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Social return on investment analysis of an art group for people with dementia
Abstract
Funding bodies require interventions to show value for money before further investment is made. Although cost-effectiveness analysis is widely used in economic evaluation it might not capture the social value generated by certain interventions. Here, we describe Social Return on Investment (SROI) analysis of the Dementia and Imagination study. SROI is similar to cost–benefit analysis in that inputs and outputs are converted into a monetary value; however, SROI also attempts to capture the social value generated. Although SROI has been used in the education and non-profit sectors, it is still relatively unused for the evaluation of health and social care interventions, partly because the valuation of outputs can be subjective.
... The Social Return on Investment (SROI) provides the ideal framework to assess the multidimensional impact that such decisions would have relative to the investment required to put them into practice [20][21][22]. Previous experiences using this method have been used to guide decision-making in multiple healthcare areas such as chronic conditions [23], disability [24], loneliness [25], substance abuse [26], surgery [27], oncology [28,29], cardiology [30,31], nephrology [32], neurology [33][34][35][36], dermatology [37], ageing [38][39][40], or maternity [41][42][43], among others [44][45][46][47][48]. To our knowledge, no other study to date has used the SROI method in HA. ...
Background
Haemophilia A (HA) has been associated with poor health-related quality of life and a large economic burden, accentuated by severity, arthropathy, and inhibitors. To meet global standards of care, the management of HA should align with the principles of care outlined by the World Federation of Haemophilia. The aims of the present study were to establish a set of proposals to improve HA management within the Spanish National Health System (SNHS) and to estimate the impact its hypothetical implementation would generate from a clinical, healthcare, economic, and social perspective.
Methods
A multidisciplinary group of experts agreed on a set of 15 proposals to improve HA management within the SNHS. Thereafter, a forecast-type Social Return on Investment analysis was carried out to estimate the impact of implementing this set of proposals within the SNHS over a one-year timeframe, in relation to the required investment.
Results
This study estimated that the implementation of the complete set of 15 proposals would require a total investment of 2.34 M€ and have a total impact of 14.60 M€. Accordingly, every euro invested in the complete set of 15 proposals would yield a social return of €6.23 (€3.37 in the worst-case scenario and €9.69 in the best-case scenario) of both tangible and intangible nature in similar proportions (45.71 and 54.29%, respectively).
Conclusions
These results can be used to inform policy and practice such that interventions that may potentially improve current public health challenges associated with the management of HA may be implemented.
... The Social Return on Investment (SROI) method provides a framework for a comprehensive evaluation of the social, environmental, and economic impact of interventions relative to the investment required to implement them (20)(21)(22). This method has been widely used to guide decision-making in health care areas such as oncology (23,24), cardiology (25,26), nephrology (27), neurology (28)(29)(30), dermatology (31), ageing (32,33), or maternity (34,35), among others (36,37). To our knowledge, no other study to date has used the SROI method to assess the impact of interventions in rheumatology. ...
Objectives:
To define a set of proposals that would improve the current management of patients with rheumatoid arthritis (RA) within the Spanish National Health System (SNHS), and to estimate the impact of their implementation from a social perspective.
Methods:
A one-year forecast-type Social Return on Investment (SROI) analysis was performed on the basis of information collected from a scientific literature review, official data, and multiple stakeholders regarding RA. A sub-analysis was performed within the areas of diagnosis, early RA (<2 years from diagnosis), and established RA (≥2 years from diagnosis).
Results:
Stakeholders agreed on a set of 22 proposals, which included incorporating specialised nursing, addressing adherence issues, providing psychological support, or promoting the role of patient associations, among others. Their implementation would require an investment of 289 million euros and yield a social return of 913 million euros, i.e. a social return of 3.16 euros per euro invested (2.92 euros in the worst-case scenario and 3.40 euros in the best-case scenario). The greatest social return relative to investment and the greatest attributed to intangible aspects were observed within the area of early RA.
Conclusions:
Evidence-based recommendations for the management of RA are aspirational. Nevertheless, the present study estimated that the implementation of the set of proposals would result in a positive impact relative to the investment needed to implement them. The results may guide management decisions to reduce the burden associated with RA, and help bridge the gap between evidence-based recommendations and routine clinical practice.
... The current SROI method further includes principles and processes typically used in evaluations of economic and financial return on investment [26]. The SROI method has not been applied to the management of MS previously, however, the methodology has been used in the area of neurology [27,28], as well as other areas such as dermatology, cardiology, rheumatology, and oncology within the SNHS [29][30][31][32][33], and other health-related areas in other countries (nephrology [34], old age [35,36], or maternity [37,38], among others [39,40]). ...
Background:
Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients' lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create.
Methods:
A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies.
Results:
The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million € and social return to 272 million €, so each euro invested could yield almost €2 of social return.
Conclusions:
This study could guide health interventions, resulting in money savings for the SNHS and increases in patients' quality of life.
... A SROI analysis has estimated that there is £8.27of social value generated for every pound of investment 34 . Research led by Bangor University on the benefits of arts activities for people living with dementia and their carers, with centres in North Wales, North East England and Derbyshire, will help to establish the SROI 195,196 . ...
This is the second in a series of reports making the economic argument for investing in prevention at different stages of the life course. In our last report we presented the economic argument for investing in Early Years across Wales, in this report we turn to older people. In the final report in this series we will explore the economic argument for investing in work and health in Wales. This independent report was commissioned by Public Health Wales to explore the economic evidence relevant to investment in older people living in Wales. As health economists, we focus on evidence of the costs to the public sector and wider society of economic issues, and evidence of the cost-effectiveness or return on investment [see glossary] of evidence-based interventions to address them. This report brings together robust international and UK evidence on the relative cost-effectiveness and return on investment of devoting public sector resources to programmes and practices supporting older people. Where possible, we have translated evidence of potential savings from these interventions to a current Wales context through currency conversion, inflation and scaling of figures (see rapid review methodology and analysis section below). Our intended audience includes Public Health bodies and other agencies in Wales, England, Scotland and Northern Ireland; the seven Health Boards across Wales; Welsh local government and the third sector, who currently and potentially have a role in supporting and benefiting from older people living across Wales. Scope of report The choice of topics covered in this report came from consultation with our multidisciplinary advisory board, Public Health Wales colleagues, academics working in the field of health and social care relating to older people and our review of policies and practice relevant to older people in Wales. This includes National Institute for Health and Care Excellence [NICE] guidance; Social Care Institute for Excellence [SCIE] resources, and national programmes active in Wales. We consulted with members of Age Alliance Wales and the Cymru Older People's Alliance (COPA) [see glossary] to identify relevant sources of Wales based economic evaluations of services and action for older people. We have been further informed by the views of older people through the consultation of older people living in Wales as part of the Welsh Government review of the Older Peoples Strategy for Wales. We hope this report reflects our social rather than medical view of health and wellbeing in older age. Ageing Well in Wales highlight five priority areas to improve the health and wellbeing of older people in Wales (age friendly communities; dementia supportive communities; falls prevention; loneliness and isolation; and opportunities for learning and employment) 1. In this report we explore the economic case for investing in older people as assets, through appraising the available economic evidence relating to older people (spanning interventions, policies and practice relevant to Wales). Rapid review methodology and analysis Rapid reviews are an efficient method of producing information in a timely manner and are often used by decision makers in health and social care settings 2. Rapid reviews can produce more timely evidence for policy and decision makers compared with traditional systematic reviews. We identified three main areas to focus our searches and synthesis of the economic literature relevant to older people in Wales (loneliness and social isolation; caring for older carers; and preventing falls). We undertook robust rapid reviews of the literature 2006-2017, published in the English language worldwide. The rapid reviews broadly followed the design, methods and processes of the Cochrane Effective Practice and Organisation of Care Group and the Campbell About this report and the approach we have taken 3 and Cochrane Economics Methods Group (CCEMG) 3. Our full search strategies are available in our electronic technical appendix (cheme.bangor.ac.uk). Primary and secondary questions were formed for each review and PubMed, DARE, HTA, Cochrane, and NHS EED databases were searched. Titles, abstracts and full papers were screened separately by two researchers and data was extracted from selected papers. Grey literature was found through hand searching and use of the internet. We included grey literature studies which we felt to be relevant to this report. In order to illustrate the current value of potential investment we have inflated figures throughout the report to reflect the market rates in 2016. Great British Pounds (GBP) from the original data year (pre 2016) have been inflated to 2016 Bank of England rates http://www.bankofengland.co.uk/ education/Pages/resources/inflationtools/calculator/default.aspx) and are marked with a †. Other currencies which are both inflated to 2016 values in local currency and then converted to GBP are marked with † †. The following local currency inflation calculators were used: • Australian Dollars
Objective:
The aim of this study was to reach a consensus on a set of proposals to optimise the disease management of Multiple myeloma (MM) within the Spanish National Health System (SNHS) and to apply the Social Return on Investment (SROI) method to estimate their social impact.
Methods:
A Multidisciplinary Working Team (MWT) including MM main stakeholders was organised. A survey was administered to gather information from patients regarding the impact of MM on different life domains. A forecast-type SROI analysis, with a 1-year timeframe, was applied.
Results:
Fifteen proposals were selected, to optimise MM management, including actions for early diagnosis, psychological support, improvement of information for patients and quick access to palliative care, among others. The implementation of these proposals would benefit patients, their informal caregivers and the SNHS. The investment required would amount to 10.32 million euros with a social return of 43.31 million euros: 4.2 euros for each euro invested. According to the sensitivity analysis, this ratio could range from 3.38 to 5.20 euros from the worst to the best-case scenario.
Conclusions:
The current management of MM could be optimised by implementing a set of proposals that would most likely result in an overall positive social return.
This chapter explores the emergence of ‘arts in dementia care’ as a field of practice. It introduces some of the challenges associated with making performance in care homes and makes a case for creative approaches that are collaborative rather than transformative. Emphasising a relationship between creativity and care, it draws a connection between the ecological turn in applied performance research and the aesthetic potential of a care environment. It explores how ideas of interdependence can shape arts practice in care homes, as well as critically informing our understanding of dementia care as a relational practice.
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