Purpose – This paper seeks to illustrate the social and economic impact of services delivered by a small charity to families affected by post-natal depression (PND). It highlights challenges and offers insights to the meaning of “social value” and “value for money” for commissioners of public health services. This has relevance for the introduction of new policies regarding commissioning. Design/methodology/approach – The analysis is based on a social return on investment (SROI) approach. Evidence was gathered from quantitative data, interviews and a literature review. The analysis examined short-, medium- and long-term effects, and attributed monetary values to social outcomes. Findings – The service provides a return of £6.50 for every £1 invested. The analysis established outcomes for service users and long-term impacts on families and children. It illustrated how these services are important in achieving more appropriate service responses, providing value for money to the NHS. Findings also relate to the definition of “social value” and “value for money”. Research limitations/implications – There is no common accepted method for identifying financial values for a number of the benefits identified in this analysis. By being transparent in how the analysis was carried out, the paper encourages further critical thinking in this area. Practical implications – Engaging commissioners in this type of analysis may assist them in the use of economic evaluation that includes social values as an input to decision making. Originality/value – The paper contributes to the understanding of “social value” and “value for money” in the context of public services. This is of importance given that the Social Value Act and “Open Public Services” reform are being implemented in the UK.
BackgroundNHS England’s Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity.MethodsThe synthesis, an innovative combination of best fit framework synthesis and realist synthesis, will develop a “blueprint” which articulates how and why MCP models work, to inform design of future iterations of the MCP model. A systematic search will be conducted to identify research and practice-derived evidence to achieve a balance that captures the historical legacy of MCP models but focuses on contemporary evidence. Sources will include bibliographic databases including MEDLINE, PreMEDLINE, CINAHL, Embase, HMIC and Cochrane Library; and grey literature sources. The Best Fit synthesis methodology will be combined with a synthesis following realist principles which are particularly suited to exploring what works, when, for whom and in what circumstances.DiscussionThe aim of this synthesis is to provide decision makers in health and social care with a practical evidence base relating to the multispecialty community provider (MCP) model of care.Systematic review registrationPROSPERO CRD42016039552.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0346-x) contains supplementary material, which is available to authorized users.
In the UK, Payment by Results (PbR) is a central element in public service reform. This policy intention is being translated into practice through programmes of varying designs and scale, operating in multiple areas of policy. There are few completed evaluations of these programmesalthough results are starting to emerge -and empirical evidence is lacking. This, combined with the strength of feeling, political imperative and conceptual confusion surrounding PbR, has meant that debate has often been heated and focused on whether or not 'PbR works'. Within this context, this article examines the role of evaluation in approaching PbR. It argues that evaluation's focus should be on explanation (looking within programmes; surfacing and testing their theories) and refinement (using findings to improve programmes; using theories to look across programmes) to advance the debate on PbR from 'for or against?' to 'when, how, for whom and under what circumstances?' The article advocates a Realist approach to this undertaking, setting out an illustrative framework of PbR's mechanisms and hypothesized outcomes for exploration and development.
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