Like many forms of community-based or voluntary sector work, we are often challenged to demonstrate our evidence base. The challenge from councils and the NHS to models like Shared Lives, Homeshare and other community or voluntary sector services is roughly, “You may be able to demonstrate what you do is good for people’s health and wellbeing, but why should we invest in it if it can’t demonstrate reduction in hospital bed days?”
One of my continuing frustrations is that we demand from community-based support and preventative interventions, which are usually relatively low cost, a higher level of evidence than we demand of much more expensive formal state services. There are large parts of the NHS, sucking up billions every year, which cannot demonstrate they reduce bed days: in fact, they may be a well-worn staging post on the route to hospital.
Every recent health and care strategy recognises the value of community and voluntary services. That value lies in their distance from hospitals and crisis services and their ability therefore to keep people who don’t need them away from those expensive services and their unavoidable side effects. If those interventions are valuable because they are far away from hospitals in time, distance, and approach, it makes no sense to demand above all else that they demonstrate their impact on those hospitals.
This isn’t to say that we should not ask community providers to demonstrate the evidence of their impact. We have worked with Kent University and the Shared Lives sector to develop an academically-robust outcome measuring tool which is available without charge to every local Shared Lives organisation in the UK. But if we are serious of the value of community approaches, we should recognise that evidence of community impact – increased indicators of heath, wellbeing and resilience – matter. For as long as we continue to measure community services using terms defined by acute and crisis services, we will continue to tie up the lion’s share of limited budgets in buildings which many of us could avoid with a little bit of the right help, in the right place, at the right time.
Escaping the invisible asylum 