Theo Georghiou presents on a Nuffield Trust evaluation project to examine the effectiveness of the voluntary sector in helping to prevent hospital admissions.

1. © Nuffield Trust
Can the voluntary sector help to prevent
hospital admissions?
Theo Georghiou
& the Nuffield Research team
22 June 2015

2. © Nuffield Trust
Social action to prevent admissions
Cabinet Office Reducing winter pressures fund (£3m).
(also match-funding by local commissioners)
Seven funded organisations
• Age UKs, British Red Cross, Westbank (Exeter), Royal Voluntary
Service.
• Explicit aim to reduce emergency admissions (+other) over
2014/15 winter, using volunteers
• Required to work with Nuffield Trust as independent evaluators
(collect and transfer data as necessary)

3. © Nuffield Trust
Main types of service
Home from hospital
• Inpatient wards, and A&E
Upstream prevention
• Referrals from GPs, wards, local integrated H&SC teams,
community
Signposting
• Referring to other voluntary or statutory orgs
‘Active’ support
• Transporting, befriending, shopping, meals, …

4. © Nuffield Trust
Story so far and to come
Since October 2014
• 7,900 people supported (500 to 2,270)
• 470 volunteers recruited (4 to 140)
• 62 staff in place (5 to 12)
Extension to September 2015 (…9,500 people supported?)
Analysis (this autumn):
Matched control evaluation (Cono Ariti, this morning)
Link local voluntary sector admin data to hospital data

5. © Nuffield Trust
Data from voluntary sector organisations
Personal
identifiers
Info about person
and/or service provided
Mrs
Louise
Smith
F
DOB
13/12/40
…
Day 54 - Referred;
Consent , Assessed
Day 56 - Driven
home, shopping
(3 hr volunteer time)
Day 60 - Visited
(1 hr volunteer time)
…
Might include
Referrals [dates, route..]
Assessments [Recorded needs, plans, wellbeing surveys…]
Services provided [what, dates, volunteer or staff, time spent…]

6. © Nuffield Trust
Data from voluntary sector organisations
Personal
identifiers
Info about person
and/or service provided
Hospital data
Mrs
Louise
Smith
F
DOB
13/12/40
…
Day 54 - Referred;
Consent , Assessed
Day 56 - Driven
home, shopping
(3 hr volunteer time)
Day 60 - Visited
(1 hr volunteer time)
…
…
Day 52 - Emergency admission
(Diagnosis of COPD, … , … )
Day 56 - Discharged home
Day 83 - AE visit, not admitted
….
Might include
Referrals [dates, route..]
Assessments [Recorded needs, plans, wellbeing surveys…]
Services provided [what, dates, volunteer or staff, time spent…]

7. © Nuffield Trust
Data from voluntary sector organisations
linked to hospital data for evaluation
Info about person and/or
service provided Hospital data
…
Day 52 - Emergency hospital admission; Diagnosis of COPD, … , … ;
Day 54 - Referred to scheme; Consent  , Assessed
Day 56 - Discharged home
Day 56 - Driven home, shopping (3 hr volunteer time)
Day 60 - Visited (1 hr volunteer time)
…
Day 83 - AE visit, not admitted
…
Linkage to
to hospital data
via HSCIC
(consent issues)
Analysis data are
pseudonymous

8. © Nuffield Trust
Varied status of the different schemes
Seven different schemes - mix of situations:
• Well established intervention, advanced data collection (and data
sharing) locally
• New intervention and databases put together from scratch
• Others somewhere in the middle – adapted existing interventions,
and modified data collection with our advice
Some are collecting a lot of data…

9. © Nuffield Trust
Age UK South Lakelands – assessment data
Health Wellbeing - over last two weeks About your home
Hospital stays last 18 months? Little interest or pleasure in doing things Live with someone?
A&E Not Admitted last 18 months? Feeling down, depressed, or hopeless Your accomodation - class
Emergency Treatment at Home last 18 months Trouble falling or staying asleep, or sleeping Type of home
Doc/Nurse last 3 months? Feeling tired or having little energy Type of heating
How many Medicines? Poor appetite or overeating Insulation
Diabetes? Feeling bad about yourself Need repairs?
Controlled by diet/insulin/etc? Trouble concentrating on things Moving around home safely?
Angina? Moving or speaking so slowly that other people Aids and adaptations in home ok?
Spray/Tabs times per week? Thoughts that you would be better off dead or Working smoke detector?
Respiratory? Feeling nervous, anxious or on edge Personal alarm?
Inhaler times per week? Not being able to stop or control worrying Feel safe now?
Stroke? Worrying too much about different things Safe in future?
How many months ago? Trouble relaxing Your money
Infect/UTI's Being so restless that it is hard to sit still State pension(s), total £
Number last 18 months? Becoming easily annoyed or irritable Occupational Pensions, total £
Arthritis/Osteoporosis? Feeling afraid as if something awful might happen Pension Credit, £
Falls? Social life Other earnings, £
Fractures? Social visitors - how often? Attendance Allowance
Health impact on daily living? Family contact - how often? DLA mobility
Hot meals number per week? Get out for engagements - how often? DLA care
Weight changing? What transport do you use? PIP mobility
Appetite changing? Have Telephone/Mobile? PIP care
Smoke? Per Day Have internet? ESA amount, £
Drinks? Per Week Use internet? Housing benefit, £
Physical Activities number per week? Confident internet? CT Reduct., £
Current health (Very good to poor) Social changed over last 3 years? Fuel costs, £ per month
Knowledge of Conditions (very confident to not) If care for someone - how impact? Manage now?
Future health management (very confident to not) Lifestyle or culture affects social life? Manage in the future?

10. © Nuffield Trust
Follow all 7,900 people’s hospital history before, and after:
Data needed – minimum
Two most important things from each area:
Good quality personal identifiers > Data linkage to HES
A start date for service > Reference date
?
?

11. © Nuffield Trust
Good quality personal identifiers
Illustration of ‘minimum’ necessary (2013 study)
N % of initial N
Initial Cohort 3,946
Dropped from
analysis
No linkage to HES 1,240 31%
Link to HES, but not found in hospital 727 18%
Other - analytical reasons 406 10%
Final analysis cohort 1,573 40%

12. © Nuffield Trust
Good quality personal identifiers
A start date for service – almost the only data we had…
Illustration of ‘minimum’ necessary (2013 study)
N % of initial N
Initial Cohort 3,946
Dropped from
analysis
No linkage to HES 1,240 31%
Link to HES, but not found in hospital 727 18%
Other - analytical reasons 406 10%
Final analysis cohort 1,573 40%
0.0 1.0 2.0
All Sites (N=1,573)
Site 2 (N=269)
Site 3 (N=156)
Site 4 (N=79)
Site 5 (N=111)
Site 6 (N=364)
Site 7 (N=152)
Site 9 (N=442)
Risk of future emergency admission
High
risk
Low
risk

13. © Nuffield Trust
We’d (all) like to know more
From HES data - client characteristics
• multiple long terms conditions, previous admissions, age,
deprivation, …
But what about the interventions themselves?
• Home from hospital vs community
• Signposting vs ‘active’
• Light vs intensive support
• Volunteer vs staff delivered
• Short vs long term follow up
> Who best to target? And how?

14. © Nuffield Trust
Final thoughts
• Cabinet office social action study – part of a suite of work on
voluntary sector’s impact on health
• Past and current work – it’s possible to use voluntary sector
person level data and link to hospital data
• Data quality and completeness - limits what you can do
• Homogeneous interventions (and data), more likely to make
nuanced (and useful?) evaluation findings

15. © Nuffield Trust
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