7. EFFICIENCY AND PRODUCTIVITY
7.1.10 Can the Department of Health cite any
examples of savings to the NHS resulting from the switch of funding
from treatment to prevention? (Q89)
Answer
Smoking cessation
1. Tobacco control activity between 1998 and
2007, which drove down smoking rates from 28% to 22%, saves the
NHS £380 million every year (ASH 2008, Cost of Smoking).
2. NHS Stop Smoking services have been shown
to be clinically effective and smokers are four times more likely
to successfully quit long term from this service. The NHS Stop
Smoking services also provide an extremely cost-effective intervention.
Results from a review of the cost-effectiveness of smoking treatment
services in England (Addiction, 2005) confirmed that:
— "treating dependent smokers is extremely
cost-effective and represents excellent value for money compared
with many other health care interventions. In fact, it is the
most cost-effective of any intervention provided by the English
health care system."
3. The cost of helping a smoker to quit
via NHS Stop Smoking services is around £200 (Stapleton,
2001). The Department's most recent data on the NHS Stop Smoking
services shows that the cost per NHS supported quitter is around
£249. This means that NHS Stop Smoking services are treating
smokers nearly ten times more cost-effectively than the benchmark
of £20,000 per quality adjusted life-year saved used
by the National Institute for Health and Clinical Excellence.
Alcohol—identification and brief advice
4. Identification and brief advice are effective
interventions directed at patients drinking at increased and high-risk
levels who are not typically complaining about, or seeking help
for, an alcohol problem.
5. A recent Cochrane Collaboration review
involving 21 randomised controlled trials[16]
provides substantial evidence of the effectiveness of a total
population approach to case identification and the delivery of
brief advice in primary care. Analysis concludes that the cost
of implementing alcohol case identification and the delivery of
brief alcohol advice would cost in the region of £21.5 million,
but would generate savings to the NHS of £35 million.
6 Since November 2007, the Department has
been running a programme to test the most cost-effective means
and settings for providing brief interventions. The programme
is delivered across three different settings: GP practices, A&E
departments and over 100 probation services. Initial findings
of best practice are expected in 2010.
Social care
7. The Personal Social Services Research
Unit (PSSRU) conducted a major evaluation of community care services
for older people (ECCEP study) in the late 1990s (Equity and
efficiency policy in community care, Davies et al, 2000).
It involved extended follow-up of a sample of frail older people
receiving community-based services and their principal informal
carers. Data were collected on the costs of the care packages
and on their effectiveness at achieving outcomes for users and
carers.
8. The study found that intensive packages
of home, day and respite care for severely disabled older people
can delay admission to care homes, reduce the use of hospital
in-patient services and yield wider outcomes for users and carers
in terms of increased satisfaction levels and function and reductions
in carer stress. It found that, for very dependent disabled people,
for every £1 spent on home care, average costs of hospital
care fell by 30 pence (The Contribution of Community-based
Health and Social Care to Inpatient Hospital Use, Fernandez
and Davies, 2002).
9. Another study by the PSSRU found that
an increase in care home and/or home care provision had the effect
of reducing rates of delayed hospital discharge and in turn reducing
average length of hospital stay and increasing hospital activity.
Furthermore, the study indicated that increased care home use
reduced hospital readmission rates (The Importance of Social
Care in Achieving an Efficient Health Care System: The case for
reducing hospital delay discharge rates, Fernandez and Forder,
2002).
10. A research team from the University
of Hertfordshire, the PSSRU, the University of Keele, John Moores
University and University College London are conducting a national
evaluation of the Partnership for Older People Projects (POPP
programme). The interim report (Windle et al 2007) of the
national evaluation included an analysis of emergency hospital
bed-day use on a monthly basis between April 2004 and December
2006. The early findings suggest that POPP sites appear, when
compared with non-POPP sites, to have a significant effect on
hospital emergency bed-day use. The interim results show reductions
against trend that would produce an average potential saving of
£1 on hospital bed-days for every £1 spent
on POPP through social care investment. These interim findings
are subject to caveats: without a full randomised control trial,
questions about attribution of POPP effects remain; and the quality
of the Hospital Episode Statistics needs to be considered.
16 Kaner et al, 2007 Back
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