GMFRS Safe and Well Visits: A Cost-Benefit Analysis · New Economy 05 application of New...
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GMFRS Safe and Well Visits: A Cost-Benefit Analysis 22/06/2016 Stephen Bray
Transcript of GMFRS Safe and Well Visits: A Cost-Benefit Analysis · New Economy 05 application of New...
GMFRS Safe and Well Visits: A Cost-Benefit Analysis
22/06/2016 Stephen Bray
New Economy 02
CONTENTS
CONTENTS ..................................................................................................... 2
Further Information .......................................................................................... 3
EXECUTIVE SUMMARY ................................................................................. 4
2 METHODOLOGY ...................................................................................... 9
3 SUMMARY OF KEY FINDINGS .............................................................. 11
4 COSTS .................................................................................................... 12
5 BENEFITS ............................................................................................... 14
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Further Information For further information about this project, please contact: Greater Manchester Fire and Rescue Service, 0161 736 5866 About New Economy New Economy is a wholly owned company of the Greater Manchester Combined Authority (GMCA) and delivers policy, strategy and research services for Greater Manchester‟s economic growth and prosperity. http://neweconomymanchester.com
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EXECUTIVE SUMMARY
Introduction
A Safe and Well visit is a person-centred home visit carried out by both Operational
and non-Operational staff (Community Safety Advisors) within Greater Manchester by
the Greater Manchester Fire and Rescue Service (GMFRS). The visit expands on the
scope of previous home safety checks by focussing on health and crime prevention,
as well as fire.
Over the last 10 years there has been a dramatic fall (nationally and locally) in the
number of accidental fires, and deaths and injuries caused by fire. This is largely due
to the prevention work carried out by the Fire Service. The underlying premise of the
Safe and Well check is that GMFRS and other Fire Services nationwide are well-
placed to build on this success to date, and have an opportunity to effectively
implement a new process that supports the systematic identification of, and response
to, health, wellbeing and home security issues in addition to focussing on fire risk
reduction.1
The first stage of Safe and Well Visits rollout within GMFRS commenced on 6th
November 2015. This centred on „winter pressures‟ and specific issues around warm
homes, social isolation, falls and flu inoculations2. In parallel to this, and developed at
pace over recent months, GMFRS has also begun to embed its wider Safe and Well
Visit process. The wider process is intended to cover a range of thematic areas,
including: falls risk assessments; alcohol and mental health advice & support; and
improved understanding and access to benefits.
GMFRS requested a full cost benefit analysis (CBA) with the aim that it would
articulate in financial terms the full potential benefit of Safe and Well Visits, both to
GMFRS and to a range of partners (health, local authorities, criminal justice, etc).
Cost Benefit Analysis Approach
The overall aim of this cost benefit analysis is to provide an independent appraisal of
the impact that Safe and Well visits have had to date, and their potential impact in the
future. In particular, the CBA seeks to describe the value of these emerging and
future outcomes to key stakeholders in financial and resource terms.
This report provides a summary of key findings from a dedicated investigation of the Safe and Well Visits‟ fiscal value to a range of partners – which is based on
1 The complementarity of the various agendas is well established in the evidence base on the
links between fire safety and the wider determinants of health and wellbeing; those most likely to suffer with health & wellbeing issues on a wider scale are also those at highest risk of fires and they tend to be vulnerable people. 2 This was part of a national project developed in partnership with Public Health England.
GMFRS and two other Fire Services were involved. An independent evaluation is being completed by Reuben Balfour, ICF on behalf of Public Health England.
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application of New Economy‟s HM Treasury-approved Cost Benefit Analysis (CBA) model.
The data analysis has considered a sample of 1,719 Safe and Well visits between 6th
November 2015 and 27th April 2016. This represents a sub-sample (19%) of the
overall 8,824 residents visited during this period (those that had consented to having
their data shared).
The cost profile of the Safe and Well programme relates primarily to the salary costs of Fire Crews, Community Safety Advisors (CSAs) and CRIT staff. There are also training costs and equipment costs added to this total, as well as costs of referrals to adult, children and mental health social care. The findings from the CBA are valuable in respect of three core requirements. It will
provide GMFRS:
(i) with an understanding of their new delivery model, and an evidence base
to feed future organisational decisions on the design, scope and delivery
of Safe and Well as the Programme continues;
(ii) with evidence on the benefits of the visits to GMCA partners; and
(iii) with a financial analysis that is recognised by HM Treasury, and
formulated using costings/methods that can subsequently be shared with
the Home Office and other government departments as required.
The CBA considers any interventions and improvements made in the first year of operation, and maps short/medium/longer term benefits over the subsequent five year period.
Key Findings – Safe and Well’s positive impact
The CBA suggests that, based on all the currently available evidence from the study period of November 2015 – April 2016, the Safe and Well programme is viable fiscally and valuable economically:
The primary finding from this CBA is that, for every £1 spent on Safe and
Well, partners as a minimum are set to save the fiscal equivalent of £2.52 in
benefits (in year and recurrent) through demand reduction. From this saving,
the programme will „pay back‟ its own costs within two years.
A secondary finding from the appraisal of potential wider, less-tangible public
value benefits, is that the intervention has substantial potential to improve the
well-being of individuals and families, with an equivalent £10.1m in public
value benefit accruing as a result.
Of the approximately £5.3m equivalent fiscal benefits accruing to the various partners from the programme over the five year period, £4.3m relates to the increased benefits to the National Health Service (NHS) as a result of the projected reduction in various fire and fall related incidents. A further £0.9m is projected to be saved by GMFRS due to the reduction in fires indicated by the Safe and Well logs and questionnaire responses.
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Development Areas – Further Evidence Of Impact Required The fiscal return on investment calculated in this report provides a „first look‟ at the potential for a range of partners to benefit from GMFRS‟ developing investment in the Safe and Well approach. Whilst the results are positive, it is important to stress that in many respects this cost benefit analysis presents only a partial view of the intervention‟s potential. First and foremost, this is a function of the fact that commitment to delivering Safe and Well visits is still a relatively recent development, and the Service will be undertaking significant work over the coming weeks and months to invest new skills, perspectives and competencies in the workforce that undertakes the visits. For instance, the rollout of training to frontline operational staff is yet to focus in any concerted way upon certain key themes, for example substance misuse. Other population-level public health themes – for example, physical exercise & weight management, or smoking cessation – are similarly yet to be fully embedded into the DNA of the Safe and Well methodology. This inevitably points towards the need for a further iteration of evaluation and CBA at a point when the intervention model has matured. This will have the added benefit that a greater number of visits will have been conducted, with a greater potential to “revisit” historic interventions and evaluate their impact and consequences in terms of measurable behaviour change over time. As part of the preparatory phase for a second iteration of the CBA, there remains a need for further work on data quality / linkage before the outcomes analysis can be further refined. Several key observations may help frame some of the action points taken forward from this CBA:
(1) Whilst referrals to adult social care, child safeguarding and mental health
services are included on the costing side of the CBA, we are as yet unable to provide any meaningful way of measuring the benefits of these. This is partly due to the lack of resources in understanding the nature of the cohort who were referred, and what happened to them once they were referred. It is necessary to capture this data to provide a true reading of the benefits obtained by Safe and Well.
(2) Analysis around Winter Warmth and fuel poverty has been limited in this CBA,
but has been attempted. It is our understanding that a more in depth piece of
analysis is currently being conducted by Public Health England into the
effectiveness of the Winter Warmth scheme. This report – which is expected
to be ready in July - should then be considered in context of the Winter
Warmth report.
(3) A more thorough and rigorous questionnaire would ideally be used in order to
obtain the most accurate answers with regards to how people were dealing
with the advice they were given at their Safe and Well visit. Of 110
questionnaires that were requested to be collated, only 28 were successful in
that the residents were contactable and willing to discuss their visit and the
subsequent actions that they had taken. This has led to extremely small
sample sizes being used to influence large figures in the report. A more robust
CBA would use larger sample sizes, and would also ideally conduct such
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interviews face to face, potentially with a carer present, rather than via the
telephone.
(4) Some results from the questionnaires have raised questions about the veracity
of the recorded responses. For example, 22% of residents contacted stated
that, following advice given, they had replaced the front door of their property
with one that that was more secure. Figures such as this seem excessively
high, but it has not currently been possible to check their veracity, or obtain a
larger sample size. As above, conducting questionnaires face to face and
potentially with a carer present would greatly reduce any concerns about the
results obtained.
(5) The CBA Model allows for an „optimism bias‟ to be added to both costs and
benefits if it is felt that the data is not of a sufficient enough quality, quantity or
reliability to comprehensively rely on. Of the 26 benefit indicators examined in
the course of this CBA, 16 had the highest bias of -40% applied, which
discounts 40% of the accrued benefit in an attempt to make the figure as
conservative as possible. This high bias has been required due to the
extremely small sample sizes from the questionnaires, and almost no data
being available on retention or deadweight. A future CBA would attempt to
achieve more accurate figures for these, via further questioning of residents
over a period of time.
1.1 The Health and Social Care Services Coordinator for GMFRS suggested that
further research be carried out to determine public value benefits achieved as
a result of intervention by the Falls team, namely:
Improved quality of life
Improved confidence which may result in someone accessing the
community and going out again when they were previously isolated and
reliant upon services
Increased independence and ability to remain at home, again reducing
need for social care and residential care
Improved mental wellbeing which may lead to a reduction in need for
other services, e.g. GP or mental health services, medication
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2 INTRODUCTION
2.1 A Safe and Well visit is a person-centered home visit carried out by both
Operational and non-Operational staff (Community Safety Advisors) within
Greater Manchester by the Greater Manchester Fire and Rescue Service
(GMFRS). The visit expands on the scope of previous home safety checks by
focussing on health and crime prevention, as well as fire.
2.2 Over the last 10 years there has been a dramatic fall (nationally and locally) in
the number of accidental fires, and deaths and injuries caused by fire. This is
largely due to the prevention work carried out by the Fire Service. The
underlying premise of the Safe and Well check is that GMFRS and other Fire
Services nationwide are well-placed to build on this success to date, and have
an opportunity to effectively implement a new process that supports the
systematic identification of, and response to, health, wellbeing and home
security issues in addition to focussing on fire risk reduction.3
2.3 The first stage of Safe and Well Visits rollout within GMFRS commenced on
6th November 2015. This centred on „winter pressures‟ and specific issues
around warm homes, social isolation, falls and flu inoculations4. In parallel to
this, and developed at pace over recent months, GMFRS has also begun to
embed its wider Safe and Well Visit process. The wider process is intended to
cover a range of thematic areas, including: falls risk assessments; alcohol and
mental health advice & support; and improved understanding and access to
benefits.
2.4 GMFRS requested a full cost benefit analysis (CBA) with the aim that it would
articulate in financial terms the full potential benefit of Safe and Well Visits,
both to GMFRS and to a range of partners (health, local authorities, criminal
justice, etc).
3 The complementarity of the various agendas is well established in the evidence base on the
links between fire safety and the wider determinants of health and wellbeing; those most likely to suffer with health & wellbeing issues on a wider scale are also those at highest risk of fires and they tend to be vulnerable people. 4 This was part of a national project developed in partnership with Public Health England.
GMFRS and two other Fire Services were involved. An independent evaluation is being completed by Reuben Balfour, ICF on behalf of Public Health England.
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3 METHODOLOGY The New Economy CBA Approach
3.1 A cost-benefit analysis makes projections about the nature and extent of the
savings made by agencies when they deploy new schemes or projects.
Across Greater Manchester the public sector is piloting new and innovative
ways of working. New Economy, with support from a network of CBA
specialists, is helping to demonstrate the amount of taxpayers‟ money that can
be saved by these new ways of working and the impact they can have on the
quality of services enjoyed by Greater Manchester residents.
3.2 This cost-benefit analysis seeks to establish the value of the provision which
has been assembled by Safe and Well, and how these benefits relate to the
costs of the programme. This CBA represents an examination of what the
costs and benefits of Safe and Well would include, had it operated at
maximum capacity for a full year.
3.3 The New Economy CBA model describes benefit along two metrics:
the first describes benefit which is purely financial, and will be referred to
from this point as “fiscal benefit”; and
the second describes benefit which encapsulates benefits, damage or cost
to infrastructure, the economy and society, and will be referred to from this
point as “public value benefit”.
Terms of Reference
3.4 The data analysis has considered a sample of 1,719 Safe and Well visits
between 6th November 2015 and 27th April 2016. This represents a sub-
sample of the overall 8,824 residents visited during this period (those that had
consented to having their data shared).
Costs
3.5 Cost profiling within this CBA is based upon an overview of spending to date,
and reflects the actual investments which GMFRS has made in order to
operationalize the model. Further costs being accrued to the Local Authority
refer to estimates of adult and children referrals.
3.6 All costings included in this report have been audited by the Safe and Well
Team. It should be noted that at present, no costs are noted with regards to
fuel, expenses or room space rental.
Benefits
3.7 Analysis of the GMFRS Safe and Well Spreadsheets has allowed the CBA to
model the benefits that relate to:
fire safety / prevention: replacing missing/defective smoke alarms; clutter in
the household and potential risk of falls/fire therein; fire prevention advice;
escape plans.
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falls in the home: both with regards to the tenant‟s health; clutter in the
household.
interventions to support people for whom health issues are identified:
referrals/advice/actions in relation to the health issues of tenant; winter
warmth/fuel poverty; mental health of tenant.
interventions to support people for whom other wellbeing issues are
identified: substance use (cigarettes, alcohol, drugs, medication)
interventions/advice relating to home security issues.
Data Sources
3.8 The full methodology employed to deliver the CBA is documented in the
underlying CBA Excel Workbook – available on request to New Economy. In
broad terms, the main data sources that have been used in conducting the
analysis are:
data and intelligence from Safe and Well logs;
responses given over the telephone to the New Economy designed
questionnaire;
a range of publicly available sets of data, research and analysis of impacts,
retentions and deadweights where this was relevant to informing gaps in the
evidence base.
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4 SUMMARY OF KEY FINDINGS Safe and Well is viable fiscally and valuable economically
4.1 The apparent overall fiscal cost-to-benefit ratio of Safe and Well is 1:2.52 and
an (annualised) £2,106,690 investment by GMFRS and the Local Authority
would be expected to generate an (annualised) £5,312,451 in fiscal benefits to
a multitude of agencies, particularly the NHS, GMFRS, local authority and the
police.
Multiple Agencies Benefit from Safe and Well
4.2 The £2.1m cost to GMFRS and the Local Authority is immediately offset by the
£4.26m benefit to the NHS. However, the individual cost to GMFRS (£1.7m) is
not offset by its benefit of £0.9m, and the Local Authority‟s cost of £0.4m is
also not offset by its benefit of £0.2m.
Benefits relating to referrals to other agencies are unable to be calculated at
present
4.3 Whilst referrals to adult social care, child safeguarding and mental health
services are included on the costing side of the CBA, we are as yet unable to
provide any meaningful way of measuring the benefits of these. This is partly
due to the lack of resources in understanding the nature of the cohort who
were referred, and what happened to them once they were referred. It is
necessary to properly capture this data (ideally in a structured, rather than non
free-text way) to provide a true reading of the benefits obtained by Safe and
Well.
4.4 Analysis around Winter Warmth and fuel poverty has been limited in this CBA,
but has been attempted. It is our understanding that a more in depth piece of
analysis is currently being conducted into the effectiveness of the Winter
Warmth scheme. This report should then be considered in context of the
Winter Warmth report.
There are a wide range of benefits generated by Safe and Well that are not fiscal in nature
4.5 There are also a wide range of benefits created by Safe and Well which are
currently not fiscally costable in nature, and are difficult to attribute to any one
agency due to their nature. These benefits pertain to the improved well-being
of individuals and families, particularly around increased autonomy, reduced
isolation, etc. At present, they are costed through the New Economics
Foundation‟s „QUALYs‟ format wherein proxy costs are given for what people
either pay for interventions such as counselling, or what people believe they
would be willing to pay for improved familial relationships, etc. The benefits for
these „public value‟ considerations are estimated to be £10.1 million by the
end of the five year period (annualised and recurring).
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5 COSTS
5.1 This section contains information on both capital expenditure and revenue and
in-kind spending.
Capital expenditure includes investments that are often made up-front in
long-term assets such as facilities or large pieces of equipment. They
usually involve large payments in assets which then go on to hold utility over
a number of years.
Revenue expenses represent the short-term spending which is needed to
maintain the ongoing operation of a model, such as paying staff salaries or
replenishing necessary supplies. These costs may fluctuate depending on
the scope of a scheme or model.
In kind expenses represent costs being covered by another agency with no
technical cost to the program. These costs are usually covered by charities
providing volunteers. The cost of their involvement is included as the CBA is
required to calculate the total costs if all payment “in kind” was removed.
5.2 Costs were furnished by the Safe and Well Team.
Capital Expenditure 5.3 It was the understanding of the Safe and Well Team that the project did not
incur any capital costs.
Revenue Spending
5.4 Safe and Well revenue costs are split between GMFRS (78% of the total) and
the Local Authority (22%).
5.5 Overall revenue spending for the first year of Safe and Well is estimated to
amount to £2,106,369. Constituent parts of this figure are detailed below.
£1,286,9235 Fire crew callout for taking part in Safe and Well
assessments. Cost covers four members of a team, but not the fire
pump itself. (This has been calculated from the £89.36 cost of a four-
person crew attending a Safe and Well visit for an average of one
hour).
£75,715 costs for CSA attendance at Safe and Well visits, based on an
hourly cost of £14.14.
£7,052 costs for CRIT team attendance at Safe and Well visits, based
on the same hourly cost as above.
5 It should be noted that this cost is made up of the £89.36 figure being extrapolated over the
period of a full year and then – as with all of the costings - has a 10% “optimism bias” added to it, to reflect the uncertainty inherent in that modelling.
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£1,600 costs “in kind” for volunteers (assuming an „in kind‟ equivalent
of the same costs as CSA and CRIT staff).
£220,796 on smoke alarms
£36,146 on fire retardant equipment
£8,283 on letter box covers
£7,888 on home security
£7,539 on letters and postage.
£4,646 training costs
£4,641 on deep fat fryers
£3,126 on stop watches
£1,268 on tape measures
£67 on four way plugs
Fuel used by vehicles travelling to and from Safe and Well visits is
currently uncosted.
Referral Costs
5.6 Three further costs occur in relation to
Adult social care referrals (£298,152)
Child Safeguarding referrals (£118,944)
Adult Mental Health Referrals (£23,904)
Key Findings
The annual cost of the first year of the Safe and Well Visits is £2,106,690.
£1,665,690 of the costs are attributable to GMFRS
£411,000 of the costs are attributable to the Local Authorities.
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6 BENEFITS 6.1 Safe and Well has generated benefits for a wide range of partners, namely –
and most obviously – the NHS, as well as to GMFRS itself, the various local
authorities, and also to Greater Manchester Police and other criminal justice
services. It should be noted that while fiscal benefits are directly attributable to
at least one agency, public value benefits are difficult to ascribe with certainty,
although this report does attempt to do so (based on costings from the New
Economics Foundation).
6.2 Where the final cost-benefit outcomes of this report are expressed, they have
been expressed as two figures, one of which accounts for fiscal benefit, and
the other of which accounts for public value benefit. Total benefits returned by
the Safe and Well project are detailed overleaf.
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6.3 The table below breaks down the fiscal benefits collated by each agency, with
the final column and row collating the total benefits. Benefits above £10k are
highlighted in light green, those above £100k in darker green and those over
£1m in bold green.
6.4 Benefit categories have been chosen based on the belief of the Safe and Well
team that these were the outcomes they were looking to capture, and also
based on the ability to collate data that would prove these outcomes.
Benefit category Local
Authority NHS Police
Prob-ation
Courts/ Legal
aid Prisons
Other CJS
GMFRS Total
Reduced use of ambulance services for a first fall £1,159
£1,159
A&E attendance for a first fall £2,044 £2,044
Hip fracture for a first fall £16,433 £16,433
Other (non hip) fracture - for a first fall
£5,305
£5,305
Reduced use of ambulance services – for previous faller
£999
£999
A&E attendance - for previous faller
£1,791
£1,791
Hip fracture - for previous faller. £14,501 £14,501
Other (non hip) fracture - for previous faller.
£4,682
£4,682
Reduced drug dependency £28,711 £9,158 £852 £3,259 £4,340 £2,343 £48,662
Reduced alcohol dependency £511 £163 £15 £58 £77 £42 £866
Avoiding fuel poverty through warm homes
£3,103,343
£3,103,343
House fires caused due to cooking under influence
£57,334 £57,334
House fires caused due to smoking
£309,795 £309,795
Fatalities caused due to smoking in the home £12,986 £90,902
£25,972 £116,874
House fires caused by occupant smoking in bed
£50,086 £50,086
Fatalities in house fires caused by occupant smoking in bed £7,421 £51,944
£14,841 £66,785
Falling asleep whilst smoking (non fatal)
£28,896 £28,896
Falling asleep whilst smoking (fatalities) £5,565 £38,958
£11,131 £50,089
House fires caused by electric heaters being left on (non fatal)
£73,363 £73,363
Fatal house fires caused by electric heaters being left on £2,019 £14,130
£4,037 £18,167
House fires caused by electric heaters being covered (non fatal)
£37,730 £37,730
Fatal house fires caused by electric heaters being covered £2,019 £14,130
£4,037 £18,167
Fire starts in wheelbin £1,554 £1,554
Preventing fire deaths through fitting of smoke alarm £124,307 £870,145
£248,643 £1,243,095
Replace front doors £2,894 £342 £548 £1,552.34 £432 £5,767
Replace windows £3,002 £354 £568 £1,611 £448 £5,984
Totals £154,315 £4,259,688 £15,217 £1,563 £4,433 £7,580 £3,265 £867,388 £5,313,449
Fig 1: Table showing the breakdown in benefits across each agency via each obtained indicator 6.5 As can be seen from figure 2 overleaf, the NHS benefits to the largest extent
from the programme, with 85% of the benefits (£4.3m) accruing to it. 11% of
the benefits (£0.9m) benefit GMFRS with 3% (£150k) to the local authorities.
The rest of this chapter will examine the benefits being made to various
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agencies as a result of each of the range of positive outcomes achieved by
Safe and Well.
Fig 2: Distribution of Safe and Well fiscal benefits, by agency beneficiary
6.6 The chart below shows the relative levels of investment and return for the
stakeholders involved in the Safe and Well programme, directly or indirectly.
As can be seen, the NHS benefits by around £4m without investing in Safe
and Well. GMFRS pays in £1.7m and receives a £500k return. The Local
Authority pays in £400k and experiences £150k return. Police and CJS
services pay in nothing but receive £30k back between themselves.
Fig 3: Representation of the benefit/costs distribution across agencies.
Local Authority : 3%
NHS : 85%
Police : 1%
Probation : 0%
Courts/Legal aid : 0%
Prisons : 0%
Other CJS : 0%
GMFRS : 11%
Fiscal Benefits
Proactive Costs
Reactive Cost Savings
£-
£500,000
£1,000,000
£1,500,000
£2,000,000
£2,500,000
£3,000,000
£3,500,000
£4,000,000
£4,500,000
Local Authority NHSPolice
ProbationCourts/Legal aid
PrisonsOther CJS
GMFRS
£
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Each of the calculated fiscal and public value benefits as calculated by the Cost Benefit Analysis Model are further discussed at length below. The order in which they appear is indicative of the order in which these areas are covered on the Safe and Well form.
Smoke Detection 6.7 26.7% of the houses visited by the Safe and Well teams did not have a smoke
alarm fitted. 67.6% of these then had one fitted under the scheme. This was
expected to benefit the NHS by £870,145, the local authorities by £124,307
and GMFRS by £248,643 in terms of a reduction in house fires that resulted in
fatalities.
6.8 Assumptions made here include:
Only 5% of target houses will be reached under the Safe and Well
programme.
Questionnaire results revealed that 90.9% of people who had had
smoke alarms fitted remembered the advice about testing them once a
week. This percentage has been used to provide the „retention rate‟
figure that informs the CBA as to the likelihood of the benefits provided
by a smoke alarm continuing to by relevant.
Data from GMFRS suggested that fatalities occur in 2.1% of house
fires when an alarm is present, but 3.65% when an alarm is not
present. This figure has also been used to inform the CBA.
6.9 Key gaps include a lack of deadweight on whether residents would have
acquired a smoke alarm regardless of the Safe and Well visit, and also the
small sample size relating to the smoke alarm maintenance question. Also,
there was no data available relating to the fiscal benefit split between the
LA/NHS/GMFRS.
6.10 There is also a calculated public benefit of £1,243,095.
Fiscal Benefits NHS: £870,145 GMFRS: £248,643 Local Authorities: £124,307 Public Value Benefit: £5,134,405
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Falls Prevention 6.11 Falls prevention was split into two categories for the purposes of the CBA, in
order to take advantage of the more precise data relating to one of these
categories. The categories related to residents who had not previously fallen,
and those that had undergone a previous fall.
6.12 Total benefit to the NHS of those who had not previously fallen was calculated
to be £24,941. Total benefit of those who had previously fallen was calculated
to be £21,973.
6.13 Assumptions made here include:
104 residents were referred to the Falls Team having not suffered a previous
fall. 80 had suffered a previous fall. These figures were extrapolated to a full
year‟s cohort.
International research suggested that 35% of people referred to a falls
prevention service would have fallen anyway. UK Department of Health
figures suggest that 43% of people who have suffered a fall will experience
another.
International research from 2012 indicated that people undergoing falls
prevention treatment were 16% less likely to fall again.
6.14 Additional assumptions and figures relate to the effectiveness and deadweight
in relation to the reduction, namely that
13% of people who have fallen will call an ambulance (Department of
Health data, 2009)
35% of people who have fallen will attend Accident and Emergency
(CRIT evidence)
2% of people who fell broke a hip
7% of people who fell sustained a fracture that was not to the hip.
6.15 The Health and Social Care Services Coordinator for GMFRS suggested that
further research be carried out to determine public value benefits achieved as
a result of intervention by the Falls team, namely:
Improved quality of life
Improved confidence which may result in someone accessing the
community and going out again when they were previously isolated and
reliant upon services
Increased independence and ability to remain at home, again reducing
need for social care and residential care
Improved mental wellbeing which may lead to a reduction in need for
other services, eg GP or mental health services, medication
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6.16 Falls prevention has fiscal benefits that solely benefit the NHS. The
breakdown of these benefits is shown below.
Benefit type Not fallen previously Fallen previously
Ambulance call-out £1,159 £999
A&E Attendance £2,044 £1,791
Hip Fracture £16,433 £14,501
Other fracture £5,305 £4,682
Total £24,941 £21,973
6.17 There is also an overall calculated public benefit of £46,914.
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Winter Warmth 6.18 178 residents visited stated that they wished to be referred to the Winter
Warmth scheme. Records indicate that all of these were given contact details,
but questionnaire responses indicate that just one in three contacted Winter
Warmth.
6.19 An assumption has been made in accordance with the „Health Impacts of Cold
Homes and Fuel Poverty‟ from the Marmot Review Team states “there was a
strong association between excess winter deaths and lower indoor
temperatures, with residents of the 25% coldest homes having around 20%
greater risk than those in the warmest.”
6.20 This suggests a “deadweight” figure of -50%, i.e. without seeking help, those
most at risk at falling into fuel poverty have a one in two chance of doing so.
6.21 One key data gap includes a lack of deadweight on whether residents would
have requested help with their potential fuel poverty situation regardless of the
Safe and Well visit.
6.22 The effectiveness of the Winter Warmth scheme itself has been calculated
from the only GM Borough – Oldham – that has researched the matter. That
figure relates to the 463 households they helped out of fuel poverty out of the
total 585 they attempted to help in the third year of the project
6.23 Another data gap occurs in relation to the assumption that a person falling into
fuel poverty will end up as a hospital in-patient at £1,863 per admittance.6
6.24 Bearing those assumptions in mind, the total fiscal benefit to the NHS is of
£1,801,659.
6.25 There is also the associated public benefit of £1,801,659.
6.26 As previously stated, another independent review of Winter Warmth is
currently being undertaken by GMFRS. It would be useful for any reader of
this report to also refer to that report when it is completed.
Fiscal Benefits NHS: £1,801,659 Public Value Benefit: £1,801,659
6 Hospital inpatients average cost per episode (elective and non-elective admissions) from the
Reference Cost Collection: National Schedule of Reference Costs - Year 2013-14 - NHS trusts and NHS foundation trusts. Weighted average of all elective inpatient, non-elective inpatient (long stay) and non-elective inpatient (short stay) data.
New Economy 021
Lifestyle, Behaviours and
Substance Use - Smoking
6.27 Six benefit categories analysed by the Cost Benefit Analysis Model relate to
smoking in the home. They are all sub-categories of two types:
Non-Fatal House Fires
House fires caused due to smoking (non fatal)
House fires caused by occupant smoking in bed (non fatal)
Falling asleep whilst smoking (non fatal)
House Fires involving Fatalities
Fatalities caused due to smoking in the home
Fatalities in house fires caused by occupant smoking in bed
Fatalities caused due to falling asleep whilst smoking
6.28 Each of the six categories has been analysed in a manner allowing for each to
remain mutually exclusive. Calculations have been made in reference to
GMFRS recorded house fire figures over the pre-Safe and Well period of
2014-2015.
6.29 Of the non-fatal categories, there were 142 non-fatal house fires caused due
to smoking in 2014-2015, 26 caused by the occupant smoking in bed, and 15
caused by the occupant falling asleep whilst smoking.
6.30 Of the fatal house fires, there were seven fatal house fires caused due to
smoking in 2014-2015, four caused by the occupant smoking in bed, and three
caused by the occupant falling asleep whilst smoking.
6.31 83% of respondents stated that they had been given advice on smoking in the
home and had been following this advice. This advice varied from smoking
outside, not going to bed with a cigarette, extinguishing cigarettes in a water-
filled container, etc.
6.32 Data gaps:
An assumption was made that nine out of ten residents would continue
to follow the advice given if they were already doing so. This may well
be too high, but unfortunately no research has been done on this topic,
and there has not yet been an ability to ask the question of residents
for a second time.
An assumption was made that those nine out of ten residents
continuing to follow advice would result in a 100% level of
New Economy 022
effectiveness to themselves in preventing smoking related fires in the
home.
The „deadweight‟ figure relating to “what would have happened
anyway” is based on National data showing the number of people
smoking in the UK reduced from 19.8% in 2012 to 18.7% in 2013
suggesting that 6% of smokers would have given up anyway. This
figure is far from ideal, relating as it does to cessation of smoking,
rather than increasing levels of safety in relation to it. However, if one
assumes a deadweight of 0% for residents who would change how
safely they smoke, then the 6% figure becomes more relevant in that
wider context.
It is worth noting that the model does not attempt, at this stage, to
broaden the modelling of impact beyond home safety implications. The
provision of brief advice with regards to smoking cessation has been
the subject of NICE evaluation, and there is an evidence base that
points towards long-term behaviour change. In order to include this in
the CBA model, however, there is a need to understand in more detail
the nature of the discussions that Safe and Well teams are seeking to
initiate and the specific nature of the follow up support to which
individuals are being referred (i.e. the evidence base on smoking
cessation allows judgements on the impact of brief advice in
combination with a support offer).
6.33 In relation to fiscal savings, the reduction in non-fatal house fires caused by
smoking in the home benefit agencies via the calculated reduction in:
House fires caused due to smoking benefitting GMFRS by £309,795
House fires caused by occupants smoking in bed benefitting GMFRS
by £50,086
House fires caused by falling asleep whilst smoking benefitting
GMFRS by £28,896
6.34 In relation to fiscal savings, the reduction in fatalities caused by smoking in the
home benefits agencies via the calculated reduction in:
House fires caused due to smoking benefitting GMFRS by £25,972,
the NHS by £90,902 and the Local Authority by £12,986.
House fires caused by occupants smoking in bed benefitting GMFRS
by £14,841, the NHS by £51,944 and the Local Authority by £7,421.
House fires caused by falling asleep whilst smoking benefitting
GMFRS by £11,131, the NHS by £38,958 and the Local Authority by
£5,565.
6.35 There is also a calculated public benefit of £622,524.
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Fiscal Benefits GMFRS:£440,720 NHS: £181,804 Local Authority: £25,972 Public Value Benefit: £622,524
New Economy 024
Lifestyle, Behaviours and
Substance Use - Alcohol
6.36 There is a strong and well-established evidence base on the cost
effectiveness of alcohol screening and brief advice, reflecting what is known
about the effect of the intervention in driving a change in the number of people
reducing their drinking to below the “increasing” or “higher risk” drinking
threshold after receiving the intervention.
6.37 Although the majority of studies tend to model benefits over a medium and
long-term timeframe (often over 30 years), the National Institute of Clinical
Excellence (NICE) has recently developed a Return on Investment (ROI) tool
that is user-configurable and therefore very useful in modelling the potential
benefits of GMFRS‟ Safe and Well visits. Key assumptions built into the ROI
modelling and / or those applied in the New Economy model are as follows:
• The effect sizes for screening and brief interventions are given in NICE
Guidance PH24 as 12.3% reduction in number of units drunk. This has
been converted into the number of people moving below the higher and
increasing drinking threshold (equating to an effectiveness/impact % of
1.79%).
• It is assumed that the efficacy of the GMFRS intervention (e.g. the
quality of the training, the quality of the delivery of the brief advice) is
broadly in line with that which would apply in the context of screening and
brief intervention applied in the context of primary care.
6.38 The Safe and Well visits database has been interrogated to determine what %
of Safe and Well visits would entail the provision of advice. For current
purposes, the model assumes that this would apply to 97 / ~18,500 visits
annually (a review of 1,179 records suggests 9 visits would be applicable).
Whilst small, this number represents that as the Safe and Well project is still in
its early stages, such a number is likely to rise as the CSAs and Fire Crews
become better trained at asking the right questions to enable residents to ask
for help.
6.39 Of this cohort of people who wanted treatment, according to Safe and Well
logs, 44% were signposted towards treatment in some way. As above, it is
expected that this figure will increase as the effectiveness and embeddedness
of training increases.
6.40 NHS Data for 2004 suggests that a “retention rate” of those who seek
treatment is 48%, and the most recent data from NICE provides a 1.79%
effectiveness for such treatment.
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6.41 Given the expected % impact figure, it is anticipated that a change in drinking
behaviour will be achieved in respect of only a handful of individual people
(around 5 per annum). The results, based on a 5 year model for benefits
monetisation, are as follows:
6.42 Subsequent predicted reduction in alcohol use would not benefit parties to a
significant degree in fiscal terms. For information, benefits would accrue to the
NHS by £511, GMP by £163, Probation by £15, Courts/Legal Aid by £58,
Prisons by £77 and other CJS by £42. There is also an argument for including
productivity gains and education cost gains here, but in reality the figures for
the more obvious benefits are so small as to be negligible in the bigger
picture.
6.43 There is also a calculated public benefit of £866.
Fiscal Benefits NHS: £511 GMP: £163 Probation: £15 Courts/Legal Aid: £58 Prisons: £77 Other CJS: £42 Public Value Benefit: £866
New Economy 026
Lifestyle, Behaviours and
Substance Use - Drugs
6.44 Reduction in drug use is one of the aims of Safe and Well Visits and one
question relates to “would you…like to receive treatment or advice [for your
drug use]”?
6.45 Four of the cohort from the study period stated that they would like advice.
This figure is extrapolated up to 43 per annum.
6.46 Of this cohort of people who wanted treatment, according to Safe and Well
logs, 75% were signposted towards treatment in some way.
6.47 Hampshire DAAT data suggests a “retention rate” of those who seek
treatment is 67%, and data correlating a wide variety of other studies predicts
an impact of 40%.
6.48 Subsequent predicted reduction in alcohol use would benefit the NHS by
£28,711, GMP by £9,158, Probation by £852, Courts/Legal Aid by £3,259,
Prisons by £4,340 and other CJS by £2,343.
6.49 There is also a calculated public benefit of £48,662.
Fiscal Benefits NHS: £28,711 GMP: £9,158 Probation: £852 Courts/Legal Aid: £3,259 Prisons: £4,340 Other CJS: £2,343 Public Value Benefit: £48,662
New Economy 027
Lifestyle, Behaviours and
Substance Use – Alcohol and
Drugs
6.50 31 non-fatal house fires were started due to cooking under the influence of
alcohol/drugs between Nov 2014 and Oct 2015.
6.51 Questionnaire results showed that 75% of Safe and Well customers asked
were able to recall the advice given to them about cooking under the influence
of alcohol/drugs. As before, an assumption must be made that nine in ten will
continue to follow the advice.
6.52 Subsequent calculations using the above figures provide evidence that a
reduced number of residents cooking under the influence of alcohol/drugs
would benefit GMFRS by £57,334.
6.53 There is also a calculated public benefit of £57,334.
Fiscal Benefits GMFRS: £57,334 Public Value Benefit: £57,334
New Economy 028
Prevention – Fires and Portable
Heaters
6.54 Four benefit categories analysed by the Cost Benefit Analysis Model relate to
the use of heaters in the home. They are all sub-categories of two types:
Non-Fatal House Fires
House fires caused due to an electric heater being left on;
House fires caused due to an electric heater being covered
House Fires involving Fatalities
House fires caused due to an electric heater being left on;
House fires caused due to an electric heater being covered
Each of the four categories has been analysed in a manner that leaves each one
mutually exclusive from the others.
6.55 Of the non-fatal categories, there were 35 non-fatal house fires caused due to
an electric heater being left on in 2014-2015, and 18 caused by an electric
heater being covered.
6.56 Of the fatal categories, there was one fatal house fire caused due to an
electric heater being left on in 2014-2015, and one caused by an electric
heater being covered.
6.57 85% of respondents stated that they had been given advice on the safe use of
electric heaters in the home and had been following this advice.
6.58 Data gaps:
An assumption was made that nine out of ten residents would continue
to follow the advice given if they were already doing so. As before, this
may well be too high, but unfortunately no research has been done on
this topic, and there has not yet been an ability to ask the question of
residents for a second time.
An assumption was made that those nine out of ten residents
continuing to follow the advice would result in a 100% level of
effectiveness to themselves in preventing heater-related fires in the
home.
The „deadweight‟ figure relating to “what would have happened
anyway” is an assumption that no people would have changed their
usage of electric heaters without prompting from the Safe and Well
Team.
New Economy 029
6.59 In relation to fiscal savings, the reduction in non-fatal house fires caused by
the incorrect use of heaters in the home benefit:
Reduction in non-fatal house fires caused due to heaters being left on would
benefit GMFRS by £73,363
Reduction in non-fatal house fires caused due to heaters being covered would
benefit GMFRS by £37,730
Reduction in house fires with fatalities caused due to heaters being left on
would benefit GMFRS by £4,037, the NHS by £14,130 and the Local Authority
by £2,019.
Reduction in house fires with fatalities caused due to heaters being covered
would also benefit GMFRS by £4,037, the NHS by £14,130 and the Local
Authority by £2,019.
6.60 There is also a calculated public benefit of £147,428
Fiscal Benefits GMFRS:£45,804 NHS: £28,260 Local Authority: £4,307 Public Value Benefit: £147,428
New Economy 030
Outdoors
6.61 One benefit category analysed by the Cost Benefit Analysis Model relates to
fires that start in a wheelie bin.
6.62 Only one (non-fatal) house fire was caused due to a fire starting in a wheelie-
bin between 2014-2015.
6.63 63% of respondents stated that they had been given advice on the safe use of
wheelie bins in relation to fires in the home.
6.64 Data gaps:
An assumption was made that nine out of ten residents would continue
to follow the advice given if they were already doing so. Once again,
this may well be too high, but unfortunately no research has been done
on this topic, and there has not yet been an ability to ask the question
of residents for a second time.
An assumption was made that those nine out of ten residents
continuing to follow advice would result in a 100% level of
effectiveness to themselves in preventing smoking related fires in the
home.
The „deadweight‟ figure relating to “what would have happened
anyway” is an assumption that no people would have changed their
usage of their wheelie bins without prompting from the Safe and Well
Team.
6.65 In relation to fiscal savings, the reduction in house fires starting from a wheelie
bin is calculated to benefit GMFRS by £1,554.
6.66 There is also a calculated public benefit of £1,554
Fiscal Benefits GMFRS:£1,554 Public Value Benefit: £1,554
New Economy 031
Home Security Checklist – Doors
and Windows
6.67 Two benefit categories analysed by the Cost Benefit Analysis Model relate to
the increasing of household security features by replacing windows and doors
for ones that are more secure.
6.68 Over the study period, it was recommended to 305 residents that they replace
their front doors for ones that were more secure. It was also recommended to
328 residents that they replace their windows for ones that were more secure.
6.69 Upon questioning, 22% of respondents stated that they had remembered the
recommendation to replace their front door and that they had acted on this.
9% stated that the same was true of their windows. Whilst these figures may
seem surprisingly high, it should be noted that a substantial amount of
residents visited by the Safe and Well teams are living in Local Authority
housing, where requests for new front doors and windows are more easily met
than in the private rented or owner/occupier sectors.
6.70 The Royal Statistical Society states that deadlocks/double locks on a door
makes it 2.8% less likely to be burgled. The RSS also states that window
locks makes a property 6.6% less likely to be burgled
6.71 Assumptions include the analysis that appears to show that 7.38% of Safe and
Well visits take place in Burglary hotspots.
6.72 In relation to fiscal savings, the calculated reduction in burglaries in relation to
these two categories would be:
In cases where doors were made more secure, there would be a
corresponding £2,894 benefit to Greater Manchester Police, £342 to
Probation, £548 to Courts/Legal Aid, £1,552 to prisons and £432 to
other Criminal Justice Services.
In cases where windows were made more secure, there would be a
corresponding £3,002 benefit to Greater Manchester Police, £354 to
Probation, £568 to Courts/Legal Aid, £1,611 to prisons and £448 to
other Criminal Justice Services.
6.73 There is also a calculated public benefit of £11,751.
Fiscal Benefits GMP: £5,896 Probation: £696 Courts/Legal Aid: £1,116 Prisons: £3,163 Other CJS: £880 Public Value Benefit: £11,751
New Economy 032
Additional Benefits
It should be noted that, whilst it has been possible to assign costs to adult and
children social care as well as mental health referrals, it has currently proven
unable to build up an accurate enough picture of the nature of these referrals
in the timescales available to produce any feasible benefits for them.
However, it has been possible to obtain case studies of various people who
have been dealt with by Safe and Well.
Case Study 1
GC of Manchester has recently come out of hospital and had been receiving palliative care. His general health and mobility are very poor. GMFRS received the referral for a Safe and Well visit from the Manchester Sensory Team. At the time of the visit, he was awaiting a visit from the Primary Assessment Team, (PAT) to assess his caring needs. GMFRS‟ Community Safety Advisor, (CSA), attended to carry out a Safe and Well and noticed that G.C had obvious issues. The CSA called the P.A.T to check on progress with regards to obtaining appropriate care support for G.C. The P.A.T told the CSA that GC only wanted someone to do his shopping so they were trying to sort out meals on wheels. After spending some time speaking to GC, he told the CSA that he would like some carers to come in and help him. He was confused as to what care and help he could have and how the care system worked and because of his illness and deafness was worried that he might not be able to communicate what his care needs are. He has no family to help. The CSA spent some time explaining benefits to GC and crucially also made other services that were trying to help GC aware that he was regularly missing callers as it took him so long to get up to answer the intercom for this flat. This was particularly important information as the district nurses were going to start visiting GC twice a week. The CSA tried to get hold of an access code or key fob for the building from Guinness Housing so that nursing staff and carers can gain easier access to G.C without having to rely on GC and so enable him to save his strength rather than making multiple visits to answer the door in his condition.
Case Study 2
D lives in Manchester and has problems with his leg and his mobility is poor. He has a history of angina and had a stroke last year. He falls regularly and last year fell and broke his back. He has diabetes and feels the cold especially as the front door of his flat has gaps in it and the wind up on third floor blows through making his flat cold. He also suffers from depression and has gone back to smoking again. The CSA carried out the usual Safe and Well intervention but spent a lot of time discussion depression as D told me he was feeling pretty low. Since visiting D, The CSA has spoken to the Housing Association to see if they can fix the doors and look at his hardwired smoke alarm that is in need of attention. They have since remedied both these things. The CSA went back out to D to deliver a Winter Warmth Pack to him and to make sure that action has been taken by the Housing Association. D‟s medical and mobility issues were being treated by his GP and he was on tablets for his depression. She encouraged him to raise this again with his GP if he felt that the tablets were not having the desired effect.
New Economy 033
