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Research proves that prevention is cheaper than cure

Pioneering research from the Personal and Social Services Research Unit at LSE and the University of Kent has revealed that investment in preventive social care services more than pays for itself in savings to the NHS. For every additional £1 spent on such services to support older people, hospitals save around £1.20 in spending on emergency beds. 

Launching the PSSRU report on January 18th, the Health Secretary, Andy Burnham, said it made a "powerful and persuasive argument for putting prevention first – not first out the door." 

Academics evaluated 146 pilot schemes, funded by the Department of Health, know as the Partnership for Older People Projects (POPPs) which were run in 29 English local authority areas from 2006 to 2009. Two-thirds of the schemes were aimed at reducing social isolation and exclusion, or promoting health living among older people, with the remainder directed specifically at avoiding hospital admission or facilitating early discharge. 

The projects developed ranged from low-level services, such as lunch-clubs, to more formal preventive initiatives, such as hospital discharge and rapid-response services. Over a quarter of a million people (264,637), average age 75, used one or more of these services during the study. 

Researchers found that the scheme could almost halve overnight stays in hospital (47 per cent), cut accident and emergency attendances by nearly a third (29 per cent) and outpatient appointments by 11 per cent. 

Dr Julien Forder one of the report's LSE authors, said: "Our research found that these measures improved quality of life and wellbeing for many older people. The projects were also found to deliver significant cost savings by reducing the use of hospital services. This work showed the potential benefits of better collaborative working between the NHS and social care in investing in prevention and early intervention." 

The PSSRU report calculates an 86 per cent probability that the POPPs projects overall were cost-effective, compared with the usual care. The scheme has proved so successful that, of the 146 projects set up, only three per cent have closed. 

Mr Burnham described the report as a window into the world of the government's proposed national care service, adding that whatever happens in the general election " we have to reduce spending in the hospital sector and we have to cut emergency admissions, because the figures are just not sustainable." 

While arguing that the initiative must stay at local level, the health secretary acknowledged that ministers might have to make national changes too. Already in the pipeline is an adjustment of the NHS tariff-payments system so that hospitals do not continue to have a perverse incentive to pull in patients. Incentives for GPs to become more involved in the schemes could be another. 

Key findings from the report were presented to an audience that included Phil Hope, Minister for Care Services, and David Behan, Director General of Social Care, Local Government and Care Partnerships at the Department of Health. 

Mr Burnham added: 'With more people over 65 than under 18 and increasing pressure on services, we need a new approach to the care and support system that is fair, simple and affordable. 

'We are radically overhauling the care and support system. Prevention, early intervention and integration of services are all fundamental principles to that reform and our vision to create a National Care Service.  

'This report also provides valuable evidence that change can happen now. If local NHS and social care services work together to invest in prevention and early intervention, we can cut costs and improve older people's quality of life.' 

Altogether, 522 organisations were involved with projects across the POPP programme, including: health bodies, such as PCTs, secondary care trusts and ambulance trusts; other bodies, such as the fire service, police and housing associations; national and local voluntary organisations; and private sector organisations. Volunteers, including many older people themselves, also made an important contribution, becoming increasingly significant over the period of the project. 

A full copy and/or executive summary of the report is available at www.pssru.ac.uk