Assessing the Value for Money of Health Trainer Services

The Department of Health National Implementation Team for Health Trainers funded an assessment of the value for money of Health Trainer Services which was completed in March 2010. The review was carried out by Graham Lister PHD, MSc; BSc. Graham is a Fellow of the Judge Business School of Cambridge University, a visiting Professor in Health and Social Care at London South Bank University and an Associate of the National Social Marketing Centre. A Summary of the Report can be found here [pdf] In the absence of long term studies of behaviour and health outcomes, which are not available for health trainers, or many other public health interventions, assessment of value for money must apply reasonable assumptions about the effects of behaviour change based on the available evidence and expert judgements from practitioners. The method Professor Lister has used for assessing value for money was developed in close consultation with experienced Health Trainer Service commissioners and providers, and takes as its starting point an analysis of the objectives of each service and the evidence available on the impact it has had on the people involved. In each case a set of indicators is proposed so that the performance of the health trainers in relation to service objectives can be measured and compared to costs. This provides a framework to assess impact against specific measures of value for money, based on assumptions drawn from the evidence of the impact of behaviour change on both short and longer term outcomes. . These assumptions must be discussed with individual service commissioners so that they can review them and apply local perspectives and values. The method Professor Lister devised, to establish reasonable assumptions upon which to base value for money assessments, is summarized below: The potential health gain and costs savings that can be achieved in each area of behaviour change was estimated from international and national statistics and studies. The impact of 1 to 1 behaviour interventions was assessed by an expert panel drawing on local studies of the extent and persistence of behaviour change. These estimates were then combined with the potential health gain and savings to indicate the expected impact of each successfully completed 1 to 1 behaviour change intervention. Other interventions including signposting, mapping of community facilities and services as well as engagement with local community groups were then valued by comparing the costs and outcomes with broadly similar interventions in primary care. This made it possible to assess the impacts on key stakeholders: the NHS, Local Authorities, and Offender Management Services, clients, communities and health trainers themselves. The estimates were then adjusted to reflect the value of addressing disadvantaged groups by applying a factor derived from the Health England Leading Priorities review ( or alternatively by a locally determined weight) and compared to the cost of providing the service. This provides an estimate of the net cost per equity weighted unit of health gain. This is necessarily a complex process reflecting services which are multifaceted and varied in order to respond to local needs and values, but it can be boiled down to a simple set of assumptions about the effectiveness of health trainer interventions applied to the measures of performance for a local service in order to assess value for money. The values applied can be varied to respond to local circumstances and the outcome can be calculated using a relatively simple ‘ready reckoner’. This method was applied to a set of case studies to test the method and the lessons it can provide about the value for money of Health Trainer Services. It showed that Health Trainer Services can achieve high levels of value for money, measured in this way. The method of assessing value for money is particularly relevant and useful to Health Trainer Services because it recognizes and values time spent engaging with marginalized communities and weights assumptions in order to reflect where clients come from the most disadvantaged and at risk groups. The intention is that the method should be further refined and developed through application by commissioners and providers working together to share the lessons they learn. There is potential not only to inform commissioning by providing value for money assessments, but to identify ways to improve the value for money of health trainers In applying this approach it is important to stress that this is just a tool to help local users explore and understand the value for money of their services and how to improve it. Professor Lister stresses that it should be combined with other methods of assessing health trainers – including qualitative and client, staff and partner feedback. This work is a very encouraging start in addressing value for money as a key challenge for Health Trainer Services and has the potential to be applied to other health promotion services as well.

Health Trainer Services using the Data Collection Reporting Service can do their own assessment of value for money using this tool:

Health Trainer Assessment Tool 3

Professor Lister’s original report is available in full here:

Health Trainer Assessment Report

The Assessment Tool was updated in 2014:

Update to Health Trainer Service Evaluation Tool 3

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