CELL Consulting was asked to support a large unitary council to undertake a cost-benefit analysis to provide a strong evidence base upon which to forecast and then measure the financial costs and benefits resulting from changes to the commissioning of prevention services across adult social care client groups.

We worked closely with Council officers facilitating discussions which helped officers understand what and where the impact of the changes would be felt and to what extent. We also wrote a financial model which we developed in conjunction with heads of service and finance staff which provided officers with a framework and tool for forecasting and measuring attributable impacts. Officers populated the model and used it to run a number of scenario tests.

The changes the Council had made to the commissioned prevention services included:

• greater capacity in their Information Advice and Guidance (IAG) function,
• making prevention services more targeted to those at risk, tenure neutral, where support had previously been provided alongside housing services and
• increased focus on managing risks to independence.

In making these changes, the ACS team were charged with both improving outcomes for clients and making financial savings. Savings needed to be made both in the cost of prevention services themselves and by reducing the cost of future care package costs through managing risks to independence.

Client issue

Officers needed to develop a strong evidence base to illustrate benefits to Council Members. However, they had no clear framework for estimating the scale and nature of the impacts of commissioning changes made. Furthermore they had to have confidence that the changes would deliver sufficient benefits to meet the efficiency savings targets they had been set, long before the start of the new financial year in which those savings had to be delivered. So they needed a predictive tool as well as a measurement approach to forecast and measure the impacts of their changes.

CELL Consulting was asked to support the process of helping the Council to forecast and measure the financial benefits the changes achieved. Using our experience of similar impact reviews we adopted a four stage approach. Under the guidance of the project’s implementation team, we undertook the following steps. All stages were done alongside the officer team at the Council to ensure insight and skills transfer. The stages were:

Agree the scale and scope of the evaluation

We facilitated a series of discussions with officers, providers and front line staff. The aim of the discussions was to identify which services, which client groups and what costs should be included in the evaluation framework.

Stakeholders were asked to set out what visible impacts they expected to see from the changes made. A key question was whether changes could be attributed to the prevention services commissioned and whether there were other outside influences.

Agree the mechanism for undertaking the financial evaluation

The objective was to construct an outline formula to use to calculate financial impacts. What would we measure and what would we compare? This was again done through facilitated discussion and provided clarity to key Council team members on the types of information necessary and areas where assumptions may need to be made.

Agree the information and assumption needs and responsibilities

Based on the proposed mechanism, discussions to identify the data sources and persons best placed to inform and decide on key assumptions was discussed and agreed.

Quantifying impacts

Using this sequenced and logical approach, a framework for evaluating impacts was designed. CELL Consulting then developed a financial model to illustrate the approach. Council officers populated the model and used it to run a number of scenario tests.

Forecasts of future impact as well as measurements of actual recorded changes were made and together these were used to inform the implementation of the new commissioning strategy and illustrate the financial savings they had achieved.

Officers were able to provide a robust evidence base to attribute benefits to the changes they had made in commissioning and take confidence that efficiency targets would be deliverable without impacting outcomes for social care clients through better management of their risk factors.