2. Back to 1999
In five years:
• 3 full staff teams
• 5 staff leave or transfer on medical grounds
• Staff sickness 52% above average
• 270 agency or bank staff
• Absorbs 60% senior management time
• Injuries and anxiety for other service users
• Regular calls to psychologist/psychiatrist/GP/Social Services
• Family distress
• Financial strain – voids, crisis management
• Regulatory failure “Put her out of borough and start again with somebody easier”
3. Tizard
Advance
Staff
Managers
Commissioner
Local behavioural specialist
Functional analysis
Increasing Xenias control over what happens in her day:
Catalogue of activities and her competence to complete
them – can do, can share, can learn, needs done for her
Detailed daily plans easy for staff to follow
Understanding and developing her communication
Reactive strategies
Family
4. Outcomes for Xenia: 2008 to 2013
0
5
10
15
20
25
30
1 2 3 4 5 6
Stripping
Vomiting
Screaming
Slapping people
Slapping her leg
Covering herself
Crying
Years: 2008-2013
Incidentsper
day
5. • Public data (e.g. PSSRU statistics) tells us what each outcome might cost, for
example:
• We used this data to estimate the savings to the public purse of better management
of vulnerable adults
• Such savings will be on top of reduced costs of direct support where appropriate
• We excluded wider estimates of social value e.g. improved wellbeing
The costs of poor outcomes
Behaviour./incident leads to: Cost
Hospital admission £549 per episode
Long stay hospital £630 per day
District nurse visit £64
Social Services visit £152
Psychiatrist visit £353
Placement breakdown £4,698
Police call out £44
Eviction proceedings £8,619
6. What we found out
• For a sample of vulnerable adults the savings from intensive support are substantial
Person 1 Person 2 Person 3 Person 4 Person 5 Person 6
Costs before support £95,351 £219,152 £241,210 £223,152 £219,152 £200,081
Costs after 2 years
support
£88,896 £88,543 £89,249 £29,636 £88,543 £88,543
Saving £6,455
£130,609
£151,961
£193,516
£130,609
£111,538
£0
£200,000
£400,000
£600,000
£800,000
£1,000,000
£1,200,000
£1,400,000
Historical
cost Cost
0-‐2
months Cost
3-‐18
months Ongoing
cost
7. Pricing in cost savings: Good for commissioners – risky for
providers
£-
£100,000.00
£200,000.00
£300,000.00
£400,000.00
£500,000.00
£600,000.00
£700,000.00
£800,000.00
£900,000.00
£1,000,000.00
1 2 3 4 5
Is Social Investment the answer to
sharing the risk?
9. Market making: Government funds
Cabinet Office
Social Outcomes Fund
BIG Lottery
Co-commissioning Fund
Bridges Social Impact Bond
Fund
£20 m
Funds non-cashable
wider savings from SIBs
£14 m Working capital for social
enterprises and charities to
deliver social outcomes
£40 m
Co-commissioning of SIBs
including grants to fund
feasibility work
10. Market Making: Big Society Capital
Wholesale fund set up in April 2012
Aim = to create a well capitalised social
investment market independent from
government
Capitalised with £600m over 5 years -
£400m from dormant bank accounts
and £200m from fines imposed on the
banking sector
