Transforming adult social care systems? A systematic review of the costs and outcomes of local area coordination in England and Wales

Adult Social Care (ASC) in England faces an ‘existential crisis’, caught between increased demand for services and continued cuts to social care and local government budgets. Increasingly, it is argued that this crisis cannot be solved without reforming our ASC systems and services, with policy shifts in the UK moving towards preventative interventions in order to reduce costs and improve the experience of service users. We currently lack detailed understanding about the effectiveness and the cost of such approaches; this systematic review addresses this gap by examining the potential costs and outcomes for one particular model of prevention, which has international reach, Local Area Coordination (LAC). A total of 14 studies – all single-site evaluations of LAC in England and Wales – were reviewed to understand the existing evidence base of the costs and outcomes of LAC programmes. A narrative synthesis approach found a range of outcomes and costs for individuals, families, communities and systems, reported across the studies. The most commonly reported outcomes were at the level of the individual including improvements in health and wellbeing, increased independence, improved relationships, connections and access to community resources, and improved personal safety, security and stability. Economic impact included cost deferral, avoidance and prevention focused on key areas, including health, housing and finance. Evaluation early in the life of the LACs meant evidence of community and system-level outcomes was more limited. Whilst this review adds to the growing body of work around the value of preventative approaches to health and social care; further research on the longer term impact is needed.