Can community projects offer a way to affordable care?

A few years ago Jessy would have been stuck in hospital because there was no provision of social care in her area

With health and social care budgets feeling the squeeze, the need to find ways to care for people that are both affordable and effective is one of the country's biggest challenges.

Around the UK many attempts are being made to deliver care in different ways and here are three different approaches to community-based care.

Derby: Local Area Co-ordination

Kathryn Humpston, a local area co-ordinator for Derby City Council, says: "I try to help people help themselves."

One of the people she visits is John, an alcoholic who was in and out of hospital because of his condition. He often spent all his money on alcohol rather than food and Kathryn has to check what is in his larder.

As he only has two tins of beans and some powdered soup in stock, she tops up his supplies, gathered by an informal community food bank operating in the Boulton area of Derby.

Local area co-ordinators were introduced into Derby five years ago, copied from an existing scheme in Western Australia.

The idea is that vulnerable older people could find a lot of the support they need from within their own communities, rather than from council services, their GPs or from hospitals.

Just over half the £500,000 annual costs of the scheme are paid for by the NHS to reduce demand on those services,

The co-ordinators tap into an often hidden network of support from neighbours, friends, family, voluntary groups and churches, who all seem willing to help improve the communities they live in by looking out for people who need help.

"All this costs nothing," says Kathryn.

The 10 co-ordinators working in Derby's inner city have helped about 700 people, all of whom have very complex needs. Only 17 of them have actually gone on to need a taxpayer-funded package of support from social services.

"If those 700 people had just one episode of social care fewer in their lifetime that would be a system saving of some £600,000," explains Mick Burrows of the NHS Southern Derbyshire Clinical Commissioning Group.

Scottish Highlands: Boleskine Community Care

Jessy has nothing but praise for her carer after coming home from hospital following a hip replacement operation.

"I wouldn't be here at all if it wasn't for her. I'd probably be still in hospital waiting to get home," she says.

A few years ago she would have been stuck in hospital because there was no provision of social care in the rural area she lives in, south of Loch Ness.

Boleskine Community Care was set up by the local community, who recognised that their older people were having to move away to get help if family members could not help.

In the Scottish Highlands the NHS, not local councils, is responsible for providing home care

It is run by local women who work for Highland Home Carers, an employee-owned company in Inverness. The carers manage themselves and do their own assessments of old people's needs.

In the Scottish Highlands, spending on health and social care is fully integrated, meaning the NHS, rather than local councils, is responsible for providing care at home.

"The way we're funded helps us to give you what you want and gives you more choices," explains carer Julie Russell. "You can choose how you use your hours."

This is because of the Scottish system of Self Directed Support, or personal budgets. Once a person's needs are assessed, they can decide how their care budget is spent. It can lead to some surprising choices.

"We've cleared snow, chopped firewood, helped in the garden, as well as taken people to the GP and all the usual personal care," says Julie.

Lancashire: Shared Lives

Angela is very clear about why she agreed to live with Gill.

"When I first saw her I thought she was very nice and I liked even more because she had a horse," Angela explains.

Gill, and her partner Pete, became Shared Lives carers for Angela about six years ago. It is a much greater commitment than the usual caring duties.

Gill and Pete share their home with her and also with Adrian, who moved in with them 14 years ago. Both Adrian and Angela have learning disabilities.

Angela and Adrian now live with Gill and her husband as an extended family

"At first I was a bit scared," says Angela. "But I thought I'll meet her and get to know her. I think it's a great idea. It's nice for families to take people like us in."

Angela and Adrian are among almost 400 people, most of them with learning disabilities, who live with their Shared Lives carers across Lancashire.

"It's the best thing I've ever done," says Gill. "We get more out of it than Adrian and Angela probably."

Carers are paid about £400 a week for each person they look after, which is a saving for the local authority compared to the alternative. For people with learning disabilities who are unable to look after themselves, the alternative would be supported living or a residential care home.

Shared Lives Plus, which oversees the Shared Lives schemes around the country, estimates it saves about £25,000 per person per year. The NHS is currently establishing five Shared Lives schemes to cater for people leaving hospital.

It estimates savings of £130m over the next five years by speeding up hospital discharges using the service.

Listen to the full series of Andrew Bomford's reports for BBC Radio 4's PM programme here.