Economic Impact of an Eye Clinic Liaison
Officer (ECLO) on Health and Social Care
Budgets: A Case Study
Introduction
Sight loss adviser services such as Eye Clinic Liaison Officer (ECLO)
services managed by the RNIB group of charities provide emotional and
practical support to over 16,000 patients each year after a diagnosis of
sight loss. This support empowers and informs patients about adapting
to living with sight loss.
This research focussed on a specific ECLO service in Wales, using
Social Return on Investment (SROI) to estimate the financial value of
outcomes attributable to the ECLO service. The framework produced
provides the next step in demonstrating the business case and costeffectiveness of providing early intervention support through the ECLO
service.
Methodology
Social Return on Investment
Social Return on Investment (SROI) is a methodology developed to
evidence and value the outcomes of non-profit activity, comparing it to
the cost to deliver them. By comparing the total value of the outcomes to
the total input value, a 'social return on investment' can be estimated.
Impact is calculated after applying a series of ‘discount factors’ to the
outcomes observed after an intervention. These factors estimate:
 Deadweight: what would've happened anyway if the intervention
hadn't occurred;
 Attribution: how much credit can be claimed for the outcomes
observed;
 Displacement: whether positive outcomes are being displaced from
elsewhere to be delivered in this intervention;
 Drop-Off: how long are the outcomes likely to last.
Study Methodology
Scoping and Identifying Stakeholders
The study focussed primarily on a single ECLO site in Wales. It was
chosen because the ECLO service is full-time and well established in the
eye clinic. Stakeholders for the study were identified in consultation with
the ECLO, and focussed primarily on patients and health professionals
in direct contact with or with knowledge of the ECLO role.
Mapping and Evidencing Outcomes
The main focus of this study was to identify and estimate the real
financial benefits and cost savings of early intervention support by an
ECLO. Therefore only outcomes with direct or clear indirect associations
with further costs to public services were included:







Increased emotional well-being
Increased job retention
Increased independence in own home
Increased welfare income
Reduced likelihood of falling
Increased service uptake
Decreased time spent by health professionals with patients
The evidence gathering took the form of a mixed quantitative and
qualitative methodology. A ten-item questionnaire measuring patientfocussed outcomes was developed. The questionnaire was delivered by
a telephone interview to 96 ECLO clients from across all ECLO services
delivered by RNIB Cymru, selected from those who had agreed to take
part in evaluation. Participants were called between two and three
months after seeing the ECLO. 66 (69 per cent) were successfully
interviewed.
To gather evidence of the impact of the ECLO on the eye clinic and
health professionals, interviews with health professionals were
conducted in one eye clinic in Wales with an established ECLO service.
Respondents were asked what they had observed about the impact of
the ECLO on patients and their own working practices. Five interviews
were successfully completed, three with consultants and two with
nurses.
Valuing Outcomes and Establishing Impact
To establish impact of the ECLO service the outcome valuation involved
reviewing the literature for direct costs e.g. social services for home
independence, reduced mental health services. Wales-specific cost data
was not available on an individual service or treatment basis so in most
cases UK data has been used.
In order to estimate the discount factors free-text additions in the
qualitative interviews conducted were used along with existing ECLO
impact evidence gathered by RNIB.
In keeping with a conservative approach to establishing impact an
additional discount factor of ‘Proxy Fit’ was applied to ensure that the
cost data used does not overestimate the cost savings of the outcome
evidenced.
For a complete methodology and application of the SROI valuation
framework, the full report can be found at
www.rnib.org.uk/economic-impact-eclo
Results
Outcomes
Increased Job Retention
Increased Service Uptake
Inceased Welfare Income
Reduced Fear of Falling
Increased Independence in Home
Increased Emotional Well-Being
3%
34%
44%
11%
59%
59%
Figure 1: Percentage of respondents reporting each outcome
Figure 1 shows the distribution of outcomes reported by the
respondents. The two most frequently reported outcomes were
increased confidence in remaining independent in the home, and
increased emotional well-being, both with 59 per cent (or 38 of 64) of
clients reporting them. Here are some quotes about increased
independence:
“I am more independent in my home as a result of the
information the ECLO has given me and the aids that are
available”
“The support from the ECLO has helped me with my day to
day living.”
Quotes about increased emotional well-being included:
“I have been worrying about my situation and having
someone to talk to helps.”
“[My well-being is improved] because she told me about all
the support that is out there and I could get in touch when I
needed to.”
The third most frequently reported outcome was increased income from
welfare benefits or intention to explore entitlement to welfare benefits. 44
per cent (29 of 66) of clients reported this:
“I now have the higher rate for the disability living
allowance and could get the help of a carer”
“Through talking to the ECLO, I am going to fill in the forms
to apply for attendance allowance.”
The fourth most frequently reported outcome was increased service
uptake or intention to take up services. 34 per cent (22 of 65) of clients
reported this:
“Talking books and papers, also waiting for the benefit
officer to come, to let me know what I am entitled to.”
“I have been in contact with the social services, I now have
someone who comes and chats to me at home.”
The fifth outcome was reduced fear of falling with 11 per cent (7 of 65) of
patients reporting this:
“Talking to the ECLO and the suggestions she made have
made me take more care.”
“I am more aware of the risk of falling from talking to the
ECLO, so I try to be extra careful.”
The least frequently reported outcome was confidence in job retention (2
of 66). However only 6 of the 66 clients were of working age, so only a
maximum of six could have reported this.
The final outcome evidenced from interviews with healthcare
professionals was a reduction in follow-up appointments as a result of
the immediate and on-going support offered to patients by the ECLO:
“I make fewer appointments with patients to return because
I know that the ECLO can support them after they leave the
clinic – nurses are maybe more sensitive to the patients, so
we used to just invite those in need back in three months to
make up for not being able to support them then and there.
Overall, I’d be lost without the ECLO!” (Eye Clinic Nurse)
Outcome Valuations
Table 1 below shows summarises the cost data used as a basis for the
unique savings and costs to health care, social care and DWP budgets
from these outcomes:
Outcome
Increased Home
Independence
Increased Mental
Well-Being
Increased Job
Retention
Increased Welfare
Uptake
Reduced Fear of
Falling
Reduced Follow-Up
Appointments
Cost Data
Local Authority home visits
Source
PSSRU (2013)
NHS for ten sessions of CBT
counselling
Job Seeker’s Allowance
(JSA)
Attendance Allowance,
Disability Living Allowance
and Carer’s Allowance
Estimated cost of falls
PSSRU (2013)
Cost of nurse appointments
DWP (2014)
DWP (2014)
Parrott (2000),
Dolan &Torgerson
(1998)
PSSRU, 2013
Table 1: Overview of cost data for outcome valuations
Applying SROI Discount Factors: Health and Social Care Savings Highlighted
Outcome
Increased
Emotional WellBeing
Increased
Independence in
Home
No. of Outcome Incidence Deadweight Attribution Displacement Incidence
Clients Observed
Estimation Estimation
Estimation
after
Discount
481
59%
284
9%
81%
0%
209
481
59%
284
3%
50%
0%
137
Reduced Fear of
Falling
481
11%
53
17%
50%
0%
22
Increased Welfare
Income
481
44%
212
38%
50%
0%
66
Increased
Service Uptake
481
34%
164
14%
100%
0%
141
Reduced FollowUp
Appointments
Increased Job
Retention
481
25%
120
0%
100%
0%
120
481
3%
14
10%
67%
100%
0
Valuation
Cost of NHS
Counselling
(£910)
12months of
Social Services
Home Visits
(£2,673)
NHS Hip
Fracture Cost
(£27,085)
12months of New
Benefit
(£3,068)
Not Valued*
Cost of Two
Nurse
Appointments
(£67)
12months Job
Seeker’s
Allowance
(£3,765)
*Increased service uptake wasn’t valued independently because of its overlap with increased home independence and
increased welfare income.
Proxy
Fit
50%
70%
3%
100%
N/A
100%
100%
Estimated Savings to Health and Social Care Budget
After applying the discount factors and valuations, the following
estimations were made for the savings resulting from the full-time ECLO
role across a one year period to the health and social care budget.
Because of this time period, no drop-off calculation was made.
Reduced Follow-Up Appointments
Increased Job Retention
Inceased Welfare Income
Reduced Fear of Falling
Increased Independence in Home
Increased Emotional Well-Being
£8,009
£0
£-201,936
£17,840
£257,080
£95,009
Figure 2: Outcome savings to the health and social care budgets
Figure 2 shows the estimated savings to the health and social care
budget as a unique result of the ECLO service for each outcome. To the
health care budget, reducing follow-up appointments is estimated to
save £8,009 in a year, reduced fear of falling is estimated at saving
£17,840 in a year, and increased emotional well-being is estimated at
saving £95,009 in a year.
Only one outcome has direct links to the social care budget, savings in
social services needed to support independence in the home. This was
estimated at £257,080 per year.
This makes a total savings of £377,936 per year.
The other outcome valued links to the welfare budget so is not excluded
from health and social care budget commentary. This outcome is
estimated to increase costs to the welfare budget of £201,936 per year.
From a patient perspective this shows the impact that ECLOs can have
on improving the economic independence by supporting patients to
claim benefits to which they are entitled.
ECLO Costs and Return on Investment Ratios
To calculate the return on investment (ROI) ratio the total net savings
are divided by the total costs. The estimated costs of the ECLO role,
combining the salary and employer’s costs with ECLO training costs,
comes to a first year total of £35,760 (RNIB Cymru, 2014; Subramanian,
Conway & Gillespie-Gallery, 2011). Therefore the savings to health and
social care budgets as a unique result of the ECLO are estimated at
£10.57 for every £1 invested.
Sensitivity Analysis
SROI best practice is to conduct a sensitivity analysis to test reliance on
assumptions and information used. Here the model is re-applied using
first more conservative and second less conservative assumptions.
Enhanced Model
Main Model
Reduced Model
12.73
10.57
6.75
Figure 3: Reduced, Enhanced and Main Model Return on Investment Ratios
A range of modelled ratios is not unusual for a sensitivity analysis. It is a
function of the multiple numerical factors involved in the SROI
methodology. In this case it shows that figures cited in the main model
are reasonable middle estimates of the likely cost savings of the ECLO
role; they are neither the lowest estimations nor the highest possible.
Conclusions
Applying the SROI methodology to one eye clinic, the total net cost
savings created by the ECLO role have been estimated. The modelling
and research have established a number of key findings:
 The valuation of the outcomes in real cost savings to health and
social care spending as a result of the unique effect of the ECLO is
estimated at £377,936 per year;
 When compared to an estimated yearly cost of £35,760, the ECLO
service delivers a real financial return to health and social care
budgets of £10.57 for every £1 invested.
Future Research
The limitations of this research are the small sample size and mixed
data sources. A larger patient sample would provide both more
confidence in the proportion of the patient population who report
outcomes, and give more qualitative evidence from which to draw
stronger estimations of the discount factors. Additionally, all being able
to source Wales specific cost evidence would strengthen the quality of
the valuations used.
However the research stands as a structured and transparent estimation
of the cost savings of the ECLO role. It provides a foundation from which
future research requirements can identified, and a model that can be
added to and improved when higher sample evidence becomes
available.
Author: Phil Sital Singh
Date: July 2014
References
Curtis, L. (2013) Unit Costs of Health and Social Care 2013. Personal
Social Services Research Unit, University of Kent.
Dolan, P. & Torgerson, D. (1998). The Cost of Treating Osteoporotic
Fractures in the United Kingdom Female Population. Osteoporosis
International, 8(6).
DWP (2014) Carer’s Allowance. Retrieved from:
https://www.gov.uk/carers-allowance
DWP (2014) Attendance Allowance. Retrieved from:
https://www.gov.uk/attendance-allowance/what-youll-get
DWP (2014) Disability Living Allowance. Retrieved from:
https://www.gov.uk/dla-disability-living-allowance-benefit/what-youll-get
Parrott, S. (2000) The Economic Cost of Hip Fracture in the UK.
Commissioned by Health Promotion England on behalf of the
Department of Trade and Industry from the Centre for Health
Economics, University of York)
RNIB Cymru (2014). Internal Information.
Subramanian, A., Conway, M. & Gillespie-Gallery, H. (2011) The Role of
Eye Clinic Liaison Officers. Royal National Institute for Blind People:
London.