Leisure services). 14% of projects involve the provision of Additional Support, (e.g., Medicines Management, Telecare Services, Falls Prevention). 8% of services provide Specialist Support, (e.g., Community Rapid Response, Hospital at Home and Intensive Support Teams).
  
• POPP pilot sites continue to have a demonstrable effect on reducing hospital emergency bed-day use when compared with non-POPP sites. The results show that for every £1 spent on POPP, an average of £0.73 will be saved on the per month cost of emergency hospital bed-days, assuming the cost of a bed-day to be £120.
  
• The POPP projects are having an effect on how users perceive their quality of life as a whole. Following involvement with a POPP project, users report they see their quality of life as improved.
  
• Users also reported that their health-related quality of life improved in five key domains, (mobility, washing/dressing, usual activities, pain and anxiety), following their involvement in the POPP projects.
  
• An analysis of those sites where data are currently available (11 out of 29 sites) appears to demonstrate the cost-effectiveness of POPP projects in terms of emergency bed-day costs, changes in health-related quality of life (QALY) and reductions in hospital overnight stay (from a mean of 8 days to 6.4 days).
  
• The total mean cost change from pre to post POPP intervention was a £410 mean cost reduction. Such a cost reduction could be a cost saving if monies could be extracted from the secondary care system.
  
• The POPP programmes also appear to be associated with a wider culture change within their localities. Generally, there seems to be a greater recognition of the importance of including early intervention and preventative services focused toward well-being.
  
• POPP partnerships across the health and social care economy seem to have strengthened and accelerated developments around joint commissioning. In particular, there has been recognition of the value of involving voluntary and community organisations in service planning and delivery.
  
• Involvement of older people within the POPP sites appears to be focused on the delivery of services; almost half the staff in the projects across the POPP programme are older volunteers.
  
• To date only 15 (4%) of the total 470 projects across the POPP programme have indicated that they do not intend to sustain their service after the end of DH funding.

2. Key Achievements

Improved Outcomes

• Improved accessibility of services to older people, including older people being more readily referred to specialist services.
  
• Provision of a wider range of services for older people from which to choose.
  
• Increased awareness by older people of the services available.
  
• Increased involvement of older people in service delivery.

System Benefits

There is a variety of practice across the 29 POPP pilot sites. There are indications that in a number of sites:

• POPP has led to more systematic, evidence-based and ‘joined-up’ systems for making investment and disinvestment decisions as part of the commissioning process;
  
• POPP sites have made effective use of a wide range of resources, services and skills available in the voluntary sector and there is now a more mixed economy of service provision to support local older people;
  
• New systems for referral and sharing of information have been established through POPP, which have improved the way in which different services work together;
  
• POPP has reinvigoratedlocality working with local older people to identify needs and inform commissioning processes not only for health and social care services, but also for wider well-being services.

3. Learning Points to Date

• Prevention and early intervention services need to address the spectrum of need from promoting access to universal services for the general population through to addressing complex needs.
  
• A broad range of council services have a key contribution to make in delivering prevention and early intervention including, for example, housing, leisure, transport and community safety.
  
• Commissioning decisions should focus on value for money and return on investment rather than performance against budget.
  
• Different interventions produce different returns and it is important to be clear about this at the outset; some interventions produce net savings whereas other investments will improve older people’s quality of life.
  
• It can be difficult to measure something that has been ‘prevented’: for example, the impact of ‘simple services’ that are focused on improving wellbeing such as provision of information, help with shopping etc. However, approximate impacts can be developed to inform commissioning processes using quality of life tools and routinely collected data.

John Dunne
24th October 2004