Parallel Session 2.6 (Re)Connecting with Meaning and Motivation
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Transcript of Parallel Session 2.6 (Re)Connecting with Meaning and Motivation
Understanding the potential and evaluating the actual impacts of
change
• Cost Consequence Approach to modelling and evaluating the impact of change
• How CCA is being used nationally
• Some simple techniques for using it in practice to evaluating change
• Challenges in using the approach
• Chance for you to have a go at impact analysis
Today
Introduction to Cost Consequence Analysis
PAIRS EXERCISE
You’ve just moved into a 3 bedroom house that has no central heating, it is heated by plug in electric heaters. Your hot water is via an immersion heater. You expect to stay in this house for about the next 4 years. You need to make a decision whether to progress with getting central heating installed.
In pairs discuss what other information you need to make the decision.
Recurrent costs of the change
Monthly gas and electricity bills prior to change £250
Predicted monthly gas and electricity after making change
£150
Monthly recurrent savings £100
INDIVIDUAL EXERCISE
• You do your sums and work out that if you have it installed, over the next 4 years you will save £4,800 pounds in gas and electricity bills.
• Assume it makes no difference to the value of your house.
• Please write on a piece of paper the maximum amount you would be willing to pay over and above the financial break even point to have central heating installed - including on demand hot water.
• You can have minus figures – so you might say that you would only install it if overall you saved at least £1,000
Non-recurrent costs of change
• Cost of installing central heating (including redecoration) = £6,000
• Costs of hotel room you book for two nights as can’t face the mess = £200
.
So will you make the change?
• Non recurrent costs = £6,200
• Recurrent savings = £100 per month
• Assume that housing market is such that it adds no value to how much your house is worth.
• Assuming inflation is zero, after 4 years you have saved £4,800 in bills giving you a net cost of £1,400
• Who would install the central heating?
Differences in perceived value
• Different people in the room will place a different value on the benefit of being warm and having on-demand hot water.
• Traditional economic analysis puts a financial value on non-financial benefits – fraught with problems.
• CCA doesn’t – it just states non financial and hence enables decision makers to have transparent discussions about the value within their context.
Cost Consequence Analysis
1. Non-recurrent costs of making change
2. Recurrent costs/savings of making change
3. Non-financial impacts of change – both positive and negative - just state – don’t try to put financial figures on
Cost Consequence Analysis
Aspects of CCA Example
Non recurrent costs of making change
• £5,200 costs
Recurrent costs/savings• £100 per month recurrent
savings
Non financial impacts• Warm house• Hot water on demand
QUESTIONS ON OVERALL APPROACH
• Model the potential impacts of changes eg
– Falls bundle– Anticipatory care planning
• Evaluate the actual impacts of changes eg
– Dementia Demonstrators– Poly-pharmacy work
Nationally using CCA to..
Applying it in practice
Scenario Models of the potential impact of changes
Using CCA approach to model impact of adopting new interventions
• Work led by primary,community and outpatients workstream of Quality and Efficiency Support Team
• Developing spreadsheets so NHS Boards/CHPs can scenario model the impact of adopting new interventions
• Exploring models for• Falls Bundles (near to completion)• Anticipatory Care Planning (next priority)• Hospital at Home and Community Assessment
of Intermediate Care• Telehealth for COPD
Using CCA approach to model impact of adopting new interventions
By quantifying PATIENT BENEFITS now and in future Identify relevant patient groups and events Extract potential clinical benefits from studies Apply to relevant patient groups in Scotland and
measure change in clinical events
By quantifying RESOURCES now and in future Identify resources required under current pathway Identify change in activities with new recommendation Identify resources associated with change, including
disinvestment
By quantifying COSTS now and in future Identify costs of current clinical events Identify potential savings from the reduced clinical
events Identify cost of resources associated with changes
Using CCA approach to model impact of adopting new interventions
Allows you to answer question of whether potential cost savings exceed cost of implementation and annual operations, and to also play in the clinical
benefits to the discussion
Example from MSK Modelling
Total cost of the pathways
Existing pathway
NHS 24 pathway
Existing pathway
NHS 24 pathway
Savings
GP appointments 109,992 104,726 5,265 £3,959,695 £3,770,141 £189,554
Outpatients 14,995 13,496 1,500 £4,015,759 £3,614,183 £401,576
NHS 24 calls 10,834 -10,834 £167,933 -£167,933Physiotherapy appointmentsof which:
69,760 45,490 24,270 £4,190,276 £2,732,447 £1,457,829
GP referrals 44,160 24,558 19,602 £2,652,560 £1,475,122 £1,177,437
Self referrals 14,080 14,080 £845,744 £845,744
GP suggested 11,520 11,520 £691,972 £691,972
NHS 24 20,932 -20,932 £1,257,325 -£1,257,325
Do not attends 4,378 2,778 1,601 £109,454 £69,440 £40,014
MRI 698 684 15 £150,806 £147,664 £3,142
X-rays 8,333 7,600 733 £546,561 £498,479 £48,083
Prescribed NSAIDs 9,171 9,316 -145 £59,115 £60,053 -£938
Prescribed Analgesics 10,214 9,658 556 £49,687 £46,984 £2,703
Total events and costs of pathways 47,229 13,081,352 11,107,323 1,974,030
Total events
Change in events
Ayrshire & Arran
Total costs (million)
In the CCA modelling will add in the clinical benefits as well as the financial impacts
Applying it in practice Evaluating the impacts of changes
Step OneMap the expected
impact of your change
Increase AZ support worker time
Reduce CPN time providing post diagnostic support
Increased number of people accessing AZ support
Reduce time from referral to individual receiving post diagnostic support
Depending on what we use reduced time for all sorts of potential impacts
Increased number of people accessing assistive technology
Increased number of people with anticipatory care plans
Increased number of people receiving appropriate post diagnostic information
Increased number of people where Talking Points is being used
Increased referrals to locality link offices
Better links to local communities
Benefits of referring for diagnosis improved and more visible to GPs
Individuals better supported in the community
Experience improved satisfaction with service providers
Increased number of referrals to OACMHTs for diagnosis
Increase in number of people diagnosed with dementia
-ve
Increased referrals of people with dementia to lunch clubs
Increased waiting lists for lunch clubs
-ve means has opposite impact to that in box arrow points to so in this case means decrease in no of referrals
Reduction in admissions to care homes and acute hospitals
Spend more money on food
Use more shower gel
Depends on whether water is metered
Costs more
If exercising with others, increased social contact
Initially feel more tired, but longer term more energy
Increase in joint pain
Positive impact on mental wellbeing
Better mental wellbeing
Less time
Take more showers
Increase calorie intake
Giving up working out 5 days a week
Have to stop doing something, impact depends on what stop doing
-ve -ve
Work out 5 days a week
Increase in calories out
A new me
Increase AZ support worker time
Reduce CPN time providing post diagnostic support
Increased number of people accessing AZ support
Reduce time from referral to individual receiving post diagnostic support
Depending on what we use reduced time for all sorts of potential impacts
Increased number of people accessing assistive technology
Increased number of people with anticipatory care plans
Increased number of people receiving appropriate post diagnostic information
Increased number of people where Talking Points is being used
Increased referrals to locality link offices
Better links to local communities
Benefits of referring for diagnosis improved and more visible to GPs
Individuals better supported in the community
Experience improved satisfaction with service providers
Increased number of referrals to OACMHTs for diagnosis
Increase in number of people diagnosed with dementia
-ve
Increased referrals of people with dementia to lunch clubs
Increased waiting lists for lunch clubs
-ve means has opposite impact to that in box arrow points to so in this case means decrease in no of referrals
Reduction in admissions to care homes and acute hospitals
Applying it in practice
Step Two Identify what impacts have measurable financial
consequences attached
Increase AZ support worker time
Reduce CPN time providing post diagnostic support
Increased number of people accessing AZ support
Reduce time from referral to individual receiving post diagnostic support
Depending on what we use reduced time for all sorts of potential impacts
Increased number of people accessing assistive technology
Increased number of people with anticipatory care plans
Increased number of people receiving appropriate post diagnostic information
Increased number of people where Talking Points is being used
Increased referrals to locality link offices
Better links to local communities
Benefits of referring for diagnosis improved and more visible to GPs
Individuals better supported in the community
Experience improved satisfaction with service providers
Increased number of referrals to OACMHTs for diagnosis
Increase in number of people on Dementia QOF registers
-ve
Increased referrals of people with dementia to lunch clubs
Increased waiting lists for lunch clubs
Green shading = Impact which can be costed.
Reduction in admissions to care homes and acute hospitals
Recurrent Costs
Issue around impact on hospital and care home admissions
Actual prior to change
Actual at Jul 2012 Difference Comments
Alzheimer Scotland Support Worker Team £51,772 £87,245 -£35,473 Team increased from 1.6 to 2.6 WTE
Costs of increased use of assistive technology -£30,000
Overall use of assistive technology increased by £60,000 over period of project. Attributed 50% of this cost to this change as data showed that 50% of increases in referrals came from AS support workers
band 7 = 4 hoursband 6 = 16 hoursband 5 = 24 hoursband 3 = 26 hours
4 hours4 hours16 hrs8.5 hrs
Same- 12 hrs- 8 hrs- 15.5 hrs
£53,907 £26,021 £27,886Summary of Social care £51,772 £87,245 -£65,473 These are real costsRecurrent Costs Health care £53,907 £26,021 £27,886 This is the value of hours released
Social Care Costs
Health CostsWeekly CPN time spent
on post diagnostic support
This is an esimate of the value of CPN time spent on post diagnostic support prior and after change. These costs may not releasable but highlight how much resource has been released for other work.
Applying it in practice
Step ThreeIdentify what impacts have non financial
consequences
Increase AZ support worker time
Reduce CPN time providing post diagnostic support
Increased number of people accessing AZ support
Reduce time from referral to individual receiving post diagnostic support
Depending on what we use reduced time for all sorts of potential impacts
Increased number of people accessing assistive technology
Increased number of people with anticipatory care plans
Increased number of people receiving appropriate post diagnostic information
Increased number of people where Talking Points is being used
Increased referrals to locality link offices
Better links to local communities
Benefits of referring for diagnosis improved and more visible to GPs
Individuals better supported in the community
Experience improved satisfaction with service providers
Increased number of referrals to OACMHTs for diagnosis
Increase in number of people diagnosed
-ve
Increased referrals of people with dementia to lunch clubs
Increased waiting lists for lunch clubs
Reduction in admissions to care homes and acute hospitals
Non Financial Consequences
Potential non-financial measuresDirection of
expected change
Service user and carer satisfaction with post diagnostic support received Improve
Number of people diagnosed with dementia (as per QOF register) Increase
Number of people receiving post diagnostic support Increase
Number of people with Dementia using assistive technology to maintain independence Increase
Time from referral to individual receiving post diagnostic support Reduce
Number of people with Dementia with anticipatory care plans Increase
Number of referrals to locality link officers Increase
Number of referrals for people with Dementia to lunch clubs Increase
Number of individuals where Talking Points is being used Increase
Number of referrals to Older Adult CMHTs Uncertain
Applying it in practice
Step Four Identify your non-recurrent costs
Non-recurrent Costs
Hours spent on project
AfC Band (or
equivalent)
Midpoint
Costing (£)1 Comments
Recruitment costs for new post £1,500Includes advertising costs, interview costs etc
Awareness raising with exisitng staff around additional post and how will work
2 hours eachband 7, band 6 x2, band 5,
band 3 £172
Non-recurrent Project manager time 18 hours band 7 £4029 Hours of Health Project Management and 9 Hours of social work project management
Costs Info Analyst - re data for evaluation 7 hours band 6 £131
Finance input re costings 4 hours band 5 £61
Admin time 12 hours band 3 £130
Psychiatrist 2 hoursConsultant
Salary£106
TOTALSummary of non recurrent costs - Health care £801 £801Summary of non recurrent costs - Social Care £201 £1,500 £1,701
Costs associated with staff time spent on project
Other
Staff Role or Pay Banding
Pay Scalemidpoint*
Weeklyrate (£)
Hourly rate (£)
Hourly rate adjusted for
employer costs (24%)
Enter Hours
worked**Total
cost (£)AfC 1 14,008 269 7.16 8.88 0.00AfC 2 14,987 287 7.66 9.50 0.00AfC 3 17,118 328 8.75 10.86 0.00AfC 4 19,933 382 10.19 12.64 0.00AfC 5 24,059 461 12.30 15.26 0.00AfC 6 29,464 565 15.07 18.69 0.00AfC 7 35,184 675 17.99 22.31 0.00
AfC 8a 42,850 822 21.92 27.18 0.00AfC 8b 50,351 966 25.75 31.93 0.00AfC 8c 59,799 1,147 30.58 37.92 0.00AfC 8d 71,642 1,374 36.64 45.43 0.00AfC 9 86,721 1,663 44.35 55.00 0.00
SMgr A 50,873 976 26.02 32.26 0.00SMgr B 58,377 1,120 29.86 37.02 0.00SMgr C 66,989 1,285 34.26 42.48 0.00SMgr D 75,735 1,453 38.73 48.03 0.00SMgr E 86,908 1,667 44.45 55.12 0.00SMgr F 99,729 1,913 51.01 63.25 0.00SMgr G 114,441 2,195 58.53 72.58 0.00SMgr H 131,324 2,519 67.16 83.28 0.00SMgr I 150,696 2,890 77.07 95.57 0.00FHO 1 23,928 459 12.24 15.17 0.00FHO 2 29,763 571 15.22 18.88 0.00
Specialist Reg 38,374 736 19.63 24.34 0.00House Officer 23,928 459 12.24 15.17 0.00
Senior HO 33,416 641 17.09 21.19 0.00Consultant 83,829 1,608 42.87 53.16 0.00
Speciality Doctor 52,546 1,008 26.87 33.32 0.00Associate Specialist 51,667 991 26.42 32.77 0.00
Clinical Medical Officer 38,857 745 19.87 24.64 0.00Sen Clin Med Officer 55,994 1,074 28.64 35.51 0.00
Total (£) 0.00
Bringing it all together
Health Social CareNon-recurrent costs £801 £1,701
Recurrent costs/savings
-£27,886 (productive savings)
£65,473 (actual costs)
Non financial consequences
• 80% of individuals receiving post diagnostic support reporting satisfied or highly satisfied (baseline of 40%)
• 100 more people per year received post diagnostic support (30% increase)
• Reduction in time waiting from diagnosis to support from 4 months to 2 weeks
• Reduction in waiting time for CPN support from 6 months to 1 month
• 10% increase in no of people diagnosed*• 30% increase in no of people with dementia using
assistive technology to support independent living*• 10% increase in no of people with dementia with
anticipatory care plans*• 10% reduction in referrals to OACMHT*
*There are other changes in the system that may have also impacted on this measure.
Not yet able to evaluate
Impact on use of care home beds and acute hospital beds longer term
More detailed analysis should sit behind the summary e.g
Number of Individuals Accessing Post Diagnostic Support
0
10
20
30
40
50
60
70
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12
No
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New Alzheimer Scotland post
diagnostic support worker started
New model of post diagnostic
support implemented
• Data Reliability
• Proportionality – effort vs benefits of data collection (sampling)
• Costing – access to relevant data
• Non-recurrent costs – difficulties collecting
• Cash releasing vs efficiency gains
• Qualitative as well as quantitative
• Outcomes as well as process measures
• Statistical significance
• When to use CCA for evaluation
Issues
Pairs Exercise (10 mins)
Using CCA to manage and evaluate impacts
Pick a change that one of you is involved with at the moment and have a go at doing an impact map
Discussion/Questions?