Health begins at home - Family Mosaic

Alexandra Czerniewska, lead researcher for the Health Begins at Home study, describes the research behind Family Mosaic’s pledge to save the NHS £3m a year.

Last year, Family Mosaic published a manifesto with a pledge to save the NHS £3m each year. 

It was a back-of-the-envelope calculation but how feasible was it? Could we save that much by reducing the frequency of hospital stays and GP visits for tenants now and in the future? How could we collect evidence that would stand up to scrutiny?

We recruited a 600 strong sample of tenants aged 50+, who agreed to complete a detailed survey at regular intervals over 18 months. Help from the London School of Economics made sure we stuck to the rules of a randomised control trial – the gold standard of research.

Participants were randomly allocated into three equal-sized cohorts.

The first 200 (our control group) receive no extra services and but are assessed at regular intervals.

The remaining 400 are our two treatment groups. They all receive encouragement to access community groups and charities (focussed around healthy lifestyles and tackling isolation). Where appropriate they are referred to Family Mosaic services for debt management, understanding welfare reform, finding employment or improving their IT skills. They also get a home MOT assessment - looking at the suitability of their home and aimed at reducing the risk of falls.

The first cohort of 200 gets this support from housing officers with extra training. The second 200 receive intensive help from a new team of health support workers. If, for example, somebody feels isolated the support worker may suggest a local walking group and accompany them for the first time.

The survey has 81 questions about health, wellbeing, the home, and use of services, using accepted Likert and numerical scales to capture measurable changes in self-reported health.

We’re nine months in, and it will take another nine months to get a full set of repeat data, but our interim report shows what we’ve collected so far:

  • 92% of participants reported at least one long-term health condition
  • a third suffered from depression
  • 40% have back pain and
  • 44% arthritis
  • half of participants told us they felt lonely all or some of the time.

The first 445 people surveyed had made:

  • 1,719 planned GP visits
  • 159 emergency GP visits
  • 1,124 planned hospital appointments
  • 156 visits to A&E and
  • spent 455 nights in hospital.

We have around 6,500 social housing tenants aged over 50. If just half of them use the same resources as our sample, that’s an immediate annual cost to the NHS of £4.7m, not including ambulance use, medical procedures while in hospital, mental health or social care costs.

Put like this, the £3m target starts to look more achievable.

So far the response has been very positive, with health officers showing high interest in the results and considering us as future partners.

A public health commissioner gave me some insight and was impressed with the rigour of the research. As a commissioner, he wants to see when projects are successful in starting to change behaviour. He is particularly interested in what we can show through evidence-based practice - will our handy service (full home MOTs and small odd jobs) have beneficial health outcomes around falls prevention and maintaining independence?

For more information, or copies of the interim report, contact Alexandra Czerniewska.