NIHR Balance of Care

The growing demand for public services makes the efficient use of available resources an increasing imperative.  One longstanding issue is the desire to provide the most cost-effective mix of hospital, residential and community-based services.  However, despite a range of policy initiatives dating back to the 1960s, there remains considerable variation in the balance of resources invested in different services in different areas, and relatively few tools with which to evaluate the options for improvement.  Against this background, the 'balance of care approach' offers a systematic framework for exploring the potential costs and consequences of changes in the provision of community and institutional services, offering the potential to examine service efficiency.  This study focused on the services provided for older people with mental health problems and explored whether certain groups of older adults currently supported in hospitals, care homes or their own homes could be more appropriately and efficiently supported in alternative settings.  The approach was innovative in that it involved detailed mirco-level work with practitioners and other key stakeholders and attempted to take account of both relative costs and likely outcomes.

Project Outline

Balance of Care Project Outline

Final Report

Challis, D., Tucker, S., Wilberforce, M., Brand, C., Abendstern, M., Stewart, K., Jasper, R., Harrington, V., Verbeek, H., Jolley, D., Fernandez, J-L, Dunn, G, Knapp, M. and Bowns, I. National trends and local delivery in old age mental health services: Towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes. Programme Grant for Applied Research, 2(4).


Tucker, S., Brand, C., Wilberforce, M. and Challis, D. (2013). The balance of care approach to health and social care planning: Lessons from a systematic literature review. Health Services Management Research, 26(1), 18-28.

Tucker, S., Brand, C., Wilberforce, M., & Challis, D. (2014). Optimising Health and Social Services for Older People. The Balance of Care Approach to Strategic Planning: A Handbook for Service Planners, Providers and Commissioners. Manchester: PSSRU.

Tucker, S., Brand, C., Wilberforce, M., Abendstern, M. and Challis, D. (2015) Identifying alternatives to old age psychiatry inpatient admission: an application of the balance of care approach to health and social care planning.  BMC Health Services Research, 15(1), 1.

PSSRU Project Team

David Challis, Professor of Community Care Research; Mark Wilberforce, Research Fellow; Sue Tucker, Research Fellow; Karen Stewart, Research Fellow; Dr Dave Jolley, Honorary Reader; Dr Michele Abendstern, Research Associate; Dr Christian Brand, Research Associate; Rowan Jasper, Research Assistant and Dr Ian Bowns, Honorary Research Fellow.