Earlier action and support: The case for prevention in adult social care and beyond

This is a joint publication from the LGA, ADASS, Social Care Institute for Excellence, Mencap, Skills for Care, Think Local Act Personal, The Care Provider Alliance and Social Care Future. 

The Government has committed to developing a new ten-year plan for health which encompasses three key shifts, from: analogue to digital; acute to community; and treatment to prevention. Prevention plays directly into the third shift, and more tangentially, but no less significantly in terms of potential, into the other two shifts.

Prevention is a central feature of the new Government’s mission-led approach to national renewal. It has important links to the Neighbourhood Health Centre agenda and has a notable accent in the Lord Darzi review of the NHS in England, as well as being an essential component of many organisations’ visions for the future of adult social care. For example, the recent Skills for Care long-term strategy for the care workforce noted that, unless Government focuses on prevention, the care workforce will need to grow even further as more people draw on care and their independence reduces. The flipside to this is that the workforce has an opportunity to take on new skills, roles and ways of working to support the preventative shift.

The time is ripe for action. The organisations which have partnered on this paper, together, represent people who draw on care and support, commissioners, delivery organisations, democratically accountable local councils, and leading research, practice and policy bodies. Many of us have long been making the case for the same shift – towards taking action and offering support earlier, so that more people can live the lives they want. But there is now a strong and promising link between the Government’s priorities and those of the organisations who have partnered together for this paper. This creates a new opportunity to deliver.

This paper has four key aims:

• Define: there is much talk of, and emphasis on, ‘prevention’ from the Government, the health and care sector, and civil society more widely. Inevitably, the word means different things to different people, which can hamper understanding of the role it could play in improving both people’s lives and value for money of the public pound. In this paper, we offer a definition based on the idea of ‘earlier action and support’ (EAAS).
• Evidence: demonstrating the social return on investment of activity typically categorised as ‘preventative’ is often where the argument for more resources falls down. In this paper, we therefore explore a range of interventions which have been selected based on certain criteria, such as publicly-available evaluation, including on social return on investment (SROI).
• Build: across the country we find examples of EAAS approaches that councils and their partners are taking or have taken previously. This needs to be captured, understood and recognised to ensure EAAS investment starts out from the strongest foundations. 
• Act: we set out how the Government – working with councils and the wider sector – could begin to take forward meaningful action on EAAS (alongside other forms of prevention), towards meeting its overall aim of shifting towards prevention.

We propose a set of modest, and achievable actions which could help set us on the right path for action on EAAS. These include:

• New Government funding for a programme of ‘EAAS Pathfinders’ to build on existing good practice and learning from innovation programmes’.
• Work with councils and their partners, including people who draw on care and support, to develop accompanying, fair and robust outcome measures to demonstrate the impact of investment.
• Work with councils and their partners – including people who draw on care and support – to develop a more consistent, pan-government approach to cost-benefit analysis, so that future activity is assessed in a consistent way.
• Provide new funding for independent evaluations of existing council services and support that are focussed on prevention.
• Review how supported housing is funded, considering a specific housing support fund in recognition of the need for both capital investment alongside revenue for supported housing and extend the Supported Housing Improvement Programme for at least another year, in the short term.
• Adopt recommendations in the recent Workforce Strategy, led by Skills for Care and developed with the wider sector, that support prevention. These include actions to attract, retain and develop registered nurses, social workers and occupational therapists, support delegated healthcare activities and Integrated Care System workforce planning, develop Directors of Adult Social Services and attract more care workers in coastal and rural areas.

There is now a high level of consensus around the vision for the future of care and support in England. The statement first developed by Social Care Future, encapsulated in the Making it Real framework, and adopted by the sector in the Time to Act Roadmap, captures it best in recognising that:

“We all want to live in the place we call home, with the people and things we love, in communities where we look out for one another, doing what matters to us.”

In the simplest terms, EAAS services and support are those that help move us towards the realisation of this vision. They are the things that can help us to keep living in a place we call home, connected and contributing to supportive communities and doing things that matter to us so that our wellbeing is maintained or increased for as long as possible. EAAS helps us maintain our independence, manage our conditions and access opportunities, activities and services which work for us in our communities. Some of the benefits realised by EAAS activity are cashable, but there are other non-cashable benefits which are vitally important, too. Our aim here is to quantify how these services and supports deliver the things that speak to our shared ambition of living a good life.

We are not alone in thinking in this way. In their essay last year, ‘The preventative state’, Demos defined prevention as moving from transactional public services to relational public services where the state takes a much wider view of how to reform services and support. For Demos, this would not just be about preventing problems from arising, but also creating the “conditions for flourishing and resilience within communities”.

In her review of Integrated Care Systems last year, Rt Hon Patricia Hewitt, talked to a linked point; that we cannot really define prevention until we have a “clear and agreed framework for what we mean by prevention”. Once agreed, Hewitt suggested that ICSs should then baseline their investment in prevention, bolstered by increasing the share of total NHS budgets at ICS level going toward prevention by at least 1 per cent over the next five years. The kind of services we have in mind when thinking about EAAS:

• Enable access to earlier support to people in anticipation of needs that may otherwise escalate.
• Are often targeted at specific cohorts of people (e.g. those experiencing long-term unemployment, people discharged from hospital), or specific areas of support (e.g. preventing falls, supporting physical activity).
• Support individuals with reason to draw on care and support, in their context – with support for those who offer care unpaid and for wider families and communities
• Are often provided within and by communities, often with minimal or no input from registered professionals.
• Require the right infrastructure to link people to services and support, to encourage and enable inclusion, and to help communities adapt to new needs.
• Often work alongside people, helping them to feel more able to do things for themselves, rather than providing things to people.
• Include services delivered and/or funded by the NHS (e.g. social prescribing), other parts of councils’ wider community capacity building work, or the voluntary and community sector, as well as by councils’ adult social services departments.

Some examples of EAAS services

There is no single model for EAAS, but they can be broken down into broad categories including:

• Information, advice or advocacy to help us access support and services, including support needed to access benefits or get back to work.
• Every-day or specialist technology to help us manage our lives.
• Community groups where we can develop skills or meet like-minded people to pursue interests.
• Support for people who provide unpaid care, so that they feel less stressed and more supported as they carry on caring for their loved ones.
• Social groups that help us feel connected to the people around us.
• Connectors and navigators who can help link people up to local activities, people and groups.
• Support to help us live independently in appropriate housing, such as wardens and activity programmes in sheltered accommodation, or our own homes through aids and adaptations.

EAAS activity is often delivered through models which are grounded in ‘people helping people’. These models of peer support and mutual support play a critical role in promoting wellbeing. They are also critically important in addressing inequity in health and care as they are often most effective at reaching into communities that are less well-served by more formal provision.

New opportunities for progress

While the case for a move towards earlier action and support has long been made, the Government’s new mission-focussed approach, and its commitment to a ten-year plan for health create new opportunities for progress. However, at the same time, the Government is dealing with difficult choices on competing priorities with limited budgets. That is why evidence matters more than ever.

We have brought together evidence from a range of evaluations of different EAAS interventions, focusing on their Social Return on Investment (SROI). The resulting prevention spending model (PSM) looks at how much money could be saved if councils were able to invest in activities that promote adults’ health and wellbeing and help to prevent health and care needs from arising or increasing in future. When considered alongside the wider benefits for people and communities that many of these kinds of services and support bring, we believe there is a compelling case for action. 

It is important to note that the 10 interventions included in this model are only examples of the wider set of EAAS interventions which we would want to see replicated, which is set out in the ‘Define’ section above. Rather the interventions here are those for which robust evaluation was available.

The PSM can be updated as more evidence emerges from evaluations. We are committed to building new data into the model and to building on the evidence and thinking presented here as it emerges to continue to build the case for earlier action and support.

Results of the prevention spending model

Across the 10 interventions studied within the PSM, we found that EAAS interventions save approximately £3.17 for every pound invested in them. If scaled up across all local authority areas, the 10 interventions combined would deliver a net benefit of approximately £7.6 billion. This would require an estimated £3.5 billion to implement across all single-tier and county councils in England, at an average of approximately £23 million per council. In return, they would result in approximately £11.1 billion in savings to local councils, the NHS and the voluntary, community and social enterprise (VCSE) sector. 

It should be noted that the estimated SROI figures for each study in the model are not necessarily identical to those reported in each supporting evaluation. That is because the SROI figure has not simply been multiplied by the number of councils to produce these figures, but instead the cost and expenditure have been separately adjusted for inflation and estimated for each council in England based on the number of people in each area accessing long-term social care support. These SROI estimates strictly relate to quantifiable savings realised by public and VCSE sector stakeholders; there are no doubt wider benefits, both financial and non-financial, enjoyed by those taking part in the interventions and their families, friends and local communities.

Table one shows the details of the 10 interventions for which comparable evaluations were identified, along with their separate estimates for cost per council, total cost required, and total value that could be achieved. As can be seen, the forms of support included are diverse and, while mutually beneficial and supportive, each adds its own unique value as part of a robust system of adult social care prevention. Some focus on supporting particular groups of people – for example, older people, people leaving hospital, and those experiencing long-term unemployment – while others focus on specific areas of support, such as preventing falls or promoting physical activity.

Table one: Estimated costs, savings and SROI for the ten interventions, were they to be implemented across all English single-tier and county councils in 2024. 

The fact that some interventions seem to deliver a higher SROI than others does not mean that only those with the highest SROI should be considered. All of the interventions included produce savings that are more than double their required costs, and it may be that those with lower SROI, such as reducing social isolation or community-led support, will result in the greatest intangible social benefits, and thus contribute the most to the overall wellbeing and independence of adults in need of support.

In the interest of caution, the projected savings from the interventions with higher SROI estimates should be regarded with greater uncertainty, and it is likely that in practice, multiple interventions could interact together and achieve greater collective impact than the sum of their contributions taken separately. For example, an older person at risk of hospitalisation from a fall could benefit from increased social contact, increased physical activity, and home adaptations, but might benefit even more from the total effect of these interventions combined. As such, while implementing any of the above interventions would achieve considerable benefit for adults with support needs and all those involved in supporting them, the greatest value would be delivered by implementing them all in a system of interlinked support. This can be achieved by providing the full funding to local councils to enable them to invest in holistic networks of support in their local areas.

Such funding for EAAS should be routed through democratically accountable local councils and with minimal national government prescription beyond a clear requirement that the design and delivery of activity should be coproduced with local communities and groups. Recognising that, in practice, the right interventions to deliver better outcomes for people locally will vary from one community to the next, EAAS activity should:

• Be locally commissioned and coproduced with people who draw on care and support and the wider community, working as equals alongside council members and officers who hold responsibility for nurturing local areas.
• Be place-based to ensure a bespoke approach which recognises areas’ different local strengths and assets, including social capital and community infrastructure, as well as local transport and housing stock.
• Include some activity that can be taken forward and delivered at pace, with some benefits achieved ahead of the final period of activity.
• Be backed by a national programme of support, but with flexibility for new and additional local models to flourish.

Breakdown of financial and social benefits realised

For a number of reasons the savings identified in the PSM may represent an underestimate of the benefits realised by investment in these models. 

Each of the studies in the model had a different approach to the extent to which their estimates SROI figures included savings that were not precisely quantifiable (for example, attributing a value to improved wellbeing without linking it to reduced service expenditure). These wider social benefits are an important part of the impact of any intervention, but as their financial value is more difficult to estimate, many studies excluded these benefits from their estimates, and used them to describe the additional impacts of each intervention above and beyond its strict return on investment.

As an example, the evaluation of a programme to help prevent falls through home assessment and modification found that every £1 invested in the programme resulted in savings of £3.17 (£2.51 when adjusted for inflation and applied across England). These savings were estimated based purely on costs to the public sector resulting from falls which were averted through preventative measures. However, the evaluation also calculated that each pound invested in the programme would result in £7.34 in wider societal return on investment, above and beyond the strict financial savings estimated.

In addition, some studies excluded from their SROI estimates concrete savings which would accrue to individuals and agencies, but that would be too difficult to precisely quantify, or that were based on the aversion of acute crises that would be too unpredictable to estimate the frequency of in a given time period. For example, the evaluation of local area coordination in Leicestershire estimated that over 50 critical incidents had been averted during the implementation of the programme. These incidents would have resulted in considerable cost to individuals and health and care services, but these savings were not included in their SROI figure in order to safeguard the figure’s reliability. This means that in many cases even the purely financial savings are likely to be a significant under-estimate.

Because of wide variations in the detail provided, it was not possible to produce a breakdown of strictly financial and wider societal components of the estimated savings for each intervention individually. However, the overall evidence base from the studies combined was used to estimate that of the £11.1 billion estimated savings from implementing the ten interventions across England, at least £7.6 billion would be realised in the form of concrete costs averted and up to £3.5 billion would take the form of less precisely quantifiable societal benefits. This would mean that around 69 per cent of the savings would relate to direct reduced expenditure for individuals and public sector agencies, at a return on investment of £2.18 in strict financial savings per pound invested, with an additional £0.98 in wider societal value per pound invested. Both of these figures are very likely to be under-estimates of the total direct savings and societal value, and the uncertainty of the evidence base on which they rely means that this breakdown should not be assumed to be uniform across council areas and intervention types.

It should be further noted that the £7.6 billion in concrete costs averted includes savings and reduced expenditure for a range of different organisations, realised over a range of timescales and in a variety of forms. It would not necessarily result in direct and immediate reductions in public sector cash flow. At its heart, this work is about creating ‘value’, not all of which will be defined in purely cashable terms. As above, we have sought to be cautious about the full range of benefits achievable through this analysis. It is therefore quite possible that their value is higher than stated.

While not all of the initiatives included in the PSM have been sustained, and some of the more significant programmes supporting EAAS such as Supporting People were disinvested by previous administrations, councils up and down the country continue to deliver EAAS interventions in different localities, often in collaboration with a range of partners.

These interventions provide the building blocks upon which the shift towards prevention can be achieved.

EAAS interventions in practice

Across the country, councils are working in partnership with people who have reason to draw on care and support and those who provide care for friends and family members, with local VCSE organisations, with providers and with other partners including in the health system, to deliver high quality EAAS interventions.

• Leicestershire: Leicestershire has been working with the Local Area Coordination Network to develop Local Area Coordination (LAC) in parts of the county since 2016. LAC is an evidence-based approach and methodology that helps local people, especially those at risk of exclusion and needing social care, to improve their lives through community-led solutions. Leicestershire Local Area Coordinators (LACs) are employed by the council and based in and alongside communities in 30 distinct areas of the county. They are present and available to be introduced to anyone from anywhere, have no time limits and build trusted relationships helping people identify their strengths and plan positive changes. They work closely with local and statutory services and groups to offer both short and long-term practical support where needed, helping people identify their own sustainable solutions to any challenges that are causing them concern. This involves working closely with the assets of the local community in which the LAC is based, creating wider opportunities for co-production and greater learning from local people and places, too.
• Hartlepool council has introduced a Community Led Support approach as part of work to help people stay closer to home and with a focus on “community hubs”. They are reporting very significant impacts including fewer people needing formal support after a ‘good conversation’ than after traditional assessment and reductions in requests for long-term support from adult social care, occupational therapy waiting lists, and other waiting lists across adult social care.
• York’s “Community Operating Model” focuses on early intervention, prevention, and asset-based community development and aligns various initiatives including Local Area Co-ordination (LAC), Social Prescribing, Community Health Champions, and neighbourhood action grants, all aiming to empower people and communities, reducing service demands. Internal City of York research estimates their LAC work supported £6.8 million of costs prevented in 2023 (£4.9 million of which would have been attributable to adult social care). With over 6,500 people helped through LAC since 2016, York’s approach continues to promote choice, control, and active citizenship, fostering healthy, interdependent lives connected to community resources.
• In Buckinghamshire, charity support provider Macintyre is working with provision supporting disabled young people as they move beyond school and into adulthood. Groups of people who more often than not fall through the gap at best and at worst find themselves many miles from people and places that are important to them. This provision avoids large costs of external placements and by setting young people off well in their adult lives has a long-term preventive effect
• In Lambeth, the council is collaborating with support provider Certitude focussed on early intervention, prevention and reablement - largely in relation to mental health and with peer support a significant part of the offer.
• Sheffield is one council working with the charity KeyRing, using Individual Service Funds to deliver a network (Living Support Network) approach to supporting people with learning disabilities. Each Living Support Network aims to stimulate mutual support by members and a volunteer helps each member to realise their full potential by using their talents to the full. Evidence has shown that the networks are cost effective, substituting for more expensive services and reducing calls on others.
• Hertfordshire County Council has successfully adapted their processes and worked with operational teams to ensure that Direct Payments/ Individual Service Funds are a first offer for people, are seen as positive, and support people to use the range of community micro- enterprises in the area - low-cost, flexible care and support for older or disabled people and their families and appropriately paid, highly satisfied new forms of care givers for people who set up and run community micro-enterprises and ventures. These offer value for money for the commissioner: in some areas those enterprises offering care and support at home can be between £4.00- £10.00 per hour cheaper than commissioned care with greater outcomes.

Supported Housing 

Despite the end of ring-fenced funding, local authorities continue to invest in supported housing to help people keep healthy and independent. The LGA published a series of case studies in September 2024 which demonstrate that investment in supported accommodation:

• Enables people to access support which empower them to live fulfilling lives
• Reduces the likelihood of going into hospital, readmission or into residential care
• Releases significant savings to the public purse.

These include:

• Kirklees: A dedicated supported housing service for those leaving prison and being treated for substance misuse. Each client lives in stand-alone property and works one-to-one with housing support officer who offers intensive support alongside treatment for alcohol and drug problems to get clients ready to move into private or social housing.
• Bradford: Local support housing providers run an intermediate support accommodation service for patients being discharged from hospital or frequently attending A&E. The service is available for those who are homeless, at risk of homelessness or with unsuitable accommodation due to the changing health needs. The saving to the NHS is estimated to be up to £47,000 per person.
• Medway: Medway Council and its providers have put in place a range of support for people experiencing or at risk of homelessness. This includes a specialist homelessness mental health nurse employed to work with Medway’s supported housing providers, providing direct help while waiting for access core NHS services. The scheme helped 151 people with complex needs access employment or training over just 9 months.
• North Somerset: A new respite service for people with learning disabilities and mental health problems has been established. A two-bedded flat has been made available for families needing a break. The accommodation is staffed 24/7 with residents supported with daily tasks, such as shopping, personal care and going out.
• West Midlands: St Basils housing association provides supported housing services for seven councils across the West Midlands. The scheme offers young people employment and mental health coaching while in supported housing. The young people reported that the support provides them with “a sense of achievement, motivation, enthusiasm and confidence”.

Innovation on EAAS

In addition to the EAAS activity led by councils and/or local partners, programmes such as the Accelerating Reform Fund, are driving innovation in EAAS. Continuing to foster innovation in EAAS and building on the evidence which emerges from these programmes will also be vital in progressing this agenda.

Taken together, these examples demonstrate the strong partnership working between people who have reason to draw on care and support, providers, commissioners and planners to deliver change, despite the existing strains on capacity and budgets.

They also provide a bedrock upon which future pathfinders on EAAS could be built, offering an existing pool of expertise and experience from which others can draw. In the next section we explore the action needed to accelerate the spread of this work.

The PSM demonstrates the value of shifting from treatment to prevention. It demonstrates that not only do EAAS interventions enable more people to live the lives they want in places that they call home, and in communities that work for them, they also have the potential to deliver savings to the public purse. The action we are calling for therefore improves people’s lives by giving practical meaning to the Government’s health mission. This is mutually reinforcing work; a win-win.

Achieving that shift requires our whole health and care system to lean into the full breadth of potential preventative opportunities, using all of the levers held by councils, and by their local partners including people drawing on care and support, hold. In this way, this shift is part of wider public service reform, described by Demos and others, in which we move from transactional to relational public services to help create the “conditions for flourishing and resilience with communities”.

Proper investment in, and commitment to, EAAS could therefore act as a testbed for broader changes to the way public services operate and interact.

We already have the expertise and infrastructure we need to drive forward an expansion of EAAS in communities across the organisations who have partnered to produce this paper. The legal basis for this activity is already enshrined in the Care Act 2014 and there is strong practical guidance through, for instance, Think Local Act Personal’s tools on Making It Real, Social Care Future’s communities of practice, and the Social Care Institute for Excellence’s guides and toolkits. However without long-term funding support to give statutory bodies the headroom needed to invest up front, we will not achieve the shift needed to help improve people’s lives or realise the savings possible.

As we have set out, funding this work must be recognised as an investment, not a cost. While it may take time to build toward investment of £3.5 billion, and while all councils and their partners need to build on their foundations to deliver on the preventative shift, there are things that can be done. We propose:

• New Government funding for a programme of ‘EAAS Pathfinders’. It’s allocation and distribution should be processes agreed between Government, councils, people who draw on care and support, providers, and other partners across the NHS and voluntary sector, to build upon existing good practice and learning from innovation programmes.
• Work with councils and their partners, including people who draw on care and support, to develop accompanying, fair and robust outcome measures to demonstrate the impact of investment. To create outcome measures that are meaningful for people as well as professionals and organisations, Think Local Act Personal’s ‘Making it Real’ I/We statements, and the Social Care Future vision should be used as a springboard to discussions.
• In line with the Hewitt Review’s recommendation, work with councils and their partners – including people who draw on care and support – to develop a more consistent, pan-government approach to cost-benefit analysis, so that future activity is assessed in a consistent way.
• Provide new funding for independent evaluations of existing council services and support that are focussed on prevention. Councils do not have the funding or time to undertake such evaluations, the results of which would be available more quickly than learning from the pilots.
• Review how supported housing is funded, considering a specific housing support fund in recognition of the need for both capital investment alongside revenue for supported housing to enable long term investments to be made by councils and savings to be made across the public sector – and in the short term, an extension of the Supported Housing Improvement Programme for at least another year.
• Adopt recommendations in the recent Workforce Strategy, led by Skills for Care and developed with the wider sector, that support prevention. These include actions to attract, retain and develop registered nurses, social workers and occupational therapists, support delegated healthcare activities and Integrated Care System workforce planning, develop Directors of Adult Social Services and attract more care workers in coastal and rural areas.

Methodology for the PSM

In order to achieve this, the LGA reviewed an extensive range of intervention case studies that had provided a net cost benefit in at least some cases. Each case study was based on an economic evaluation of a preventative activity relevant to adult social care taking place in one or more English local councils. Nevertheless, the cost benefits delivered by the interventions were not necessarily specific to the local government sector, also resulting in savings to the NHS, other public sector bodies and voluntary organisations and charities.

These studies were identified by a literature review examining, among other sources, the compendium of social care evaluation studies in the Economics of Social Care Compendium (ESSENCE) continuation study, provided by the National Institute for Health Research (NIHR) and the Care Policy and Evaluation Centre (CPEC) of the London School of Economics and Political Science (LSE). These studies were conducted by reputable organisations including government departments, universities, the Social Care Institute for Excellence (SCIE) and accredited market research agencies.

The literature review identified 23 interventions matching the criteria above which had publicly available evaluation studies including social return on investment (SROI) estimates; in some cases, multiple interventions were evaluated within the same study. The LGA conducted a detailed examination of the evidence bases for these evaluations, and identified 10 interventions for which especially robust evidence of positive SROI through preventative measures in adult social care was available. These interventions were piloted across a wide range of English councils and over a time period from 2009 to 2019, demonstrating their wide applicability across space and time, and delivered a return on investment of between £2.20 and £7.78 per £1 invested in them.

The 10 selected interventions were incorporated into the prevention spending model (PSM) by obtaining the reported costs invested and value realised from each study. These figures were adjusted for inflation to produce figures equivalent to what the costs and value gained would have been had the intervention taken place in 2024. For the 2009 Supporting People intervention, which took place across the United Kingdom, the figures were down-weighted to provide estimates for England alone, using relative expenditure on social care between England and the other countries of the United Kingdom to determine the weighting values.

For the other nine interventions, which were piloted by one or a small number of councils, each non-participating English single tier or county council was assigned a weighting score based on the number of adults in the area accessing long-term support, and how that number compared to the equivalent number for the council(s) where the intervention was being piloted. This weighting was applied to the inflation-adjusted cost and value figures to estimate the approximate costs and benefits that could have been realised had the intervention in question been implemented in each local authority in 2024. By necessity, this assumes that similar cost to value ratios would be realised across England to those realised in practice in the pilot authorities; for this reason, the costs and value reported in each study were carefully scrutinised, and studies were excluded where they were found to be based on an insufficient evidence based, or claimed to demonstrate anomalously high ratios of value delivered per pound invested.

Some interventions were excluded from the model because they were found to deliver a value of less than one pound per pound invested, and therefore did not seem to achieve a positive return on investment. To exclude studies on this basis would not always be valid: if they concerned a similar kind of activity to studies that were included in the model, but were excluded simply on the basis of their low SROI figures, this would be an example of selection bias, and would mask the possibility of the activities included in the model failing to achieve a significant return on investment. Nevertheless, the exclusion of the interventions in question was valid, as they concerned forms of support qualitatively different from those included in the model, and the model as a whole simply does not recommend supporting those forms of support which proved not to deliver a sufficient SROI to justify the costs of the interventions in question. Instead, the model restricts itself to recommending those forms of intervention which delivered savings above and beyond the costs required to implement them.

Intervention case studies

The following sections provide a summary of each individual intervention and its evaluation.

Supporting People

The Supporting People programme provided strategically planned housing-related services to vulnerable people, with the goal of providing a stable environment to enable independent living. Recipients included both those with longer term support needs, such as older people, and some who were able to return to relative independence after a short-term intervention.

The programme was launched in April 2003, aiming to generate savings elsewhere in the public sector by reducing recipients’ future support needs through crisis and acute care arrangements. It was rolled out nationwide across the United Kingdom, unlike most of the rest of the studies featured in the prevention model, which tended to be restricted to one or a small number of council areas.

The research and evaluation report were prepared by Capgemini on behalf of the then Department for Communities and Local Government (DCLG), now the Ministry for Housing, Communities and Local Government (MHCLG), in January 2008. This was based on workshops with groups of Supporting People lead officers and a desk-based investigation of available data on the impact of the programme. The total cost of Supporting People packages was compared to that of the likely alternatives if Supporting People were not available, and the impact that Supporting People and its alternatives would have in reducing adverse outcomes among client groups.

The research found that Supporting People required an investment of £1.55 billion and avoided an alternative expenditure £4.32 billion, thus delivering net savings of £2.77 billion at a SROI rate of £2.79 saved per pound invested.

Table two shows a breakdown of costs and value per annum, adjusted for inflation and down-weighted to apply to England only, by the type of clients supported. This demonstrates that the overall SROI varies substantially between client groups, ranging from £1.04 per pound invested among homeless families in settled accommodation up to £5.42 per pound invested among older people in highly sheltered accommodation. It is likely that SROI would also vary between different council areas due to their differing needs and circumstances, although the available evidence suggests a consistently positive return on investment.

Table two: Breakdown of estimated costs and savings from a nationwide reimplementation of the Supporting People programme by client group.

Gloucestershire Active Together

Gloucester County Council’s Active Together programme aimed to encourage participation in sports and physical activity, and involved a range of community groups, including among others sports clubs, scout groups, parish and town councils, and schools. The county council received applications for funding, which it provided for purposes such as the purchase of sports equipment, the refurbishment of sports facilities, the improvement of green spaces, and the facilitation of social activities in a physical activity setting.

The evaluation was conducted by a team led by Dr Colin Baker of the University of Gloucestershire. The university was commissioned by Public Health Gloucestershire in September 2014 to evaluate the Social Return on Investment of the programme, and employed a mixed methods approach to do so.

The evaluation found that every pound invested in Active Together returned £7.25 to society across the outcome areas of community connections and resources, education and skills, and health and well-being. Health and well-being accounted for around two-thirds of the societal return of the programme. Adjusting the figures quoted in the study for inflation, and scaling them up to cover all English social care authorities, suggested that were this programme implemented across the country today, an investment of £334 million would result in achieving benefits and value of approximately £2.6 billion, a return on investment of £7.78 per pound invested.

Going the Extra Mile, Gloucestershire

Going the Extra Mile (GEM) was a partnership project that aimed to help people into employment through training, work experience and volunteering, and personal action and development plans. The programme operated in Gloucestershire between 2016 and 2022, and was funded by the National Lottery Community Fund and the European Social Fund.

This evaluation was also conducted between 2017 and 2019 by a team of academics from the University of Gloucestershire, led by Professor Paul Courtney. It was based on a qualitative inclusive inquiry of stakeholder and participant experiences, and a process evaluation followed by an outcomes survey, and the SROI model also incorporated the results of previous analyses of outcomes data.

The study found that the programme had a SROI of £2.39 of value provided per pound invested. Adjusting the figures provided by inflation, and scaling them up to represent all English authorities, suggests that on a national scale, an investment of £465 million would result in a value of £1.1 billion delivered at a SROI of £2.37 per pound invested.

Partnerships for Older People Projects

The Partnerships for Older People Projects (POPP) aimed to promote the health, well-being and independence of older people and to prevent or delay their need for higher intensity or institutional care. This was a pilot programme with 29 councils participating between May 2005 and March 2009, working in partnership with health and voluntary sector stakeholders. A total of 522 organisations participated in the initiative. The projects supported ranged from projects such as lunch clubs to formal preventative initiatives, such as hospital discharge and rapid response services.

The initiative’s impact was measured by the Personal Social Services Research Unit, a collaboration between the University of Kent, London School of Economics, and the University of Manchester, through a team of academics led by Dr Karen Windle. It found that an expenditure of £1 on the programme resulted in additional benefits totalling £1.20. Adjusted for inflation and scaled up for the whole of England, this suggests that a total cost of £392.5 million would result in total value delivered of £863.4 million.

Community Champions

Community Champions was a programme which sought to train people in local areas to volunteer at community centres or hubs to assist people in accessing local services, and to motivate them to adopt behaviours to improve their health and wellbeing. This initiative was implemented across a range of locations in the London boroughs of Hammersmith and Fulham, Kensington and Chelsea, and Westminster.

The evaluation of this programme was conducted between October 2017 and May 2018 by Envoy Partnership, a social value and impact management consultancy which found that £5.10 of value was delivered by the programme per pound invested. Scaling the reported figures up to England, and adjusting for inflation, suggests that a total cost of £55.7 million would result in total savings of £281.5 million, at a SROI of £5.06 per pound invested.

Stabilise and Make Safe

Stabilise and Make Safe (SAMS) was a short-term intervention intended to increase a person’s chance of long-term independence following hospitalisation or community referral. This initiative was piloted in Trafford Council in 2017, and its evaluation by the Social Care Institute for Excellence (SCIE) found that it returned £7.78 of value for every pound invested. Adjusting these figures for inflation, and projecting them to cover all of England, suggests that the total costs of a nationwide implementation of this programme would cost around £40.8 million, and deliver around £275.8 million in returned value, at a SROI of £6.76 per pound invested.

Local Area Coordination

Local area coordination (LAC) is an approach to community-based intervention that aims to increase individual and community capacity, and reduced demand for primary and acute services. A ‘strengths-based’ approach, it builds on existing strengths of individuals and communities, recruiting and training local area coordinators to become trusted community figures who can assist people and signpost them to services at an early stage, before their needs become acute.

The local area coordination programme in Leicestershire was evaluated by MEL Research in October 2016. It should be noted that the literature review also uncovered an evaluation of the LAC programme in Derby by the Kingfishers consultancy and assured by Social Value UK in March 2016. Both studies could not be featured in the prevention spending model because they involve the same intervention, which should not be scaled up twice. As a result, the Derby evaluation was excluded from the model, and the Leicestershire version was included instead.

The Leicestershire evaluation found that an investment of £1 resulted in delivered savings of around £4.10 (and a similar SROI was found in the Derby evaluation). Projecting these figures to cover England, and adjusting for inflation, this would mean that a total cost of around £56 million would unlock savings of £229.5 million, at a SROI of £4.11 per pound invested.

Small but Significant

Small but Significant is a handyperson service aiming to enable older people to maintain independence by carrying out small repairs and minor home adaptations. The evidence in this area focused on an evaluation of the Preston Care and Repair Handyperson Service in Lancashire, which was carried out by Care and Repair England in partnership with the Rayne Foundation.

The evaluation found that £4.28 in savings to health and care were delivered per pound spent on the handyperson service. Adjusted for inflation, and applied to the whole of England, we thus estimate that a nationwide programme would cost around £8.3 million and deliver around £44.1 million in savings to other services, at a SROI of £5.31.

Falls Prevention Programmes

Falls are a leading cause of hospitalisation and other health complications among older people. As such, a variety of programmes aiming specifically to prevent falls among this demographic have been initiated by local councils.

In 2018, Public Health England (PHE) carried out an evaluation of a programme for falls prevention through home assessment and modification in the York area. It should be noted that the PHE evaluation also estimated the SROI of three other falls prevention initiatives, but that, since these interventions returned savings of less than £1 per pound invested, these were not incorporated in the prevention spending model or recommended for scaling up nationwide.

Home assessment and modification was found to generate £3.17 in savings per pound invested. Scaling this up to England and adjusting to 2024 levels of inflation, this would involve a total cost of £15 million and deliver savings of £37.6 million, at a SROI of £2.51 per pound invested.

Community-Led Support

Community-Led Support is a set of principles and practices for local authorities to work collaboratively with their staff, partners and communities to improve the interconnected delivery of social care services. This form of support is intended to provide people with quicker access to the right support, to promote independence, resilience and wellbeing, and to enable better use of local resources.

A pilot implementation of community-led support was supported across seven local authorities between June 2016 and November 2017 by the National Development Team for Inclusion (NDTi). The evaluation of this programme was published by the NDTi in December 2017, and found that £2.22 in savings was generated per pound invested in the initiative. This was scaled up and adjusted for inflation to produce an estimated total cost of £2 million to implement the programme nationwide in 2024, resulting in projected savings of £4.5 million, at a SROI of £2.25 per pound invested.

Timescale of benefits delivery

Most of the featured studies did not provide a clear schedule of the time period across which their interventions’ estimated benefits are expected to accrue. However, many studies did estimate the maximum time at which significant benefits would be realised. These timeframes can be thought of as the approximate range over which the estimated savings of each programme are delivered, although it should not be assumed that the rate of realisation of savings will be uniform across the period in question.

Table three shows the maximum timeframes for delivery of savings reported by those studies which provided them. These timeframes ranged from one year to 10 years, with the interventions delivering the biggest savings tending to vary between two and five years. A weighted average of these figures, weighting each study by the relative amount of savings delivered, suggests that the benefits of an intervention would span across just over three years on average.

Table three: Maximum timeframes for realisation of savings.

The model calculated an estimation of the financial savings realised per year, out of the £11.2 million realised if all of the programmes were scaled up nationally. For the interventions which included a timeframe, their total estimated savings were distributed across the period, assuming a normal distribution cut off at the 95 per cent level. This assumes that most of the savings of each intervention would be delivered at the midpoint of its provided time frame, with fewer savings being delivered just after the intervention, as there would not have been enough time for many benefits to be realised, or towards the end of the timeframe, as by this point the benefits of the preventative measures may have started to fade. The Partnerships for Older People Projects was assigned a time frame of seven years, since its evaluation stated that it would take “over five years” to realise the full savings estimated, and seven years would be a reasonable estimate of this. For the two interventions which did not provide any estimate of timescale, Active Together and Stabilise and Make Safe, the weighted average of approximately three years was used for this purpose.

Table four shows how the estimated £11.1 billion of savings could be realised over a ten-year timescale, were the ten interventions to be scaled up for implementation across England. This shows that approximately £3.7 billion would be expected to be saved in the first year after fully implementing the interventions, with a further £5.5 billion saved in the second year, amounting to almost 83 per cent of the total savings delivered in the first two years after implementation. Remaining savings would be incremental and fall sharply over time, from £984 million saved in the third year to just over £8 million saved in the tenth year.

These estimates must be interpreted with caution, as they are based on a range of assumptions and are accompanied by considerable uncertainties. This scenario assumes all ten interventions being implemented concurrently and being completed simultaneously, after which the ten-year timescale would begin. Like the overall estimates, it assumes that the costs and savings would be proportional across all English councils, and also that these savings would take the same timescale to be realised regardless of location. In practice, it would be likely for the rate at which savings are realised to vary considerably between different local areas: places which are at greater risk of the acute care demands which the interventions aim to prevent would be likely to receive savings very quickly, as successful preventative measures remove the need for the expenditure which would otherwise have been required. 

Areas with fewer people in imminent risk of requiring sustained care services, with fewer health problems or younger populations, would take a longer time to fully obtain the savings from these preventative measures. Finally, it should be understood that all of the estimated savings are the result of a single, one-off implementation of the interventions measured, and were these to be operated on a regular or continuous basis, the savings delivered would not slope off over time but would deliver sustained benefits and savings for as long as they were active.

Table four: Estimated timetable for savings delivery over ten years.