A Social Impact Bond for dementia care – shaping health and care services through social investment
Context
Dementia is a long-term degenerative condition which requires joined-up care across clinical and social care settings. However, all too often support in the community is fragmented or missing and people living with dementia are admitted to hospital repeatedly and unnecessarily.
There are nearly one million people living with dementia (PLWD) in the UK, and this is expected to grow to 1.6 million by 2050. There is also a greater prevalence of dementia in Black and South Asian ethnic groups, yet they are less likely to receive a dementia diagnosis — as many services designed to address the needs of individuals with dementia often overlook the requirements of minority groups.
Care and treatment costs people living with dementia and their families more than £20 billion per year and costs the health and social care system more than £12 billion per year.
Due to the incredible work that was delivered using the original funding from the Care & Wellbeing Fund, the service has now received further funding from the Hounslow Borough-based partnership to establish a broader multi-discipline team. This is a huge testament to Social Finance and we would like to say a big thank you to them.
Jacki Hunt, Former Divisional Manager, Hounslow Adults Unplanned and Integrated Care
Evidence & impact
How EDCS works
The Enhanced Dementia Care Service (EDCS) is a multi-organisation service that consists of health, social care and voluntary services who provide integrated support for people living with dementia in the community to help prevent crisis, unnecessary hospital admissions, and enable them to live independently.
Over 3 years (April 2021 – March 2024), 530 EDCS service users were assessed with an integrated care plan that supported better more integrated care for them and their carers.
Hospital admissions amongst this group were significantly lower, with around half of those cared for by the service (262) experiencing no unwarranted or avoidable hospital admissions within 12 months of being on the service. This resulted in significant savings, which allowed hospital resources to be re-allocated to other patients requiring treatment.
As a result of this success, the Hounslow Borough Based Partnership allocated additional funding to expand the service and continues to fund it to date. Each year has seen between a 7.5% and 12% decrease in people with dementia presenting at A&E.
Learn more about the service in this video:
Working together with our colleagues in Primary Care, Mental Health Services, hospitals and the voluntary sector, we are now able to help more people living with dementia to live independently and prevent unnecessary hospital admissions. I would like to say a big thank you to everyone who has helped to improve our local services and who will continue with us on our journey to becoming a dementia-friendly borough.
Samia Chaudhary, Councillor for Hounslow Health, Hounslow Council
In Summer 2023 Social Finance secured funding from the Dunhill Medical Trust (now the Vivensa Foundation) and Alzheimer’s Society to build on the learnings and to test different ways of measuring and improving outcomes for older people living with dementia and other complex needs.
The challenge ahead
It has made all the difference. I really recommend it to anybody. I feel really fortunate. I knew nothing about was happening in Hounslow and I’m really impressed with how much support we’ve had from nurses coming round, because it’s practical and also for me to know that there’s someone there for me to talk to. We look upon them know as friends, quite honestly.
Jo Spencer, Carer
What have we learned?
Sharing resources on – and examples of experiences with – different funding mechanisms and how they can be used will ensure system stakeholders are aware of funding options available to them. This will support the wider principles of sustainability and efficiency.
Operational functions are critical to strengthening service delivery, user engagement, and data sharing and collection. This includes awareness by raising and service promotion to diversify referral routes; to reach and support underserved communities; and to recruit and retain staff and volunteers. Data functions, including collection and analysis, also need to be bolstered. If the right data is captured and used effectively, it can be a valuable asset; however, training and the agreement of data sharing protocols is needed to ensure this happens.
Our findings demonstrate how vital unpaid carers are to the ecosystem that supports older people living with dementia and other needs. They provide essential care that bolsters adult social care provision, often at the expense of their own financial, emotional, and physical health. It is vital that the support infrastructure for unpaid carers is recognised and invested in throughout the system. This is an area which needs further testing and funding.
The programme has seeded an energetic and knowledgeable Learning Community, the power of which can be harnessed to generate widespread and sustainable change in the funding and delivery of person-centred care. This is an opportunity to reduce duplication, consider scalability of interventions, and to test thinking on service development, its funding, and its evolution.
Evidence shows that considering the social determinants of health and taking a person-centred approach when planning the delivery of services is essential. This encourages care providers to coordinate their approach and to deliver better health outcomes.