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Understanding the potential and
evaluating the actual impacts of
            change
Today

•   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
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       £150
              making change


          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

•   Non-recurrent costs of making change

•   Recurrent costs/savings of making change

•   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    • £5,200 costs
making change

                          • £100 per month recurrent
Recurrent costs/savings
                            savings

                          • Warm house
Non financial impacts
                          • Hot water on demand
QUESTIONS ON OVERALL APPROACH
Nationally using CCA to..

•   Model the potential impacts of changes eg
     – Falls bundle
     – Anticipatory care planning


•   Evaluate the actual impacts of changes eg
     – Dementia Demonstrators
     – Poly-pharmacy work
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
Using CCA approach to model impact of
      adopting new interventions

  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



 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
                                                        Ayrshire & Arran
pathways
                             Existing    NHS 24                Existing        NHS 24
                                                    Change                                  Savings
                             pathway    pathway                pathway         pathway
                                                   in events
                                 Total events                     Total costs (million)

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     -£167,933
Physiotherapy appointments
                              69,760      45,490     24,270    £4,190,276      £2,732,447   £1,457,829
of which:
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



     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 One
          Map the expected
        impact of your change
Depending on what                                                   Reduction in
                         we use reduced                                                      admissions to
                         time for all sorts of                                               care homes and
                         potential impacts                     Individuals                   acute hospitals
           Reduce                                              better
           CPN time                                            supported
           providing                                           in the                     -ve means has opposite
           post          Increased number                                                 impact to that in box arrow
                                                               community
           diagnostic    of people                                                        points to so in this case
           support       accessing assistive                                              means decrease in no of
                                                                                    -ve   referrals
                         technology


Increase                 Increased number        Benefits of
                                                                                              Increase
AZ         Increased     of people with          referring           Increased
                                                                                              in number
           number of     anticipatory care       for                 number of
support                                                                                       of people
           people        plans                   diagnosis           referrals to
worker                                                                                        diagnosed
           accessing                             improved            OACMHTs
time                                                                                          with
           AZ                                    and more            for
                                                                                              dementia
           support       Increased number        visible to          diagnosis
                         of people receiving     GPs
                         appropriate post
           Reduce        diagnostic                                      Experience
           time from     information                                     improved
           referral to                                                   satisfaction with
           individual                                                    service
           receiving     Increased number                                providers
           post          of people where
           diagnostic    Talking Points is
           support       being used
                                                                             Increased                 Increased
                                                   Better links              referrals of              waiting
                         Increased referrals       to local                  people with               lists for
                         to locality link          communities               dementia to               lunch
                         offices                                             lunch clubs               clubs
 Parallel Session 2.6 (Re)Connecting with Meaning and Motivation
If exercising with
                                                        Positive impact on
           others, increased
                                                        mental wellbeing
           social contact


           Initially feel more    Giving up working out 5
           tired, but longer      days a week
           term more energy
                                               -ve      -ve
           Increase in joint
           pain

Work out
           Increase in calories
5 days a   out
                                  A new me
week

           Increase calorie
           intake                 Spend more money on
                                  food
                                                                      Costs
                                  Use more shower gel
           Take more                                                  more
           showers                Depends on whether
                                  water is metered
           Better mental
           wellbeing
                                     Have to stop doing something, impact
           Less time
                                     depends on what stop doing
Depending on what                                                   Reduction in
                         we use reduced                                                      admissions to
                         time for all sorts of                                               care homes and
                         potential impacts                     Individuals                   acute hospitals
           Reduce                                              better
           CPN time                                            supported
           providing                                           in the                     -ve means has opposite
           post          Increased number                                                 impact to that in box arrow
                                                               community
           diagnostic    of people                                                        points to so in this case
           support       accessing assistive                                              means decrease in no of
                                                                                    -ve   referrals
                         technology


Increase                 Increased number        Benefits of
                                                                                              Increase
AZ         Increased     of people with          referring           Increased
                                                                                              in number
           number of     anticipatory care       for                 number of
support                                                                                       of people
           people        plans                   diagnosis           referrals to
worker                                                                                        diagnosed
           accessing                             improved            OACMHTs
time                                                                                          with
           AZ                                    and more            for
                                                                                              dementia
           support       Increased number        visible to          diagnosis
                         of people receiving     GPs
                         appropriate post
           Reduce        diagnostic                                      Experience
           time from     information                                     improved
           referral to                                                   satisfaction with
           individual                                                    service
           receiving     Increased number                                providers
           post          of people where
           diagnostic    Talking Points is
           support       being used
                                                                             Increased                 Increased
                                                   Better links              referrals of              waiting
                         Increased referrals       to local                  people with               lists for
                         to locality link          communities               dementia to               lunch
                         offices                                             lunch clubs               clubs
Applying it in practice

                   Step Two
Identify what impacts have measurable financial
            consequences attached
Depending on what                                                Green shading
                         we use reduced                                                   = Impact which
                         time for all sorts of                                            can be costed.
                         potential impacts                     Individuals
           Reduce                                              better
           CPN time                                            supported                  Reduction in
           providing                                           in the                     admissions to
           post          Increased number                                                 care homes and
                                                               community            -ve
           diagnostic    of people                                                        acute hospitals
           support       accessing assistive
                         technology


Increase                 Increased number        Benefits of
                                                                                             Increase
AZ         Increased     of people with          referring           Increased
                                                                                             in number
           number of     anticipatory care       for                 number of
support                                                                                      of people
           people        plans                   diagnosis           referrals to
worker                                                                                       on
           accessing                             improved            OACMHTs
time                                                                                         Dementia
           AZ                                    and more            for
                                                                                             QOF
           support       Increased number        visible to          diagnosis
                                                                                             registers
                         of people receiving     GPs
                         appropriate post
           Reduce        diagnostic                                      Experience
           time from     information                                     improved
           referral to                                                   satisfaction with
           individual                                                    service
           receiving     Increased number                                providers
           post          of people where
           diagnostic    Talking Points is
           support       being used
                                                                             Increased              Increased
                                                   Better links              referrals of           waiting
                         Increased referrals       to local                  people with            lists for
                         to locality link          communities               dementia to            lunch
                         offices                                             lunch clubs            clubs
Recurrent Costs

                                              Actual prior to    Actual at
                                                 change          Jul 2012 Difference             Comments
                     Alzheimer Scotland
                     Support Worker Team               £51,772     £87,245
                                                                        -£35,473 Team increased from 1.6 to 2.6 WTE
                                                                                 Overall use of assistive technology
                                                                                 increased by £60,000 over period of
 Social Care Costs
                                                                                 project. Attributed 50% of this cost to
                                                                                 this change as data showed that 50% of
                   Costs of increased use                                        increases in referrals came from AS
                   of assistive technology                              -£30,000 support workers
                                                                                 This is an esimate of the value of CPN
                                           band 7 = 4 hours 4 hours  Same        time spent on post diagnostic support
                   Weekly CPN time spent
                                           band 6 = 16 hours 4 hours - 12 hrs prior and after change. These costs may
    Health Costs       on post diagnostic
                                           band 5 = 24 hours 16 hrs  - 8 hrs     not releasable but highlight how much
                             support
                                           band 3 = 26 hours 8.5 hrs - 15.5 hrs resource has been released for other
                                                      £53,907 £26,021 £27,886 work.
Summary of         Social care                        £51,772 £87,245 -£65,473 These are real costs
Recurrent Costs    Health care                        £53,907 £26,021 £27,886 This is the value of hours released


          Issue around impact on hospital and care home admissions
Applying it in practice

               Step Three
Identify what impacts have non financial
             consequences
Depending on what
                         we use reduced
                         time for all sorts of
                                                               Individuals                  Reduction in
           Reduce        potential impacts
                                                               better                       admissions to
           CPN time                                            supported                    care homes and
           providing                                           in the                       acute hospitals
           post          Increased number
                                                               community            -ve
           diagnostic    of people
           support       accessing assistive
                         technology


Increase                 Increased number        Benefits of
                                                                                             Increase
AZ         Increased     of people with          referring           Increased
                                                                                             in number
           number of     anticipatory care       for                 number of
support                                                                                      of people
           people        plans                   diagnosis           referrals to
worker                                                                                       diagnosed
           accessing                             improved            OACMHTs
time       AZ                                    and more            for
           support       Increased number        visible to          diagnosis
                         of people receiving     GPs
                         appropriate post
           Reduce        diagnostic                                      Experience
           time from     information                                     improved
           referral to                                                   satisfaction with
           individual                                                    service
           receiving     Increased number                                providers
           post          of people where
           diagnostic    Talking Points is
           support       being used
                                                                             Increased              Increased
                                                   Better links              referrals of           waiting
                         Increased referrals       to local                  people with            lists for
                         to locality link          communities               dementia to            lunch
                         offices                                             lunch clubs            clubs
Non Financial Consequences

                                           Potential non-financial measures
                                                                                     Direction 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
                                                         Costs associated with staff time spent
                                                                       on project
                                                                     AfC Band
                                                         Hours spent    (or       Midpoint
                                                          on project equivalent) Costing (£)1     Other                  Comments
                                                                                                           Includes advertising costs, interview
              Recruitment costs for new post                                                      £1,500
                                                                                                           costs etc
                                                                      band 7, band
              Awareness raising with exisitng staff
                                                         2 hours each 6 x2, band 5,    £172
              around additional post and how will work
                                                                         band 3
                                                                                                           9 Hours of Health Project Management
Non-recurrent Project manager time                        18 hours        band 7       £402                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
                                                                       Consultant
              Psychiatrist                                 2 hours                     £106
                                                                         Salary
                                                                                                                            TOTAL
Summary of non recurrent costs - Health care                                           £801                                  £801
Summary of non recurrent costs - Social Care                                           £201       £1,500                    £1,701
Hourly rate
                                                                   adjusted for     Enter
       Staff Role          Pay Scale     Weekly       Hourly        employer       Hours       Total
    or Pay Banding         midpoint*     rate (£)     rate (£)      costs (24%)   worked**    cost (£)
          AfC 1                 14,008          269         7.16             8.88                  0.00
          AfC 2                 14,987          287         7.66             9.50                  0.00
          AfC 3                 17,118          328         8.75            10.86                  0.00
          AfC 4                 19,933          382        10.19            12.64                  0.00
          AfC 5                 24,059          461        12.30            15.26                  0.00
          AfC 6                 29,464          565        15.07            18.69                  0.00
          AfC 7                 35,184          675        17.99            22.31                  0.00
         AfC 8a                 42,850          822        21.92            27.18                  0.00
         AfC 8b                 50,351          966        25.75            31.93                  0.00
         AfC 8c                 59,799       1,147         30.58            37.92                  0.00
         AfC 8d                 71,642       1,374         36.64            45.43                  0.00
          AfC 9                 86,721       1,663         44.35            55.00                  0.00
         SMgr A                 50,873          976        26.02            32.26                  0.00
         SMgr B                 58,377       1,120         29.86            37.02                  0.00
         SMgr C                 66,989       1,285         34.26            42.48                  0.00
         SMgr D                 75,735       1,453         38.73            48.03                  0.00
         SMgr E                 86,908       1,667         44.45            55.12                  0.00
         SMgr F                 99,729       1,913         51.01            63.25                  0.00
         SMgr G                114,441       2,195         58.53            72.58                  0.00
         SMgr H                131,324       2,519         67.16            83.28                  0.00
         SMgr I                150,696       2,890         77.07            95.57                  0.00
         FHO 1                  23,928          459        12.24            15.17                  0.00
         FHO 2                  29,763          571        15.22            18.88                  0.00
     Specialist Reg             38,374          736        19.63            24.34                  0.00
     House Officer              23,928          459        12.24            15.17                  0.00
       Senior HO                33,416          641        17.09            21.19                  0.00
       Consultant               83,829       1,608         42.87            53.16                  0.00
   Speciality Doctor            52,546       1,008         26.87            33.32                  0.00
 Associate Specialist           51,667          991        26.42            32.77                  0.00
Clinical Medical Officer        38,857          745        19.87            24.64                  0.00
 Sen Clin Med Officer           55,994       1,074         28.64            35.51                  0.00
                                                                                  Total (£)        0.00
Bringing it all together
Health                                   Social Care
Non-recurrent costs                   £801                                         £1,701
Recurrent                 -£27,886 (productive                       £65,473 (actual costs)
costs/savings                   savings)
Non financial         •     80% of individuals receiving post diagnostic support
                            reporting satisfied or highly satisfied (baseline of 40%)
consequences
                      •     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       Impact on use of care home beds and acute hospital
evaluate              beds longer term
More detailed analysis should sit
                                                                              behind the summary e.g
No of individuals currently with named contact worker providing support




                                                                                                           Number of Individuals Accessing Post Diagnostic Support


                                                                          70




                                                                          60

                                                                                                                                                 New model of
                                                                                                                                                post diagnostic
                                                                                                                                                   support
                                                                          50                                                                     implemented




                                                                          40




                                                                                                                   New Alzheimer
                                                                          30                                        Scotland post
                                                                                                                 diagnostic support
                                                                                                                   worker started



                                                                          20




                                                                          10




                                                                           0
                                                                               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
Issues
• 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
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?

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Parallel Session 2.6 (Re)Connecting with Meaning and Motivation

  • 1. Understanding the potential and evaluating the actual impacts of change
  • 2. Today • 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
  • 4. 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.
  • 5. Recurrent costs of the change Monthly gas and electricity bills prior to change £250 Predicted monthly gas and electricity after £150 making change Monthly recurrent savings £100
  • 6. 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
  • 7. 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
  • 8. 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?
  • 9. 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.
  • 10. Cost Consequence Analysis • Non-recurrent costs of making change • Recurrent costs/savings of making change • Non-financial impacts of change – both positive and negative - just state – don’t try to put financial figures on
  • 11. Cost Consequence Analysis Aspects of CCA Example Non recurrent costs of • £5,200 costs making change • £100 per month recurrent Recurrent costs/savings savings • Warm house Non financial impacts • Hot water on demand
  • 13. Nationally using CCA to.. • Model the potential impacts of changes eg – Falls bundle – Anticipatory care planning • Evaluate the actual impacts of changes eg – Dementia Demonstrators – Poly-pharmacy work
  • 14. Applying it in practice Scenario Models of the potential impact of changes
  • 15. 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
  • 16. 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
  • 17. Using CCA approach to model impact of adopting new interventions 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 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
  • 18. Example from MSK Modelling Total cost of the Ayrshire & Arran pathways Existing NHS 24 Existing NHS 24 Change Savings pathway pathway pathway pathway in events Total events Total costs (million) 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 -£167,933 Physiotherapy appointments 69,760 45,490 24,270 £4,190,276 £2,732,447 £1,457,829 of which: 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 In the CCA modelling will add in the clinical benefits as well as the financial impacts
  • 19. Applying it in practice Evaluating the impacts of changes Step One Map the expected impact of your change
  • 20. Depending on what Reduction in we use reduced admissions to time for all sorts of care homes and potential impacts Individuals acute hospitals Reduce better CPN time supported providing in the -ve means has opposite post Increased number impact to that in box arrow community diagnostic of people points to so in this case support accessing assistive means decrease in no of -ve referrals technology Increase Increased number Benefits of Increase AZ Increased of people with referring Increased in number number of anticipatory care for number of support of people people plans diagnosis referrals to worker diagnosed accessing improved OACMHTs time with AZ and more for dementia support Increased number visible to diagnosis of people receiving GPs appropriate post Reduce diagnostic Experience time from information improved referral to satisfaction with individual service receiving Increased number providers post of people where diagnostic Talking Points is support being used Increased Increased Better links referrals of waiting Increased referrals to local people with lists for to locality link communities dementia to lunch offices lunch clubs clubs
  • 22. If exercising with Positive impact on others, increased mental wellbeing social contact Initially feel more Giving up working out 5 tired, but longer days a week term more energy -ve -ve Increase in joint pain Work out Increase in calories 5 days a out A new me week Increase calorie intake Spend more money on food Costs Use more shower gel Take more more showers Depends on whether water is metered Better mental wellbeing Have to stop doing something, impact Less time depends on what stop doing
  • 23. Depending on what Reduction in we use reduced admissions to time for all sorts of care homes and potential impacts Individuals acute hospitals Reduce better CPN time supported providing in the -ve means has opposite post Increased number impact to that in box arrow community diagnostic of people points to so in this case support accessing assistive means decrease in no of -ve referrals technology Increase Increased number Benefits of Increase AZ Increased of people with referring Increased in number number of anticipatory care for number of support of people people plans diagnosis referrals to worker diagnosed accessing improved OACMHTs time with AZ and more for dementia support Increased number visible to diagnosis of people receiving GPs appropriate post Reduce diagnostic Experience time from information improved referral to satisfaction with individual service receiving Increased number providers post of people where diagnostic Talking Points is support being used Increased Increased Better links referrals of waiting Increased referrals to local people with lists for to locality link communities dementia to lunch offices lunch clubs clubs
  • 24. Applying it in practice Step Two Identify what impacts have measurable financial consequences attached
  • 25. Depending on what Green shading we use reduced = Impact which time for all sorts of can be costed. potential impacts Individuals Reduce better CPN time supported Reduction in providing in the admissions to post Increased number care homes and community -ve diagnostic of people acute hospitals support accessing assistive technology Increase Increased number Benefits of Increase AZ Increased of people with referring Increased in number number of anticipatory care for number of support of people people plans diagnosis referrals to worker on accessing improved OACMHTs time Dementia AZ and more for QOF support Increased number visible to diagnosis registers of people receiving GPs appropriate post Reduce diagnostic Experience time from information improved referral to satisfaction with individual service receiving Increased number providers post of people where diagnostic Talking Points is support being used Increased Increased Better links referrals of waiting Increased referrals to local people with lists for to locality link communities dementia to lunch offices lunch clubs clubs
  • 26. Recurrent Costs Actual prior to Actual at change Jul 2012 Difference Comments Alzheimer Scotland Support Worker Team £51,772 £87,245 -£35,473 Team increased from 1.6 to 2.6 WTE Overall use of assistive technology increased by £60,000 over period of Social Care Costs project. Attributed 50% of this cost to this change as data showed that 50% of Costs of increased use increases in referrals came from AS of assistive technology -£30,000 support workers This is an esimate of the value of CPN band 7 = 4 hours 4 hours Same time spent on post diagnostic support Weekly CPN time spent band 6 = 16 hours 4 hours - 12 hrs prior and after change. These costs may Health Costs on post diagnostic band 5 = 24 hours 16 hrs - 8 hrs not releasable but highlight how much support band 3 = 26 hours 8.5 hrs - 15.5 hrs resource has been released for other £53,907 £26,021 £27,886 work. Summary of Social care £51,772 £87,245 -£65,473 These are real costs Recurrent Costs Health care £53,907 £26,021 £27,886 This is the value of hours released Issue around impact on hospital and care home admissions
  • 27. Applying it in practice Step Three Identify what impacts have non financial consequences
  • 28. Depending on what we use reduced time for all sorts of Individuals Reduction in Reduce potential impacts better admissions to CPN time supported care homes and providing in the acute hospitals post Increased number community -ve diagnostic of people support accessing assistive technology Increase Increased number Benefits of Increase AZ Increased of people with referring Increased in number number of anticipatory care for number of support of people people plans diagnosis referrals to worker diagnosed accessing improved OACMHTs time AZ and more for support Increased number visible to diagnosis of people receiving GPs appropriate post Reduce diagnostic Experience time from information improved referral to satisfaction with individual service receiving Increased number providers post of people where diagnostic Talking Points is support being used Increased Increased Better links referrals of waiting Increased referrals to local people with lists for to locality link communities dementia to lunch offices lunch clubs clubs
  • 29. Non Financial Consequences Potential non-financial measures Direction 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
  • 30. Applying it in practice Step Four Identify your non-recurrent costs
  • 31. Non-recurrent Costs Costs associated with staff time spent on project AfC Band Hours spent (or Midpoint on project equivalent) Costing (£)1 Other Comments Includes advertising costs, interview Recruitment costs for new post £1,500 costs etc band 7, band Awareness raising with exisitng staff 2 hours each 6 x2, band 5, £172 around additional post and how will work band 3 9 Hours of Health Project Management Non-recurrent Project manager time 18 hours band 7 £402 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 Consultant Psychiatrist 2 hours £106 Salary TOTAL Summary of non recurrent costs - Health care £801 £801 Summary of non recurrent costs - Social Care £201 £1,500 £1,701
  • 32. Hourly rate adjusted for Enter Staff Role Pay Scale Weekly Hourly employer Hours Total or Pay Banding midpoint* rate (£) rate (£) costs (24%) worked** cost (£) AfC 1 14,008 269 7.16 8.88 0.00 AfC 2 14,987 287 7.66 9.50 0.00 AfC 3 17,118 328 8.75 10.86 0.00 AfC 4 19,933 382 10.19 12.64 0.00 AfC 5 24,059 461 12.30 15.26 0.00 AfC 6 29,464 565 15.07 18.69 0.00 AfC 7 35,184 675 17.99 22.31 0.00 AfC 8a 42,850 822 21.92 27.18 0.00 AfC 8b 50,351 966 25.75 31.93 0.00 AfC 8c 59,799 1,147 30.58 37.92 0.00 AfC 8d 71,642 1,374 36.64 45.43 0.00 AfC 9 86,721 1,663 44.35 55.00 0.00 SMgr A 50,873 976 26.02 32.26 0.00 SMgr B 58,377 1,120 29.86 37.02 0.00 SMgr C 66,989 1,285 34.26 42.48 0.00 SMgr D 75,735 1,453 38.73 48.03 0.00 SMgr E 86,908 1,667 44.45 55.12 0.00 SMgr F 99,729 1,913 51.01 63.25 0.00 SMgr G 114,441 2,195 58.53 72.58 0.00 SMgr H 131,324 2,519 67.16 83.28 0.00 SMgr I 150,696 2,890 77.07 95.57 0.00 FHO 1 23,928 459 12.24 15.17 0.00 FHO 2 29,763 571 15.22 18.88 0.00 Specialist Reg 38,374 736 19.63 24.34 0.00 House Officer 23,928 459 12.24 15.17 0.00 Senior HO 33,416 641 17.09 21.19 0.00 Consultant 83,829 1,608 42.87 53.16 0.00 Speciality Doctor 52,546 1,008 26.87 33.32 0.00 Associate Specialist 51,667 991 26.42 32.77 0.00 Clinical Medical Officer 38,857 745 19.87 24.64 0.00 Sen Clin Med Officer 55,994 1,074 28.64 35.51 0.00 Total (£) 0.00
  • 33. Bringing it all together
  • 34. Health Social Care Non-recurrent costs £801 £1,701 Recurrent -£27,886 (productive £65,473 (actual costs) costs/savings savings) Non financial • 80% of individuals receiving post diagnostic support reporting satisfied or highly satisfied (baseline of 40%) consequences • 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 Impact on use of care home beds and acute hospital evaluate beds longer term
  • 35. More detailed analysis should sit behind the summary e.g No of individuals currently with named contact worker providing support Number of Individuals Accessing Post Diagnostic Support 70 60 New model of post diagnostic support 50 implemented 40 New Alzheimer 30 Scotland post diagnostic support worker started 20 10 0 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
  • 36. Issues • 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
  • 37. 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

Notas do Editor

  1. Get them to then line up in room in order of how much willing to pay –but once have most and least get them to space out as if room is the spectrum so you can see visually whether they cluster around a similar amount. Ask the most and least just to say why they put that much. Aim of this is just to get them to see that they put different financial values on the benefits – suspect they will cluster around a certain amount but there will also be outliers. Will come back to this at later stage when talk about how CCA treats non-financial benefits and why it doesn’t look to put a financial value on it – as leaves it open for each individual to put that value on.
  2. Pick up any other one-off costs that were shouted out in previous exercise here.
  3. Assuming inflation is zero so don’t have to get into Net Present Value issues and discounting as this is just an overview. Need to check with Paul if going to pick this up in costing bit
  4. In terms of second question – refer back to initial exercise and highlight that it is worth different amounts to different people. Talk about traditional approach to economic analysis would be to put a financial value against the hot water on demand and being warm. However financial value can be very finger in air and also people can put a value on to make business case stack up. Cost consequence says lets not do this – lets just state the non-financial benefits and leave decision makers to put their own value on them. Is a more transparant way of doing things.
  5. So this is what you would consider when doing a CCA for a change initiative. Traditionally we don’t think about the non-recurrent costs of making the change – but these can be significant and need to be thought about. Also in terms of transferring learning – it is useful for other areas to see how much time it took to make the change.
  6. Give them a couple of mins to discuss and then get them to shout out the addition information they need – which include Cost of installing the central heating and any other non-recurrent costs Current amount spent on heating bills Predicted amount once central heating installed
  7. So in terms of working out your outcome and process measures – we’ve promoted the concept of driver diagrams. Nothing fancy here – just saying work out what your aim is – and then which bits of the system you will need to work on to deliver that aim. The advantage of them is that they help to show that it is rarely just one thing you have to work on to deliver an aim.
  8. First step is to identify where the non-financial consequences are Then you want to think about how you might measure them And then you need to think about proportionality – how much work is involved in measuring them and decide whether the benefits of measuring outweigh the costs.
  9. Give them a couple of mins to discuss and then get them to shout out the addition information they need – which include Cost of installing the central heating and any other non-recurrent costs Current amount spent on heating bills Predicted amount once central heating installed