Issue 2: March 2012

A DEMAND LED APPROACH TO SERVICES FOR OLDER PEOPLE

By David Welsh, Scottish Director, iMPOWER

Changing whose behaviour?

As demand for services for older people increases and budgets come under growing pressure, experience in some areas suggests local authorities and health bodies need to look beyond traditional, supply-led approaches to savings. The case for demand-led and behaviour change initiatives is very clear.

Various official reports, parliamentary enquiries and speeches by government ministers make it clear there are very serious financial constraints impacting Scotland’s local authorities and other public sector bodies. In a frequently cited piece of research released in 2011, NESTA estimated that an additional £27billion (20% of 2011 GDP) will be needed by 2025 to pay for Scotland’s long-term health problems. The Scottish Government itself projects that the costs of long-term care alone will increase by almost 75% by the year 2030.

NESTA estimated that an additional £27billion (20% of 2011 GDP) will be needed by 2025 to pay for Scotland's long-term health problems

Clearly, in order to sustain good standards of care for older people, we have to do some things differently. Some policy responses will focus on the integration of public services, workforce planning and better contracting to deliver more efficient ways of working. Perhaps the key breakthrough will lie in early intervention and prevention initiatives as highlighted strongly in last year’s Christie Commission report. The proposals outlined in that report argued strongly for such initiatives to be at the centre of balancing care and costs.

In late 2011 iMPOWER spoke to 100 senior executives in local government across the UK. The research revealed that, faced with real cuts to real services, local authorities are now seeking creative alternatives to generating savings. In this context, behaviour change and demand management are high on the local government executive agenda.

These initiatives take many forms, both simple and complex including; addressing mismatched expectations through changes in process and communication, ensuring that over-supply is reduced, reducing costs of those who do have needs by tapping into citizen-driven innovations (personalisation with a purpose), building the community skills and capacity to take on more responsibility and reduce needs in the long term thereby transforming the relationship with the citizen.

The research revealed that, faced with real cuts to real services, local authorities are now seeking creative alternatives to generating savings

Almost all executives (98%) believe they can reduce demand by changing behaviour, 72% believe that managing demand for services and changing citizen behaviours offer significant potential to offset declining budgets and two thirds claim that these present the single greatest opportunity to reduce costs. However, changing behaviour is demanding and often uncomfortable for everybody concerned.

As a very significant proportion of local government spend, the biggest opportunity to manage demand (and reduce costs in the long-term) comes from Residential Care Services for the Elderly, which in 2010 cost £5.12bn across the UK and just under £1bn in Scotland alone. Through managing demand, it is possible to influence the cost drivers associated with these and other services. An analysis of national performance and expenditure data sets showed that average available savings were equivalent to 14% of baseline expenditure for those services. Extrapolating that into Scotland gives an indicative £125m saving across Scotland.

improved outcomes through behaviour change is largely driven by service user motivation - working with the elderly, their families and medical professionals to design processes and services that meet their needs

But importantly, this is not just about savings. While behaviour change initiatives can help lower costs of delivery through preventing unplanned or unnecessary expenditure, it facilitates better outcomes for users.

For example, a typical initiative might be in encouraging take-up of Reablement, a targeted early intervention that helps vulnerable adults and the elderly regain skills and confidence to live independently and remain longer in their own homes (and thus reduce costly hospital admissions). In some parts of Scotland there are exciting developments of this kind under way, but such approaches need to be more widespread.

Delivering those improved outcomes through behaviour change is largely driven by service user motivation – working with the elderly, their families and medical professionals to design processes and services that meet their needs. In other words, genuine engagement, tailored communication and reinforced messages from all relevant professionals are central to changes in behaviour.

We can see in various settings that citizens behave the way they do because the public sector behaves the way it does. It is interesting that 44% of the executives questioned agree that citizens “..will never change their behaviour if local authorities do not lead the way”. That suggests that local authorities, often along with other public service partners, have to take some major initiatives and many will need to be brave about the way they approach that .

Some of the background to the work iMPOWER has done with different local authorities can be found at http://www.impower.co.uk/

 

 

By David Welsh, Scottish Director, iMPOWER

Issue 2: March 2012

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