CELL Consulting were asked to support the financial evaluation of a service improvement programme around intermediate care for the elderly.

A new intervention by the CCG targeted at admission avoidance for over 65s and on reducing length of stay had been in operation for over 12 months. An interim review including a cost-benefit analysis was needed to assess impact and inform further implementation plans.

We worked closely with front-line teams, management from commissioners, acute and community providers to gather information on the scope, nature and timing of the service implementation. We also gathered a large amount of data on hospital admissions and A&E attendances from the HES and SUS reports and conducted a range of in-depth analyses of this data to produce a strong evidence base illustrating the attributable impacts of the changes.

Based on the insight gained from interviews with the front-line teams, we established where to look in the HES/SUS data-set for impacts. This helped both to focus our analysis on areas where any changes were most likely to be attributable to the new intervention and also to narrow the review scope so that small changes were apparent in the many thousands of rows of data..

We analysed the data and linked key events in the implementation of the intermediate care service to shifts in patterns of attendances and admissions to identify critical factors in the success of the project (e.g. the nature and timing of awareness events among clinicians).

By measuring the changes in the rates of A&E attendances leading to hospital admissions and looking at the measured reduction in length of stay we were able to undertake a cost-benefit analysis, comparing the cost of the intervention with the non-elective admission costs avoided as a result of the intervention. While this provided only estimates, the client had the evidence needed to be assured that the intervention was more than self funding and should continue from a financial perspective.