05 July 2013

On Friday, I visited the 999 Club in Deptford with Tamsyn Roberts of the Cabinet Office. We are constructing a business case for some of the services they offer – specifically those designed to reduce chaotic and repeated use of crisis health services.

We contend that it would be cheaper to increase support for some 999 service users if the result is better engagement with mainstream health services and less reliance on emergency care. This is because an appointment with a GP is about a fifth of the price of going to A+E for the same treatment.

Very easy to describe our ambition. Very complex to fulfil it.

First step: Identify the people who may be high cost.

The 999 Club had set up an inter-agency meeting where we could identify some members for whom we could cost their service use. Open-access centres like the 999 Club are the eyes and ears of public services, identifying new trends in needs and social issues years before they make it to a health or social care white paper. If you want to know what the social exclusion issues of our time are, the members and staff at the 999 club can tell you.

The focus of our research – which is part of our role in the Connecting Policy with Practice programme with the Big Lottery Fund and IfG – is to translate what we find at 999 into wider lessons for national policy makers. Namely we hope to shed light on why we have a system where someone can cost emergency and health services over £100k a year, but their health and wellbeing is not improving. The questions I asked at the meeting included:

1)Whose job is it to notice if someone is using a GP surgery, A+E, getting arrested, evicted, re-housed and dropping out of services regularly?
2)Does anyone ever pull together how much it all costs?
3)Why don’t different hospitals and surgeries share their data between them, so they can identify the borough and city-wide use of services and offer something more cost effective instead?

For this group of people – those who often have complex lives – there are few helpful answers. Consequently, the best person to ask about global service use is actually the person using the services. Ironically, they are considered to be the ‘chaotic’ one, yet they are the only person, it seems, with an accurate overview of how they engage with the system.

The information that they can give us – combined with what we can piece together from other services – will enable us to construct a baseline financial assessment of the cost of their service use. From this, we can measure the impact of offering increased support aimed at improving their health and wellbeing by using the right services for the right problem.

As mentioned earlier though, describing your ambition is far easier than fulfilling it. More in a fortnight.

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