The growing demand for public services makes the efficient use of available resources an increasing imperative. One longstanding issue is the desire to provide the most cost-effective mix of hospital, residential and community-based services. However, despite a range of policy initiatives dating back to the 1960s, there remains considerable variation in the balance of resources invested in different services in different areas, and relatively few tools with which to evaluate the options for improvement. Against this background, the 'balance of care approach' offers a systematic framework for exploring the potential costs and consequences of changes in the provision of community and institutional services, offering the potential to examine service efficiency.
This study took place between 2007 and 2012 and was part of an NIHR funded 5-year programme grant. It focused on the services provided for older people with mental health problems and explored whether certain groups of older adults currently supported in hospitals, care homes or their own homes could be more appropriately and efficiently supported in alternative settings. The approach was innovative in that it involved detailed mirco-level work with practitioners and other key stakeholders and attempted to take account of both relative costs and likely outcomes.
Final Report
Challis, D., Tucker, S., Wilberforce, M., Brand, C., Abendstern, M., Stewart, K., Jasper, R., Harrington, V., Verbeek, H., Jolley, D., Fernandez, J-L, Dunn, G, Knapp, M. and Bowns, I. National trends and local delivery in old age mental health services: Towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes. Programme Grant for Applied Research, 2(4).
Publications
Tucker, S., Brand, C., Wilberforce, M. and Challis, D. (2013). The balance of care approach to health and social care planning: Lessons from a systematic literature review. Health Services Management Research, 26(1), 18-28.
Tucker, S., Brand, C., Wilberforce, M., & Challis, D. (2014). Optimising Health and Social Services for Older People. The Balance of Care Approach to Strategic Planning: A Handbook for Service Planners, Providers and Commissioners. Manchester: PSSRU.
Tucker, S., Brand, C., Wilberforce, M., Abendstern, M. and Challis, D. (2015) Identifying alternatives to old age psychiatry inpatient admission: an application of the balance of care approach to health and social care planning. BMC Health Services Research, 15, 267. https://doi.org/10.1186/s12913-015-0913-1
Tucker S, Hargreaves C, Wilberforce M, Brand C. and Challis D. (2017). What becomes of people admitted to acute old age psychiatry wards? An exploration of factors affecting length of stay, delayed discharge and discharge destination. International Journal of Geriatric Psychiatry, 32(9): 1027-1036.
The study aimed to consider whether the current mix of services between inpatient, nursing and residential homes on the one hand and community services on the other, is appropriate. The study is compared the patterns of service allocation and the feasibility of changing the balance of care using expert panels to undertake an 'in vivo' evaluation of alternative modes of care. The study was funded by Eden Valley Primary Care Trust (2003 to 2005).
Publications
Tucker SE, Hughes J, Scott J, Burns AS, Challis DJ. (2007). Commissioning services for older people with mental health problems: Is there a shared vision? Journal of Integrated Care, 15, 2, 3-12.
Tucker SE, Hughes J, Burns AS, Challis DJ. (2008). The Balance of Care - Reconfiguring Services for Older People with Mental Health Problems. Aging and Mental Health, 12, 1, 81-91.
This study, commissioned by the Department of Health (2000 to 2001), examined the potential effects in changes to income support provided to residents in care homes. The concern was whether this funding would influence the balance of care by making local authorities more or less likely to fund support in care homes rather than care at home. The work involved a balance of care simulation in a number of different local authorities taking account of both managerial front line actors in the decision making process of admissions to care homes.
Final Report
Publication
Clarkson, P., Hughes, J. and Challis, D. (2003) Public funding for residential and nursing home care: projection of the potential impact of proposals to change the residential allowance in services for older people, International Journal of Geriatric Psychiatry, 18, 3, 211-216.
This study was conducted in five local authority areas covered by Pennine Care NHS Foundation Trust and focused on services provided for adults of working age with mental health problems. It involved the collection and analyses of routine service user data, workshops, and economic modelling to identify options for service redesign and improvement. The approach was characterised by high stakeholder involvement - including practitioners, commissioners, providers, service users and carers. This study took place between August 2012 and April 2014. More information can be found on the NIHR SSCR website project page.
Research Summary
Optimising Adult Mental Health Service Configuration across Health and Social Care: Research Summary
Public Engagement
This was critical to the success of the study and the Lay Reference Group contributed to all stages of the research.
Group members commented positively on their participation in the research. One member summarised their experience and agreed for it to be shared.
Pennine Care NHS Foundation Trust Service User and Carer Forum also contributed to the study. A summary provided for the group at the end is here.
Publications
Tucker, S., Hughes, J., Brand, C., Buck, D., and Challis, D. (2015). The quality and implications of Balance of Care studies: lessons from a systematic review. Health Services Management Research, 28, 1-2, 34-45.
Tucker, S., Hughes, J., Jolley, D., Buck, D., Hargreaves, C., and Challis, D. (2018). Reconfiguring in-patient services for adults with mental health problems: changing the balance of care. British Journal of Psychiatry Open, 4, 420-426.