Curtis Unit Costs Healthcare Pssru 2011

Unit Costs of Health & Social Care 2011
Compiled by
Lesley Curtis
UnitCostsofHealthandSocialCare2011
CompiledbyLesleyCurtis

UniversityofKent,2011 Publishedby: PersonalSocialServicesResearchUnit CornwallisBuilding TheUniversityofKent Canterbury KentCT27NF Telephone:01227827773 Email:pssru@kent.ac.uk PSSRUwebsite:www.pssru.ac.uk ThePSSRUalsohasbranchesat: LondonSchoolofEconomicsandPoliticalScience DepartmentofSocialPolicyandAdministration HoughtonStreet LondonWC2A2AE Telephone:02079556238 Email:pssru@lse.ac.uk TheUniversityofManchester FacultyofMedicine,DentistryandNursing FirstFloor,DoverStreetBuilding OxfordRoad ManchesterM139PL Telephone:01612755250 Email:pssru@manchester.ac.uk Ifyouwouldlikeadditionalcopiesofthisreport,pleasecontactthePSSRUlibrarianinCanterbury (telephone:01227827773;email:pssru_library@kent.ac.uk). ThisisanindependentreportcommissionedandfundedbythePolicyResearchProgrammeinthe DepartmentofHealthwithasmallamountofadditionalresourcesfromtheDepartmentforEducation fundedChildhoodWellbeingResearchCentre.Theviewsexpressedarenotnecessarilythoseofthe Department. ISSN:1368230X ISBN:9781902671741

Contents
Preface...............................................................................................................................................1
LesleyCurtis
Improvementstoroutinedata...............................................................................................................................3 Acknowledgements................................................................................................................................................5 References..............................................................................................................................................................5
Thecostofextracarehousing............................................................................................................7
TheresiaBumkerandAnnNetten
SharedLivesmodelforcareandsupport.......................................................................................12
JohnDickinson
CalculatingthecostandcapacityimplicationsforlocalauthoritiesimplementingtheLaming (2009)recommendations.................................................................................................................16
LisaHolmes
I.SERVICES.......................................................................................................................................21 1.Servicesforolderpeople......................................................................................................................23
1.1Privatesectornursinghomesforolderpeople..............................................................................................25 1.2Privatesectorresidentialcareforolderpeople.............................................................................................26 1.3Localauthorityresidentialcareforolderpeople...........................................................................................27 1.4Localauthoritydaycareforolderpeople......................................................................................................28 1.5Extracarehousingforolderpeople...............................................................................................................29 1.6Communityrehabilitationunit.......................................................................................................................30 1.7Intermediatecarebasedinresidentialhomes ..............................................................................................31 . 2.Servicesforpeoplewithmentalhealthproblems................................................................................33 2.1NHSreferencecostsformentalhealthservices............................................................................................35 2.2Localauthoritycarehomesforpeoplewithmentalhealthproblems ..........................................................36 . 2.3Privatesectorresidentialcarehomesforpeoplewithmentalhealthproblems..........................................37 2.4Localauthoritysocialservicesdaycareforpeoplewithmentalhealthproblems........................................38 2.5Privatesectordaycareforpeoplewithmentalhealthproblems.................................................................39 2.6Cognitivebehaviourtherapy(CBT)................................................................................................................40 2.7Counsellingservicesinprimarymedicalcare ................................................................................................41 . 2.8Individualplacementandsupport.................................................................................................................42 2.8.1Costcomponents.........................................................................................................................................43 2.8.2Unitcostsperpersonperyear....................................................................................................................43 2.8.3Equivalentcostindaycaredays.................................................................................................................43 2.9DeprivationoflibertysafeguardsinEngland:implementationcosts............................................................44 2.10Mindfulnessbasedcognitivetherapygroupbasedintervention..............................................................45 2.11Interventionsformentalhealthpromotionandmentalillnessprevention................................................46 3.Servicesforpeoplewhomisusedrugsoralcohol.................................................................................51 3.1Residentialrehabilitationforpeoplewhomisusedrugsoralcohol ..............................................................54 . 3.2Inpatientdetoxificationforpeoplewhomisusedrugsoralcohol.................................................................55 3.3Specialistprescribing......................................................................................................................................56
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Unit Costs of Health and Social Care 2011
3.4Alcoholhealthworker,Accident&Emergency..............................................................................................57 4.Servicesforpeoplewithlearningdisabilities.......................................................................................59 4.1Grouphomesforpeoplewithlearningdisabilities........................................................................................61 4.2Fullystaffedlivingsettings.............................................................................................................................62 4.3Semiindependentlivingsettings...................................................................................................................63 4.4Localauthoritydaycareforpeoplewithlearningdisabilities.......................................................................64 5.Servicesforyoungeradultswithphysicalandsensoryimpairments...................................................65 5.1Highdependencycarehomeforyoungeradultswithphysicalandsensoryimpairments...........................67 5.2Residentialhomeforyoungeradultswithphysicalandsensoryimpairments.............................................68 5.3Specialneedsflatsforyoungeradultswithphysicalandsensoryimpairments............................................69 5.4Rehabilitationdaycentreforyoungeradultswithbraininjury.....................................................................70 6.Servicesforchildrenandtheirfamilies................................................................................................71 . 6.1NHSreferencecostsforchildrenshealthservices........................................................................................73 6.2Carehomeforchildrenlocalauthority......................................................................................................74 6.3Carehomeforchildrennonstatutorysector............................................................................................75 6.4Localauthorityfostercareforchildren..........................................................................................................76 6.5SocialservicessupportforChildreninNeed..................................................................................................77 6.5.1Socialservicescostsperchildperweekbyregion.....................................................................................77 6.5.2Socialservicescostsperchildperweekbyneedcategory.........................................................................78 6.5.3Averagecost(perweek)perchildreceivingaservice.............................................................................78 6.5.4Averageamountsspentonchildrenreceivingaservice(perweek) .......................................................78 . 6.6Comparativecostsofprovidingsexuallyabusedchildrenwithindividualandgrouppsychotherapy..........79 6.6.1Grouptherapy.............................................................................................................................................80 6.6.2Individualtherapy .......................................................................................................................................81 . 6.7Keyworkerservicesfordisabledchildrenandtheirfamilies.........................................................................82 6.8Multisystemictherapy(MST)........................................................................................................................83 6.9Multidimensionaltreatmentfostercare........................................................................................................84 6.9.1CostsofeightsocialcareprocessesforMTFC............................................................................................84 6.9.2Processcostsforothertypesofprovisionforyoungpeople......................................................................84 6.10IncredibleYearsparentingprogramme.......................................................................................................85 6.11Shortbreakprovisionfordisabledchildrenandtheirfamilies....................................................................86 7.Hospitalandotherservices ..................................................................................................................89 . 7.1NHSreferencecostsforhospitalservices......................................................................................................91 7.2NHSwheelchairs.............................................................................................................................................92 7.3Localauthorityequipmentandadaptations..................................................................................................93 7.4Trainingcostsofhealthserviceprofessionals................................................................................................94 7.5RapidResponseService..................................................................................................................................95 7.6Hospitalbasedrehabilitationcarescheme....................................................................................................96 7.7ExpertPatientsProgramme...........................................................................................................................97 7.8Reablementservice.......................................................................................................................................98 7.9Publichealthinterventions............................................................................................................................99 8.Carepackages.....................................................................................................................................101 8.1Communitycarepackagesforolderpeople................................................................................................103 8.1.1Communitycarepackageforolderpeople:verylowcost........................................................................103 8.1.2Communitycarepackageforolderpeople:lowcost ...............................................................................104 . 8.1.3Communitycarepackageforolderpeople:mediancost.........................................................................105 8.1.4Communitycarepackageforolderpeople:highcost..............................................................................106 8.1.5Communitycarepackageforolderpeople:veryhighcost ......................................................................107 . 8.2Carepackagesforolderpeople,peoplewithlearningdisabilities,peoplewithmentalhealth problemsandpeoplewithphysicaldisabilities............................................................................................108 8.2.1Carepackagesforolderpeople.................................................................................................................109 8.2.2Carepackagesforpeoplewithlearningdisabilities..................................................................................110 8.2.3Carepackagesforpeoplewithmentalhealthproblems..........................................................................111
8.2.4Carepackagesforpeoplewithphysicaldisabilities..................................................................................112 8.3Thecostofautism........................................................................................................................................113 8.3.1Childrenwithautism(preschool).............................................................................................................114 8.3.2Childrenwithlowfunctioningautism(ages017)..................................................................................115 8.3.3Childrenwithhighfunctioningautism(ages017)..................................................................................116 8.3.4Adultswithautism.....................................................................................................................................117 8.4Servicesforchildrenincare.........................................................................................................................118 8.4.1Childrenincare:lowcostwithnoevidenceofadditionalsupportneeds...........................................119 8.4.2Childrenincare:mediancostchildrenwithemotionalorbehaviouraldifficulties.............................120 8.4.3Childrenincare:highcostchildrenwithemotionalorbehaviouraldifficultiesandoffending behaviour......................................................................................................................................................121 8.4.4Childrenincare:veryhighcostchildrenwithdisabilities,emotionalorbehaviouraldifficulties plusoffendingbehaviour..............................................................................................................................122 8.5YoungadultswithacquiredbraininjuryintheUK.......................................................................................123 8.6Palliativecareforchildrenandyoungpeople..............................................................................................124 8.6.1Shortillnesstrajectory:cancer..................................................................................................................124 8.6.2Longerlifeillnesstrajectories:cardiaccare..............................................................................................125 8.6.3Longerlifeillnesstrajectories:cysticfibrosis............................................................................................126 8.6.4Longerlifeillnesstrajectories:childwithmultipledisabilities.................................................................127
II.COMMUNITYBASEDHEALTHCARESTAFF..................................................................................129 9.Scientificandprofessional..................................................................................................................131
9.1Communityphysiotherapist.........................................................................................................................133 9.2NHScommunityoccupationaltherapist ......................................................................................................134 . 9.3Communityspeechandlanguagetherapist.................................................................................................135 9.4Communitychiropodist/podiatrist...............................................................................................................136 9.5Clinicalpsychologist......................................................................................................................................137 9.6Communitypharmacist................................................................................................................................138 10.Nursesanddoctors...........................................................................................................................139 10.1Communitynurse(includesdistrictnursingsister,districtnurse) ............................................................141 . 10.2Nurse(mentalhealth)................................................................................................................................142 10.3Healthvisitor..............................................................................................................................................143 10.4Nursespecialist(community).....................................................................................................................144 10.5Clinicalsupportworkernursing(community)............................................................................................145 10.6Nurse(GPpractice).....................................................................................................................................146 10.7Nurseadvanced(includesleadspecialist,clinicalnursespecialist,seniorspecialist)...............................147 10.8aGeneralpractitionercostelements.....................................................................................................148 10.8bGeneralpractitionerunitcosts............................................................................................................149 10.8cGeneralpractitionercommentary.......................................................................................................150
III.COMMUNITYBASEDSOCIALCARE............................................................................................151 11.Socialcarestaff.................................................................................................................................153
11.1Socialworkteamleader/seniorpractitioner/seniorsocialworker...........................................................155 11.2Socialworker(adultservices).....................................................................................................................156 11.3Socialworker(childrensservices).............................................................................................................157 11.4Socialworkassistant..................................................................................................................................158 11.5Approvedsocialworker..............................................................................................................................159 11.6Homecareworker......................................................................................................................................160 11.7Communityoccupationaltherapist(localauthority).................................................................................161 11.8Homecaremanager...................................................................................................................................162 11.9Familysupportworker...............................................................................................................................163 12.Healthandsocialcareteams............................................................................................................165 12.1NHScommunitymentalhealthteam(CMHT)forolderpeoplewithmentalhealthproblems.................167
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12.2Communitymentalhealthteamforadultswithmentalhealthproblems................................................168 12.3Crisisresolutionteamforadultswithmentalhealthproblems................................................................169 12.4Assertiveoutreachteamforadultswithmentalhealthproblems............................................................170 12.5Earlyinterventionteamforadultswithmentalhealthproblems.............................................................171 12.6GenericsingledisciplinaryCAMHSteam...................................................................................................172 12.7GenericmultidisciplinaryCAMHSteam....................................................................................................173 12.8DedicatedCAMHSteam.............................................................................................................................174 12.9TargetedCAMHSteam...............................................................................................................................175
IV.HOSPITALBASEDHEALTHCARESTAFF......................................................................................177 13.Scientificandprofessional................................................................................................................179
13.1Hospitalphysiotherapist ............................................................................................................................181 . 13.2Hospitaloccupationaltherapist.................................................................................................................182 13.3Hospitalspeechandlanguagetherapist....................................................................................................183 13.4Dietitian......................................................................................................................................................184 13.5Radiographer..............................................................................................................................................185 13.6Hospitalpharmacist....................................................................................................................................186 13.7Alliedhealthprofessionalsupportworker.................................................................................................187 14.Nurses...............................................................................................................................................189 14.1Nurseteammanager(includeswardmanager,sisterandclinicalmanager)............................................191 14.2Nurseteamleader(includesdeputyward/unitmanager,wardteamleader,seniorstaffnurse)............192 14.3Nurse,dayward(includesstaffnurse,registerednurse,registeredpractitioner)....................................193 14.4Nurse,24hourward(includesstaffnurse,registerednurse,registeredpractitioner).............................194 14.5Clinicalsupportworker(hospital)..............................................................................................................195 15.Doctors..............................................................................................................................................197 15.1Foundationhouseofficer1........................................................................................................................199 15.2Foundationhouseofficer2........................................................................................................................200 15.3Registrargroup...........................................................................................................................................201 15.4Associatespecialist.....................................................................................................................................202 15.5Consultant:medical....................................................................................................................................203 15.6Consultant:surgical....................................................................................................................................204 15.7Consultant:psychiatric...............................................................................................................................205
V.SOURCESOFINFORMATION.......................................................................................................207 16.Inflationindices.................................................................................................................................209
16.1TheBCIShouserebuildingcostindexandtheretailpriceindex...............................................................209 16.2TheHospital&CommunityHealthServices(HCHS)index.........................................................................209 16.3Grossdomesticproduct(GDP)deflatorandthetenderpriceindexforpublicsectorbuildings...............210 16.4ThePSSannualpercentageincreasesforadultservices(allsectors)........................................................210 16.5ThePSSannualpercentageincreasesforadultlocalauthorityservices...................................................211 16.6ThePSSannualpercentageincreasesforadultandchildrensservices(allsectors)................................211 16.7ThePSSannualpercentageincreasesforlocalauthorityadultandchildrensservices............................211 17.NHSStaffEarningEstimates.............................................................................................................212 17.1Basicpayandearningsforunqualifiedandqualifiednurses.....................................................................212 17.2Basicpayforunqualifiedandqualifiedalliedhealthprofessionals(AHPs)...............................................212 17.3Basicpayandearningsformedicalstaffgroups........................................................................................213 18.Glossary.............................................................................................................................................214
19.References ........................................................................................................................................217 . 20.IndexofReferences..........................................................................................................................225 21.Listofusefulsources.........................................................................................................................227 22.Listofitemsfrompreviousvolumesnotincludedinthisvolume....................................................229
Preface
Lesley Curtis
Thisisthelatestinaseriesofvolumeswhichpresentsunitcostsforawiderangeofhealthandsocialcareservicesusinga standardisedmethodologybasedineconomictheory.Eachvolumereflectsourcurrentknowledgeandovertimeweseek torefineandimprovetheestimatesasnewinformationbecomesavailable.Moreover,wealwaysciteoursourcesand assumptionssouserscanadapttheinformationfortheirownpurposes.Since1993,theunitcostsprogrammeandthe annualpublicationoftheUnitCostsofHealthandSocialCarehasbeenfundedbytheDepartmentofHealth.Overthelast twoyearswehavehadadditionalinputsfromtheDepartmentforEducationtoallowinclusionofunitcostsforawider rangeofchildrensservices.
Workoverthepastyearhasfocusedonupdatingmanyoftheprocessesweusetoprovidetheseestimatesandtoensure theyareascloseaspossibletotodaysservicecosts.Wehaveoverhauledthedatabaseswhichunderpinmanyofthe calculations,transferredtomoreflexiblepublicationsoftwareand,ofcourse,redesignedthefrontcover.
Wehaveaddedschemawherenewinformationaboutserviceshasbecomeavailable,commonlythroughtheresearch communitybutalsofromdatacollectedbycentralgovernment.Wehavealsoupdatedsomeoftheroutineaspectsofour unitcostestimationsthosewhichspanseveralschemassuchasNHSTrustoverheadsandtimeusedata(seebelow). Againasinpreviousyears,wehaveexcludedinformationwhichismorethantenyearsoldandwhichwecannolongerbe confidentreflectstodaysservices.Thishastwotypesofimpact.First,whereunitcostshavebeenbasedentirelyona particularresearchprojectandwehavenonewinformationtoupdatetheschema,suchasforsomeofthestaffed accommodationfacilitiesforpeoplewithmentalhealthproblems.Inthesecasestheschemahasbeendeletedfromthis volume.AlistoftheseservicescanbefoundinsectionVandtheseunitcostscanberetrievedfrompreviousvolumes.The secondtypeofimpactiswhereourtenyearruleaffectsjustpartofthecalculation,perhapsthewayprofessionalsspend theirtime.Thisdoesnotaffectourbasicunitcostper(working)hourbutitdoesmeanthatsomeoftheweightedunit costs(perclientcontact,forexample)cannotcurrentlybeestimated.
Manydifferentsourcesofinformationareneededtocreatetheunitcostsinthesevolumes.Whileeveryeffortismadeto reflectcurrentpracticeandtokeepabreastofpolicyandpracticerequirements,thereisalwaysapressingneedfor contemporaryinformation.Inparticular,wewouldliketohearfromreaderswhohaveaccesstoinformationonoccupancy ratesinresidentialanddaycareservices,andinformationonhowprofessionalsusetheirtime.Pleasecontactme,Lesley Curtis,atL.A.Curtis@kent.ac.ukifyouwouldliketodrawourattentiontoforthcomingstudiesorotherinformationwhich mayimproveourestimates.
Beforeweoutlinethechangesandadditionsinthisyearsvolume,wewouldliketotakethisopportunitytoexpressour enormousthankstoProfessorAnnNetten.Annhasguidedtheunitcostvolumesfromtheirinceptionthroughtothe2011 volume.Inthattime,theUnitCostsofHealthandSocialCarehasbecomeaprimesourceofinformationforcentral governmentdepartments,localcommissionersandproviderorganisations,aswellasresearchers.Althoughnolongerthe chairoftheadvisorygroup,Annisstillavaluablesourceofadviceontheunitcostsprogramme,andtakesakeeninterest initsdirection.TheadvisorygroupcontinuestobesupportedbyDepartmentofHealthpersonnelandSCIErepresentatives, aswellassomeoftheforemostacademicsworkinginhealthandsocialcareeconomics.ItwillnowbechairedbyProfessor JenniferBeecham,anexpertadvisoronthegroupsinceitwasformed.
Whats new in the publication this year?

Articles Thisyearwehaveincludedthreearticles.ThefirstisfromTheresiaBumkerandAnnNettenfromthePSSRUatthe UniversityofKent,whichprovidessomeofthefirstinformationonthecostsofextracarehousing.Between2004and 2010,227millionwasmadeavailablebytheDepartmentofHealthtolocalauthoritiesandtheirhousingpartnersto
stimulateprovisionofawidevarietyofinnovativeextracareschemes.Thisarticlepresentsthefindingsfromanevaluation of19newbuildextracarehousingschemeslocatedacrossEngland. ThesecondarticlehasbeenprovidedbyJohnDickinsonfromSharedLivesPlus(formerlyNAAPSUK).SharedLivesPlusis theUKnetworkforSharedLivescarers,homeshareprogrammesandothercommunitybasedmicroenterprises.The articlediscussesthecomplexityoffundingSharedLivesplacements(formerlyknownasAdultPlacements),andpresents informationabouttheircostandqualitybasedonevidenceproducedbytheCareQualityCommission(CQC)and ImprovementandEfficiencySouthEast. InourthirdarticleLisaHolmesfromtheCentreforChildandFamilyResearchatLoughboroughUniversityreportsfindings fromastudycommissionedbytheLocalGovernmentAssociation.Thestudyexploredthecostandthecapacity implicationsforlocalauthoritiesofimplementingLordLamings(2009)recommendationsontheprotectionand safeguardingofchildrenandyoungpeople.Anationalsurveywascompletedby46ofthe152localauthoritiesinEngland, andindepthresearchconductedinnine.Thearticlesummarisesthefindings.Itidentifiesworkersconcernsaswellasthe additionaltimerequirementsandcostsofimplementingsixoftherecommendations. New unit costs Care packages Tworecentdocumentssummarisethegovernmentscommitmenttopersonalisedservices,ShapingtheFutureofCare Together(DepartmentofHealth,2009)setsoutavisionforanewcareandsupportsysteminEngland,andmorerecently BuildingtheNationalCareService(DepartmentofHealth2010a).Bothadvocateanincreasingemphasisonselfdirected careusingDirectPayments,IndividualBudgetsandPersonalBudgets.Consequently,therehasbeengreaterinterestinthe costofcarepackages,andinrecentyearswehavedrawnonseveralstudiestoexpandtherangeofcarepackagesshownin thesevolumes.Forexample,lastyearweextractedinformationfromtwostudies(Knappetal.,2009;Barrettetal.,2010)to showthecarepackagecostsforchildrenwithautism,andastudybyBeechametal.(2009)wasusedtopresent informationonsupportsforyoungadultswithacquiredbraininjury.Thisyear,wehavedrawnonthenationalevaluationof theIndividualBudgetPilotProjects(Glendinningetal.,2008)toextendthissection.Thestudyprovidedinformationonthe packagesofcarereceivedbymorethanathousandserviceusersrepresentingfourclientgroups:olderpeople,peoplewith learningdisabilities,peoplewithmentalhealthproblemsandpeoplewithphysicaldisabilities.Forthestudy,theservice usersneedswerecategorisedascritical,substantialandmoderateandinformationwascollectedonaprespecifiedsetof services;thetypeofaccommodationinwhichtheyusuallylived,thenumberofhoursofhomecareanddaycarereceived eachweekandthesocialsecuritybenefitstheyreceived.Thesecarepackageshavebeensummarisedbyclientgroupand needcategoryandthecostsareprovidedinchapter8. Public health interventions Estimationsoftheeconomicburdenofpreventablediseaseanddisabilityarebecomingincreasinglyfrequentinthehealth sectorintheUK.Inschema7.9,wepresentsummaryinformationfromtworecentreportsonthecostsofsuch interventions(MatrixEvidence&Bazian,2008;NorthWestPublicHealthObservatory,2011).Weselectedinformation fromUKcoststudiestoensurethatthecostswouldreflectservicesavailableintheUKincludinginterventionsthatmay reducelongtermworkplaceabsence,helpmanagehighriskdrinkingandreduceharmcausedbysmoking.
Inschema2.11,wepresentcostsforpublichealthinterventionsthathaveanimpactonmentalhealth.Thesehavebeen drawnfromastudycommissionedbytheDepartmentofHealthwhichpresentsthekeyfindingsfromadetailedanalysisof thecostsandbenefitsoffifteendifferentinterventions(Knappetal.,2011).Thisreportunderpinnedtherecentcross governmentstrategyNoHealthwithoutMentalHealth(DepartmentofHealth,2011.) Mindfulnessbased cognitive therapy Thisyear,wehaveincludedaschema(1.10)providedbyBarbaraBarrettandSarahByfordfromtheCentreforEconomics ofMentalHealth(CEMH)onthecostsofmindfulnessbasedcognitivetherapy.Thisinterventionisamanualized,group basedskillstrainingprogrammedesignedtoenablepatientstolearnskillsthatpreventtherecurrenceofdepression.
Multisystemic therapy Wehavealsoincludedaschema(6.8)providedbyMariaCareyfromtheCentreforEconomicsofMentalHealthonthe costsofmultisystemictherapy(MST).MSTisanintensivefamilyandcommunitybasedtreatmentprogrammethattakesa holisticapproachtoworkingwithchronicandviolentjuvenileoffendersbylookingattheirhomesandfamilies,schoolsand teachers,neighbourhoodsandfriends. Resource panels InlastyearsUnitCostsvolume,weincludedanarticlebyLisaHolmesandSamanthaMcDermidonthecostsofshortbreak provisionandthelinkedsocialcareprocesses.Aspartofthatstudy,butnotreportedinthearticle,thecostsofresource panelsforshortbreakserviceswerealsocalculated.Twoofthethreeparticipatingauthoritiesusedpanelstodecidehow resourcesmaybemostusefullydeployedtosupportfamilies.Thecostsarepresentedinschema6.10.Thisfocusonacare processisadeparturefromourusualfocusonservices,althoughwehaveaddressedthisinsomeofourarticlesinearlier volumes.Itisanareaofunitcostestimationswehopetoextendasmoreinformationbecomesavailable. Palliative care for children FollowingtheGovernments2006manifestocommitmenttoimprovepalliativecare,theSecretaryofStateforHealth commissionedanindependentreviewofchildrenspalliativecareservices(DepartmentofHealth2007).Thisreviewwas basedonfindingsfromawideconsultationwithstakeholdersandincludedresearchcommissionedfromtheYorkHealth EconomicsConsortium(Lowsonetal.,2008).TheYorkresearchprovidedexamplesofillnesstrajectoriesandtheassociated costsforchildrenusingpalliativecare.Asummaryofthisinformation,includingcostsatcurrentprices,canbefoundinthe carepackagesectionofthereport(section8). Deprivation of Liberty Safeguards in England: implementation costs Followingtheprovisionofanadditional10millionforlocalauthoritiesandtheNHStofundtheimplementationof DeprivationofLibertySafeguards,wehaveincludedaschema(2.9)thatidentifiesthecosts.Againaprocessratherthana service,theschemacoverscostsfromtheassessmentstagethroughtoprovisionofcourtprotection.Informationwas drawnfromastudybyShahandcolleagues(2011).
Improvements to routine data

Overheads Inlastyearspublication,wediscussedthedifficultyofestimatingthelevelofoverheadsrequiredtosupportanyonetype ofprofessionalandnotedthattherehasbeenadearthofstudiesthatidentifythesecosts.Lastyear,however,weused datafromtwonewresearchstudiestoimproveestimatesforlocalauthorityoverheads(Selwynetal,2009;Glendinninget al,2010).Inturn,thisincreasedtheunitcostofmanysocialcareservicesbyaround30percent. OverthelastdecadewehavebasedourestimatesforNHSoverheadsonroutinedatareturnstotheDepartmentofHealth andinformationprovidedbyTrustsparticipatingintheReadyReckonerproject(Nettenetal.,1998).However,long standingconcernsaboutthedatawereaddressedthisyearandinformationhasbeendrawnfromtheNHS(England) SummarisedAccounts,20092010toprovidenewestimates(TheNationalAuditOffice,2010).TheSummarisedAccounts collateexpendituredatafromStrategicHealthAuthorities(SHAs),121NHSTrusts(includingNHSDirect)and152Primary CareTrusts(PCTs).GivencurrentandproposedchangestothewaytheNHSisorganisedwehavebasedourcalculationson theNHSTrustaccountsasthesearethebodiesmainlyresponsibleforprovidinghealthandsocialcarestaff.
Inpreviousvolumeswehavemadeadistinctionbetweentwocategoriesofoverheads.Directoverheadscoverthe resourcesrequiredtodeliverservicestousersorpatientsandaredirectlyrelatedtothelevelofserviceactivity.Indirect overheadsincludefunctionsoftheorganisationwhichsupporttheservicesandallowtheorganisationtooperate; exampleswouldbetheHumanResourcesorFinanceDepartments.Unfortunately,theinformationprovidedinthe SummarisedAccountsdoesnotidentifythesecategoriesseparately,andwehaveadaptedourestimationmethodto obtainapercentagefigurethatreflectstherelationshipbetweenalloverheadsanddirectsalarycosts.TheSummarised Accountsshowthenumberofcare(direct)andnoncare(indirect)staffandcostsforthelattergroupwereestimatedusing theaveragesalaryforNHSmanagementandadministrativestaff(www.officialdocuments.gov.uk/document/ hc1011/hc04/0410/0410.pdf).Thecalculationresultedinanadditional19.1percentoncarestaffcoststocover
management,estatesandadministrativestaff.Theremainingoverheadsincludethecoststotheprovider(officecosts, travellingsubsistence,leasedandcontracthire,advertising,transportandmoveableplant,telephonerentalsetc.),supplies andservices(clinicalandgeneral),utilitiesandpremisescosts(water,sewerage,electricityandgas,cleaning,air conditioning)andeducationandtrainingcostsfortheprofessionalstaff.Theseaccountedforanadditional41.6percentof directcarestaffsalarycosts,makingatotalofoverheadsmultiplierfordirectsalarycostsof60.7percent.More informationonNHSaccountingprocedurescanbefoundintheNHSCostingManual(DepartmentofHealth,2010b).
ThisapproachbringsourestimateforNHSoverheadsmoreinlinewiththenewfigureforsocialservices.Ofcourse,itis muchhigherthanthatusedinearliervolumesandhasthereforeraisedtheunitcostsofmanyhealthcareprofessionals. Wehaveusedthisnewfigurewhenupdatingschemastakenfrompreviousvolumesandforsomeofthenewschemas. However,wheremorerecentstudieshavecalculatedoverheadsfromlocaldata,asinthecaseofthereablementstudy, wehaveretainedthesefigures. Qualifications Inlastyearspublication,weincludednewinformationonthecostofobtainingsocialworkqualifications,following researchundertakentocalculatetheestimatedworkinglifeofasocialworkerandthecostofprovidingthesocialwork degree.Thisyear,incollaborationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland (HEFCE),wehavereviewedourestimatesforthequalificationcostsforhealthprofessionalstobringtheminlinewith currentfundingarrangementsandassumptionsaboutthebenefitsforserviceprovidersduringclinicalplacements.Asin previousvolumes,wherenoinformationisavailableonthecostofprovidingplacementstohighereducation establishmentsorserviceproviderswehaveassumedthatthefundingavailablecoversthecost.Moreinformationabout thechangestofundingarrangementsinhealthcareisavailablefromtheDepartmentofHealth(2010c).Futureeditionsof theUnitCostspublicationwillkeepabreastofthesechanges. Time use Formanyprofessionalsweprovideweightedunitcostsalongsidethecostper(working)hour.Thesehavebeenadjustedin linewiththetimeprofessionalsspendundertakingcertaintasks.Forexample,acostperhourofpatientcontactwould includerecognitionoftheothertasksthatarelinkedtocontact,perhapsupdatingcasenotes,orliaisingwithother professionals.Weusemultiplierswhichareappliedtothebasichourlycostderivedfromtimeusestudiesforthedifferent professionalgroups.However,suchstudiesareraresoitisdifficulttoensurethatalltimeisappropriatelyallocated.Our underlyingassumptionisthatallworkingtimerelatesdirectlyorindirectlytopatientcare,unlesswehaveclearevidence otherwise.Thus,forexample,studydays,attendanceatconferences,tradeunionactivitiesandgeneraladministrative tasksareallassumedtobelinkedtopatientcare.
Giventheeconomicclimate,healthprovidersseekthebestskillmixforanyservice.Overtheyears,thishasmeantthat someprofessionals(suchasnurses)havetakenonmoreresponsibility,whichinturnhasmeantthatthebalanceof activitiesundertakenbyotherstaff(suchashealthcareassistants)hasalsochanged.Forexample,arecentstudyfoundthat healthcareassistantsnowcarryouttwiceasmuchdirectpatientcareonthewardsasnurses,andarenowdeemedtobeat theheartofpatientcare(Clover,2010).Inordertoreflectthisintheunitcosts,thisyearwehavereplacedthetimeuse multipliersusedinpreviousvolumeswithfigurescalculatedfrommorerecentstudies. Cost of travel AnothertaskundertakenthisyearwastotrytoimproveourtravelestimatesforbothNHSandlocalauthoritystaff,which havebeendrawnfromaPSSRUstudycarriedoutintheearly1990s(Netten,1992).Wesearchedforstudiesthatwould providesomeguidanceonthenumberofmilescoveredbynursesforhomevisitsanddiscussedtheissuewithmembersof theRoyalCollegeofNursing(RCN).TherewasnorelevantliteratureavailableandtheRCNtoldusthatcostscouldvary considerablydependingonlocality.Weconcludedthatnonationallyapplicablefigurecouldbederivedatthistime. Instead,wehaveincludedtheNHSguidanceontravelcostsintherelevantschemas.Forlocalauthoritystaff,wehavecited theHMRevenueandCustomsmileageratesfor2010/11. Community pharmacy Thisyear,followingtheCommunityPharmacyCostofServiceInquiryundertakenbyPricewaterhouseCoopersand publishedinJuly2011,wehavebeenabletoupdatetheinformationoncommunitypharmacyinschema9.6.
Clinical psychologist Thisyear,wehavebasedthecostofaClinicalPsychologistonahighersalarypoint;AgendaforChangeBand8aratherthan Band7.WehavelearntthatBand7isconsideredtobeatransitiongradetofullspecialistpractitionerstatus.
Acknowledgements
Finally,inputtingthisvolumetogether,therearemanypeopletothankwhohavehelpeddirectlybyprovidingdata, permissiontousematerial,backgroundinformationandadvice.Wewouldalsoliketothankallthosewhohaveemailedor telephonedwithhelpfulinformationaboutnewstudieswhichhashelpedensureweareprovidingthemostuptodate information.GratefulthanksareextendedparticularlytoJenniferBeechamwhohasbeenaninvaluablesourceofsupport inpreparingthisvolume,andtoAmandaBurns,JaneDennettandEdLudlowfortakingchargeofitsdesign.
OtherswhohaveassistedthisyearinsomewayareSueAmbler,BarbaraBarrett,TheresiaBumker,AlistairBuxton,Sarah Byford,AdrianaCastelli,IsabellaCraig,DavidCubey,JohnDickinson,JessicaDunn,WillianFenton,LisaHolmes,Karen Jones,ArminKirthiSingha,MartinKnapp,MatthewLangdon,RossLeach,DavidLloyd,SamanthaMcDermid,AnnNetten andReneeRomeo.AlsothanksareduetoJustineSchneider,NalyniShanmugathasan,DavidStevens,MarianTaylor,Matt Walker,HelenWeatherlyandRaphaelWittenberg.
Asalways,ifyouareawareofothersourcesofinformationwhichcanbeusedtoimproveourestimatesorifyouhaveany othercomments,pleasecontactLesleyCurtison01227827193oremailL.A.Curtis@kent.ac.uk.
References
AuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. Barrett,B.,Byford,S.,Sharac,J.,Hudry,K.,Leadbitter,K.,Temple,K.,Aldred,C.,Slonims,V.,Green,J.&thePACT Consortium(2010)ServiceandWiderSocietalCostsofPreSchoolChildrenwithAutismintheUK,KingsCollege London,UniversityCollegeLondon,UniversityofManchester,NewcastleUniversity,StockportPrimaryCareTrust, GuysHospitalLondon,andthePACTConsortium,UK(notpubliclyavailable). Beecham,J.,Perkins,M.,Snell,T.&Knapp,M.(2009)Treatmentpathsandcostsforyoungadultswithacquiredbraininjury intheUnitedKingdom,BrainInjury,23,1.3038. Clover,B.(2010)Healthcareassistantstakeoverbulkofbedsidecare,NursingTimes.www.nursingtimes.net/specialist news/acutecarenews/healthcareassistantstakeoverbulkofbedsidecare/5016132.article. DepartmentofHealth(2000)TheNHSPlan:APlanforInvestment:APlanforReform,Cm48181,TheStationeryOffice, London. DepartmentofHealth(2006)Ourhealth,ourcare,oursay:anewdirectionforcommunityservices,TheStationeryOffice, London. DepartmentofHealth(2007)PalliativeCareServicesforChildrenandYoungPeopleinEngland,TheStationeryOffice, London. www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_074698.pdf DepartmentofHealth(2009)ShapingthefutureofcaretogetherGreenPaper,TheStationeryOffice,London. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102338 DepartmentofHealth(2010a)Buildingthenationalcareservice,TheStationeryOffice,London. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_114922 DepartmentofHealth(2010b)NHSCostingManual2009/2010,TheStationeryOffice,London. www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_122933.pdf DepartmentofHealth(2010c)LiberatingtheNHS:DevelopingtheHealthcareWorkforce,TheStationeryOffice,London. Office.www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_122933.pdf DepartmentofHealth(2011)Nohealthwithoutmentalhealth,TheStationeryOffice,London. www.dh.gov.uk/en/Aboutus/Features/DH_123998 Emerson,E.Robertson,J.,Gregory,N.,Hatton,C.,Kessissoglou,S.,Hallam,A.,Knapp,M.,Jarbrink,K.&Netten,A.(1999) QualityandCostsofResidentialSupportsforPeoplewithLearningDisabilities:AComparativeAnalysisofQualityand CostsinVillageCommunities,ResidentialCampusesandDispersedHousingSchemes,HesterAdrianResearchCentre, UniversityofManchester,Manchester.
Glendinning,C.,Jones,K.,Baxter,K.,Rabiee,P.,Curtis,L.,Wilde,A.,Arksey,H.&Forder,J.(2010)HomeCareReablement Services:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth, London. Glendinning,C.,Challis,D.,Fernandez,J.,Jacobs,S.,Jones,K.,Knapp,M.,Manthorpe,J.,Moran,N.,Netten,A.,Stevens,M. &Wilberforce,M.(2008)EvaluationoftheIndividualBudgetsPilotProgramme:FinalReport,SocialPolicyResearch Unit,UniversityofYork,York. Knapp,M.,Romeo,R.&Beecham,J.(2009)EconomiccostofAutismintheUK,Autism,13,3,May,317336. Knapp,M.,McDaid,D.&Parsonage,M.(2011)Mentalhealthpromotionandmentalillnessprevention:Theeconomiccase, DepartmentofHealth,London. www2.lse.ac.uk/LSEHealthAndSocialCare/pdf/MHPP%20The%20Economic%20Case.pdf Lowson,K.,Lowson,P.andDuffy,S.(2007)IndependentReviewofPalliativeCareServicesforChildrenandYoungPeople: EconomicStudy,FinalReport,YorkHealthEconomicsConsortium,DepartmentofHealthIndependentReviewTeam, London. MatrixEvidence&Bazian(2008)PrioritisingInvestmentsinPublicHealth,DepartmentofHealth,London. Netten,A.(1992)SomecostimplicationsofCaringforPeople:Interimreport,PSSRUDiscussionPaper809/4,Personal SocialServicesResearchUnit,UniversityofKent,Canterbury. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofAReadyReckonerforStaffCostsintheNHS, Vols1&2,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. Selwyn,J.,Sempik,J.,Thurston,P.,&Wijedasa,D.(2009)AdoptionandtheInteragencyFee,ResearchreportDCSFRR149, HadleyCentreforAdoptionandFostercareStudies,SchoolforPolicyStudies,UniversityofBristol,Bristol. Shah,A.,Pennington,M.,Heginbotham,C.&Donaldson,C.(2011)DeprivationofLibertySafeguardsinEngland: implementationcosts,TheBritishJournalofPsychiatry(2011),199,232238,doi:10.1192/bjp.bp.110.089474. NationalCouncilforPalliativeCare(2010)EndofLifeCareManifesto,www.ncpc.org.uk/site/manifesto
The cost of extra care housing

Theresia Bumker and Ann Netten, Personal Social Services Research Unit
Extracarehousingaimstomeetthehousing,careandsupportneedsofolderpeople,whilehelpingthemtomaintaintheir independenceintheirownprivateselfcontainedaccommodation.Between2004and2010,theDepartmentofHealths ExtraCareHousingFund(ECHF)provided227millioncapitalfundingforlocalauthoritysocialservicesdepartmentsand housingassociations,tostimulateprovisionofinnovativeschemesandencouragepartnershipsinthatprocess (DepartmentforCommunitiesandLocalGovernment,2008;DepartmentofHealth,2003,2005). Althoughthereisnoagreeddefinitionofextracarehousing,LaingandBuisson(2010)suggestthatitcanberecognisedby severalcharacteristics:itisprimarilyforolderpeople;theaccommodationis(almostalways)selfcontained;carecanbe deliveredflexibly,usuallybyateamofstaffbasedonthepremises;supportstaffareavailableonthepremisesfor24hours aday;domesticcareisavailable;communalfacilitiesandservicesareavailable;mealsareusuallyavailable,andchargedfor whentaken;itaimstobeahomeforlife;anditofferssecurityoftenure.Smallerextracareschemestypicallyhave40or moreunitsofaccommodation(Evans,2009a),whileretirementvillages,typicallywithmorethan100units(Croucheretal., 2006;Evans,2009a)provideawiderrangeofsocialandleisureactivitiesandmoreaccommodationforpurchase. Individualsareencouragedtomoveintoretirementvillagesatayoungeragetostimulatethedevelopmentofamixed communityofinterestsandabilities. Extracarehousingisanimportantinnovationthathasconsiderablepotentialtosupportolderpeopleinleadingactive, engagedlives.Factorsencouragingthedevelopmentofextracareschemesincludetheageingofthepopulation,thepolicy endorsementofageinginplace,thedevelopmentofnewlifestylesinlaterlife,andthewiderecognitionoftheneedfor greaterchoiceandflexibilityinhousingoptionsforolderpeople(Evans,2009b;Heywoodetal.,2002).Thegenerallyvery positiveexperiencethatextracareresidentsreport(e.g.Bernardetal.,2007;Callaghanetal.,2009;Croucheretal.,2007; EvansandVallelly,2007)suggestthatthisisindeedapromisingtypeofprovision.However,particularlyinthecurrent financialclimate,thisraisestheissueofcost.Inthisarticlewediscussthecostingofextracarehousingbasedonan evaluationbythePersonalSocialServicesResearchUnit(PSSRU).Overfouryears,theevaluationfollowedthe developmentof19newbuildextracarehousingschemeslocatedacrossEngland,whichreceivedsupportfromthe2004 2006fundingroundsoftheDepartmentofHealthsExtraCareHousingFund(Dartonetal.,2011).
Methodology
Asfaraspossible,ouranalysisadoptedtheeconomicprinciplesofreflectingthelongrunmarginalopportunitycostto societyofextracareprovision.Marginalcostistheadditiontototalcostattributabletotheinclusionofonemore individual.Opportunitycostmeansthattheresourceimplicationsshouldreflectopportunitiesforegoneratherthan amountsexpended,althoughoftenthetwoarethesame.Alongrunapproachisrequiredthattakesintoaccounttheneed tocreatenewserviceswhichareassociatedwith,forexample,theexpansionofservicestorespondtounmetneedsinthe community(Allen&Beecham,1993).However,tradeoffsareinevitablyrequiredbetweenthesetheoreticalprinciplesand thepracticalconstraintsfacinganempiricalstudy.Forexample,whileinterestedincalculatinglongrunmarginal opportunitycosts,itisconventionalforshortrunaveragerevenuecostsplusthecostimplicationsofcapitalandoverheads tobeusedasaproxyvalue(Beecham,1995;Drummondetal.,1987). Ourexaminationofcostsofextracarehousingwasguidedbyseveralcostestimationprincipleswidelyappliedineconomic evaluationsofhealthandsocialcare(e.g.Beecham,1995,2000;Knapp,1993,1995;Netten&Beecham,1993).Most importantly,costsweremeasuredcomprehensivelytoincludeasmanyservicecomponentsaspossible.Thisisa particularlyimportantprincipleforextracarehousingsincethecomplexityoffundingandchargingcanleadtodistorted viewsabouttherelativecostofprovision.Inturn,thiscanleadtoinefficientallocationofresources.Wediscussthe separatecostcomponentsinturn,whichtogetherprovideanestimateoftheunitcostofextracarehousing(perperson perweek). Datafromthe20062011DepartmentofHealthfundedPSSRUevaluationofextracarehousingwereusedintheanalyses. Costinformationwasdrawnfromavarietyofsources,asdescribedinBumker&Netten(2011):

thebidformssubmittedtotheExtraCareHousingFund; developmentcostsandannualfinancialaccountsprovidedbythehousingassociationsincludingsome contractorsbids; selfcompletionquestionnairescirculatedtomanagers,whichcoveredschemecharacteristics,staffingandcharges toresidents; asurveyconductedinmid2007withlocalauthoritiesextracarehousingleads,whichsoughtinformationon workingpartnerships,majorchangestoschemesandimplementationissues; residentinterviewsatadmissionandsixmonths,whichincludedquestionsonindividualshealthandsocialcare serviceuse.
The(opportunity)costofcapitalwascalculatedastheannuitywhichdepletesthelumpsumvalueoverthelifetimeofthe building,commonlyestimatedat60years(Beecham,1995).TheappropriatediscountrateistheonesetbyHMTreasury forpublicservicesintheUKat3.5percent(Netten,2003).Currentmarketvalueswereprovidedbythehousing associationsorobtainedfromtherelevantDistrictValuersOffice.Forthosepropertiesconstructedpre2008,capital valueswereupratedto2008Quarter4pricesusingtheBCISTenderPriceindex(BuildingCostInformationService,2008). Toavoiddoublecounting,itemssuchascapitalfinancinganddepreciationwereremovedfromschemesannualincome andexpenditureaccountswhencalculatingrevenuecosts.Forhealthandsocialcareexpenditure,serviceuseinformation reportedbyresidentswascombinedwithunitcostsforthoseservices(perhour,pervisitetc.).Theintentionwastodraw onlocalsourcesunlesstherewasnoreasontoexpectthesetobedifferentfromnationallyapplicabledata.Unless otherwisestated,nationalunitcostsandinflationindicescamefromCurtis(2008).Informationwascollectedonservices forwhichtheresidentslefttheiraccommodationtoattend,suchasdayactivitycentres,appointmentsatgeneral practitionersurgeries,orhospitalbasedservices.Someprofessionalserviceswereprovidedtoresidentsintheirhomes: personalcare,communitynurse,occupationaltherapist,chiropodistorsocialworkervisitsareexamples.Forservicesthat absorbahighproportionoftotalcosts,moredetailwascollected.Forexample,thedurationofhospitaladmissionwe adoptedwasrecorded.Asfaraspossible,weadoptedabottomupcostingapproach,whichrequiresaclearunderstanding oftheprocessesinvolved,theunitsofactivitytobemeasured,andtheresourcesrequiredfortheactivitiesandprocesses tooccur.Thecostfornonrecipientsofeachservicewaszero.Althoughsomesupportwasprovidedbyfamilymembers andfriends(informalcaregivers),itwasnotfeasibletocollectsufficientlydetailedinformationtoestimatecostsforthese inputs.
Results
Ourcostestimatesarebasedonasampleof465individuals,67intwovillagesand398inthe16smallerschemes.The meanagewas76years,withhalfofrespondentsagedbetween70and85.Abouttwothirdswerefemaleandthemajority ofresidents(77percent)livedaloneatthetimeoftheinterview.Mostpeoplehadpreviouslybeenlivinginordinary housing(63percent),but18percenthadbeenlivinginshelteredorsupportedhousing,and10percenthadbeenlivingin acarehome.Themeanscoreof14.73ontheBarthelIndex(Mahoney&Barthel,1965)illustratesresidentsfunctional abilitytoperformactivitiesofdailyliving(ADLs).Approximately43percentofresidentswerequiteablescoring17ormore (scorescanrangefrom0maximumdisabilityto20minimumdisability).ScoresontheMinimumDataSetCognitive PerformanceScale(MDSCPS;Morrisetal.,1994)indicatethatonly3percentofthosewhomovedintoextracaresuffered frommoderatetoseverecognitiveimpairment,andchallengingbehaviourwasrare.Intermsofresidentsmedical histories,morethan75percentwereassessedashavinganunderlyinglongtermcondition,butonlyonequarterof residentsneededanynursingcare.ThemeanscoreontheCASP19scale(Hydeetal.,2003),forwhichhigherscores indicatedbetterselfreportedqualityoflife,was36(scorescanrangefrom057). Themeancost,at2008prices,oflivinginextracarehousing,wasestimatedat416perresidentperweek,withastandard deviationof180andarangeof175to1,240.Asisusualforcostdata,therewasapositivelyskeweddistributionand themediancostwaslowerthanthemeanof362perweek.Figure1showstheproportionsofcostaccountedforbythe differentelements,andTable1presentsmoredetailontheirdistribution.Mostvariabilitywasobservedintheestimatesof healthcare(mean65,range0634)andsocialcarecosts(mean102,range0612),reflectingvariationintheway individualsuseservices.
ServiceuseandtheaveragecontributiontototalcostsaresummarisedinTable2,aggregatingthecarepackage informationforeachstudymember.Thefiguresinthefirstcolumnillustratethevarietyofservicesusedbyextracare residents,spanningsecondaryandprimaryhealthcareservices,aswellassocialcareservicesprovidedbylocalauthority andindependentsectororganisations(e.g.personalcare).ThefinaltwocolumnsofTable2showtherelativecontribution tothetotalcarepackagecostsforthosepeopleusingeachserviceand,inthefinalcolumn,acrossallresidents.Aswould beexpected,accommodationabsorbedahighproportionoftotalcostasresidentsliveinnewschemesbuilttoahigh qualityandspecification.Accommodation,housingmanagementandlivingexpensesaccountedfor60percentoftotal cost.Intermsofnonaccommodationcosts,thelevelofpersonalcareprovisionisnoteworthy:65percentofresidents reportedreceipt,andtheassociatedcostaccountedfor22percentofthetotalcostsofsupportforallresidents(final column).Hospitalbasedservicesalsoplayedamajorrole.Inpatientserviceswereusedbyonly28percentofsample members,butabsorbed17percentofthecostsforthoseadmitted.Similarly,therapyservices,whetherprovidedwithinor outsidethehospital,wereusedbyonly27percentbuttogetheraccountedforjustlessthan6percentofthecostsfor thoseusingtheseservices.Incontrasttothesequiteexpensiveservices,someserviceswereusedbyamuchhigher proportionofresidentsbutmadeasmallercontributiontototalcost;chiropody,nurseandtheGPareexamples.Thistype ofdescriptiveinformationbeginstorevealwherethecostburdenslie.
Conclusion
AmajorcontributionoftheevaluationofextracarehousingbythePSSRUhasbeenagreaterunderstandingofthecostsof thistypeofprovision.However,becauseitisacomplexareatocost,itisimportanttobecautiousintheinterpretationand generalisationofthefindingsreported.Thediversechargingarrangementsacrossschemes,thevariedfunding arrangements,andtheinterplaybetweenwelfarebenefitsandaffordabilityallcontributetothiscomplexity.However,a clearpictureemergesshowingthatnoonesectorwillbothbearthecostsandreapthebenefits.
Table 1: Cost per resident, per week

21.29 52.76 15.90 9.81 4.80 2.85 0.81 102.04 111.81 64.76 106.55 79.95 3.38 415.79 179.10 *Averageacross4schemeswithspecificcostoutlayforactivityprovision
Costcomponent Capital,incl.land Housingmanagement Supportcosts Activitiescost* Socialcare Healthcare Livingexpenses Unitcostperweek No.residents 465 465 465 119 465 465 465 465 Mean 105.67 Std.Dev Min Max
50.93 21.17 2.41 1.41 0.00 0.00 73.80 173.98
157.12 77.67 22.14 3.52 612.00 634.29 81.80 1241.70
10
Figure 1: Distribution of components of costs of extra care housing

16%
ECHcostcomponents
25% Annuitisedcapitalcost Housingmanagementand supportcost Livingexpenseestimate Socialcarecost Healthcarecost
25%
15%
19%
Note:Housingmanagementandsupportincludeorganisingactivitieswherethiswasspecifiedandhousingsupporttasks suchasgeneralcounselling,advice,andassistancewithdomestictasksandcleaning.Housingsupportcostsaccountedfor2 percentofthetotaloverall.
Table 2: Distribution of costs by service

ServicesusedinExtraCareHousing Accommodation Housingmanagement Housingsupportservices Activitiesprovision Livingexpenses Healthservices GPvisitathome GPvisitatGPsurgery Nursevisitathome NursevisitatGPsurgery Chiropody Healthclinicvisit Therapistvisitathome Therapistvisitathospital Hospitalaccident&emergency Hospitaloutpatientservices Hospitalinpatientstay Socialcareservices Daycareservices Socialworker/caremanagervisit Personalcareathome Averagecontributionofservicetototalcost(%) Residentsusing Residentsusing Allresidents eachservice(%) service(%) (%) 100.0 28.7 25.4 100.0 14.0 12.7 100.0 2.7 2.4 25.6 0.8 0.2 100.0 22.3 19.2 52.8 1.5 0.8 58.0 1.7 0.8 51.9 5.2 3.5 30.3 0.4 0.1 63.1 0.7 0.4 5.7 3.6 0.2 19.3 3.7 0.8 7.3 2.0 0.2 0.3 27.0 1.0 48.4 2.9 1.3 27.8 17.0 7.2 11.7 14.2 1.8 45.8 1.6 0.6 65.4 28.0 22.2
References
Allen,C.&Beecham,J.(1993)Costingservices:idealsandrealityinA.Netten&J.Beecham(Eds.),CostingCommunityCare: TheoryandPractice.Aldershot:Ashgate.
11
Bumker,T.&Netten,A.(forthcoming) Bumker,T.,Netten,A.,Darton,R.&Callaghan,L.(2011)EvaluatingExtraCareHousingforolderpeopleinEngland:A comparativecostandoutcomeanalysiswithresidentialcare.JournalofServiceScienceandManagement.Vol.4,No.4 (earlyonlineaccessinDecember). Beecham,J.(1995)Collectingandestimatingcosts.InM.R.J.Knapp(Ed.),TheEconomicEvaluationofMentalHealthCare pp.6182).Aldershot:Arena. Beecham,J.(2000)UnitCostsNotExactlyChild'sPlay.London:DepartmentofHealth,DartingtonSocialResearchUnitand PersonalSocialServicesResearchUnitattheUniversityofKent. Bernard,M.,Bartlam,B.,Sim,J.&Biggs,S.(2007)Housingandcareforolderpeople:lifeinanEnglishpurposebuilt retirementvillage.Ageing&Society,27,555578. BuildingCostInformationService(2008)SurveysofTenderPrices,RoyalInstitutionofCharteredSurveyors,Kingstonupon Thames. Callaghan,L.,Netten,A.& Darton,R.(2009)Thedevelopmentofsocialwellbeinginnewextracarehousingschemes.York:JosephRowntree Foundation. Croucher,K.,Hicks,L.,Bevan,M.&Sanderson,D.(2007)Comparativeevaluationofmodelsofhousingwithcareforlater life.York:JosephRowntreeFoundation. Croucher,K.,Hicks,L.&Jackson,K.(2006)Housingwithcareforlaterlife:Aliteraturereview.York:JosephRowntree Foundation. Curtis,L.(2008)UnitCostsofHealthandSocialCare2008,PersonalSocialServicesResearchUnit,UniversityofKent, Canterbury. Darton,R.,Bumker,T.,Callaghan,L.&Netten,A.(2011)ThePSSRUEvaluationoftheExtraCareHousingInitiative: TechnicalReport.Canterbury:PersonalSocialServicesResearchUnit,UniversityofKent. DepartmentforCommunitiesandLocalGovernment(2008)LifetimeHomes,LifetimeNeighbourhoods.Anationalstrategy forhousinginanageingsociety.London:DepartmentforCommunitiesandLocalGovernment. DepartmentofHealth(2003)Governmentannouncesfundingforextracarehousing,PressRelease2003/0248.London: DepartmentofHealth. DepartmentofHealth.(2005)Independence,wellbeingandchoice:Ourvisionforthefutureofsocialcareforadultsin England.Cm6499.London:TheStationeryOfficefortheDepartmentofHealth. Drummond,M.F.,Stoddart,G.L.&Torrance,G.W.(1987)MethodsfortheEconomicEvaluationofHealthCareProgrammes. OxfordMedicalPublications. Evans,S.(2009a)CommunityandAgeingMaintainingqualityoflifeinhousingwithcaresettings.Bristol:PolicyPress. Evans,S.(2009b)'Thatlotupthereandusdownhere':socialinteractionandasenseofcommunityinamixedtenureUK retirementvillage.AgeingandSociety,29,199216. Evans,S.&Vallelly,S..(2007)Socialwellbeinginextracarehousing.York:JosephRowntreeFoundation. Heywood,F.,Oldman,C.&Means,R.(2002)HousingandHomeinLaterLife.Buckingham:OpenUniversityPress. Hyde,M.,Wiggins,R.D.,Higgs,P.&Blane,D.B.(2003)Ameasureofqualityoflifeinearlyoldage:thetheory,development andpropertiesofaneedssatisfactionmodel(CASP19).AgingandMentalHealth,73,186194. Knapp,M.(1993)TheprinciplesofappliedcostresearchinA.Netten&J.Beecham(Eds.),CostingCommunityCare:Theory andPractice.Aldershot:Ashgate. Knapp,M.(Ed.)(1995)TheEconomicEvaluationofMentalHealth.Aldershot:Arena. Laing&Buisson(2010).ExtraCareHousingUKMarketReport2010,10thedition.London:Laing&Buisson. Mahoney,F.I.,&Barthel,D.W.(1965)Functionalevaluation:theBarthelIndex.MarylandStateMedicalJournal,14,6165. Morris,J.N.,Fries,B.E.,Mehr,D.,Hawes,C.,Phillips,C.,Mor,V.etal.,(1994)MDSCognitivePerformanceScale.Journalof Gerontology:MedicalSciences,49,M174M182. Netten,A.(2003)Newdevelopmentsandchangesinguidanceonthediscountrate,inA.Netten&L.Curtis(eds)UnitCosts ofHealthandSocialCare2003,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. Netten,A.&Beecham,J.(Eds.)(1993)CostingCommunityCare:TheoryandPractice.Aldershot:Ashgate.
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Shared Lives model for care and support

John Dickinson, Head of Shared Lives, Shared Lives Plus (formerly NAAPS UK) The schemes
SharedLivesisaregulatedserviceinwhichafamily,coupleorsinglepersonincludeanotherindividualintheirfamilyand communitylife.Inmanycasesadisabledorolderpersonbecomesapermanentpartofasupportivefamily.Theservice, regulatedbytheCareQualityCommissioninEngland,isdeliveredthroughSharedLivesschemesofwhichthemajorityare runbythelocalauthority(86percent)butwhichareincreasinglybeingrunindependently(14percent).SharedLives carersarecarefullyselectedandtrainedbyregulatedSharedLivesschemes,withthegoalofenablingpeopletobenefit fromahighlypersonalisedservicewhichdependsonachievingagoodmatchbetweentheindividualrequiringsupportand theSharedLivescarerwhowishestosupportthem.AstudycomparingCommissionforSocialCareInspection(nowthe CareQualityCommission)ratingsfoundthat79ofSharedLivesschemesinSouthEastEnglandwereratedexcellentor good,comparedwith69percentofcarehomes.ServiceusersinalloftheSharedLivesschemesintheevaluation identifiedanumberofsuccessfuloutcomes:livingthelifetheywanted;havingchoicesandbeingincontrol;developing confidence,skills,independence;andhavingdifferentexperiences(NAAPS,2010). SharedLivesisprovidedbymostlocalauthoritiesinEnglandandiswellestablishedintheotherUKandsomeEuropean countries.Statisticspublishedin2009showedthat4,000peopleweresupportedbySharedLivesschemes(previously knownasadultplacements),anincreaseof36percenton2008(TheInformationCentre,2010).Traditionallyaservice providedforadultswithlearningdisabilities,currentlymanySharedLivesschemesalsoprovidedaysupportforadultswith arangeofneeds,andinmanycasesdisabledandolderpeoplebecomeapermanentpartofasupportivefamily.Theyare alsoincreasinglybeingusedbyolderpeople,peoplewithmentalhealthproblemsandpeoplewithphysicaldisabilities. Sometimesfostercarerswhohavebeenprovidinglongtermsupporttoadisabledchild,transfertoaSharedLivesscheme inordertocontinuesupportingtheindividual.The2009statisticsshowthatatotalof3,470SharedLivesplacementswere beingrun,ofwhich3,060(88percent)wereforadultswithlearningdisabilities,120(3percent)forpeoplewithphysical disabilitiesand290(8percent)forpeoplewithmentalhealthproblems(TheInformationCentre,2010). Examplesofhowtheschemescanworkarelistedbelow: Theycanprovideaninterimplacementforpeoplewithmentalhealthproblemsrecentlydischargedfromhospital andalsohelppreventreadmission. SharedLivescarerscanprovidesupporttopeoplewithdementiaintheirneighbourhoodenablingthepersonto remainintheirownhome.Theycanalsooffersupporttofamilymemberssothatthepersondoesnothaveto leavetheirfamiliarsurroundings. Theycanprovidesupportforcareleaversandprovideasettinginwhichtheycanlearndailylivingskillsinavery practicalway,inpreparationformovingonintogreaterindependence. Theycansupportparentswithalearningdisabilityandcanhelptoteachparentingskills,whichmayprevent unnecessaryadmissionofachildtocare. Theycanproviderespitetounpaidfamilycarers,anarrangementwhichcanalsohelpwithlongtermsuccession planningforolderfamilycarers. TherearenumberofimportantdistinguishingfactorsthathelpmakeSharedLivesworkforpeople: TherecruitmentandapprovalprocessforSharedLivescarersisthoroughanddoesnotjustlookattheindividual applicant/sbutatthewholefamilyanditsplaceinthelocalcommunity. Arrangementsaresubjecttoacarefulmatchingprocessandplacementagreementswhichensurethatthe individualhasmaximumchoiceandcontrol.Thisisprobablythemostimportantfactorinachievingasuccessful placement. PeopleusingSharedLiveshavetheopportunitytobepartoftheSharedLivescarersfamilyandsocialnetworks. SharedLivescarersusetheirfamilyhomeasaresource. Arrangementsprovidecommittedandconsistentrelationships. TherelationshipbetweentheSharedLivescarerandthepersonplacedwiththemisofmutualbenefit.

13
PeoplelivinginSharedLiveshouseholdsaremoreabletobeactivecitizenscontributingtothelifeoftheirlocal community. SharedLivescarerscansupportnomorethanthreepeopleatanyonetime. SharedLivescarersdonotemploystafftoprovidecaretothepeopleplacedwiththem,butmaygetadditional supportfromtheSharedLivesschemesifrequired.
Funding Shared Lives placements

BecauseSharedLivesisregulatedasacommunityratherthanaresidentialcareservice,itenablesthesupportedpersonto maximisetheirbenefitsandhaveaccesstothefullrangeofbenefits,includinghousingbenefitand,insomecases, SupportingPeoplefunding.Personalcareandsupportneedsarefundedthroughcommunitycarepersonalbudgets,and serviceuserscontributionsareassessedthroughFairerCharging:ameanstesttodeterminetheirabilitytocontribute. Thisapproachtofundingensuresthatthepersonretainsalargeramountoftheirincomethaniftheywereinresidential careandthisincreasestheirchoicesandopportunitiestousetheirmoneyastheywish.Also,asneedschange,iftheyneed assistancewithspecialisedequipmentoradaptationstotheiraccommodation,SharedLivescarersareeligibletobe consideredforadisabledfacilitiesgrant.
PaymentstoSharedLivescarerscomprisethefollowing: Rent,whichispaiddirecttotheSharedLivescarer,usuallyfundedbyhousingbenefit; Foodandutilitiescosts,whichareusuallyanagreedfixedamount,arepaiddirecttothecarerbythepersoninthe arrangement; CareandsupportneedsandmanagementcostsfortheSchemewhicharefundedfromtheCommunityCare budget,andincreasinglyviapersonalbudgets. PaymentlevelstoSharedLivescarersareusuallydecidedaccordingtothelevelofsupporttheSharedLivescarergivesto theserviceuser,ratherthanthehoursworked,witharangeofbandsforratesofpayment.SharedLivescarersreceivea fixedamount,ratherthananhourlyrate.Somereceiveuptofourweekspaidbreaksperyear,andiftheyhaveasupported personlivingwiththemtheyareentitledtorespitecare.In2009,ratesrangedbetween267and653perweekfora longertermplacement(includingboardandrent).Paymentsforshortbreaksvariedbetween159and550perweek. Costsforseparatedaytimeplacementsofserviceusersinlongtermplacementswereusuallymetbythesponsoring authority.PaymentstoSharedLivescarersaretreatedfavourablybyHerMajestysRevenueandCustoms(HMRC),witha fixedallowanceof10,000perannumplus250foreachpersonsupportedeachweekorpartofaweek. AbusinesscaseforSharedLives(NAAPS,2009)estimatedthattodevelopaschemethatcouldsupport85serviceusers wouldrequireaninvestmentof620,000overafiveyearperiod.Basedondatafromthe2009study,overthesameperiod itcouldgeneratenetsavingsof12.99millionbyreducingtheneedforcostlierservices,residentialcareinparticular.It wascalculatedthattheaverageunitcostofaSharedLivesplacementincludingcareandsupport,boardandlodgingand managementcostsis419perweek,withcareandsupportcostsamountingtoameanof293perweek(seeTable1).A flatrateweeklymanagementchargeforalltypesofplacementisincludedinthiscost.
Table 1: Range of weekly payments to Shared Lives carers and management costs
Range (perweek)
Overallaverage carecost(per week) 361
Management charge (perweek) 58
Allinpriceforlongterm placement,including boardandlodging Careandsupportinlong term
Min. 267
Max. 653
Totalaveragecost (perweek) 419
151
430
235
58
293
14
Whenwecomparedthecostperweek,ofsupportingapersoninaSharedLivessettingwiththeunitcostsforresidential careperweek(Curtis,2008)(seeTable2).Thegreatestsavingswereobtainedfromlongtermplacementsforpeoplewith learningdisabilitiesbutitwasestimatedthatsavingsperpersonwouldnotberealiseduntilthesecondyearofoperation.
Table 2: Potential savings

Typeofservice Nationalunitcostperweek 1,059 465 780 602 1,288 SharedLivesunitcostper week(overallmean) 419 419 419 419 293 Potentialsavings: per weekifpersonissupported inSharedLivesratherthan elsewhere 640 46 361 183 995
Learningdisability residentialcare Olderpeopleresidential care Physicaldisability residentialcare Mentalhealthresidential care Learningdisability supportedliving
Potentialsavingswerealsoindicatedbythe2009studyforothertypesofSharedLivesplacements,suchasdaytime supportandfloatingsupport,however,thefinancialdataarelessreliable. The2009study(NAAPS,2010)concludedthattheremaybeaschemesizebelowwhichitisdifficulttodeliverahighquality SharedLivesserviceandachievesuccessfuloutcomesascostspercasetendtobelowerinthelargerschemes.Inthe aforementionedbusinesscaseforSharedLives,alevelof85placementsisassumed.Greaterefficienciescanberealised whentaskssuchasplanninganddeliveringtraining,recruitingandmaintaininganApprovalPanel,ordevelopingquality assurancesystemssupportalargernumberofserviceusers. SharedLivesfitswellwithgovernmentstrategiestoengagemembersoflocalcommunitiesinsupportingthemore vulnerablemembersofsociety.Thiscaremodelisabletodeliverhighqualityoutcomesforpeopleatacompetitiveprice. Aboveall,asaserviceofchoice,itenablespeopletolivethelifetheywant,withahighdegreeofcommunitypresenceand activecitizenship.
Some case studies of people Shared Lives has helped

TonylivesintheNorthEastofEngland.Afterleavingresidentialspecialschoolhespent15yearslivinginaresidentialcare home.Hisrealdesirewastolivewithhisfamilywhichwasnotpossible,butbeingpartofafamilyremainedattheheartof hispersoncentredplan.TonynowliveswithLinda,aSharedLivescarer.HepayshisrentandboardusingHousingBenefit andhisotherbenefitsincome.HiscareandsupportneedsaremetfromhisPersonalBudgetsomeofwhichheretainsasa DirectPayment.HeusesthistopayforextrasupportwhenhegoestowatchNewcastleUnitedplayandwhenhegoeson holiday,bothofwhichhelikestodoseparatelyfromLinda. Jennywaslivinginaresidentialcommunitybutwantedtoliveinherownflatonedaybutwasfrightenedtodothis becauseshedidntknowhowtocook,iron,useawashingmachine,usepublictransportorbudgetandhandlehermoney well.ShemovedinwithMaryandIansothatshecouldlearntheseskills.Shestayedfortwoandahalfyearsandthen movedintoahomeofherownwithcontinuedsupportfromMaryandIan,inmuchthesamewayshewouldhadshea familyofherown.Shereturnstotheirhouseforsomeweekendsandisalwaysincludedinfamilycelebrations.
15
Moraglivesinasmallvillagewithanincreasinglyelderlypopulation.Thenearesttownis15milesawayandtherearevery fewservicesinthearea.OntwodaysaweekMoragtakesthreefrailelderlyladiesintoherhomeandtheyspendtheday chattingandplayingbridge.Theyhaveallbeenfriendsformanyyears,butcantgettoeachothershousesanymore. MeetingatMoragskeepsthemintouchandensurestheydonotbecomeisolatedandlonely.
SharedLivesPlus(formerlyknownasNAAPSUK)istheUKNetworkforsmallcommunityservicesincludingSharedLives, Homeshareandcommunityservices.SharedLivesPlusprovidessupportservicestobothSharedLivesSchemesandto SharedLivesCarersandrepresentsthesectoratanationallevelwithregulatorsandgovernmentdepartmentsandother stakeholdersthroughouttheUK.www.sharedlivesplus.org.uk
References
Curtis,L.(2008)UnitCostsofHealthandSocialCare2008,PersonalSocialServicesResearchUnit,Canterbury. TheInformationCentre(2010)CommunityCareStatistics200809:SocialServicesActivityReport,England,TheInformation Centre,Leeds.http://bit.ly/ePy13M NAAPS(2010)TheSharedLifeofmyChoice,NAAPSUKLtd. www.naaps.org.uk/downloads/The_shared_life_of_my_choice_final.pdf NAAPSandImprovementandEfficiencySouthEast(2009)ABusinessCaseforSharedLives,NAAPSUKLtd. www.communitycatalysts.co.uk/wpcontent/uploads/2011/06/ DerbyCountyCouncilSharedLivesforLocalAuthorities.pdf
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Calculating the cost and capacity implications for local authorities implementing the Laming (2009) recommendations
Lisa Holmes, Centre for Child and Family Research1 Introduction
The'BabyPeter'case,LordLaming'sProgressReport,TheProtectionofChildreninEngland(2009)andthegovernments subsequentactionplan(HMGovernment,2009a)allemphasisedtheimportanceofaccurateandearlyidentificationofthe needsofchildrenandtheirfamiliesandtheimportanceofhighqualityassessmentstoinformplansandserviceresponses. TheCentreforChildandFamilyResearchatLoughboroughUniversitywascommissionedbytheLocalGovernment Association(LGA)toexplorethecostandcapacityimplicationsforchildrenssocialcareofimplementingLordLamings (2009)recommendations(Holmesetal.,2010b).Thepotentialfinancialandcapacityimplicationswereexploredforsixof the58recommendations(numbers11,15,16,19,20and24),withanemphasisonreferralandassessmentprocesses, caseloads,appropriatelevelsofsupervisionandtrainingandsupport.TheresearchwascarriedoutbetweenOctober2009 andFebruary2010andwascommissionedtoprovideunitcostsofkeysocialcareactivitiesandprocessesrelatingtothesix recommendationslistedabove,alongwithcontextualinformationonthewiderissuesthatimpactedonthe implementationoftherecommendations(seeBox1).
Box 1: Laming recommendations

11. TheDepartmentforChildren,SchoolsandFamiliesshouldreviseWorkingTogethertoSafeguardChildrentosetoutclearexpectations
atallpointswhereconcernsaboutachildssafetyarereceived,ensuringintake/dutyteamshavesufficienttrainingandexpertisetotake referralsandthatstaffhaveimmediate,onsitesupportavailablefromanexperiencedsocialworker.Localauthoritiesshouldtake appropriateactiontoimplementthesechanges.

15. TheSocialWorkTaskForceshouldestablishguidelinesonguaranteedsupervisiontimeforsocialworkersthatmayvarydependingon
experience.
16. TheDepartmentforChildren,SchoolsandFamiliesshouldreviseWorkingTogethertoSafeguardChildrentosetouttheelementsof
highqualitysupervisionfocusedoncaseplanning,constructivechallengeandprofessionaldevelopment. 19. TheDepartmentforChildren,SchoolsandFamiliesmuststrengthenWorkingTogethertoSafeguardChildren,andChildrensTrusts musttakeappropriateactiontoensure:

1) 2)
allreferralstochildrensservicesfromotherprofessionalsleadtoaninitialassessment,includingdirectinvolvementwiththechildoryoungpersonand theirfamily,andthedirectengagementwith,andfeedbackto,thereferringprofessional; coregroupmeetings,reviewsandcaseworkdecisionsincludealltheprofessionalsinvolvedwiththechild,particularlypolice,health,youthservicesand educationcolleagues.Recordsmustbekeptwhichmustincludethewrittenviewsofthosewhocannotmakesuchmeetings;andformalproceduresarein placeformanagingaconflictofopinionsbetweenprofessionalsfromdifferentservicesoverthesafetyofachild.
20. Allpolice,probation,adultmentalhealthandadultdrugandalcoholservicesshouldhavewellunderstoodreferralprocesseswhichprioritisethe protectionandwellbeingofchildren.Theseshouldincludeautomaticreferralwheredomesticviolenceordrugoralcoholabusemayputachildatriskof abuseorneglect. 24. TheSocialWorkTaskForceshould:

1) 2) 3) developthebasisforanationalchildrenssocialworkersupplystrategythatwilladdressrecruitmentandretentiondifficulties,tobeimplementedbythe DepartmentforChildren,SchoolsandFamilies.Thisshouldhaveaparticularemphasisonchildprotectionsocialworkers; workwiththeChildrensWorkforceDevelopmentCouncilandotherpartnerstoimplement,onanationalbasis,clearprogressionroutesforchildrens socialworkers; developnationalguidelinessettingoutmaximumcaseloadsofchildreninneedandchildprotectioncases,supportedbyaweightingmechanismto reflectthecomplexityofcases,thatwillhelpplantheworkloadsofchildrenssocialworkers;and developastrategyforremodellingchildrenssocialworkwhichdeliverssharedownershipofcases,administrativesupportandmultidisciplinarysupport tobedeliverednationally.
4)
AssistantDirector,CentreforChildandFamilyResearch,LoughboroughUniversity,Leicestershire,LE113TU.
17
Method
Anationalsurveywascompletedby46ofthe152localauthoritiesinEngland,andindepthresearchwascarriedoutin nineauthorities.Theindepthresearchincludedanonlinesurveyof34frontlineworkerstoexplorecaseloads,supervision, trainingandsupport;anonlinesurveyof33frontlineworkerstoobtaintimeuseactivitydataforthecalculationofthe unitcosts;interviewswithsafeguardingmanagersacrossthenineauthoritiesandfocusgroupswithfrontlinestaffinfour oftheauthoritiestoprovideagreaterinsightintokeypracticeissues.Additionaltimeuseactivitydatawasutilisedfroma relatedstudytoexplorethecostsofservicesprovidedtoallchildreninneed(Holmesetal,2010a). Unitcostswerecalculatedusingabottomupapproach(Beecham,2000;Wardetal.,2008).Unitcostsperhourforeach ofthetypesofpractitionerswerethencalculated,basedontherelevantschemainCurtis(2007).Theunitcostsare displayedinTable1.
Table 1: Unit costs per hour1

Jobtitle/role Socialworker Familysupportworker2 Teammanager Administrator Servicemanager Headofservice Unitcostperhour 25.16 20.00 32.77 14.79 49.48 74.29
Key findings
Contextual issues Thisstudyfocusedonfrontdoordeliveryofservicesandtheworkofsocialcareintakeandreferralteams.Datafromthe nationalsurveyrevealedthewideremitoftheteams.Themajorityofteams(91percent)workedwithcasesuptoor beyondthecompletionofcoreassessments;around25percentoftheseteamswerealsoholdingchildreninneedcases andwereinvolvedinSection47,childprotectionenquiriesorcompletionofcaseworkaspartofthePublicLawOutline. Alloftheauthoritiesthatparticipatedintheindepthresearchreportedthattheyhadexperiencedanincreaseincontacts and/orreferralsfollowingthemediaattentionsurroundingtheBabyPetercase.Furthermorepractitionersreportedthat theyhadmanagedtheincreaseincontacts/referralsbyworkinglongerhours;theyalsoexpressedconcernaboutthe longertermsustainabilityofworkingtheincreasedhours. Aroundthreequartersoftheparticipatingauthorities(33)reportedthattheyhadmadechangestotheirreferral, assessmentorsupervisionprocessesfollowingthepublicationofTheProtectionofChildreninEngland(Laming,2009).The mostfrequentlycitedchangeswereanincreaseinmanagerialoversightofcases,strengtheningofauditsystemsand adaptationstosupervisionpolicies. ThestudyidentifiedthatitwasproblematictomaketooclearadistinctionbetweenpracticepreandpostLamingand safeguardingmanagersreflectedthattheirpracticewaslargelyinlinewiththerecommendations.However,practitioners didhighlightparticularconcernsabouttheimplicationsofimplementingrecommendation19(1),showninBox1.
Theunitcostshavebeenbasedonsalaryinformationprovidedbytwoparticipatinglocalauthoritiesandthencalculatedusingthesocialcareschema outlinedinCurtis(2007).Thefigureswereadjustedsothattrainingwasnotincluded;instead,trainingwasincludedasaseparateactivitybasedon actualnumberofdaysspentontraining. 2 Salaryscaleswerenotprovidedforfamilysupportworkers.ThereforetheunitcostperhourwastakenfromCurtis(2007).
18
Recommendations 19(1) and 20
Time spent and cost of contacts, referrals and initial assessments TheactivitiesthatconstitutetheinitialcontactandreferralprocesseswerebasedonthoseoutlinedinWorkingTogetherto SafeguardChildren(HMGovernment,2006;2009b).Practitionersreportedthathavingsufficienttimeforallofthetasks wasdeterminedbyworkloadpressures,andtheyexpressedconcernsaboutprioritisationoftasksandtheimpactonthe qualityofassessments. Thefindingsfromtheonlinesurveysrevealedconsiderablevariationsinthetimesocialcarepractitionersspentresponding toinitialcontactsandreferrals.Thereportedtimespentbysocialworkersoninitialcontactsrangedfrom15minutesto justoverthreehours,withanaveragetimeof49minutesperinitialcontact,andanadditionalinputfromtheteam managerof30minutes(onaverage).BasedontheunitcostsoutlinedinTable1,theunitcostofaninitialcontactwas 36.94. Theunitcostofareferralwasanadditional117.41,basedonanaverageactivitytimeof4hoursand40minutes(rangeof 2.5hourstomorethan13hours).Thisincludestimespentonfeedbacktoreferrers,whichwasreportedtotakeanaverage of18minutesperreferral. Thereportedtimespentonaninitialassessmentrangedfrom4hoursand40minutestomorethan20hours.Themean timespentbysocialworkerstocompleteaninitialassessmentwas10.5hours.Theunitcostofaninitialassessmentwas 361.70,includingtheactivitybythesocialworker,teammanagerandadministrator. Recommendations 15 and 16 Supervision Thefindingsfromthenationalsurveyindicatedthatthemajorityofthelocalauthorities(91percent)hadformal supervisionpoliciesinplace.Therewasalsolittlevariationinthereportedfrequencyofsupervision,withmost(85per cent)citingmonthlysupervisionsessions.Furthermore,nearlythreequarters(71percent)oftheworkersthatcompleted theonlinesurveysreportedthattheyconsideredthesupervisiontobesufficient.Thesupervisionsessionswerereported tolastbetweenoneandtwohoursonaverage,andalltheworkersratedsupervisionassatisfactoryorbetter,with85of themratingtheirsupervisioneithergoodorexcellent. Frontlineworkersreportedthatsupervisionsessionsfocusedpredominantlyoncaseplanning,andtwothirdsreportedthat moretimeshouldbespentonconstructivechallengeofpracticeandprofessionaldevelopment.Athirdoftheworkers reportedthatmoretimeshouldbespentaddressingtheirwelfareneeds.However,additionaltimewouldberequiredto incorporatetheseelementsintosupervisionsessions. Recommendation 11 Training and support BetweenDecember2008andDecember2009,thereportednumberofdaysspentontrainingrangedfrom0to20,withan averageofjustlessthan7days.Halfoftheworkersreportedthatthislevelwasinsufficient,andthemajority(73percent) citedprioritisationofcaseworkasthereasonforinsufficienttimespentontraining.Workersreportedthat,ideally,ten daysayearshouldbeallocatedfortraining. Recommendation 24 Recruitment and caseloads Datafromthenationalsurveyidentifiedthataroundtwothirds(65percent)oftheauthoritieshadvacanciesintheirintake andreferralteams,althoughathirdofthesewerebeingcoveredbyagencystaff.Furthermore,interviewswith safeguardingmanagershighlightedthechallengesofrecruitingandretainingstaffinintakeandreferralteams.The perceptionofthelowstatusofsocialwork,alongwiththespecificdemandsandanxietiesofchildprotectionwork,were citedascausesofrecruitmentdifficulties.
19
Datasuppliedbyfrontlineworkersindicatedaconsiderablevariationincaseloads,rangingfrom9to24childrenor4to29 familiespersocialworkerinthereferralandintaketeams.Nearlytwothirdsoftheworkersreportedanincreaseincase loadsintheprevioussixmonthsandthreequartersreportedaneedtoprioritisetasksandspecifictypesofcases.
Conclusion ThestudyrevealedthatexplorationofthecostandcapacityimplicationsofLamingsrecommendationsarecomplex,and thattherewasnotacleardemarcationpreandposttheLamingreport.Itwasalsoapparentthatauthoritieswere concernedabouttheincreaseincontactsandreferralsandtheimpactthishadontheircapacity. Ofthesixrecommendations,practitionersweremostconcernedabouttheimplicationofrecommendation19(1),andthe impactthatthiswouldhaveonalreadyincreasedreferrals.Asaresultofthesefindings,theLGAproposedafivepointplan toensuresocialworkreformsresultinthebestpossibleprotectionofvulnerablechildren.TheLGAarguedthatthe governmentshouldreviseitspolicyonLamingsrecommendation19(1),thatallreferralsfromprofessionalsshouldleadto aninitialassessmentasthiswaslikelytohavethebiggestimpactonsocialworkteams. Followingpublicationofthestudyreport,theGovernmentdecidedthatlocalauthoritiesshouldberesponsibleformaking thedecisiononwhethertoconductaninitialassessment:thatis,discretionhasbeenreintroduced(HMGovernment, 2010). References Beecham,J.(2000)Unitcostsnotexactlychildsplay:AguidetoestimatingunitcostsforChildrensSocialCare,Joint publicationfromtheDepartmentofHealth,DartingtonSocialResearchUnitandthePersonalSocialServicesResearch Unit,UniversityofKent,Canterbury. Curtis,L.(2007)UnitCostsofHealthandSocialCare2007,PersonalSocialServicesResearchUnit,UniversityofKent, Canterbury. HMGovernment(2006)WorkingTogethertoSafeguardChildren.Aguidetointeragencyworkingtosafeguardand promotethewelfareofchildren,TheStationeryOffice,London. HMGovernment(2009a)TheprotectionofchildreninEngland:actionplan.ThegovernmentsresponsetoLordLaming, TheStationeryOffice,London. HMGovernment(2009b)WorkingTogethertoSafeguardChildren:Consultationdocument.Aguidetointeragencyworking tosafeguardandpromotethewelfareofchildren,TheStationeryOffice,London. HMGovernment(2010)TheGovernmentsResponsetoLordLaming:OneYearOn,TheStationeryOffice,London. Holmes,L.,McDermid,S.,Soper,J.,Sempik,J.&Ward,H.(2010a)Thecostsandoutcomesofchildwelfareinterventions: extendingthecostcalculatormethodologytoincludeservicestochildreninneed.ReporttoDepartmentforChildren SchoolsandFamilies,Loughborough,CentreforChildandFamilyResearch,LoughboroughUniversity. Holmes,L.,Munro,E.R.&Soper,J.(2010b)Calculatingthecostandcapacityimplicationsforlocalauthoritiesimplementing theLaming(2009)recommendations,LocalGovernmentAssociation,London. Laming,LordH.(2009)TheProtectionofChildreninEngland:AProgressReport,TheStationeryOffice,London. Ward,H.,Holmes,L.&Soper,J.(2008)CostsandConsequencesofPlacingChildreninCare,JessicaKingsley,London.
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21
I. SERVICES
22
23
1. Services for older people

1.1Privatesectornursinghomesforolderpeople 1.2Privatesectorresidentialcareforolderpeople 1.3Localauthorityresidentialcareforolderpeople 1.4Localauthoritydaycareforolderpeople 1.5Extracarehousing 1.6Communityrehabilitationunit 1.7Intermediatecarebasedinresidentialhomes
24
25
1.1 Private sector nursing homes for older people

UsingPSSEX12009/101returnsupratedbythePSSPay&Pricesinflator,themediancostperpersonforsupportingolder peopleinanursingcarehomewas524perweekandthemeancostwas523perweek.Twentyfivepercentoflocal authoritieshadaveragegrosscostsof454orless,andfor25percentcostswere588ormore.ThestandardNHSnursing carecontributionis108.70.2WhenweaddthistoPSSexpenditure,thetotalexpectedmeancostis632andthemedian costis633. Costsandunit 2010/2011 Notes estimation value A.Fees 719 perweek The directunitcostofprivatesector nursinghomesisassumedtobethefee. Whereamarketisfairlycompetitive,suchasthatforprivatesectornursing homes,itisreasonabletoassumethatthefeewillapproximatethesocietal costoftheservice.3AweightedaveragefeeforEnglandreflectingthe distributionofsingleandsharedroomswastakenfromtheLaing&Buisson marketsurvey.4 Externalservices B.Communitynursing Nocurrentstudiesindicatehowexternalservicesareusedbynursinghome C.GPservices residents.Seepreviouseditionsofthisvolumeforsourcesofinformation. D.Otherexternal services E.Personalliving 22.30per TheDepartmentforWorkandPensions(DWP)personalallowanceforpeople expenses week inresidentialcareoranursinghomeis22.30.5Thishasbeenusedasaproxy forpersonalconsumption. Shorttermcare Nocurrent informationisavailableonwhetherresidentsinshorttermcareare lesscostlythanthosewholivefulltimeinanursinghome.Seeprevious editionsofthisvolumeforsourcesofinformation. Dependency Nocurrentinformationisavailableontherelationshipofdependencywith cost.Seepreviouseditionsofthisvolumeforsourcesofinformation. Londonmultiplier 1.12xA FeesinLondonnursinghomeswere12 percenthigherthanthenational average.4 Unitcostsavailable2010/2011 719establishmentcostperpermanentresidentweek(A);741.30establishmentcost pluspersonallivingexpensesper permanentresidentweek
1 2
TheInformationCentre(2011)PSSEX12009/10,TheInformationCentre,Leeds. DepartmentofHealth(2010)AdviceNoteonNursingCareBands,DepartmentofHealth,London. 3 Kavanagh,S.,Schneider,J.,Knapp,M.,Beecham,J.&Netten,A.(1992)Elderlypeoplewithcognitiveimpairment:costingpossiblechangesinthebalance ofcare,PSSRUDiscussionPaper817/2,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. 4 Laing&Buisson(2010)CareofElderlyPeople:UKMarketReport2010,Laing&Buisson,London. 5 DisabilityAlliance(2011)DisabilityRightsHandbook,35thEdition,April2010April2011.AGuidetoBenefitsandServicesforallDisabledPeople,Their Families,CarersandAdvisers,DisabilityAlliance,London.
26
1.2 Private sector residential care for older people

UsingPSSEX12009/101returnsupratedbythePSSPay&Pricesinflator,themediancostperpersonforsupportingolder peopleinaresidentialcarehomeprovidedbyotherorganisationswas466perweekandthemeancostwas474per week.Themediancostforolderpeopleinownprovisionresidentialcarewas939perweekandthemeancostwas844 perweek.UsingtheAdultSocialServicesExpenditureSurvey2009/10,2themeancostfortheprovisionofprivatesector residentialcarewasestimatedtobe458.ThishasbeenupratedusingthePSSPayandPricesinflator. Costsandunit 2010/2011value Notes estimation A.Fees 497perweek Thedirectunitcostofprivatecarehomesisassumedtobethefee.Wherea marketisfairlycompetitive,suchasthatforprivatesectorresidential homes,itisreasonabletoassumethatthefeewillapproximatethesocietal costoftheservice.3AweightedaveragefeeforEnglandreflectingthe distributionofsingleandsharedroomswastakenfromtheLaing&Buisson marketsurvey.4 Externalservice B.Community nursing Nocurrentstudiesindicatehowexternalservicesareusedbyresidential C.GPservices carehomeresidents.Seepreviouseditionsofthisvolumeforsourcesof D.Otherexternal information. services E.Personalliving 22.30perweek TheDepartmentforWorkandPensions(DWP)personalallowancefor expenses peopleinresidentialcareoranursinghomeis22.30.5Thishasbeenused asaproxyforpersonalconsumption. Shorttermcare Nocurrentinformationisavailableonwhetherresidentsinshorttermcare arelesscostlythanthosewholivefulltimeinaresidentialcarehome.See previouseditionsofthisvolumeforsourcesofinformation. Dependency Nocurrentinformationisavailableontherelationshipofdependencywith cost.Seepreviouseditionsofthisvolumeforsourcesofinformation. Londonmultiplier 1.19xA FeesinLondonresidentialhomeswere19 percenthigherthanthenational average.4 Unitcostsavailable2010/2011 497establishmentcostperpermanentresidentweek(A);519.30 establishmentcost pluspersonallivingexpensesper permanentresidentweek(AandE).
1 2
TheInformationCentre(2011)PSSEX12009/10,TheInformationCentre,Leeds. LocalGovernmentAssociation/AssociationofDirectorsofAdultSocialServices(2010)ReportonAdultsSocialServicesExpenditure20092010,York Consulting,Leeds. 3 Kavanagh,S.,Schneider,J.,Knapp,M.,Beecham,J.&Netten,A.(1992)Elderlypeoplewithcognitiveimpairment:costingpossiblechangesinthebalance ofcare,PSSRUDiscussionPaper817/2,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. 4 Laing&Buisson(2010)CareofElderlyPeople:UKMarketReport2010,Laing&Buisson,London. 5 DisabilityAlliance(2011)DisabilityRightsHandbook,35thEdition,April2010April2011.AGuidetoBenefitsandServicesforallDisabledPeople,Their Families,CarersandAdvisers,DisabilityAlliance,London.
27
1.3 Local authority residential care for older people

ThistableusesthePersonalSocialServicesExpenditurereturn(PSSEX1)1forrevenuecosts,whichhavebeenupratedusing thePSSPay&Pricesinflator. Costsandunit 2010/2011 Notes estimation value Capitalcosts(A,B& Basedonthenewbuildandlandrequirementsforlocalauthorityresidentialcare C) establishments.Theseallowfor57.3squaremetresperperson.2Capitalcosts A.Buildingsand 70perweek havebeenannuitisedover60yearsatadiscountrateof3.5percent. oncosts B.Land 11.50per BasedonDepartmentforCommunitiesandLocalGovernmentstatistics. 3 The week costoflandhasbeenannuitisedat3.5percentover60years. C.Othercapitalcosts. Capitalcostsnotrelatingtobuildingsandoncostsareincludedintherevenue costssonoadditionalcosthasbeenaddedforitemssuchasequipmentand durables. D.Revenuecosts 901per ThemedianrevenuecostestimateistakenfromPSSEX12009/10 upratedusing week thePSSPay&PricesIndex1Capitalchargesrelatingtobuildingsandoncostshave beendeducted.Twentyfivepercentoflocalauthoritieshadaveragegrosscosts of646orlessand25percentof1,073ormore.Themeancostwas825per week. E.Agencyoverheads SocialServicesManagementandSupportServices(SSMSS)costsareincludedin PSSEX1revenuecostfiguressonoadditionaloverheadshavebeenadded. Externalservices F.Communitynursing Nocurrentstudiesindicatehowexternalservicesareusedbyresidentialcare G.GPservices homeresidents.Seepreviouseditionsofthisvolumeforsourcesofinformation. H.Otherexternal services I.Personalliving 22.30per TheDepartmentforWorkandPensions(DWP) personalallowanceforpeoplein expenses week residentialcareoranursinghomeis22.30.4Thishasbeenusedasaproxyfor personalconsumption. Useoffacilityby 52.18weeks client p.a. Occupancy 89% BasedoninformationreportedbyLaing&Buisson.5 Shorttermcare Nocurrentinformationisavailableonwhetherresidentsinshorttermcareare lesscostlythanthosewholivefulltimeinaresidentialcarehome.Seeprevious editionsofthisvolumeforsourcesofinformation. Dependency Nocurrentinformationisavailableontherelationshipofdependencywithcost. Seepreviouseditionsofthisvolumeforsourcesofinformation. Londonmultiplier 1.035x(Dto BasedonPSSEX12009/10 data.1 E) Unitcostsavailable2010/2011 982.50establishmentcostperpermanentresidentweek(includesAtoE);1,005 carepackagecostsperpermanent residentweek(includesAtoEandI).
1 2
TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 3 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 4 DisabilityAlliance(2011)DisabilityRightsHandbook,35thEdition,April2010April2011.AGuidetoBenefitsandServicesforallDisabledPeople,Their Families,CarersandAdvisers,DisabilityAlliance,London. 5 Laing&Buisson(2010)CouncilssettoshuntsocialcarecoststotheNHSandserviceusersascutstakeeffect,Laing&Buisson, www.laingbuisson.co.uk/LinkClick.aspx?fileticket=7NqbssCOgKA%3D&tabid=558&mid=1888.
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1.4 Local authority day care for older people

ThistableusesthePersonalSocialServicesExpenditurereturn(PSSEX1)1forrevenuecosts,whichhavebeenupratedusing thePSSPay&Pricesinflator.Inordertoprovideacostperdaycaresession,thistableassumesthatclientsattenddaycare, onaverage,forthreesessionsperweek.Inevitably,someserviceuserswillattendmoreoftenandotherslessoften dependingonindividualcircumstances. Costsandunit 2010/2011value Notes estimation Capitalcosts(A,B&C) Basedonthenewbuildandlandrequirementsforlocalauthorityday A.Buildingsandoncosts 4.80persession carefacilities(whichdonotdistinguishclientgroup).Theseallowfor 33.4squaremetresperperson.2Capitalcostshavebeenannuitisedover 60yearsatadiscountrateof3.5percent. B.Land 0.80persession BasedonDepartmentforCommunitiesandLocalGovernment statistics.3Thecostoflandhasbeenannuitisedat3.5percentover60 years. C.Othercapitalcosts Capitalcostsnotrelatingtobuildingsandoncostsareincludedinthe revenuecostssonoadditionalcosthasbeenaddedforitemssuchas equipmentanddurables. Revenuecosts ThemedianrevenuecostestimateistakenfromPSSEX12009/10 D.Salaryandother 30persession upratedusingthePSSPay&Pricesindex.4Themedianandmeancosts perclientperweekare90and94respectively.Capitalcharges revenuecosts relatingtobuildingshavebeendeducted.Assumingolderpeopleattend E.Capitalcharges 3sessionsperweek,themediancostperdayis30andthemeancostis 31. F.Agencyoverheads SocialServicesManagementandSupportServices(SSMSS)costsare includedinPSSEX1revenuecostfiguressonoadditionaloverheads havebeenadded. Useoffacilitybyclient Assumesclientsattend3sessionsofdaycareperweek. Occupancy BasedonastudycarriedoutbyPSSRU ondaycareservicesforolder peoplewithdementia,theoccupancyratewas87%.5 Londonmultiplier 1.43xA;2.73xB; RelativeLondoncostsaredrawnfromthesamesourceasthebasedata 1.56x(D) foreachcostelement. Unitcostsavailable2010/2011 36persession(includesAtoD).
1 2
TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 3 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 4 TheInformationCentre(2011)PSSEX12009/10,TheInformationCentre,Leeds. 5 Reilly,S.,Venables,D.,Challis,D.,Hughes,J.&Abendstern,M.(2004)DayCareServicesforOlderPeoplewithdementiaintheNorthWestofEngland, PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury.www.pssru.ac.uk/pdf/MCpdfs/Daycare1.pdf.
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1.5 Extra care housing for older people

Thisisbasedonanevaluationofextracarehousingwhichfollowedthedevelopmentof19newbuildextracarehousing schemeslocatedacrossEngland.1 Extracarehousingisprimarilyforolderpeople,andtheaccommodationis(almostalways)selfcontained.Carecanbe deliveredflexibly,usuallybyateamofstaffonthepremisesfor24hoursaday.Domesticcareandcommunalfacilitiesare available.Formoreinformation,seetheBumker&Nettenarticleonpage7. Allcostshavebeenupratedfrom2008tocurrentpricesusingtheappropriateinflators.Themeancostoflivinginextra carehousingwasestimatedat420perresidentperweek,withastandarddeviationof190andarangeof180to 1,399.Themediancostwas380perresidentperweek. Costsandunitestimation 2010/2011value Notes A.Capitalcosts Basedondetailedvaluationsforthebuildingsandthelandprovided bythehousingassociationsoperatingtheextracareschemes.For Buildingandlandcosts 93perresidentper propertiesconstructedbefore2008,capitalvalueswereobtained week fromtheBCIS,anddownratedusingtheAllInTenderPriceIndex. Includedisthecostofland,worksincludingsitedevelopmentand landscaping,equipmentandfurniture,professionalfees(architects, designandsurveyorsfees).1 B.Housingmanagement Informationtakenfromtheannualincomeandexpenditureaccounts andsupportcosts foreachindividualschemeafteratleastonefulloperationalyear. Housingmanagement 55perresident Averagerunningcostswerecalculatedbydividingtheadjustedtotal runningcostbythenumberofunitsinthescheme.Thecostincludes perweek managementstaffcosts(salaryandoncostsincludingnational Supportcosts 10.30perresident insuranceandpensioncontributions,andofficesupplies),property maintenanceandrepairs,groundsmaintenanceandlandscaping, perweek cleaningofcommunalareas,utilities,andappropriatecentral establishmentcosts(excludingcapitalfinancing). C.Personallivingexpenses 86perresident Assignificantvariabilityexistedintheapproachestomealprovision perweek intheschemes,itemsrelatedtocateringcostswereremovedfrom thefinancialaccountsandthecostoffoodandotherconsumables wasestimatedusingtheFamilyExpenditureSurvey(2010)andbased ontables27and32.2 D.Healthandsocialservice Estimatesofhealthandsocialservicecostsweremadecombining costs resourceuseinformationreportedby465residents,sixmonthsafter admission,withtheappropriateunitcoststakenfromtherespective localauthoritiesor,whereappropriate,fromnationalsources.3 Healthservices 67perresidentper Healthcareestimatesrangedfrom0656. week Socialservices 107perresident Socialcareestimatesrangedfrom0641. week. Useoffacilitybyclient 52.18weeksper annum Unitcostsavailable2010/2011 158.30accommodation,housingmanagementandsupportcosts;244.30accommodation,housingmanagement, supportandlivingexpenses;418totalcost.
Darton,R.,Bumker,T.,Callaghan,L.&Netten,A.(2011).ThePSSRUEvaluationoftheextracarehousingInitiative:TechnicalReport.PersonalSocial ServicesResearchUnit,UniversityofKent. 2 OfficeforNationalStatistics(2010)FamilySpending2010edition,OfficeforNationalStatistics,London,availableatwww.ons.gov.uk/ons/rel/family spending/familyspending/2010edition/index.html 3 Curtis,L.(2008)UnitCostsofHealthandSocialCare2008,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury.
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1.6 Community rehabilitation unit

ThistableisbasedonajointprojectbetweenKentCountyCouncil,AshfordBoroughCouncil,AgeConcernandAshford PrimaryCareTrust(Curtis,2005).1HomeBridgeprovidesrecuperativecareinsevenpurposebuiltselfcontainedunitsfor olderpeoplewhoneedaperiodofrecuperationfollowinganillness,fallorwherepeoplehavehadincreasingproblems managingdailyliving.Itprovidesintensivetherapyandsupporttorebuildmobilityandconfidencesotheycanreturnback home.Originallyestimatedin2005,costshavebeenupratedusingtheappropriateinflators. Costsandunitestimation 2010/2011value Notes A.Wages/salaryand 78,516peryear Theteamcomprisesa schememanager(20%),aparttimecare oncosts manager(80%)andsupportworkers. Employersnationalinsuranceisincludedplus18percentofsalaryfor employerscontributiontosuperannuation. B.Directoverheads 25,133peryear Thisincludesmaintenance,runningcosts,repair/renewalof Administrativecosts 4,455peryear fixtures/fittings.Buildingexpensesandequipmentcosts.Includes Managementcosts 18,487peryear ProjectManager(0.05),CARTcoordinator,socialservicesteamleader (0.08%)andAgencyfees. C.Indirectoverheads 12,040peryear Tocoverthefinancefunction. D.Capital: Basedonactualcostofthe7units, alounge(sharedbysheltered buildingcosts 23,610peryear housing)andanofficeandupratedusingtheTenderPriceIndexfor landcosts 11,938peryear PublicSectorBuilding(nonhousing).Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. Occupancy 71% Onaverage, 5(5places)unitsofthe7(7places)areoccupiedatany onetime. Caseload 32peryear Theannual caseloadforJanuary2004toJanuary2005was32clients. Averagelengthofstay 33nights Hoursandlengthof 7daysaweek(to Theserviceisavailable7daysaweekwithsupportworkersworking service includeweekends 10.5hoursdaily(3,832peryear).Theschememanagerisavailable andbankholidays) fromMondaytoFriday7amto3pmandincaseofemergencythereis coverduringevenings,nightsandweekendsviathecallcentre. Patientrelatedhours AllclientsreceiveaninitialassessmentwhenreferredtoHomeBridge usuallyathospital.Theyareassessedonarrivalbyacommunitycare manager,whocontinuestomonitorthemthroughouttheirstayand Typicalepisode 10hoursperweek dischargesthemattheendoftheirstay.50percentofclientsstayon average29nightsandreceive41hoursofcontactwithasupport Lowcostepisode 7hoursperweek workerperweek.25percentofclientsstay10daysandreceivean Highcostepisode 5hoursperweek additional10hourswithasupportworkereachweek.25percentof clientsstayonaverage64daysandreceive137hourswithsupport workers. Costofhospital 291 Between35hoursofahospitalcaremanagerstimewhoprepares the assessmentandadmission dischargefromhospitalandarrangesthereferraltoHomeBridge.A toHomebridge further3hoursisrequiredbythesocialservicesdutydesktomakethe admissionarrangementsatHomeBridge.Thisisbasedonthesalaryof asocialworkassistant. Costofdischargefrom 379 Thisiscarriedoutbyacommunitycaremanagerandtakes8.5hours. It Homebridge involves7.5hoursfacetofacecontacttimeforliaisonwithpatient, professionals,familiesandservicesandalso1houradministration. CostofHealthServices 636 Onaverage, 7hoursoftherapyornursingcarewasprovidedbythe providedbythe CARTteam. CommunityAssessment andRehabilitationTeam (CART) Unitcostsavailable2010/2011 Fullunitcosts(allactivities):Perperson(actualoccupancy)34,836 peryear,670 weekly(includesAtoE);Perperson (full occupancy)24,883peryear,479weekly.Costperepisode:2,744(typicalepisode),2,084(lowcostepisode);5,766 (highcostepisode).
1
Curtis,L.(2005)Thecostsofrecuperativecarehousing,inL.Curtis(ed)UnitCostsofHealthandSocialCare2005,PersonalSocialServicesResearchUnit, UniversityofKent,Canterbury.
31
1.7 Intermediate care based in residential homes

ThisinformationisbasedonPSSRUresearchcarriedoutwiththeSocialWorkandSocialCareSectionattheInstituteof Psychiatry.1Itprovidesthecostsofcomparativeintermediatecareschemesbasedinresidentialhomes.Theaverage weeklycostperclientacrossthefourschemesis609,andtheaverageannualcostperclientis3,478.Allcostshavebeen upratedtopresentvaluesusingtheappropriatePSSinflators.TheNationalEvaluationoftheCostsandOutcomesof IntermediateCareforOlderPeople2shouldalsobedownloadedforcomparativecosts. Socialcareonly Socialandhealthcare SchemeAprovides SchemeBis SchemeDisrunbythelocal SchemeCisashort atherapeutic stayresidentialhome authorityinconjunctionwith providedbythe theprimarycaretrustand programmeof forpeoplehaving localauthorityfor recuperativecare difficultymanagingat provides6weeksofsupport peoplewith andrehabilitationtoolder with16 home,orwhohave dementia.Afeeis peoplewhohavethe recuperativebeds. paidbythelocal beenrecently potentialtoreturntotheir Carestaffincludes dischargedfrom authorityforcare ownhomeafterastayin careworkers,a hospitalorare staff. seniornightcarer consideringentrytoa hospital.Staffincludesacare andrehabilitation residentialcarehome. manager,therapists,avisiting medicalofficerand workers. Afeeispaidbythe promotingindependence localauthorityfor assistants. carestaff. Wages/salary 223,151 153,018 105,489 165,190 Oncosts 47,977 32,899 22,680 35,516 Employersnational insuranceplus14 percentofsalary foremployers contributionto superannuation Directoverheads 253,269 54,398 50,002 28,459 Includessalariesof supervisorystaff, runningcostsand supplies Indirectoverheads Managementfees (incl.premises 164,365 costs) 36,269 43,518 9,390 Capital/premises 3 725,031 283,833 178,171 238,555 Totalcosts Caseload 196 51 64 67 Averagelengthof 34days 54days 45.5days 32days stay No.ofbeds 16 10 8 8 Weeklycostsper resident 869 544 427 571 Averageannualcost perclient 3,699 5,565 2,784 3,560 Costoftypicalclient episode 4,221 4,199 2,776 2,614
Baumann,M.,Evans,S.,Perkins,M.,Curtis,L.,Netten,A.,Fernandez,J.L.&Huxley.,P.(2007)Organisationandfeaturesofhospital,intermediatecare andsocialservicesinEnglishsiteswithlowratesofdelayeddischarge,Health&SocialCareinthecommunity,2007Jul;15(4):295305. Barton,P.,Bryan,S.,Glasby,J.,Hewitt,G.,Jagger,C.,Kaambwa,B.,Martin,G.,Nancarrow,S.,Parker,H.,Parker,S.,Regen,E.&Wilson,A.(2006)A NationalEvaluationoftheCostsandOutcomesofIntermediateCareforOlderPeople.ExecutiveSummary,IntermediateCareNationalEvaluationTeam (ICNET),UniversityofBirminghamandUniversityofLeicester. 3 Wherethefeeforprovidingtheschemewasprovided,80%wasestimatedbytheserviceproviderastheamountforcarestaffsalaries.Theremainder wasallocatedtooverheads.

2
33
2. Services for people with mental health problems

2.1NHSreferencecostsformentalhealthservices 2.2Localauthoritycarehomesforpeoplewithmentalhealthproblems 2.3Privatesectorresidentialcarehomesforpeoplewithmentalhealthproblems 2.4Localauthoritysocialservicesdaycareforpeoplewithmentalhealthproblems 2.5Privateorganisationsprovidingdaycareforpeoplewithmentalhealthproblems 2.6Cognitivebehaviourtherapy(CBT) 2.7Counsellingservicesinprimarymedicalcare 2.8Individualplacementandsupport 2.9DeprivationoflibertysafeguardsinEngland:implementationcosts 2.10Mindfulnessbasedcognitivetherapygroupbasedintervention 2.11Interventionsformentalhealthpromotionandmentalillnessprevention
35
2.1 NHS reference costs for mental health services

WehavedrawnontheNHSTrustandPrimaryCareTrustscombinedtoreportfromtheNHSReferenceCostsofselected mentalhealthservices.1Allcostshavebeenupratedto2010/11pricesusingtheHCHSPayandPricesinflators.Thecostsof selectedmentalhealthcareservicesforchildrencanbefoundinschema6.1. Lowerquartile Upperquartile Mean MENTALHEALTHSERVICES Inpatientattendances(costperbedday) Intensivecareadult 520 683 630 Acutecareadult 287 329 312 Rehabilitationadult 229 324 282 Elderly 287 355 319 Weightedaverageofalladultmentalhealthinpatient beddays. 286 348 321 Specialistinpatientservices(costperbedday) 426 Eatingdisorder(adults) 378 503 Daycarefacilities(costperdayregular attendances) Weightedaverageofallattendances(adults) 126 86 156 Weightedaverageofallattendances(elderly) 100 60 125 Outpatientattendances,consultantservices(followup facetofaceattendance) Drugandalcoholservicesadult 157 117 194 Otherservicesadult 164 113 196 Elderly 154 100 198 Weightedaverageofalladultoutpatientattendances 143 100 174 Communitysetting,consultantservices(facetoface contact) Weightedaverageofallcontacts 132 91 147
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459.
36
2.2 Local authority care homes for people with mental health problems
ThistableusesthePersonalSocialServicesExpenditurereturn(PSSEX1)1forrevenuecosts,whichhavebeenupratedusing thePSSPay&Pricesinflator. Costsandunit 2010/2011 Notes estimation value Capitalcosts Basedonthenewbuildandlandrequirementsforhomesforpeoplewith A.Buildingsandoncosts 83per mentalhealthproblems.Capitalcostshavebeenannuitisedover60yearsat residentweek adiscountrateof3.5percent.2 Revenuecosts Themedianrevenueweeklycostestimate (628)forsupportingadultsin B.Salarycostsandother 628per ownprovisionresidentialcare(includesfullcostpayingandpreservedrights revenuecosts residentweek residents).Capitalcostsrelatingtobuildingsandlandhavebeendeducted. Themeancostperclientperweekisreportedasbeing1,096.Fivecouncils reportedcostsofover2,000perclientweek,andhavenotbeenincludedin thisestimate. C.Agencyoverheads SocialServicesManagementandSupportServices(SSMSS)costsareincluded inPSSEX1revenuecostfiguressonoadditionaloverheadshavebeenadded. Othercosts TheDWPpersonalallowanceforpeopleinresidentialcareoranursinghome D.Personalliving 22.30per is22.30.3Thishasbeenusedasaproxyforpersonalconsumption. expenses week E.Externalservices Noinformationisavailable. Useoffacilitybyclient 365.25days peryear Occupancy 100% Nostatisticsavailable,therefore100percentoccupancyassumed. Londonmultiplier 1.23x(AtoB) RelativeLondoncostsaredrawnfromthesamesourceasthebasedatafor eachcostelement. Unitcostsavailable2010/2011 711perresidentweekestablishmentcosts(includesAtoB);733 perresidentweekcarepackagecosts (includesAtoD).
1 2
TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 3 DisabilityAlliance(2011)DisabilityRightsHandbook,35thEdition,April2010April2011.AGuidetoBenefitsandServicesforallDisabledPeople,Their Families,CarersandAdvisers,DisabilityAlliance,London.
37
2.3 Private sector residential care homes for people with mental health problems
ThistableusesthePersonalSocialServicesExpenditurereturn(PSSEX1)1forrevenuecosts,whichhavebeenupratedusing thePSSPay&Pricesinflator.
Costsandunitestimation Capitalcosts A.Buildingsandoncosts Revenuecosts B.Salaryandother revenuecosts C.Agencyoverheads Othercosts D.Personalliving expenses E.Serviceuse Useoffacilitybyclient Occupancy Londonmultiplier
2010/2011 value 83per residentweek 590per residentweek 22.30per week 365.25days peryear 100% 1.46x(AtoB)
Notes Basedonthenewbuildandlandrequirementsforhomesforpeoplewith mentalhealthproblems.Capitalcostshavebeenannuitisedover60yearsat adiscountrateof3.5percent.2 Themedianrevenueweeklycostestimateforsupportingadultsinown provisionresidentialcare(includesfullcostpayingandpreservedrights residents.Capitalchargesrelatingtobuildingandoncostshavebeen deducted.Themeancostperclientperweekis595.
SocialServicesManagementandSupportServices(SSMSS)costsareincluded inPSSEX1revenuecostfiguressonoadditionaloverheadshavebeenadded. TheDWPallowanceisusedasaproxyforpersonalconsumption.3 Noinformationavailableonserviceuse. Nostatisticsavailable,therefore100 percentoccupancyassumed. RelativeLondoncostsaredrawnfromthesamesourceasthebasedatafor eachcostelement.
Unitcostsavailable2010/2011 673perresidentweekestablishmentcosts(includesAtoB);695 perresidentweekcarepackagecosts(includesAtoD).
1 2
TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 3 DisabilityAlliance(2010)DisabilityRightsHandbook,34thEdition,April2009April2010.AGuidetoBenefitsandServicesforallDisabledPeople,Their Families,CarersandAdvisers,DisabilityAlliance,London.
38
2.4 Local authority social services day care for people with mental health problems
ThistableusesthePersonalSocialServicesExpenditurereturn(PSSEX1)1forrevenuecosts,whichhavebeenupratedusing thePSSPay&Pricesinflator.Themediancostperclientweekwas100andthemeancostperclientweekwas89 Councilsreportingcostsofmorethan500perclientweekhavebeenexcludedfromtheseestimates.Inordertoprovidea costperdaycaresession,itisassumedthatclientsattenddaycareonaverageforthreesessionsperweekasthisis recommendedaspartofatotalrecoveryprogramme.2 Costsandunitestimation 2010/2011 Notes value Capitalcosts Basedonthenewbuildandlandrequirementsfordaycarefacilities(which A.Buildingsandoncosts 4.10per donotdistinguishbyclientgroup).Theseallowfor33.4squaremetresper session person.3Capitalcostshavebeenannuitisedover60yearsatadiscountrate of3.5percent. B.Land 0.70per BasedoninformationprovidedbytheDepartmentforCommunitiesand session LocalGovernment,2010.4Landcostshavebeendiscountedat3.5percent over60years. C.Othercapital Capitalcostsnotrelatingtobuildingsandoncostsareincludedinthe revenuecostssonoadditionalcosthasbeenaddedforotheritemssuchas equipmentanddurables. D.Revenuecosts 29per Thisisthemediancostpersession(29)forownprovisiondaycarefor session peoplewithmentalhealthproblems.Capitalchargesrelatingtobuildings havebeendeducted.Themeancostperclientsessionis26.
E.Agencyoverheads Occupancy Londonmultiplier
87% 1.40xA; 2.70xB; 1.10xD
SocialServicesManagementandSupportServices(SSMSS)costsare includedinPSSEX1revenuecostfiguressonoadditionaloverheadshave beenadded. BasedonastudycarriedoutbyPSSRU.5 RelativeLondoncostsaredrawnfromthesamesourceasthebasedata.
Unitcostsavailable2010/2011 34perusersession(includesAtoD).
1 2
TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. SalfordCityCouncil(2011)MentalHealth,SalfordCityCouncil,www.salford.gov.uk/mentalhealth.htm. 3 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 5 Reilly,S.,Venebles,D.,Challis,D.,Hughes,J.&Abendstern,M.(2004)DayCareServicesforOlderPeoplewithdementiaintheNorthWestofEngland, PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury.www.pssru.ac.uk/pdf/MCpdfs/Daycare1.pdf.
39
2.5 Private sector day care for people with mental health problems
ThistableusesthePersonalSocialServicesExpenditurereturn(PSSEX1)1forrevenuecosts,whichhavebeenupratedusing thePSSPay&Pricesinflator.Themediancostperclientweekis77,andthemeancostis76.Inordertoprovideacost perdaycaresession,itisassumedthatclientsattenddaycareonaverageforthreesessionsperweekasthisis recommendedaspartofatotalrecoveryprogramme.2Fivecouncilsreportingaveragecostsofeithermorethan500per clientweekorlessthan2perclientweekhavebeenexcluded. Costsandunitestimation 2010/2011 Notes value Capitalcosts Basedonthenew buildandlandrequirementsfordaycarefacilities, A.Buildingsandoncosts 4.10per whichdonotdistinguishbyclientgroup.Theseallowfor33.4square session metresperperson.3Capitalcostshavebeenannuitisedover60yearsata discountrateof3.5percent. B.Land 0.70per BasedoninformationprovidedbytheDepartmentforCommunitiesand session LocalGovernment,2010.4Landcostshavebeendiscountedat3.5per centover60years. C.Othercapital Capitalcostsnotrelatingtobuildingsareincludedintherevenuecostsso noadditionalcosthasbeenaddedforotheritemssuchasequipmentand durables. D.Revenuecosts 22per Themediancostpersessionfordaycare(22)providedbyother session organisations.Capitalchargesrelatingtobuildingshavebeendeducted. Themeancostperclientsessionisalso22.
E.Agencyoverheads Occupancy Londonmultiplier
87% 1.40xA; 2.70xB 0.98xD
SocialServicesManagementandSupportServices(SSMSS)costsare includedinPSSEX1revenuecostfiguressonoadditionaloverheadshave beenadded. BasedonstudycarriedoutbyPSSRU.5 MedianrevenuecostswerelowerinLondon.1
Unitcostsavailable2010/2011 27perusersession(includesAtoE).
1 2
TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. SalfordCityCouncil(2011)MentalHealth,SalfordCityCouncil,www.salford.gov.uk/mentalhealth.htm. 3 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 5 Reilly,S.,Venebles,D.,Challis,D.,Hughes,J.,.Abendstern,M.(2004)DayCareServicesforOlderPeoplewithdementiaintheNorthWestofEngland, PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury.www.pssru.ac.uk/pdf/MCpdfs/Daycare1.pdf.
40
2.6 Cognitive behaviour therapy (CBT)

Thistableisbasedoncostsestimatedforarandomisedcontrolledtrialofinterventionsforadolescentswithdepression. ThesettingwastwoChildandMentalHealthServices(CAMHS)teamsinsecondarycarewhereCBTwasdelivered.1 Costsandunit 2010/2011 Notes estimation value A.Wages/salary 42,667per BasedonfulltimeequivalentbasicsalaryoftheJanuaryMarch2011 NHS year StaffEarningsestimates2foraspecialtydoctor(midpoint),clinical psychologist(band7median)andmentalhealthnurse(band5median).An averagehasbeentakenofthesesalaries. B.Oncosts 10,703per Employersnational insuranceisincludedplus14percentofsalaryfor year employerscontributiontosuperannuation. C.Qualifications Noinformationavailable. D.Overheads TakenfromNHS(England)SummarisedAccounts.3Seeprefaceformore information. Management, 10,140per Managementandothernoncarestaffcostswere19.1percentofdirectcare administrativeand salarycostsandincludedadministrationandestatesstaff. year estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyinclude Nonstaff 22,415per coststotheproviderforoffice,travel/transportandtelephone,education andtraining,suppliesandservices(clinicalandgeneral),aswellasutilities year suchaswater,gasandelectricity. E.Ongoingtraining Informationnotavailableforallcarestaff. F.Capitaloverheads 3,315per BasedonthenewbuildandlandrequirementsofanNHSofficeandshared year facilities,capitalcostshavebeenannuitisedover60yearsatadiscountrate of3.5percent.4,5Basedontheassumptionthatthereisoneofficeperteam. Workingtime 42weeks Includes29daysannualleaveand8statutoryleavedays.Assumes6 peryear, study/trainingdaysand12dayssicknessleave.6Weightedtoreflectteam 37.5hours composition.Basedonatotalof1549hoursperyear. perweek Ratioofdirectto 1:1 Fiftypercentoftimeisspentonfacetofacecontactand50percenton indirecttimeonfaceto otheractivities. facecontact Lengthofcontact 55minutes AveragedurationofCBTsession. Unitcostsavailable2010/2011 58perhour;115perhourfacetofacecontact;106 costofCBTsession.
Goodyer,I.M.,Harrington,R.,Breen,S.,Dubicka,B.,Leech,A.,Rothwell,J.,White,L.,Ford,C.,Kelvin,R.,Wilkinson,P.,Barrett,B.,Byford,S.&Roberts, C.(2007)ArandomisedcontrolledtrialofSSRIswithandwithoutcognitivebehaviouraltherapyinadolescentswithmajordepression,BritishMedical Journal,doi:10.1136/bmj.39224.494340.55. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2010. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 TheInformationCentre(2011)ResultsoftheNHSSicknessAbsenceSurvey2010,NHSEmployers,London.
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2.7 Counselling services in primary medical care

Counsellingandpsychotherapyareumbrellatermsthatcoverarangeoftalkingtherapies.Theyaredeliveredbytrained practitionerswhoworkwithpeopleoverashortorlongtermtohelpthembringabouteffectivechangeorenhancetheir wellbeing(BritishAssociationforCounsellingandPsychotherapy,2011).1 Costsandunit 2010/2011 Notes estimation value A.Wages/salary 37,500per BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChange year Band7oftheJanuaryMarch2011NHSStaffEarningsestimates.2See sectionVforinformationonmeansalaries. B.Salaryoncosts 9,318per Employersnationalinsuranceisincludedplus14percentofsalaryfor year employerscontributiontosuperannuation. C.Overheads TakenfromNHS(England)SummarisedAccounts.3Seeprefaceformore information. Management, 8,942per administrativeand Managementandothernoncarestaffcostswere19.1percentofdirect year estatesstaff caresalarycostsandincludedadministrationandestatesstaff. Nonstaff 19,476per Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyinclude coststotheproviderforoffice,travel/transportandtelephone,education year andtraining,suppliesandservices(clinicalandgeneral),aswellasutilities suchaswater,gasandelectricity. D.Capitaloverheads 3,453per Basedonnewbuildandlandrequirementsforapracticenursenon year treatmentspace.Capitalcostshavebeenannuitisedover60yearsata discountrateof3.5percent.4 E.Travel Noinformationavailable. Ratioofdirecttoindirect 1:0.30 Astudyofninepracticesfoundthat, onaverage,eachsessionlasted55 timeonclientcontact minutesandthemeannumberofsessionswas7(median6).5Seventyseven percentofthetimewasspentonfacetofacecontact,and23percentof thetimeonotherwork. Consultations 55minutes Averagelengthofsurgeryconsultation.4 Workingtime 42weeksper Eachpracticeinthestudyemployedcounsellorsforbetween6and49hours year perweek.Basedonworkinghoursof1535hoursperyear.4 37.5hoursper week Unitcostsavailable2010/2011 51perhour(includesAtoD);66perhourofclientcontact(AtoD);60 perconsultation.
1 2
BritishAssociationforCounsellingandPsychotherapy(2011)BACPdefinitionofCounselling,BACP.www.bacp.co.uk/. TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 5 Simpson,S.,Corney,R.,Fitzgerald,P.&Beecham,J.(2000)ARandomisedControlledTrialtoEvaluatetheEfficacyandCostEffectivenessofCounselling withPatientswithChronicDepression,ReporttotheNHSHealthTechnologyAssessmentProgramme,Vol.4,No.36.
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2.8 Individual placement and support

Provided by Justine Schneider and Sheila Durie
Description of IPS Peoplewithseverementalhealthproblemsfaceparticularbarrierstoemployment,bothinrelationtotheirimpairments1 andasaresultofstigmaandprejudice.2Toovercomethese,anapproachknownasIndividualPlacementandSupport(IPS) hasbeendeveloped3andhasstrongevidencetosupportit.4,5Thereare25criteriaforfidelityofIPStothestandardsof bestpractice.Themanagementratioandthecaseloadsizesusedherearewithintheboundsofgoodtoexemplaryscores; mostoftheotherfidelitycriteriahavelittleornodirectimpactonservicecosts.Caseloadcapacityisdeterminedbothby size,andbyturnover.ThereisevidencefromtheUSthateachplaceonacaseloadservesabout1.8clientsoverayearsoa caseloadof20hasathroughputof38individualsperyearonaverage.Althoughcaseloadsizeisusedheretoestimatea rangeofunitcostsforIPS,turnoverhasnotbeenfactoredinbecauseitislikelytovaryaccordingtotheskillsofthepost holder. Necessary conditions for IPS to operate SuccessfuloperationofIPSrequiresworkorientedmentalhealthservices,throughcrosssectorengagementand partnershipworking.ThespecialistskillsofIPSstaffandmanagersprovidedirectinterventionswithserviceusersand employerstoplacepeopleinworkandsupportthemasrequired.Responsibilityforthemaintenanceofworkoriented mentalhealthissharedmorewidelyacrossprofessionalsinthefield. Variations in the costs presented TheIPSapproachrequiresemploymentspecialiststobeintegratedintothementalhealthteam.Howeverthereisawide rangeoflevelsatwhichthespecialistsarecurrentlyappointed.ThereforeinTable2.8.1,weoffercostsforfourgradesof staff,twowithprofessionalqualifications(e.g.psychology,occupationaltherapy)andtwowithnoparticularqualifications. Thesedifferentlevelsofpay,combinedwitharangeofcaseloadsizes,yieldarangeofunitcosts,asshowninTable2.8.2. Tothesalarycostsareaddedtheusualoverheads,plusacostforateamleader,whoaccordingtoIPSwisdomshouldnot supervisemorethan10staffandshouldbeavailabletoprovidepracticalsupport.Asmallmarketingbudgetisincluded here,butannualcostsfortrainingwerenotavailable.WewereadvisedbyexperiencedIPSservicesthatnoothercostsare commonlyincurred.TheunitcostperyearshowninTable2.8.2rangesfrom2,268to9,180,dependingoncaseloadsize andsalaryleveloftheworker.Thisdoesnottakeaccountofturnoverinclientswhoareunlikelytoremainintheservicefor afullyear. Comparative costs of day care UnitcostsofIPSmaybecomparedtothecostsofprivatesectordaycare.InTable2.5ofthisvolume,thecostofprivate sectordaycarewas54(27persession)outsideofLondon.Table2.8.3showsthenumberofdaycaresessionsatthiscost whichwouldcorrespondtoeachlevelofIPScostsfromTable2.8.2.Thisrangesfrom34sessionslessthanonedayper week,to131sessions,orjustunderthreedaysperweek.Whereasdaycareisoftenallocatedinperpetuity,IPSisgearedto findingapersonpaidwork,andthereforetheamountconsumedbyagivenindividualislikelytodecreaseovertime. Moreover,thereissomeevidencethatthoseindividualswhoattainworkgainselfesteem6andreducetheirrelianceon mentalhealthservices,thoughnotnecessarilyonbenefits.7
McGurk,S.&Mueser,K.(2004)Cognitivefunctioning,symptomsandworkinsupportedemployment;Areviewandheuristicmodel,Schizophrenia Research,70,147174. 2 Thornicroft,G.(2006)Shunned:DiscriminationAgainstPeopleWithMentalIllness,OxfordUniversityPress,Oxford. 3 DepartmentofHealth(2006)VocationalServicesforPeoplewithSevereMentalHealthProblems:CommissioningGuidance,CSIPforDepartmentofWork andPensionsandDepartmentofHealth. 4 Bond,G.R.,Drake,R.E.&Becker,D.R.(2008)Anupdateonrandomizedcontrolledtrialsofevidencebasedsupportedemployment,Psychiatric RehabilitationJournal,31,280289. 5 Burns,T.,Catty,J.,Becker,T.,Drake,R.,Fioritti,A.,Knapp,M.,Lauber,C.,Rossler,W.,Tomov,T.,vanBusschbach,J.,White,S.&Wiersma,D.(2007)The effectivenessofsupportedemploymentforpeoplewithseverementalillness:arandomisedcontrolledtrial,TheLancet,370,11461152. 6 SesamiResearchandPracticePartnership(2007)TheSESAMIevaluationofemploymentsupportintheUK:Backgroundandbaselinedata,Journalof MentalHealth,16,3,375388. 7 Schneider,J.,Boyce,M.,Johnson,R.,Secker,J.,Grove,B.&Floyd,M.(2009)Impactofsupportedemploymentonservicecostsandincomeofpeople, JournalofMentalHealth,18,6,533542.
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2.8.1 Cost components

Salary Salaryoncosts Superannuation Overheadsstaff Overheadsother Capital Teamleader Marketingbudget Total Unqualified Band3 17,800 1,511 2,492 4,142 8,110 2,353 7,016 1,015 44,438 Unqualified Band4 20,600 1,861 2,884 4,815 9,433 2,353 7,016 1,015 49,976 Qualified Band5 24,600 2,361 3,444 5,777 11,323 2,353 7,016 1,015 57,888 Qualified Band6 31,500 3,223 4,410 7,435 14,584 2,353 7,016 1,015 71,535
2.8.2 Unit costs per person per year

Caseloadsize 10people 15people 20people 25people Unqualified Band3 5,724 3,834 2,862 2,268 Unqualified Band4 6,426 4,266 3,186 2,592 Qualified Band5 7,452 4,968 3,726 2,970 Qualified Band6 9,180 6,156 4,590 3,672
2.8.3 Equivalent cost in day care days

Caseloadsize 10people 15people 20people 25people . Unqualified Band3 106 71 53 42 Unqualified Band4 119 79 59 48 Qualified Band5 138 92 69 55 Qualified Band6 170 114 85 68
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2.9 Deprivation of liberty safeguards in England: implementation costs

In2009,thegovernmentprovidedadditionalfundingof10millionforlocalauthoritiesand2.2millionfortheNational HealthService(NHS)fortheimplementationofdeprivationoflibertysafeguards(DoLS),whichwasfullyimplementedon1 April2009inEnglandandWales.ThisamendsabreachoftheEuropeanConventiononHumanRightsandprovidesforthe lawfuldeprivationoflibertyofthosepeoplewholackthecapacitytoconsenttoarrangementsmadefortheircareor treatmentineitherhospitalsorcarehomes,butwhoneedtobedeprivedoflibertyintheirownbestinterests,toprotect themfromharm. In2009,astudywascarriedouttoestimatethecostslikelytobeincurredwiththeimplementationoftheDoLSinEngland, anddataonresourceutilisationwerecollectedfromprofessionalsconductingthesixformalassessmentsrequired.1These are:ageassessment,mentalhealthassessment,mentalcapacityassessment,bestinterestassessment,eligibility assessmentandnorefusalassessment,thelatterofwhichestablisheswhetherauthorisationofdeprivationofliberty wouldconflictwithotherauthorities(forexamplepowerofattorney)fordecisionmakingforthatindividual. Atotalof40interviewswereplannedtoincludeprofessionalsconductingthesixDoLSassessments,thesecretarialstaffin DoLSofficesandtheindependentmentalcapacityadvocates.Eachprofessionalprovidedtheaveragetimetakenforan individualDoLSassessmentorforcombinedassessments,whenmorethanoneofthesixDoLSassessmentswere conductedtogether.Averagetravellingtimeanddistancewerealsoprovided.Totalassessmenttimeforeachindividual (includingtravellingtime)wasmultipliedbytheunitcostforthatprofessionalandatravellingallowance. TheaveragecostforasingleDoLSassessmentacrossthefiveDoLSofficeswas1,277.Thestandarddeviationaroundthe estimatedcostofasingleDoLSassessmentwas393,andthe95percentconfidenceintervalwas506to2,048.Allcosts havebeenupratedto2010/2011pricesusingtheappropriateinflators. Costsforasingledeprivationoflibertysafeguards(DoLS)assessment. Allassessmentsincludetravel time DoLS office 1 468 657 306 106 40 1,577 DoLS office 2 213 395 171 81 40 900 DoLS office 3 545 277 121 57 40 1,040 DoLS office 4 270 961 552 56 40 1,879 DoLS Averageof office thefive 5 offices 232 346 536 290 69 40 1,167 565 288 74 40 1,313
Assessmentsbymentalhealth assessor Assessmentsbybestinterest assessor Secretarialcosts Independentmentalcapacity advocatesassessments Courtprotectioncosts Totalcosts
Shah,A.,Pennington,M.,Heginbotham,C.&Donaldson,C.(2011)DeprivationofLibertySafeguardsinEngland:Implementationcosts,TheBritish JournalofPsychiatry(2011),199,232238,doi:10.1192/bjp.bp.110.089474..
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2.10 Mindfulness based cognitive therapy group based intervention

Mindfulnessbasedcognitivetherapyisamanualised,groupbasedskillstrainingprogrammedesignedtoenablepatientsto learnskillsthatpreventtherecurrenceofdepression.Itisderivedfrommindfulnessbasedstressreduction,aprogramme withprovenefficacyinamelioratingdistressinpeoplesufferingchronicdisease. Inordertoprovidetheunitcostsofthisservice,wehavedrawnoninformationprovidedbyKuykenetal.(2008)1which wasbasedondatafromthreemindfulnessbasedcognitivetherapytherapistswhotookpartinthestudy.Therewere12 individualsineachgroup. Costsandunitestimation Unitcost Notes 2010/2011 A.Wages/salary 37,600peryear BasedonthemeanbasicsalaryforAgendaforChangeBand7ofthe JanuaryMarch2011NHSStaffEarningsestimatesforqualifiedAllied HealthProfessionals.2SeesectionVforfurtherinformationonmedian salaries. B.Salaryoncosts 9,345peryear Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. C.Qualifications Noinformationavailable D.Overheads TakenfromNHS(England)SummarisedAccounts.3Seeprefacefor moreinformation. Management, 8,920peryear Managementandothernoncarestaffcostswere19.1percentof administrationandestates directcaresalarycostsandincludedadministrationandestatesstaff. staff Nonstaff 19,717peryear Nonstaffcostswere41.6percentofdirectcaresalarycosts.They includecoststotheproviderforoffice,travel/transportand telephone,educationandtraining,suppliesandservices(clinicaland general),aswellasutilitiessuchaswater,gasandelectricity. E.Capitaloverheads 2,256peryear BasedonthenewbuildrequirementsofNHSfacilities,butadjustedto reflectshareduseofbothtreatmentandnontreatmentspace.4,5 Workingtime 41.3weeksper Includes29daysannualleaveand8daysstatutoryleave.6 Assumes5 annum study/trainingdaysand12dayssicknessleave.7Unitcostsbasedon 37.5hoursper 1549perannum. week Facetofacetime 1:0.67 BasedondatafromthethreeMBCTtherapistswhotookpartinthe study. Lengthofsessions 2hours Therapysessionslasted twohours. Unitcostsavailable2010/2011 50perhour,84perdirectcontacthour,168 persession,14 perserviceuser.
Kuyken,W.,Byford,S.,Taylor,R.S.,Watkins,E.,Holden,E.,White,K.,Barrett,B.,Byng,R.,Evans,A.,Mullan,E.&Teasdale,J.D.(2008)Mindfulnessbased cognitivetherapytopreventrelapseinrecurrentdepression,JournalofConsultingandClinicalPsychology,76,966978. 2 TheInformationCentre(2010)NHSStaffEarningsJune2011,TheInformationCentre,Leeds. 3 NationalAuditOffice(2010)NHS(England)SummarisedAccounts20092010,TheStationeryOffice,London. 4 BuildingCostInformationService(2011)SurveysofTenderPrices,March,RoyalInstituteofCharteredSurveyors,London. 5 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 6 NHSEmployers(2005)AgendaforChange,NHSTermsandConditionsofServiceHandbook,NHSEmployers,London. 7 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London.
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2.11 Interventions for mental health promotion and mental illness prevention
InformationhasbeendrawnfromKnappetal.(2011)1andprovidesasummaryofthekeyfindingsofastudyexploringthe economiccaseformentalhealthpromotionandprevention,basedonadetailedanalysisofcostsandbenefitsforfifteen differentinterventions. Thefullreportcanbedownloadedat: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_126085 Health visiting and reducing post natal depression Context:Moderatetoseverepostnataldepressionaffectsaroundoneineightwomenintheearlymonthsfollowing childbirth.TheNationalInstituteforHealthandClinicalExcellence(NICE)recommendsthescreeningofpostnatal depressionaspartofroutinecare,andtheuseofpsychosocialinterventionsandpsychologicaltherapyforwomen dependingontheseverityofdepressivesymptoms. Intervention:Healthvisitorsarewellplacedtoidentifymotherssufferingfrompostnataldepressionandtoprovide preventativescreeningandearlyinterventions.AnumberofUKtrialsofhealthvisitorinterventionshavefoundpositive effects:womenweremorelikelytorecoverfullyafterthreemonths;targetedantenatalinterventionwithhighriskgroups wasshowntoreducetheaveragetimemothersspentinadepressedstate;andacombinationofscreeningand psychologicallyinformedsessionswithhealthvisitorswasclinicallyeffective6and12monthsafterchildbirth. Cost:Thebiggestdirectcostsoftheinterventionwereassociatedwithtraining(estimatedat1,400perhealthvisitor), plustheadditionaltimespentbyhealthvisitorsprovidingscreeningandcounsellingformothers. Parenting interventions for the prevention of persistent conduct disorders Context:Conductdisordersarethemostcommonchildhoodpsychiatricdisorders,withaUKprevalenceof4.9percentfor childrenaged510years.Theconditionleadstoadulthoodantisocialpersonalitydisorderinabout50percentofcases,and isassociatedwithawiderangeofadverselongtermoutcomes,particularlydelinquencyandcriminality.Thecoststo societyarehigh,withaveragepotentialsavingsfromearlyinterventionpreviouslyestimatedat150,000percase. Intervention:Parentingprogrammescanbetargetedatparentsofchildrenwith,oratriskof,developingconduct disorder,andaredesignedtoimproveparentingstylesandparentchildrelationships.Reviewshavefoundparenttraining tohavepositiveeffectsonchildrensbehaviour,andthatbenefitsremainoneyearlater.Longertermstudiesshow sustainedeffectsbutlackcontrolgroups;costeffectivenessdataarelimited,butinonetrial,healthandsocialservices costswerefoundtoreduceovertime. Cost:Themediancostofan812weekgroupbasedparentingprogrammeisestimatedat952perfamily,whilethatof individualinterventionsis2,078.Assuming80percentofpeoplereceivegroupbasedinterventionsand20percent individualinterventions,inlinewithNICEguidance,theaveragecostoftheinterventioncanbeestimatedat1,177per family. Schoolbased social and emotional learning programmes to prevent conduct problems in childhood. Context:Conductproblemsinchildhoodcoverarangeofoppositionalorantisocialformsofbehaviour,suchas disobedience,lying,fightingandstealing,andareassociatedwitharangeofpooroutcomes,includingincreasedriskof criminalactivity,fewerschoolqualifications,parenthoodatayoungage,unemployment,divorceorseparation,substance abuse,andpsychiatricdisorders,manyofwhichleadtoincreasedcostsacrossseveralagencies. Intervention:SchoolbasedSocialandEmotionalLearning(SEL)programmeshelpchildrenandyoungpeopletorecognise andmanageemotions,andtosetandachievepositivegoals.InternationalevidenceshowsthatSELparticipants demonstratesignificantlyimprovedsocialandemotionalskills,attitudes,behaviourandacademicperformance. 1 Knapp,M.,McDaid,D.&Parsonage,M.(2011)Mentalhealthpromotionandmentalillnessprevention:Theeconomiccase,DepartmentofHealth,
London.www2.lse.ac.uk/LSEHealthAndSocialCare/pdf/MHPP%20The%20Economic%20Case.pdf
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Cost:Thecostsofarepresentativeintervention,includingteachertraining,programmecoordinatorandmaterials,were estimatedat132perchildperyear(2009prices). Schoolbased interventions to reduce bullying Context:Beingbulliedatschoolhasadverseeffectsonbothpsychologicalwellbeingandeducationalattainment.Thereis evidencefromlongitudinaldatathatthishasanegativelongtermimpactonemployabilityandearnings;onaverage, lifetimeearningsofavictimofbullyingarereducedbyaround50,000.AccordingtoanOfstedsurvey,239percentof childrenreportedbeingbulliedintheprevious12months. Intervention:Antibullyingprogrammesshowmixedresults.Onehighqualityevaluationofaschoolbasedantibullying interventionfounda2122percentreductionintheproportionofchildrenvictimised. Cost:Informationislimitedonthecostofantibullyingprogrammes,butonestudyestimatesthisat15.50perpupilper year(2009prices). Early detection for psychosis Context:ItisestimatedthateachyearinEnglandmorethan15,000peopleexhibitearlysymptomsbeforetheonsetoffull psychosis.Progressionofthediseaseisassociatedwithhighercoststopublicservices(includinghealth,socialcareand criminaljustice),lostemployment,andgreatlydiminishedqualityoflifefortheindividualandtheirfamily. Intervention:Earlydetectionservicesaimtoidentifytheearlysymptomsofpsychosis,reducetheriskoftransitiontofull psychosis,andshortenthedurationofuntreatedpsychosisforthosewhodevelopit.Suchservicesincludecognitive behaviouraltherapy,psychotropicmedication,andcontactwithpsychiatrists.Thiscontrastswithtreatmentasusualwhich typicallyconsistsofGPandcounsellorcontacts. Cost:Oneyearofanearlydetectioninterventionhasbeenestimatedtocost2,948perpatient,comparedwith743for standardcare(2009prices). Early intervention for psychosis Context:Psychosisrelatedtoschizophreniaisassociatedwithhighercoststopublicservices(includinghealth,socialcare andcriminaljustice),lostemployment,andgreatlydiminishedqualityoflifefortheindividualwiththeillnessandtheir family. Intervention:Earlyinterventionteamsaimtoreducerelapseandreadmissionratesforpatientswhohavesufferedafirst episodeofpsychosis,andtoimprovetheirchancesofreturningtoemployment,educationortraining,andmoregenerally theirfuturequalityoflife.Thisinterventioninvolvesamultidisciplinaryteamthatcouldincludearangeofprofessionals (psychiatrists,psychologists,occupationaltherapists,communitysupportworkers,socialworkers,vocationalworkers). Cost:Theannualdirectcostperpatientofthistypeofservice,plusothercommunitypsychiatricservicesandinpatient care,hasbeenestimatedat10,927at2008/2009prices.Thefirstyearoftheearlyinterventionteamsinputisestimated tocost2,282perpatient. Screening and brief intervention in primary care for alcohol misuse Context:Itisestimatedthat6.6millionadultsinEnglandcurrentlyconsumealcoholathazardouslevels,and2.3millionat harmfullevels. Intervention:AninexpensiveinterventioninprimarycarecombinesuniversalscreeningbyGPsofallpatients,followedby a5minuteadvicesessionforthosewhoscreenpositive. Cost:Thetotalcostoftheinterventionaveragedoverallthosescreenedwas17.40at2009/2010prices.
2
Ofsted(2008)Childrenonbullying,Ofsted.www.ofsted.gov.uk/resources/childrenbullying.
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Workplace screening for depression and anxiety disorders Context:LabourForceSurveydatasuggestthat11.4millionworkingdayswerelostinBritainin2008/09duetowork relatedstress,depressionoranxiety.Thisequatesto27.3dayslostperaffectedworker. Intervention:Workplacebasedenhanceddepressioncareconsistsofemployeescompletingascreeningquestionnaire, followedbycaremanagementforthosefoundtobesufferingfrom,oratriskofdeveloping,depressionand/oranxiety disorders.Thoseatriskofdepressionoranxietydisordersareofferedacourseofcognitivebehaviouraltherapy(CBT) deliveredinsixsessionsover12weeks. Cost:Itisestimatedthat30.90(at2009prices)coversthecostoffacilitatingthecompletionofthescreening questionnaire,followupassessmenttoconfirmdepression,andcaremanagementcosts.Forthoseidentifiedasbeingat risk,thecostofsixsessionsoffacetofaceCBTis240. Promoting wellbeing in the workplace Context:Deterioratingwellbeingintheworkplaceispotentiallycostlyforbusinessesasitmayincreaseabsenteeismand presenteeism(lostproductivitywhileatwork),andinthelongertermpotentiallyleadstoprematurewithdrawalfromthe labourmarket. Intervention:Thereareawiderangeofapproaches:flexibleworkingarrangements;careerprogressionopportunities; ergonomicsandenvironment;stressaudits;andimprovedrecognitionofriskfactorsforpoormentalhealthbyline managers.Amulticomponenthealthpromotioninterventionconsistsofpersonalisedhealthandwellbeinginformation andadvice;ahealthriskappraisalquestionnaire;accesstoatailoredhealthimprovementwebportal;wellnessliterature, andseminarsandworkshopsfocusedonidentifiedwellnessissues. Cost:Thecostofamulticomponentinterventionisestimatedat80peremployeeperyear(2009prices). Debt and mental health Context:Onlyabouthalfofallpeoplewithdebtproblemsseekadvice,andwithoutinterventionalmosttwothirdsof peoplewithunmanageabledebtproblemswillstillfacesuchproblems12monthslater.Researchhasdemonstratedalink betweendebtandmentalhealth.Onaverage,thelostemploymentcostsofeachcaseofpoormentalhealthare11,432 perannum,whiletheannualcostsofhealthandsocialserviceuseare1,508. Intervention:Currentevidencesuggeststhatthereispotentialfordebtadviceinterventionstoalleviatefinancialdebt, andhencereducementalhealthproblemsresultingfromdebt.Forthegeneralpopulation,contactwithfacetofaceadvice servicesisassociatedwitha5percentlikelihoodofdebtbecomingmanageable,whiletelephoneservicesachieve47per cent. Cost:Thecostsofthistypeofinterventionvarysignificantly,dependingonwhetheritisthroughfacetoface,telephoneor internetbasedservices.TheDepartmentforBusiness,InnovationandSkillssuggestsexpenditureof250perclientfor facefacedebtadvice;telephoneandinternetbasedservicesarecheaper(2009prices).

Populationlevel suicide awareness training and intervention Context:Theeconomicimpactsofsuicideareprofound,althoughcomparativelyfewstudieshavesoughttoquantifythese costs.Thisisinpartbecauseaproportionofindividualswhosurvivesuicideattemptsarelikelytomakefurtherattempts,in somecasesfatal. Intervention:ThereisevidencethatsuicidepreventioneducationforGPscanhaveanimpactasapopulationlevel interventiontopreventsuicide.Withgreateridentificationofthoseatrisk,individualscanreceivecognitivebehavioural therapy(CBT),followedbyongoingpharmaceuticalandpsychologicalsupporttohelpmanageunderlyingdepressive disorders.
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Cost:AcourseofCBTinthefirstyearisaround400perperson.Furtherongoingpharmaceuticalandpsychological therapyisestimatedtocost1,182ayear.ThecostofsuicidepreventiontrainingforGPs,basedontheAppliedSuicide InterventionSkillsTraining(ASIST)course,is200. Bridge safety measures for suicide prevention Context:Jumpingfromheightaccountsforaround3percentofcompletedsuicides. Intervention and Cost:Followingtheinstallationofasafetybarrierin1998,atacostof300,000(in2009prices),the numberofsuicidesreducedfromanaverageof8.2perannuminthefiveyearsbeforethebarrier,to4perannuminthe fiveyearsafteritwasinstalled. Collaborative care for depression in individuals with Type II diabetes Context: Depressioniscommonlyassociatedwithchronicphysicalhealthproblems.USdataindicatethat13percentofall newcasesofTypeIIdiabeteswillalsohaveclinicaldepression.Thesepatternsareimportantasevidenceshowsthatco morbiddepressionexacerbatesthecomplicationsandadverseconsequencesofdiabetes,inpartbecausepatientsmay morepoorlymanagetheirdiabetes.Thishassubstantialeconomicconsequences. Intervention:Collaborativecare,includingGPadviceandcare,theuseofantidepressantsandcognitivebehavioural therapy(CBT)forsomepatients,canbedeliveredinaprimarycaresettingtoindividualswithcomorbiddiabetes. Cost:Itisestimatedthatthetotalcostofsixmonthsofcollaborativecareis682,comparedwith346forusualcare. Tackling medically unexplained symptoms Context:Somatoformconditionspresentphysicalsymptomsforwhichthereisnoidentifiablephysicalcause.These medicallyunexplainedsymptomsarethoughttobetriggeredorexacerbatedbymentalandemotionalfactors,suchas psychosocialstress,depressionoranxiety.Thefinancialcoststopublicservicesandsocietyareconsiderable. Intervention:Cognitivebehaviouraltherapy(CBT)hasbeenfoundtobeaneffectiveinterventionfortacklingsomatoform conditionsandtheirunderlyingpsychologicalcauses. Cost:AcourseofCBTmaylastfor10sessionsat40persession.Costsassociatedwiththeneedtoraisetheawarenessof GPstothepotentialroleofCBTtreatmentforsomatoformconditions,eitherthroughelearningorfacetofacetraining, arealsoincluded. Befriending of older adults Context:Befriendinginitiatives,oftendeliveredbyvolunteers,provideanupstreaminterventionthatispotentiallyof valuebothtothepersonbeingbefriendedandthebefriender. Intervention:Theinterventionisnotusuallystructuredandnordoesithaveformallydefinedgoals.Instead,aninformal, naturalrelationshipdevelopsbetweentheparticipants,whowillusuallyhavebeenmatchedforinterestsandpreferences. Thisrelationshipfacilitatesimprovedmentalhealth,reducedlonelinessandgreatersocialinclusion. Cost:Thecontactisgenerallyforanhourperweekorfortnight.Thecosttopublicservicesof12hoursofbefriending contactisestimatedat85,basedonthelowerendofthecostrangeforbefriendinginterventions.
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3. Services for people who misuse drugs or alcohol

3.1Residentialrehabilitationforpeoplewhomisusedrugsoralcohol 3.2Inpatientdetoxificationforpeoplewhomisusedrugsoralcohol 3.3Specialistprescribing 3.4Alcoholhealthworker,Accident&EmergencyDepartment
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Servicesforpeoplewhomisusedrugsoralcohol
StatisticsproducedbytheNationalDrugTreatmentMonitoringSystem(NDTMS),presentedintheNationalTreatment Agencys(NTA)AnnualReport2008/09,1revealedtheprevalenceofpeoplewhomisusedrugsoralcohol. TheinformationpresentedinTables3.1to3.3wasprovidedbytheNationalTreatmentAgency2andpresenttheunitcosts ofthreeprincipletreatmentinterventions:(a)residentialrehabilitation,(b)inpatientdetoxificationand(c)specialist prescribing.TheseinterventionsaredescribedfullyinBusinessDefinitionforAdultDrugTreatmentProviders(National TreatmentAgency,2010).3 Nationalaveragecostsfortheinterventionswerecalculated.Theseexcludedinstanceswheretheproviderdatafellinthe topandbottom5percentofunitcostsforserviceusersintreatmentORdaysintreatment,andthetopandbottom10per centofunitcostsforserviceusersintreatmentANDdaysintreatment.
NationalTreatmentAgencyforSubstanceMisuse(2009)AnnualReport,2008/09.www.nta.nhs.uk/uploads/nta_annual_report_0809_2.pdf,Accessed 14September2010. 2 PersonalcommunicationwiththeNationalTreatmentAgency(2010). 3 NationalTreatmentAgencyforSubstanceMisuse(2010)NDTMSDatasetG,Definition,BusinessDefinitionforAdultDrugTreatmentProviders. www.nta.nhs.uk/uploads/yptreatmentbusinessdefinitionv7.05.pdf,Accessed14September2010.
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3.1 Residential rehabilitation for people who misuse drugs or alcohol

Residentialrehabilitationconsistsofarangeoftreatmentdeliverymodelsorprogrammestoaddressdrugandalcohol misuse,includingabstinenceorientateddruginterventionswithinthecontextofresidentialaccommodation.Other examplesincludeinpatienttreatmentforthepharmacologicalmanagementofsubstancemisuse,andtherapeutic residentialservicesdesignedtoaddressadolescentsubstancemisuse.Ofthe210,815individualsreceivingstructureddrug treatmentin2008/09,14,711wereinresidentialrehabilitation.Therealfigureislikelytobehigherasonlyabouttwo thirdsofresidentialproviderssentdatatotheNationalDrugTreatmentMonitoringSystemin2008/09. Informationhasbeendrawnfromasampleof34residentialrehabilitationprogrammestoproduceaunitcostperresident weekof647at2010/2011pricesupratedfrom2007/08.TheGrossDomesticProduct(GDP)indexhasbeenused,as suggestedbytheNTA.Itwasnotpossibletoprovidedetailsofcostsforthisserviceduetothemethodofdatacollection.
NationalTreatmentAgencyforSubstanceMisuse(2009)AnnualReport,2008/09.www.nta.nhs.uk/uploads/nta_annual_report_0809_2.pdf,Accessed 14September2010.
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3.2 Inpatient detoxification for people who misuse drugs or alcohol

AnInpatientUnit(IPU)providescaretoserviceuserswithsubstancerelatedproblems(medical,psychologicalorsocial) thataresoseverethattheyrequiremedical,psychiatricandpsychologicalcare.ThekeyfeatureofanIPUistheprovision oftheseserviceswith24hourcover,7daysperweek,fromamultidisciplinaryclinicalteamwhohavehadspecialist traininginmanagingaddictivebehaviours. Treatmentinaninpatientsettingmayinvolveoneormoreofthefollowinginterventions:(a)assessment,(b)stabilisation and(c)assistedwithdrawal(detoxification).Acombinationofallthreemaybeprovided,oronefollowedbyanother. Thethreemainsettingsforinpatienttreatmentare:(a)generalhospitalpsychiatricunits,(b)specialistdrugmisuse inpatientunitsinhospitalsand(c)residentialrehabilitationunits(usuallyasaprecursortotherehabilitationprogramme). SeeBusinessDefinitionforAdultDrugTreatmentProviders1formoredetailedinformationonthisintervention. BasedoninformationprovidedbytheNationalTreatmentAgencyin2010,theaveragecostforinpatientdetoxification (NHSandvoluntaryorganisations)is147perpatientday,whichisequivalentto1,029perpatientweek.Allcostshave beenupratedto2010/11pricesusingtheGrossDomesticProduct(GDP)index,assuggestedbyNTA. Costsandunit 2010/2011value Notes estimation A.Directpay 86per Salariesplusoncostsforcarestaff. patientday B.Directoverheads 15per Includesdrugs,pharmacyanddispensingcosts.Alsoincludesothertreatment patientday materials,toxicologyanddrugtesting,medicalsupplies,rentandrates,staff travel,training,serviceusertravelcosts,volunteerexpenses,contingency management,officecostsspecificallyattributedtotheprovisionofthe service,nonpayadministration(forexample,telephonesandinformation technology). C.Indirectcostsand 46per Includescapitalcharges,capitalonrefurbishment,propertyandbuildings, overheads patientday housekeeping,catering,porterage,transport,wastedisposal,security, finance,humanresources,personnel,communicationsandcorporate charges. Unitcostsavailable2010/2011 147perpatientdayor1,029 perpatientweek
NationalTreatmentAgencyforSubstanceMisuse(2010)NDTMSDatasetG,Definition,BusinessDefinitionforAdultDrugTreatmentProviders, www.nta.nhs.uk/uploads/yptreatmentbusinessdefinitionv7.05.pdf.
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3.3 Specialist prescribing

Specialistprescribingiscommunityprescribingfordrugmisuseinaspecialistdrugservicesetting,normallystaffedbya multidisciplinarysubstancemisuseteam.Specialistprescribinginterventionsnormallyincludecomprehensiveassessments ofdrugtreatmentneedandtheprovisionofafullrangeofprescribingtreatmentsinthecontextofcareplanneddrug treatment.Thespecialistteamshouldalsoprovideorprovideaccessto,arangeofothercareplannedhealthcare interventionsincludingpsychosocialinterventions,awiderangeofharmreductioninterventions,BloodBorneVirus(BBV) preventionandvaccination,andabstinenceorientedinterventions. TheteamsincludespecialistdoctorswhoareusuallyconsultantaddictionpsychiatristswithaCertificateofCompletionof Training(CCT)inpsychiatry,withendorsementinsubstancemisuseworkingexclusivelytoprovideafullrangeofservices tosubstancemisusers.SeeBusinessDefinitionforAdultDrugTreatmentProviders1formoredetailedinformationonthis intervention. BasedoninformationprovidedbytheNationalTreatmentAgency,2theaveragecostforspecialistprescribingis51per patientweek.Allcostshavebeenupratedfrom2007/08usingtheGrossDomesticProduct(GDP)index,assuggestedby theNTA. Usingreferencecosts2009/2010,3themeancostperclientcontactinaNHSandPCTcombineddrugsandalcoholmental healthteamwas137perfacetofacecontactand47pernonfacetofacecontact.Thesecostshavebeenupratedusing theHospitalandCommunityHealthServices(HCHS)inflator. 2010/2011value Notes Costsandunit estimation A.Directpay 25per Salariesplusoncostsforcarestaff. patientweek B.Directoverheads 17per Includesdrugs,pharmacyanddispensingcosts.Alsoincludesother patientweek treatmentmaterials,toxicologyanddrugtesting,medicalsupplies,rentand rates,stafftravel,training,serviceusertravelcosts,volunteerexpenses, contingencymanagement,officecostsspecificallyattributedtothe provisionoftheservice,nonpayadministration(forexample,telephones andinformationtechnology). C.Indirectcostsand 9per Includescapitalcharges,capitalonrefurbishment,propertyandbuildings, overheads patientweek housekeeping,catering,porterage,transport,wastedisposal,security, finance,humanresources,personnel,communicationsandcorporate charges. Unitcostsavailable2010/2011 51perpatientweek
NationalTreatmentAgencyforSubstanceMisuse(2010)NDTMSDatasetG,Definition,BusinessDefinitionforAdultDrugTreatmentProviders, www.nta.nhs.uk/uploads/yptreatmentbusinessdefinitionv7.05.pdf. 2 PersonalcommunicationwiththeNationalTreatmentAgency(2010). 3 DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459.
57
3.4 Alcohol health worker, Accident & Emergency

Alcoholhealthworkers(AHWs)areexperiencedmentalhealthnurseswhohaveundertakenspecifictrainingincounselling peoplewhomisusealcohol.AHWsinteractwithpeopleinanonconfrontationalandpatientcentredwayandduringan assessmentmayofferfeedbackaboutsafelevelsofdrinkingandsuggestarangeofstrategiesaimedatreducinglevelsof consumption. InformationforthistableisbasedonastudycarriedoutbytheCentrefortheEconomicsofMentalHealthattheInstitute ofPsychiatry,London.1
Costsandunit estimation A.Wages/salary 2010/2011value 32,600peryear
BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand6of theJanuaryMarch2011NHSStaffEarningsestimates.Medianfulltimeequivalent totalearningswhichincludebasicsalaryplushoursrelatedpay,overtime,occupation payments,locationpayments,andotherpaymentssuchasredundancypayor 2 paymentofnoticeperiodswere34,300. SeesectionVforfurtherinformationon meansalaries. Employersnationalinsurancecontributionisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. 3 (1998). CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthand 4 theHigherEducationFundingCouncilforEngland(HEFCE). Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails.Ithasbeenassumedthat thishealthworkerrequiresthesamequalificationsasastaffnurse/wardmanager. 5 TakenfromNHS(England)SummarisedAccounts. Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary costsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe providerforoffice,travel/transportandtelephone,educationandtraining,supplies andservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedtoreflect 6,7 sharedofficespaceforadministration,andrecreationalandchangingfacilities. Treatmentspacehasnotbeenincluded. 8 Includes29daysannualleaveand8daysstatutoryleave. Assumes5study/training 9 daysand12dayssicknessleave. Unitcostsbasedon1549workinghours.
Notes
B.Salaryoncosts C.Qualifications
8,005peryear 9,356peryear
D.Overheads Management, administrationandestates Staff Nonstaff
7,756peryear 16,892peryear 2,256peryear
E.Capitaloverheads Workingtime
41.3weeks perannum 37.5hours perweek 1 BasedonasurveyofAHWsinaLondonA&Edepartment, 82percentoftimeisspent Ratioofdirecttoindirect onfacetofacecontactand18percentononwardreferral. timeon: cliniccontacts 1:0.22 1 Percliniccontact. BasedonsurveyofAHWsinLondonA&Edepartment. Lengthofcontact 55minutes Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 44(50)perhour;54(61)perclinicconsultation
Barrett,B.,Byford,S.,Crawford,M.J.,Patton,R.,Drummond,C.,Henry,J.A.&Touquet,R.(2006)Costeffectivenessofscreeningandreferraltoan alcoholhealthworkerinalcoholmisusingpatientsattendinganaccidentandemergencydepartment:adecisionmakingapproach,DrugandAlcohol Dependence,Jan4;81(1):4754.Epub2005Jul11. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 8 NHSEmployers(2005)AgendaforChange:NHSTermsandConditionsofServiceHandbook,NHSEmployers,London. 9 TheInformationCentre(2011)ResultsoftheNHSSicknessAbsenceSurvey2010,NHSEmployers,London.
59
4. Services for people with learning disabilities

4.1 4.2 4.3 4.4

Grouphomesforpeoplewithlearningdisabilities Fullystaffedlivingsettings Semiindependentlivingsettings Localauthoritydaycareforpeoplewithlearningdisabilities
61
4.1 Group homes for people with learning disabilities

ThecostsofgrouphomesarebasedontheresultsofastudyfundedbytheWellcomeTrustandconductedbyFelceand colleaguesin2005.1Thesamplecomprisesresidentslivinginfullystaffedandsemiindependentlivingsettings(53service users).Thesecostshavebeenupratedusingtheappropriateinflators.SeeDeinstitutionalisationandCommunityLiving: outcomesandcosts(Manselletal.2007,chapter3),whichprovidesfurtherdetailsonserviceprovisionforpeoplewith learningdisabilities.2,3 Costsandunitestimation 2010/2011value Notes A.Capitalcosts 73perweek Capitalcostsfor buildingsandlandwerecalculatedusing marketvaluationsofproperty.Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent.1 Revenuecosts B.Staffing(directandnondirect 728perweek Calculatedusingfacilityspecificaccountsinformation.1 staffing) C.Onsiteadministration 22perweek D.Agencyoverheads 128perweek Othercosts E.Personallivingexpensesfor 251perweek Thiscosthasbeenbasedontheallowancesreceivedbya itemssuchasfood,utilities, sampleofresidentslivinginfullystaffedandsemi personalcareandleisure independentlivingsettings.ItincludesaLowerDisability Allowance(carecomponent),EmploymentandSupport Allowance25plus,JobSeekersAllowance(incomebased)and HousingBenefitaswellasthePersonalAllowancesforasingle person(25plus)andHousingBenefit(premiumsingle).4 Externalservices F.Hospital 10perweek ClientspecificserviceusewasrecordedusingtheClient G.Community 19perweek ServiceReceiptInventory(CSRI)5with35residentsingroup homesinterviewed.1 H.Dayservices 210perweek Useoffacilitybyclient 52.18weeksper annum Multiplierforlevelofdisability Higherlevelsof Thesampleofserviceusersusedtoderivetheschema were ability:0.82x(BtoH) ofmildtomoderateintellectualdisabilityandthereforerelate tothosewithhigherlevelsofability(ABS>145). Lowerlevelsofability: Forlowerlevelsofabilityamultiplierof1.60couldbeapplied (lowerlevelsofability:1.60x(BtoH). 1.60x(BtoH) Unitcostsavailable2010/2011 951establishmentcostperresidentweek(includesAtoD),1,441 care packagecosts(includesAtoH).
Felce,D.,Perry,J.,Romeo,R.,Robertson,J.,Meek,A.,Emerson,E.&Knapp,M.(2008)Outcomesandcostsofcommunitylivingsemiindependentliving andfullystaffedgrouphomes,AmericanJournalonMentalRetardation,113,2,87101. 2 Mansell,J.,Knapp,M.,BeadleBrown,J.&Beecham,J.(2007)Deinstitutionalisationandcommunityliving:outcomesandcosts:reportofaEuropean study.Volume2:MainReport, TizardCentre,UniversityofKent,Canterbury. 3 Mansell,J.,Knapp,M.,BeadleBrown,J.&Beecham,J.(2007) Deinstitutionalisationandcommunityliving:outcomesandcosts:reportofaEuropean study,CountryReport:UnitedKingdom, TizardCentre,UniversityofKent,Canterbury. 4 DepartmentforWorkandPensions(2011)Benefitsuprating,http://gmwrag.files.wordpress.com/2010/12/benefit_rates_2011_2012.pdf. 5 Beecham,J.&Knapp,M.(1992)Costingpsychiatricinterventions,inG.Thornicroft,C.Brewin&J.Wing(eds)MeasuringMentalHealthNeeds,Oxford UniversityPress,Oxford.
62
4.2 Fullystaffed living settings

ThecostsoffullystaffedlivingsettingsarebasedontheresultsofastudyfundedbytheWellcomeTrustandconductedby Felceandcolleaguesin2005.1Allcostshavebeenupratedusingtheappropriateinflators.SeeDeinstitutionalisationand CommunityLiving:outcomesandcosts(Manselletal.2007,chapter3),whichprovidesfurtherdetailsonserviceprovision forpeoplewithlearningdisabilities.2,3 Costsandunit 2010/2011value Notes estimation A.Capitalcosts 81perweek Capitalcostsfor buildingsandlandwerecalculatedusingmarket valuationsofproperty.Capitalcostshavebeenannuitisedover60 yearsatadiscountrateof3.5percent. Revenuecosts B.Staffing(directand 964perweek nondirectstaffing) Calculatedusingfacilityspecificaccountsinformation.1 C.Onsite 30perweek administration D.Agencyoverheads 156perweek Othercosts Thiscosthasbeenbasedontheallowancesreceivedbyasampleof E.Personalliving 251perweek residentslivinginfullystaffedandsemiindependentlivingsettings.It expensesforitems includesaLowerDisabilityAllowance(carecomponent),Employment andSupportAllowance25plus,JobSeekersAllowance(incomebased) suchasfood,utilities, andHousingBenefitaswellasthePersonalAllowancesforasingle personalcareand person(25plus)andHousingBenefit(premiumsingle).4 leisure Externalservices F.Hospital 8perweek ClientspecificserviceusewasrecordedusingtheClientServiceReceipt G.Community 18perweek Inventory(CSRI),5with35residentsinfullystaffedlivingsettings interviewed.Costsfordayserviceswereestimatedusingaccounts H.Dayservices 241perweek information,whereavailable.1Unitcostsforallotherserviceswere takenfromthisvolume. Useoffacilityby 52.18 weeksperannum client Multiplierforlevelof Higherlevelsofability: ClientsweregroupedaccordingtoscoresontheAdaptiveBehaviour disability 0.82x(BtoH) Scale(ABS).6Scoresbetweenzeroand145weregroupedaslessable; Lowerlevelsofability: scoreshigherthan145weregroupedasmoreable(145wasselected toallowrelativelyevendistributionbetweengroups.)Allparticipantsin 1.60x(BtoH) thestudyweremildtomoderateintellectualdisability. Unitcostsavailable2010/2011 1,231establishmentcostsperresidentweek(includesAtoD);1,749 carepackagecosts(includesAtoH).
Felce,D.,Perry,J.,Romeo,R.,Robertson,J.,Meek,A.,Emerson,E.&Knapp,M.(2008)Outcomesandcostsofcommunitylivingsemiindependentliving andfullystaffedgrouphomes,AmericanJournalonMentalRetardation,113,2,87101. 2 Mansell,J.,Knapp,M.,BeadleBrown,J.&Beecham,J.(2007)Deinstitutionalisationandcommunityliving:outcomesandcosts:reportofaEuropean study.Volume2:MainReport, TizardCentre,UniversityofKent,Canterbury. 3 Mansell,J.,Knapp,M.,BeadleBrown,J.&Beecham,J.(2007) Deinstitutionalisationandcommunityliving:outcomesandcosts:reportofaEuropean study,CountryReport:UnitedKingdom, TizardCentre,UniversityofKent,Canterbury. 4 DepartmentforWorkandPensions(2011)Benefitsuprating,http://gmwrag.files.wordpress.com/2010/12/benefit_rates_2011_2012.pdf. 5 Beecham,J.&Knapp,M.(1992)Costingpsychiatricinterventions,inG.Thornicroft,C.Brewin&J.Wing(eds)MeasuringMentalHealthNeeds,Oxford UniversityPress,Oxford. 6 Nihira,K.,Leland,H.&Lambert,N.(1993)AdaptiveBehaviorScaleResidentialandCommunity,2ndEdition,ProEd,Austin,Texas.
63
4.3 Semiindependent living settings

ThecostsofsemiindependentlivingsettingsarebasedontheresultsofastudyfundedbytheWellcomeTrustand conductedbyFelceandcolleaguesin2005.1Thesamplecomprised35serviceuserswhowereresidentinsemi independentlivingsettings.Thesesettingswerepartiallystaffed,havingnopaidsupportforatleast28hoursperweek whenserviceuserswereawakeathome.Thesesettingsdidnothaveanyregularnighttimesupportorsleepover presence.Allcostshavebeenupratedusingtheappropriateinflators.SeeDeinstitutionalisationandCommunityLiving: outcomesandcosts(Manselletal.2007,chapter3)whichprovidesfurtherdetailsonserviceprovisionforpeoplewith learningdisabilities.2,3 Costsandunit 2010/2011value Notes estimation A.Capitalcosts 59perweek Capitalcostsfor buildingsandlandwerecalculatedusingmarket valuationsofproperty.Theyhavebeenannuitisedover60yearsata discountrateof3.5percent. Revenuecosts B.Staffing(directand nondirectstaffing) 263perweek C.Onsite Calculatedusingfacilityspecificaccountsinformation.1 administration 10perweek D.Agencyoverheads 65perweek Othercosts Thiscosthasbeenbasedontheallowancesreceivedbyasampleof E.Personalliving 251perweek residentslivinginfullystaffedandsemiindependentlivingsettings.It expensesforitems includesaLowerDisabilityAllowance(carecomponent),Employment andSupportAllowance25plus,JobSeekersAllowance(incomebased) suchasfood,utilities, andHousingBenefitaswellasthePersonalAllowancesforasingle personalcareand person(25plus)andHousingBenefit(premiumsingle).4 leisure Externalservices F.Hospital 10perweek ClientspecificserviceusewasrecordedusingtheClientServiceReceipt G.Community 15perweek Inventory(CSRI),5with35residentsinsemiindependentlivingsettings interviewed.Costsfordayserviceswereestimatedusingaccounts H.Dayservices 132perweek information,whereavailable.1Unitcostsforallotherserviceswere takenfromthisvolume. Useoffacilitybyclient 52.18weeksper annum Multiplierforlevelof Higherlevelsofability: ClientsweregroupedaccordingtoscoresontheAdaptiveBehaviour disability 0.82x(BtoH) Scale(ABS).6Scoresbetweenzeroand145weregroupedaslessable; Lowerlevelsofability: scoreshigherthan145weregroupedasmoreable.(145wasselected toallowrelativelyevendistributionbetweengroups.)Allparticipantsin 1.60x(BtoH) thestudyhadmildtomoderateintellectualdisability. Unitcostsavailable2010/2011 397establishmentcostsperresidentweek(includesAtoD);805 carepackagecosts(includesAtoH).
Felce,D.,Perry,J.,Romeo,R.,Robertson,J.,Meek,A.,Emerson,E.&Knapp,M.(2008)Outcomesandcostsofcommunitylivingsemiindependentliving andfullystaffedgrouphomes,AmericanJournalonMentalRetardation,113,2,87101. 2 Mansell,J.,Knapp,M.,BeadleBrown,J.&Beecham,J.(2007)Deinstitutionalisationandcommunityliving:outcomesandcosts:reportofaEuropean study.Volume2:MainReport, TizardCentre,UniversityofKent,Canterbury. 3 Mansell,J.,Knapp,M.,BeadleBrown,J.&Beecham,J.(2007) Deinstitutionalisationandcommunityliving:outcomesandcosts:reportofaEuropean study,CountryReport:UnitedKingdom, TizardCentre,UniversityofKent,Canterbury. 4 DepartmentforWorkandPensions(2011)Benefitsuprating,http://gmwrag.files.wordpress.com/2010/12/benefit_rates_2011_2012.pdf. 5 Beecham,J.&Knapp,M.(1992)Costingpsychiatricinterventions,inG.Thornicroft,C.Brewin&J.Wing(eds)MeasuringMentalHealthNeeds,Oxford UniversityPress,Oxford. 6 Nihira,K.,Leland,H.&Lambert,N.(1993)AdaptiveBehaviorScaleResidentialandCommunity,2ndEdition,ProEd,Austin,Texas.
64
4.4 Local authority day care for people with learning disabilities
ThistableusesthePersonalSocialServicesExpenditurereturn(PSSEX1)1forrevenuecosts,whichhavebeenupratedusing thePSSPay&Pricesinflator.Themediancostwas300perclientweekandthemeancostwas285perclientweek (includingcapitalcosts).Thesedatadonotreporthowmanysessionsclientsattendedeachweek. 2010/2011 Notes Costsandunit value estimation Capitalcosts(A,B Basedonthenewbuildandlandrequirementsforlocalauthoritydaycare &C) facilities(whichdonotdistinguishbyclientgroup).Theseallowfor33.4square A.Buildingsand 4.60per metresperperson.2Capitalcostshavebeenannuitisedover60yearsata discountrateof3.5percent. oncosts session B.Land 0.80per BasedonDepartmentforCommunitiesandLocalGovernmentstatistics.3 Land session costshavebeendiscountedat3.5percentover60years. C.Othercapital Capitalcostsnotrelatingtobuildingsandoncostsareincludedintherevenue costssonoadditionalcosthasbeenaddedforothercapitalsuchasequipment anddurables. Revenuecosts Assumingpeoplewithlearningdisabilitiesattenddaycarefivedaysaweek,the D.Salaryandother 55persession medianandmeancostsperdaywere55and52respectively.Capitalcharges revenuecosts ontherevenueaccountwhichrelatetobuildingshavebeendeducted. E.Agency SocialServicesManagementandSupportServices(SSMSS)costsareincludedin overheads PSSEX1revenuecostfiguressonoadditionaloverheadshavebeenadded. Useoffacilityby Assumesattendance of5sessionsaweek. client Occupancy Nocurrentinformationisavailable. Londonmultiplier 1.20x(AtoB); RelativeLondoncostsaredrawnfromthesamesourceasthebasedataforeach 1.20x(DtoE) costelement. Unitcostsavailable2010/2011 60persession(includesAtoD).
1 2
TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 3 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011.
65
5. Services for younger adults with physical and sensory impairments

5.1Highdependencycarehomeforyoungeradultswithphysicalandsensory impairments 5.2Residentialhomeforyoungeradultswithphysicalandsensoryimpairments 5.3Specialneedsflatsforyoungeradultswithphysicalandsensoryimpairments 5.4Rehabilitationdaycentreforyoungeradultswithbraininjury
67
5.1 Highdependency care home for younger adults with physical and sensory impairments
ThistableisbasedoninformationreceivedfromJohnGroomsin2002detailingthecostsofprovidingahighdependency residentialcentre.1Thisregisterednursinghomeprovides17nursingplacesandoneresidentialcareplace,forpeoplewith severephysicaldisabilities(commonlymultiplesclerosisandbraininjury)whoareagedbetween18and65onadmission. Alloftheresidentsusewheelchairsandmanyhavecommunicationproblems.Theemphasisistoenablepeopletodevelop theirindividualityandlifestyleinanenvironmentthatisacceptabletothemastheirlongtermhome.Eachresident occupiesanopenplanflatletwithensuitefacilitiesandasimplefoodpreparationarea.Theobjectiveistoprovidealiving environmentthatoffersprivacyandreasonablespaceinwhichtolivetothosewhodonothavetheoptionofcommunity livingbecauseoftheseverityoftheircondition.Costshavebeenupratedto2010/2011pricesusingthePSSinflators. Costsandunit 2010/2011value Notes estimation CapitalCosts(A,B,C&D) Capitalcostsfor buildingsandland werecalculatedusingdata which A.Buildings 196perweek reflectHousingCorporationaccessibilityandbuildstandards.Costshave beeninflatedusingtheBCIS/ABIHouseRebuildingindex.2Thevalueof thebuildingwasannuitisedovera60yearperiodanddiscountedat3.5 percent. B.Landcosts 27perweek Landcostshavebeendiscountedat3.5percentover60years.3 C.Equipment/durables: wheelchairs 7.70perweek Costofpoweredchair,seeschema7.2. furnishings/fittings 8.30perweek Depreciationonfurniture/fittings,calculatedusingfacilityspecific accounts. D.Vehicles 5.60perweek Revenuecosts E.Salarycosts 848perweek Costsofdirectmanagement,administrative,maintenance,medicaland carestaff.Calculatedusingfacilityspecificaccountsinformation. Calculatedusingfacilityspecificaccounts. F.Training 16perweek Includesrepairsandcontractsandcyclicalmaintenance. G.Maintenance 19perweek Calculatedusingfacilityspecificaccounts. H.Medicalcosts 12perweek I.Otherrevenuecosts 189perweek Includesinsurance,travel,staffadverts,uniforms,printingandstationery, telephone,postage,equipmentreplacement,householdexpenses, premisescosts,costofprovisions,household,linenandlaundrycosts. J.Overheads 50perweek Chargesincurredforsupportfromthelinkednationalorganisation. K.Externalservices Noinformationavailable. Useoffacilitybyresident 52.18weeks perannum Numberofresidents 18 17nursinghomeplacesand1residentialhomeplace. Unitcostsavailable2010/2011 1,378perresidentweek.
1 2 3
InformationprovidedbyDavidNewnham,DirectorofServicesandDevelopmentatJohnGroomsin2005. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011.
68
5.2 Residential home for younger adults with physical and sensory impairments
ThistableisbasedoninformationreceivedfromJohnGroomsandisbasedononeresidentialhomeforyoungeradults withphysicalandsensoryimpairments.1Thehomehas20placesforpeopleagedbetween18and65onadmission.Itdoes notspecialiseinprovidingaserviceforanyparticulartypeofdisability,butmanyoftheresidentsarepeoplewithcerebral palsyandbraininjury.Theresidentsoccupyindividualopenplanflatletsofferingensuiteandfoodpreparationfacilities. Manyresidentspreparetheirownmeals,andactivitiesofdailylivingskillsaredevelopedwiththegoalofenabling residentstoliveindependentlyinthecommunity.Theaimisforabout50percentofresidentstofollowthisroutewhile theremainderwillremainforlongtermcare.Therateofmoveonisslow,withoneortwopeopleleavingtoliveinthe communityperyear.Dependencyofresidentsisincreasing,presentinggreaterobstaclesforthemingainingindependent livingskillsandreducingthelikelihoodoftheirlivingindependentlyinthecommunity.Costshavebeeninflatedto 2010/2011pricesusingthePSSPayandPricesinflators. UsingPSSEX12009/10upratedusingthePSSPay&Pricesinflator,themeancostoflocalauthorityresidentialcarefor adultswithaphysicaldisabilityorsensoryimpairmentis1,297andthemediancostis877.2Themeancostofresidential careprovidedbyothersforadultswithaphysicaldisabilityorsensoryimpairmentis824andthemediancostis829.2 Costsandunit 2010/2011value Notes estimation Capitalcosts(A,B,C& Capitalcostsfor buildingandlandwerebasedontheactualcostofthe D) buildingandupratedusingtheBCIS/ABIHouseRebuildingindex.Thevalue A.Buildings 85perweek ofthebuildingwasannuitisedovera60yearperioddiscountedat3.5per cent. B.Landcosts 13perweek Basedonanapproximatemeasurementof0.35acresprovidedbyJohn Grooms.Landcostshavebeenannuitisedat3.5percentover60years. C.Equipment/durables: wheelchairs 7.70perweek Costofpoweredchair,seeschema7.2. furnishings/fittings 6.90perweek Depreciationonfurniture/fittings,calculatedusingfacilityspecific accounts. D.Vehicles 2.00perweek Calculatedusingfacilityspecificaccounts. Revenuecosts E.Salarycosts F.Training G.Maintenance H.Otherrevenuecosts 519perweek 8.00perweek 30perweek 72perweek Costsofdirectmanagement,administrative,maintenance,medicaland carestaff.Calculatedusingfacilityspecificaccounts. Calculatedusingfacilityspecificaccounts. Includesrepairsandcontractsandcyclicalmaintenance. Includesinsurance,travel,staffadverts,uniforms,printingandstationery, telephone,postage,equipmentreplacement,householdexpenses,medical, premisesandhouseholdandlaundrycosts.Calculatedusingfacilityspecific accountsinformation. Chargesincurredforsupportfromthelinkednationalorganisation. Noinformationavailable.
I.Overheads 24perweek J.Externalservices Useoffacilityby 52.18weeks resident perannum Numberofresidents 20places Unitcostsavailable2010/2011 768perresidentweek.
1 2
InformationprovidedbyDavidNewnham,DirectorofServicesandDevelopmentforJohnGrooms,London. TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds.
69
5.3 Special needs flats for younger adults with physical and sensory impairments
ThistableisbasedoninformationreceivedfromJohnGroomsin2002detailingthecostsofprovidinga24houronsite careserviceforfivepeoplewithdisabilities.1Theserviceconsistsofthreesingleflats,adoubleflatandofficespacewhichis alsousedatnighttoaccommodateasleepinginmemberofstaff.Theserviceprovidesatleastonepersonondutyboth dayandnight,withtwocrossoverperiodsduringthedaywhentwopeopleareonduty.Thecareprovidedmayinclude personalcare,domestictasks(includingmealpreparation),andassistanceinmaintainingsocialcontacts,monitoringwell beingandteaching/encouragingdailylivingandsocialskills.Residentsliveasindependentlyaspossible,makinguseof externalhealthandsocialcareservicesasidentifiedbelow.Costshavebeeninflatedto2010/2011prices.
Costsandunit estimation Capitalcosts(A,B&C) A.Buildings
2010/2011value 128perweek 21perweek 7.70perweek 8.50perweek 420perweek 0.90perweek 2.10perweek 16perweek 8.90perweek 184perweek 127perweek 211perweek 243perweek 151perweek 7.00perweek
B.Landcosts C.Equipment/durables: wheelchairs furnishings/fittings Revenuecosts D.Salarycosts E.Travel F.Training G.Otherrevenuecosts H.Overheads Personallivingexpenses I.Basiclivingcosts J.Otherlivingcosts K.Externalservices ResidentA ResidentB ResidentC ResidentD
Notes Capitalcostsforbuildingswerecalculatedusingdatawhichreflect HousingCorporationaccessibilityandbuildstandards.Thecosthasbeen upratedusingtheBCIS/ABIHouseRebuildingindex.2Thevalueofthe buildingwasannuitisedovera60yearperioddiscountedat3.5percent. Thecostoflandhasbeenannuitisedat3.5percentover60years. Costofpoweredchair,seeschema7.2. Depreciationonfurniture/fittings. Costsofdirectmanagementandcarestaff.Calculatedusingfacility specificaccountsinformation. Calculatedusingfacilityspecificaccounts. Includesinsurance,staffadverts,uniforms,printingandstationery, telephone,postage,equipmentreplacement,householdexpenses, premisesandcostofprovisions. Chargesincurredforsupportfromthelinkednationalorganisation. Basedoninformationtakenfromthedisabledpeoplescostsofliving: morethanyouwouldthinkforserviceuserswithhightomediumneeds.3 Basiclivingcostsincludefoodanddrinks,clothingandfootwear,health, andmiscellaneouscostssuchaspersonalcareandinsurances.Itis assumedthathousing,fuelandpowercostsarecoveredbythefee. Thisincludesrecreation,cultureandeducationcosts. ResidentAattendsadaycentreworkshop3daysperweek,fundedby socialservices.Inaddition,hasvolunteersupport. ResidentBisattendedbythedistrictnurseeachnightandduringtheday ontwooccasionseachweek.Fouradditionalhourscareperdayprovided byschemescarestaff. ResidentsCisindependentandrarelyhaspersonalcareinputunless unwell.FromtimetotimerequestshelpwithdomestictasksfromLA socialservices. ResidentDisindependentandhasnoexternalinput.
52.18weeks perannum Numberofclients 5 Unitcostsavailable2010/2011 604perweeksaccommodationandonsitesupport(includesAtoG);757 perweekallserviceandaccommodationcosts (includesAtoG&K);941perweekaccommodation,supportservicesandbasicliving(equivalenttocarehomecosts)(A toI&K);1,068comprehensivepackagecostincludingexternalservicesandalllivingexpenses(includesAtoK).

1 2
Useoffacilitybyclient
InformationprovidedbyDavidNewnham,DirectorofServicesandDevelopmentforJohnGrooms,London. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 3 Smith,N.,Middleton,S.,AshtonBrooks,K.,Cox,L.&Dobson,B.withReith,L.(2004)DisabledPeoplesCostsofLiving.MoreThanYouWouldThink, JosephRowntreeFoundation,York.
70
5.4 Rehabilitation day centre for younger adults with brain injury
ThistableisbasedoninformationreceivedfromJohnGroomsin2002,detailingthecostsofprovidingadayrehabilitation centreforpeoplewithacquiredbraininjury,1includingthosewithtraumaticbraininjuryandyoungerpeoplewhohavehad strokes.Thefacilityprovidesupto30placesperday,withacurrentcaseloadofapproximately160people.Thecentre operatesonanoutpatientbasisandoffersafullandintensiverehabilitationprogramme.Theservicemodelreliesonstrong partnershipswithhealthandsocialservices,aswellasAddenbrookeHospital,whoprovidespecialisttraumaticbraininjury services.Theserviceenablespeoplewithbraininjurytoremainintheirownhomesandtoreceivespecialistintensive rehabilitation,ratherthanbeingreferredtospecialistresidentialrehabilitationinotherareasofthecountry.Theservice hasenabledthedevelopmentofmultidisciplinaryteamworkwithafocusonthetreatmentofpeoplewithbraininjuryina nonhealthcaresetting.Costshavebeeninflatedto2010/2011prices. Costsandunit 2010/2011value Notes estimation Capitalcosts(A,B,C&D) Thecapitalcostsfor thebuildings andlandwerebasedonthe A.Buildings 13perday actualcostsofbuildingsin2001/2002andupratedusingthe BCIS/ABIHouseRebuildingindex.2Thevalueofthebuildingwas annuitisedovera60yearperioddiscountedat3.5percent. B.Landcosts 1.30perday Basedon1,053squaremetres.DataprovidedbyJohnGroomsand annuitisedatadiscountrateof3.5percentover60years. C.Equipment/durables: furnishings/fittings 1.60perday Depreciationonfurniture/fittingscalculatedusingfacilityspecific accounts. D.Capitalcostsfor transport Revenuecosts E.Salarycosts 52perday Costsofdirectmanagement,administrative,maintenanceand medical.Calculatedusingfacilityspecificaccountsinformation. Calculatedusingfacilityspecificaccounts. F.Travel 1.50perday Calculatedusingfacilityspecificaccounts. G.Training 0.50perday Includesrepairsandcontractsandcyclicalmaintenance. H.Maintenance 2.60perday Includesinsurance,staffadverts,uniforms,printingandstationery, I.Otherrevenuecosts 14perday telephone,postage,equipmentreplacement&household expensesandpremisescosts. J.Overheads 5.00perday Chargesincurredforsupportfromthelinkednational organisation. Useoffacilitybyclient 253daysperyear Thecentreisclosedatweekendsandduringpublicholidays. Numberofclients 30places 160clientsattendthecentre. Unitcostsavailable2010/2011 92perplaceperday.
1 2
InformationprovidedbyDavidNewnham,DirectorofServicesandDevelopmentforJohnGrooms,London. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames.
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6. Services for children and their families

6.1NHSreferencecostsforchildrenshealthservices 6.2Communityhomeforchildrenlocalauthority 6.3Communityhomeforchildrennonstatutorysector 6.4Localauthorityfostercareforchildren 6.5Socialservicessupportforchildreninneed 6.6Comparativecostsofprovidingsexuallyabusedchildrenwithindividualandgroup psychotherapy 6.7Keyworkerservicesfordisabledchildrenandtheirfamilies 6.8MultiSystemicTherapy(MST) 6.9Multidimensionaltreatmentfostercare 6.10IncredibleYearsParentingProgramme 6.11Shortbreaksfordisabledchildrenandtheirfamilies
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6.1 NHS reference costs for childrens health services

WehavedrawnontheNHSTrustandPrimaryCareTrustscombinedtoreportfromtheNHSReferenceCostsofselected childrenshealthservices.1Allcostshavebeenupratedto2010/2011levelsusingtheHCHSPay&Pricesinflator. Lowerquartile Upperquartile Nationalaverage COMMUNITYSERVICES Therapyservices Physiotherapygroup(onetoone) 160(89) 30(52) 93(77) Occupationaltherapygroup(onetoone) 175(148) 84(76) 155(118) Speechtherapyservicesgroup(onetoone) 101(101) 48(63) 78(84) Othercommunityservices(includeschildpublic health,safeguarding,statutoryworkforeducation andsocialservicesandotherservices,butexcludes TFC291andothervaccinationprogrammes) Weightedaverageoffacetofacecontact 351 196 290 Weightedaverageofnonfacetofacecontact 198 113 186 Communityandoutreachnursing 25(22) Schoolbasedchildrenshealthservicesgroup(onetoone) 42(46) 38(36) Vaccinationprogrammes 18 Schoolbasedchildrenshealthservices 30 28 41 Communitynursingservicesgeneral 106 82 OUTPATIENTATTENDANCES Weightedaverageforallpaediatricservices n/a n/a 775 MENTALHEALTH 314 Daycarefacilitiesregularattendances 284 216 Specialistinpatientservices(weightedaverageofeating 784 disorder,andmotherandbabyunits) 663 550 Consultantservicesoutpatient,weightedaverageofdrugs 266 andalcohol,andotherservicesfollowupfacetoface 261 207 1,340 ChildandAdolescentMediumSecureServices 1,130 980
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6.2 Care home for children local authority

TheCostsandEffectivenessofServicesforChildreninNeedstudyManagement,LeadershipandResourcesinChildrensHomes(funded undertheDepartmentofHealthsCostsandEffectivenessofServicesforChildrenInNeedinitiative)1estimatedthecostsforasampleof 30localauthorityresidentialhomesinEngland.Usingacombinationofthisresearchandpubliclyavailabledata,thistablepresentsthe costsperresidentweekforalocalauthoritycarehomeforchildren.Establishmentcostsperweekwere2,767perresidentweekand costsincludingexternalserviceswere2,965.AllcostshavebeenupratedusingthePSSPay&Pricesindex.BasedonSection2512ofthe DepartmentforEducationsFinancialDatacollectionforoutturn2009/10andactivitydata(tables7and8ofareportprovidedbythe 3 DepartmentforEducationforthiswork), thecostforaweekinanownprovisionresidentialhomeforchildrenwas3,106when upratedusingthePSSPayandPricesindex.Thiswascalculatedbydividingnetcurrentexpenditure(363,977,726)forresidentialcare forchildren(ownprovision)bythenumberofownprovisionactivitydays(843,072).
Costsandunit estimation 2010/2011 value Perresident week 111 13 2,643 5 16 2 175 Notes
Capitalcosts(A,B&C) A.Buildings B.Land Revenuecosts C.Salaryandother revenuecosts D.Agencyoverheads E.Othercosts Externalservices: Healthservices Socialservices Youthjusticesector Educationsector (excludinginhouse education) Useoffacilitybyclient Occupancy Londonmultiplier
52.18weeks 84%
1.06xA;2.73x B;1.01x(D) Unitcostsavailable2010/2011 2,767establishmentcostsperresidentweek(includesAtoE);2,965carepackagecostsperresidentweek(includesAtoE).
Basedonthenewbuildandlandrequirementsforlocalauthoritychildrenshomes.These allowfor59.95m2perperson.4Capitalcostsarediscountedat3.5percentover60years. BasedonstatisticsprovidedbytheDepartmentforCommunitiesandLocalGovernment.5 Landcostshavebeenannuitisedat3.5percentover60years. MeancostsforchildrenlookedafterinownprovisionchildrenshomesarebasedonPSS EX1returnsfor2007/20086upratedusingthePSSPay&PricesIndex.Capitalchargesfor buildingshavebeendeducted. SocialServicesManagementandSupportServices(SSMSS)costsareincludedinPSSEX1 revenuecostfiguressonoadditionaloverheadshavebeenadded. ServiceusedatatakenfromtheManagement,LeadershipandResourcesinChildrens Homesstudyarelikelytobeanunderestimateasinformationonkeyservicesonlywas 1 requested. CostsofhospitalservicesweretakenfromTrustFinancialreturns(CIPFA,2001)anduprated 7 to2010/2011pricesusingtheHCHSPay&Pricesindex. Supportprovidedbyfieldsocialworkers,leavingcareworkersandfamilysupportworkers. UnitcostsweretakenfromNettenetal.(2001)8andupratedto2010/2011pricesusingthe PSSPay&Pricesindex.Costsforpolicecontactsandyouthcustodywereestimatedusing 9 informationcontainedinFinnetal.(2000) andupratedto2010/2011pricesusingthePSS Pay&PricesIndex.Costsestimatedaccordingtothelocationofthehomeusinginformation containedinCIPFA(2001).7Hometuitioncostswereestimatedusingmethodologyreported byBerridgeetal.(2002).10Themidpointofthepayscaleforqualifiedteacherswasused, includingemployersnationalinsuranceandsuperannuationcontributions.Apercentage (65%)wasaddedtocoverotherinstitutionalexpenditureandLEAoverheads. TakenfromtheManagement,LeadershipandResourcesinChildrensHomesstudyand 1 basedontheoccupancyrateforallCommunityChildrensHomes. RelativeLondoncostsaredrawnfromthesamesourceasthebasedataforeachcost 4,5,6 element.
Hicks,L.,Gibbs,I.,Weatherly,H.andByford,S.(2009)Management,leadershipandresourcesinchildren'shomes:whatinfluencesoutcomesin residentialchildcaresettings?,BritishJournalofSocialWork,39,5,828845. DepartmentforEducation(2011)Section251dataarchive:Outturndatadetailedlevel200809onwards,outturnsummary200910,Departmentfor Education,London. www.education.gov.uk/schools/adminandfinance/financialmanagement/schoolsrevenuefunding/section251/archive/b0068383/section251data archive/outturndatadetailedlevel200809onwards. 3 PersonalcommunicationwiththeDepartmentforEducation,2011. 4 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 5 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 6 DepartmentofHealth(2008)PSSEX12007/08,DepartmentofHealth,London. 7 CharteredInstituteofPublicFinanceandAccountancy(CIPFA)(2001)PersonalSocialServicesStatistics19992000Actuals,StatisticalInformation Service,CIPFA,London. 8 Netten,A.,Rees,T.&Harrison,G.(2001)UnitCostsofHealthandSocialCare2001,PersonalSocialServicesResearchUnit,UniversityofKent, Canterbury. 9 Finn,W.,Hyslop,J.&Truman,C.(2000)MentalHealth,MultipleNeedsandthePolice,RevolvingDoorsAgency,London. 10 Berridge,D.,Beecham,J.,Brodie,I.,Cole,T.,Daniels,H.,Knapp,M.&MacNeill,V.(2002)CostsandConsequencesofServicesforTroubledAdolescents: AnExploratory,AnalyticStudy,ReporttotheDepartmentofHealth,UniversityofLuton.
2
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6.3 Care home for children nonstatutory sector

TheCostsandEffectivenessofServicesforChildreninNeedstudyManagement,LeadershipandResourcesinChildrensHomes(funded undertheDepartmentofHealthsCostsandEffectivenessofServicesforChildrenInNeedinitiative)1estimatedtheaveragecostsofa sampleofcarehomesinthenonstatutorysectorinEngland.Usingacombinationofthisresearchandpubliclyavailabledata,asdetailed inthistable,establishmentcostsperweekwere2,472perresidentweekandcostsincludingexternalserviceswere2,557.Allcosts havebeenupratedusingthePSSPay&Pricesindex.BasedonSection2512oftheDepartmentforEducationsFinancialDatacollection 3 foroutturn2009/10andactivitydata(tables7and8ofareportprovidedbytheDepartmentforEducationforthiswork), thecostfora weekinaprivateresidentialhomeforchildrenwas3,467whenupratedusingthePSSPayandPricesIndex.Thiswascalculatedby dividingnetcurrentexpenditure(558,885,557)forresidentialcareforchildren(private)bynumberofactivitydays(1,159,610). Costsandunit 2010/2011value Notes estimation Perresident week Capitalcosts(A,B&C) Basedonthenewbuildandlandrequirementsforlocalauthoritychildrenshomes. A.Buildings 111 Theseallowfor59.95m2perperson.4Capitalcostsarediscountedat3.5percentover 60years. B.Land 13 BasedonDepartmentforCommunitiesandLocalGovernmentstatistics.5Landcosts havebeenannuitisedat3.5percentover60years. Revenuecosts Themeancostforchildrenlookedafterinownprovisionchildrenshomesisbasedon C.Salaryandother 2,347 PSSEX1returnsfor2007/2008upratedusingthePSSPay&PricesIndex.6Capital revenuecosts chargeshavebeendeducted.IntheLeadershipandResourcesinChildrensHomes study,staffcostsaccountedfor64percentofthetotalcostofhomesonaverage. D.Agencyoverheads SocialServicesManagementandSupportServices(SSMSS)costsareincludedinPSS EX1revenuecostfiguressonoadditionaloverheadshavebeenadded. E.Othercosts Externalservices: UnitcostsofhospitalservicesweretakenfromTrustFinancialreturns(CIPFA,2001) 7 Healthservices 37 andupratedto2010/2011pricesusingtheHCHSPay&Pricesindex. Supportprovidedbyfieldsocialworkers,leavingcareworkersandfamilysupport Socialservices 8 8 workersweretakenfromNettenetal.(2001). Costsforpolicecontactsandyouthcustodywereestimatedusinginformation Youthjusticesector 5 containedinFinnetal.(2000).9Costsestimatedaccordingtothelocationofthehome usinginformationcontainedinCIPFA(2000).7 HometuitioncostswereestimatedusingmethodologyreportedbyBerridgeetal. Educationsector 34 10 (2002). Themidpointofthepayscaleforqualifiedteacherswasused,including (excludinginhouse employersnationalinsuranceandsuperannuationcontributions.Apercentage(65%) education) wasaddedtocoverotherinstitutionalexpenditureandLEAoverheads. Privatesectorcosts 2 Useoffacilitybyclient 52.18weeks Occupancy 84% TakenfromtheManagement,LeadershipandResourcesinChildrensHomesstudy 1 andbasedontheoccupancyrateforallCommunityChildrensHomes. Londonmultiplier 1.06xA;2.73 RelativeLondoncostsaredrawnfromthesamesourceasthebasedataforeachcost 4,5,6 xB;0.84x(C) element. Unitcostsavailable2010/2011 2,472establishmentcostsperresidentweek(includesAtoD);2,557carepackagecostsperresidentweek(includesAtoE).
Hicks,L.,Gibbs,I.,Weatherly,H.andByford,S.(2009)Management,leadershipandresourcesinchildren'shomes:whatinfluencesoutcomesin residentialchildcaresettings?,BritishJournalofSocialWork,39,5,828845. DepartmentforEducation(2011)Section251dataarchive:Outturndatadetailedlevel200809onwards,outturnsummary200910,Departmentfor Education,London. www.education.gov.uk/schools/adminandfinance/financialmanagement/schoolsrevenuefunding/section251/archive/b0068383/section251data archive/outturndatadetailedlevel200809onwards. 3 PersonalcommunicationwiththeDepartmentforEducation,2011. 4 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 5 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 6 DepartmentofHealth(2008)PSSEX12007/08,DepartmentofHealth,London. 7 CharteredInstituteofPublicFinanceandAccountancy(CIPFA)(2001)PersonalSocialServicesStatistics19992000Actuals,StatisticalInformation Service,CIPFA,London. 8 Netten,A.,Rees,T.&Harrison,G.(2001)UnitCostsofHealthandSocialCare2001,PersonalSocialServicesResearchUnit,UniversityofKent, Canterbury. 9 Finn,W.,Hyslop,J.&Truman,C.(2000)MentalHealth,MultipleNeedsandthePolice,RevolvingDoorsAgency,London. 10 ProvisionalcostbasedonthecostofmainstreamschoolingtakenfromD.Berridgeetal.(2002)CostsandConsequencesofServicesforTroubled Adolescents:AnExploratory,AnalyticStudy,ReporttotheDepartmentofHealth,UniversityofLuton.
2
76
6.4 Local authority foster care for children

Thisschemaprovidesthecostoflocalauthorityfostercareforchildren.Forinformationonmultidimensionaltreatment fostercare,seeschema6.8ofthisvolume. Costsandunit 2010/2011 Notes estimation value A.Boardingout 400perchild UsingSection2511 anddividingtotalnetexpenditureforownprovision allowancesand fostercareof663,972,914bythetotalnumberofactivitydays perweek administration (11,938,827),2thecostperdayfor2009/10was55.60(389perweek). WhenupratedusingthePSSPayandPricesinflator,thiswas400perchild perweek. UsingSection2511anddividingtotalnetexpenditureforallfostercare (includesownprovision,private,otherpublicandvoluntaryfostercare)of 1,269,391,7952bythetotalnumberofactivitydays(16,612,420),2thecost perdayforallprovisionfostercarefor2009/10was76.30(535perweek). WhenupratedusingthePersonalSocialServicesPSSPayandPricesinflator, thiswas548perweek. B.Socialservices 230perchild Themajorityofchildrenlookedafterareinfosterplacementsandthemean (includingcostofsocial perweek costofsupportfromfieldworkteamsandcentres(costedstaff/centretime) workerandsupport) hasbeenestimatedbyusingtheChildreninNeed(CiN)Census20053and upratedtocurrentlevelsusingthePSSPayandPricesInflators. C.Otherservices, 64perchild AstudybyBeechamandKnapp(1995)4 foundthatotherservicesincluding including health,educationandlawandorder(estimatedonthesamebasisas perweek education servicestothoseincommunityhomes)addedafurther16percenttothe cost. Serviceusebyclient 52.18weeks peryear Londonmultiplier 1.24 BasedonPSSEX1datafor2007/08.5 CostsinLondonwereconsiderably higher,andthisislikelytobepartlyasaresultofhavingalargermarket, withIndependentFosteringAgenciesavailable. Unitcostsavailable2010/2011 694perchildperweek(includesAtoC).
DepartmentforEducation(2011)Section251dataarchive:Outturndatadetailedlevel200809onwards,outturnsummary200910,Departmentfor Education,London. www.education.gov.uk/schools/adminandfinance/financialmanagement/schoolsrevenuefunding/section251/archive/b0068383/section251data archive/outturndatadetailedlevel200809onwards. 2 PersonalcommunicationwiththeDepartmentforEducation,2011. 3 DepartmentforEducationandSkills(2005)ChildreninNeedinEngland:ResultsofaSurveyofActivityandExpenditureasReportedbyLocalAuthority SocialServicesChildrenandFamiliesTeamsforaSurveyWeekinFebruary2005,DepartmentforEducationandSkills,London. 4 Beecham,J.&Knapp,M.(1995)Thecostsofchildcareassessment,inR.Sinclair,L.Garnett&D.Berridge(eds)SocialWorkAssessmentwithAdolescents, NationalChildrensBureau,London. 5 DepartmentofHealth(2008)PSSEX12007/08,DepartmentofHealth,London.
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6.5 Social services support for Children in Need

Until2005,theChildreninNeedCensuswasabiennialsurveywhichcollectedinformationonthenumbersand characteristicsofchildreninneed:thatis,childrenreceivingsocialservicessupport.Theunitcostsoftheseserviceswere alsopublishedforasurveyweekinFebruary2005whichincluded234,700children.1Since2008/09,theChildreninNeed Censushasbeenannual,buthascontainedslightlydifferentinformation.In2008/09,althoughfinancialinformationwas collected,ratherthanbeingforasampleweekasinpreviouscensuses,thecollectioncoveredsixmonths.Further differencesbetweenthesetwosurveysarediscussedinMahon(2008).2 Inthisschema,therefore,wepresentinformationcollectedin2005whichisbasedonservicesreceivedbyeachchildseen duringasurveyweekinFebruary.Thesecostshavebeenupratedto2010/2011costsusingthePSSPayandPricesinflators. At2010/2011prices,theaverageweeklycostforlookedafterchildrenwas789,whileforchildrensupportedintheir familiesorindependently,thecostwas161,withanaveragecostperChildInNeedof333. Threetypesofexpenditurearecaptured. 1)Thecostsoffieldandcentrestafftimecarryingoutsocialservicesactivitieswith,oronbehalfof,identifiedchildrenin needandtheirfamilies. 2)Thecostsofprovidingcareandaccommodationforchildrenlookedafter(andsimilarregular,ongoingexpenditurethat canbetreatedinthesameway). 3)Oneofforadhocpaymentsandpurchasesforchildreninneedortheirfamilies.
6.5.1 Social services costs per child per week by region

Location Childrensupportedin familiesor independently Total Average no.of cost children perchild 60,265 144 35,235 144 40,760 155 32,490 224 168,750 161 Childrenlookedafter Total
Allshirecounties Allunitaryauthorities Allmetropolitandistricts AllLondonauthorities England
Totalno. of children 22,875 12,115 18,685 12,230 65,900
Average cost perchild 737 846 702 944 783
Totalno.of children 83,140 47,350 59,445 44,720 234,700
Averagecost perchild 305 322 328 420 334
1 2
Forfurtherinformationonthissurveyseewww.dcsf.gov.uk/rsgateway/DB/VOLv000647/vweb022006.pdf Mahon,J.(2008)TowardstheNewChildreninNeedCensus,YorkConsulting,www.education.gov.uk/research/data/uploadfiles/DCSFRW039.pdf, accessed15September2010.
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Needcategory1
6.5.2 Social services costs per child per week by need category
Childrensupportedin familiesorindependently Totalno.of Meancostper children child 50,900 161 21,100 184 8,400 161 20,000 138 23,400 150 12,200 184 3,900 173 5,500 230 8,000 127 15,400 150 Childrenlookedafter
Totalno.ofchildren
Abuse/neglect Disability Parentalillnessordisability Familyinacutestress Familydysfunction Sociallyunacceptablebehaviour Lowincome Absentparenting Casesotherthanchildreninneed Casesnotstated
36,000 8,700 3,200 4,100 6,400 1,800 270 4,400 460 660
Meancostper child 748 748 702 978 886 1,381 760 691 668 541
6.5.3 Average cost ( per week) per child receiving a service

Childrensupportedin familiesor independently Meancostperchild 132 23 6 161 Childrenlookedafter Total
Costsforstaff/centretime Ongoingcosts Oneoffcosts Totalcosts
Meancostperchild 230 547 12 789
Meancostperchild 161 167 5 333
6.5.4 Average amounts spent on children receiving a service ( per week)

Childrensupportedin familiesorindependently Meanhours Meancost perchild perchild 1.5 253 2.5 184 2.6 190 2.3 161 Childrenlookedafter Total Meanhours perchild 1.8 2.7 2.7 2.7 Meancost perchild 409 403 483 333
Asylumseekingchildren Disabledchildren Autisticchildren Allchildren
Meanhours perchild 2.4 3.0 2.8 3.5
Meancost perchild 691 817 950 789
AsspecifiedinDepartmentforEducationandSkills(2005)ChildreninNeedinEngland:ResultsofaSurveyofActivityandExpenditureasReportedby LocalAuthoritySocialServicesChildrenandFamiliesTeamsforaSurveyWeekinFebruary2005,DepartmentforEducationandSkills,London.
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6.6 Comparative costs of providing sexually abused children with individual and group psychotherapy
AspartoftheChildreninNeedresearchinitiative,PaulMcCroneandcolleagues(2005)comparedthecostsofindividual andgrouppsychotherapyforchildrenwhohavebeensexuallyabused.1SubjectswererecruitedtotwoclinicsinLondon andrandomlyallocatedtothetwotreatments.Girlsbetweentheagesofsixand14who,withintheprevioustwoyears, haddisclosedsexualabuseandhadsymptomsofemotionalorbehaviouraldisturbancethatwarrantedtreatmentwere eligibleforinclusion.Thegirlswhoconsentedtoparticipateinthestudywererandomlyallocatedeithertoindividual (n=35)orgrouppsychotherapy(n=36).Theindividualtreatmentcomprisedupto30sessionsoffocusedpsychoanalytical psychotherapy.Individualtherapistsreceivedsupervisionfromaseniorchildpsychotherapistinpairsaftereveryother session.Thegrouptreatmentconsistedofupto18sessionswithaboutfivegirlsofsimilarages,andincorporated psychotherapeuticandpsychoeducationalcomponents.Variousprofessionalsprovidedtherapy,includingchild psychiatrists,psychotherapists,nursepractitionersandspecialist,occupationaltherapistsandsocialworkers.Thegirlswere assessedatbaseline,andfollowedupatoneandtwoyearsaftertreatmenthadcommenced. Researchfoundthatthesetherapieshavesimilaroutcomesand,althoughthisisasinglesmallstudyandfurtherworkis requiredtostrengthentheevidencebasebeforechangeinpracticeisundertaken,resultsofthestudysuggestthatgroup therapyismorecosteffectivethanindividualtherapy.Themeancostofgrouptherapyupratedto2010/2011levelswas 2,893,andthetotalmeancostofindividualtherapyupratedto2010/2011levelswas4,728. Serviceusedataextractedfromcasenotesandtherapistsfileswerecombinedwithunitcostsrepresentingthelongrun marginalopportunitycostsoftheprofessionalsinvolvedinprovidingtheservice.SomeofthesewereobtainedfromUnit CostsofHealthandSocialCare19992whileotherswereestimatedfrom(national)payscalesandanyadditionalelements werebasedonsimilarservicesreportedinthatpublication.Theseunitcostsconsistofsalary,employersuperannuation andnationalinsurancecontributions,overheadsandcapitalcosts.Costsshowninthetableshavebeenupratedto 2010/2011levelsusingtheappropriateindices.
McCrone,P.,Weeramanthri,T.,Knapp,M.,Rushton,A.,Trowell,J.,Miles,G.&Kolvin,I.(2005)Costeffectivenessofindividualversusgroup psychotherapyforsexuallyabusedgirls,ChildandAdolescentMentalHealth,10,2631.ForfurtherinformationcontactProfPaulMcCrone,Centrefor theEconomicsofMentalHealth,BoxPO24,HealthServicesResearchDepartment,InstituteofPsychiatry,DeCrespignyPark,LondonSE58AF (p.mccrone@iop.kcl.ac.uk). 2 Netten,A.,Dennett,J.&Knight,J.(1999)UnitCostsofHealthandSocialCare1999,PersonalSocialServicesResearchUnit,UniversityofKent, Canterbury.
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6.6.1 Group therapy

Intervention Introductorymeeting Mean(sd)no.ofmeetings Mean(sd)cost, Initialassessment Mean(sd)no.ofassessments Mean(sd)cost, Therapyprovidedtogirls Mean(sd)no.ofsessions Mean(sd)cost, Carerssupport Mean(sd)no.ofsessions Mean(sd))cost, Supervisionofgirlstherapists Mean(sd)numberofsessions Mean(sd)cost, Supervisionofcarersworkers Mean(sd)numberofsessions Mean(sd)cost, Followupassessments oneyearfollowup Mean(sd)numberof assessments Mean(sd)cost Mean(sd)totalcost, Samplesize (n=36) 1(0) 71(15) 1(0) 594(44) 13.3(4) 578(209) 10.1(5.3) 537(382) 13.3(4.0) 454(153) 3.4(1.8) 220(156) 1.5(0.7) 438(237) Provider Duration(minutes) 16 16 120 90 105
Consultantpsychiatrist Seniorsocialworker Researchpsychologist Consultantpsychiatrist/senior registrar Seniorsocialworker
Variousprofessionalsproviding18 sessions
75
Socialworkerproviding10sessions
50
Seniorsocialworker/consultant psychiatristproviding18sessions
75
Seniorsocialworkerproviding monthlysessions
60
Researchpsychologist Consultantpsychiatrist/senior registrar Seniorsocialworker Allproviding1sessioneach
30 45 45
2,893(1,196)
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6.6.2 Individual therapy

Intervention Introductorymeeting Mean(sd)no.ofmeetings Mean(sd)cost, Initialassessment Mean(sd)no.ofassessments Mean(sd)cost, Samplesize (n=35) 1(0) 69(16) 1(0) 585(47) Provider Duration(minutes)
Consultantpsychiatrist Seniorsocialworker Researchpsychologist Consultantpsychiatrist/senior registrar Seniorsocialworker Variousprofessionalsproviding30 sessions Socialworkerproviding15sessions
16 16 120 90 105
Therapyprovidedtogirls Mean(sd)no.ofsessions Mean(sd)cost, Carerssupport Mean(sd)no.ofsessions Mean(sd))cost, Supervisionofgirlstherapists Mean(sd)numberofsessions Mean(sd)cost, Supervisionofcarersworkers Mean(sd)numberofsessions Mean(sd)cost, Followupassessments Oneyearfollowup Mean(sd)no.ofassessments Mean(sd)cost Mean(sd)totalcost,
26(8.1) 1,401(521) 14.2(9.3) 1,367(932) 13.0(4.1) 518(162) 4.7(3.1) 387(286) 1.4(0.7) 402(247)
75 50 60 60 30 45 45
Seniorchildpsychotherapist providing15sessions Seniorsocialworkerproviding monthlysessions Researchpsychologist Consultantpsychiatrist/senior registrar Seniorsocialworker Allproviding1sessioneach
4,728(2,210)
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6.7 Key worker services for disabled children and their families
Keyworkersprovideasinglepointofcontactfordisabledchildrenandtheirfamilies,supportingthemandfacilitating accesstootherservices.Bothkeyworkersandthefamiliessupportedseethekeyworkerroleasprovidinginformationand advice,identifyingandaddressingneeds,accessingandcoordinatingservicesforthefamily,providingemotionalsupport, andactingasanadvocate.TheNationalServiceFrameworkforChildren,YoungPeopleandMaternityServices (DepartmentofHealth&DepartmentforEducationandSkills,2004)1recommendsprovisionofkeyworkerstohelp familiesobtaintheservicestheyrequire.Researchhasshownthatkeyworkerservicesappeartogenerategoodoutcomes forfamilies,andprovisionisencouragedthroughcentralgovernmentpolicy. In2004/05,researchwascarriedoutinsevenservicesitesprovidingkeyworkerservicesinordertoexplorethe effectivenessofdifferentmodelsandalsotocalculatecosts(Grecoetal.,2005;Beechametal.,2007).2,3Intotal,205 familiesreturnedquestionnairesofwhichtherewere189validresponses.Predominately,keyworkersincludedinthe samplecamefromfourprofessionalbackgrounds:healthvisiting,nursing,teachingandsocialwork.However,parents, paediatricians,dieticians,speechtherapists,occupationaltherapists,physiotherapistsandearlyyearsworkersalsoactedas keyworkers.Thechildrensupportedbythesesevenkeyworkerserviceshadarangeofdiagnosesofwhichautistic spectrumdisorders,cerebralpalsyanddevelopmentaldelaywerethemostcommon.Mostchildrenhadmorethanone condition. Thetablebelowshowsthattheaveragecostperworkinghourforthesevenserviceswas35,rangingfrom27to43. Thishasbeencalculatedbydividingthetotalcostbythetotalnumberofhoursforwhichstaffmembersundertookkey workingactivities.Theunitcostistherefore,weightedforthestaffmixoneachservice.Overathreemonthperiod,the averageandmeancostofcontact,takingintoaccounttelephonecallsandthecostsofvisits,were155and89 respectively.Allcostshavebeenupratedtoreflect2010/2011prices. Assumingthislevelofcontacttobeconstantover12months,annualaveragecontactcostswouldbe717.Using informationprovidedby11keyworkersreportingtimeuse,thecontacttootheractivityratiois1:2.6(foreachhourspent incontactwiththefamily,twoandahalfhoursarespentonactivitiessuchastravel,liaison,meetingsetc.).At2010/2011 prices,thetotalcostofallschemeswas2,306,302andthetotalcaseloadwas1,237,givinganaverageannualcostper familyacrosstheschemesof1,864. Useandcostsofkeyworkerservicesinthreemonthspriortosurvey Service Costper Meannumberof Meancostofvisits Meannumberof Mediancostofvisits visits telephonecalls working andtelephonecalls andtelephonecalls (range) (range) hour() () () A 27 2.9(08) 6.7(116) 147 128 B 43 2.7(024) 5.0(060) 190 92 C 37 3.6(010) 5.4(180) 194 145 D 39 1.9(012) 2.5(012) 111 61 E 39 2.8(020) 4.6(050) 189 117 F 33 4.4(012) 2.5(012) 114 77 G 25 1.4(06) 2.1(06) 40 25 Total/average 35 2.8(024) 4.4(060) 155 89
DepartmentofHealth&DepartmentforEducationandSkills(2004)NationalServiceFrameworkforChildren,YoungPeopleandMaternityServices, DepartmentofHealth&DepartmentforEducationandSkills,London. 2 Greco,V.,Sloper,P.,Webb,R.&Beecham,J.(2005)AnExplorationofDifferentModelsofMultiAgencyPartnershipsinKeyWorkerServicesforDisabled Children:EffectivenessandCosts,SocialPolicyResearchUnit,UniversityofYork. 3 Beecham,J.,Sloper,P.,Greco,V.&Webb,R.(2007)Thecostsofkeyworkersupportfordisabledchildrenandtheirfamilies,Child:Care,Healthand Development(OnlineEarlyArticles),doi:10.1111/j.13652214.2007.00740.x.
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6.8 Multisystemic therapy (MST)

Thisschemaisbasedonacostingwhichwasundertakenforarandomisedcontrolledtrialofinterventionsforadolescents aged1117yearsatriskofcontinuingcriminalactivity.1 Costsandunitestimation Unitcost Notes 2010/2011 A.Salaryplusoncosts 45,362peryear Basedonthesalaryofacharteredcounsellingpsychologist. Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. B.Overheads TakenfromNHS(England)SummarisedAccounts.2Seeprefacefor moreinformation. Management, 8,664peryear Managementandothernoncarestaffcostswere19.1percentof administrationandestates directcaresalarycostsandincludedadministrationandestatesstaff. staff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.They Nonstaff 18,871peryear includecoststotheproviderforoffice,travel/transportand telephone,educationandtraining,suppliesandservices(clinicaland general),aswellasutilitiessuchaswater,gasandelectricity. C.Capitaloverheads 2,592peryear BasedonthenewbuildandlandrequirementsofNHSfacilitiesand adjustedtoreflectsharedusedofbothtreatmentandnontreatment space.Capitalcostshavebeenannuitisedover60yearsatadiscount rateof3.5percent. Workingtime 41.3weeksper Includes29daysannualleaveand8daysstatutoryleave.Assumes5 annum study/trainingand12dayssicknessleave.3,Unitcostsbasedon1549 37.5hoursper hoursperannum. week Facetofacetime 1:1.40 Thedirect:indirectratiowasbasedonasurveyofthethreeMST therapistswhotookpartinthetrial. Lengthofsessions 60minutes Therapysessionslasted60minutes. Unitcostsavailable2010/2011 49perhour;117pertherapysession.
Butler,S.,Baruch,G.,Hickey,N.&Fonagy,P.(publishedonlineNovember2011).ArandomizedcontrolledtrialofMultisystemicTherapyandstatutory therapeuticinterventionforyoungoffenders,JournaloftheAmericanAcademyofChildandAdolescentPsychiatry.www.jaacap.com/. 2 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 3 NHSEmployers(2005)AgendaforChange:NHSTermsandConditionsofServiceHandbook,NHSEmployers,London.
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6.9 Multidimensional treatment foster care

Multidimensionaltreatmentfostercare(MTFC)isaprogrammeofinterventiondesignedforyoungpeoplewhodisplay emotionalandbehaviouraldifficulties.Itisbaseduponsociallearningandattachmenttheories,andprovidesintensive supportinafamilysetting.AmultidisciplinaryteamofprofessionalsworkwithMTFCfostercarerstochangebehaviour throughthepromotionofpositiverolemodels.Placementsareintensiveandtailoredtothechildsspecificneeds,with24 hoursupporttocarers.Thespecialisedteamofprofessionalsisresponsiblefortheplanninganddeliveryofthe programme,andeachpractitionerhasaclearlydefinedrole.Thecoreteamconsistsofaprogrammesupervisor,individual therapist,birthfamilytherapist,skillsworker,administrator,fostercarerrecruiterandeducationworker;additionalstaff maybeappointedinsomelocalauthorities(seetable6.4forinformationonlocalauthorityfostercareforchildren). ResearchwascarriedoutbytheCentreforChildandFamilyResearch,LoughboroughUniversitytocalculatethecostsof multidimensionaltreatmentfostercare1andtoanalysehowthesecostscomparewiththoseofothertypesofprovisionfor youngpeoplewithsimilarneeds.Thisresearchbuiltonapreviousstudytoexplorethecostsandoutcomesofservices providedtolookedafterchildren,andthecalculationofunitcostsofeightsocialcareprocesses.2Theprocesscostsshown belowalignwiththoseinthetablesforchildrenincare(8.4.18.4.4),inparticularthehighcostchildren.Costsperhour havebeencalculatedusingCurtis(2007)3andincludeoverheadsandcapitalcosts.Foreachprocessthesalaryand overheadcostshavebeenmultipliedbythetimespentbythepractitionersinvolvedtocalculatetheunitcosts.Thecosts tablulatedbelowforprovidingandmaintainingtheplacementaccountforover90percentofthecostsofacareepisode, butexcludethesetupcosts.Costshavebeenupratedfrom2006/2007to2010/2011pricesusingthePSSPayandPrices Inflators.
6.9.1 Costs of eight social care processes for MTFC

Processnumber MTFCcostperchild (2010/2011prices) 6,723 131 6,164 287 6,407 439 3,019 1,271
Processone:decisiontoplaceandfindingfirstMTFCplacement Processtwo:careplanning Processthree:maintainingtheplacement(permonth) Processfour:leavingcare/accommodation Processfive:findingsubsequentMTFCplacement Processsix:review Processseven:legalprocess Processeight:transitiontoleavingcareservices
6.9.2 Process costs for other types of provision for young people
Processnumber Processone Processtwo Processthree Processfour Processfive Processsix Processseven Processeight LAfostercareinLAarea (2010/2011prices) 1,167 131 2,980 287 693 625 3,019 1,271 Agency/fostercareinLAarea (2010/2011prices) 1,519 131 5,481 287 1,044 625 3,019 1,271 AgencyresidentialinLAarea (2010/2011prices) 1,470 131 10,720 287 1,131 625 3,019 1,271
Holmes,L.,Westlake,D.&Ward,H.(2008)CalculatingandComparingtheCostsofMultidimensionalTreatmentFosterCare,ReporttotheDepartment forChildren,SchoolsandFamilies,LoughboroughCentreforChildandFamilyResearch,LoughboroughUniversity. 2 Ward,H.,Holmes,L.&Soper,J.(2008)CostsandConsequencesofPlacingChildreninCare,JessicaKingsleyPublishers,London. 3 Curtis,L.(2007)UnitCostsofHealthandSocialCare2007,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury.
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6.10 Incredible Years parenting programme

TheIncredibleYearsseriesisoneofpartofthreeinterlockingtrainingprogrammesforparents,childrenandteachers.1The parentingprogrammesspantheagerangeof012years.Thechildandteacherprogrammesspantheagerangeof38 years.TheschemabelowshowscostsfortheWebsterStrattonIncredibleYearsbasicparentingprogrammewhichwere collectedin2003/04andhavebeenupratedusingthehospitalandcommunityhealthservicesinflators(HCHS).Thecosts havebeencalculatedusingweeklydiariescompletedbyleadersoffourgroupsandthecostinformationsuppliedbythe IncredibleYearsWelshOffice.Thefiguresincludecostsofweeklyattendanceatsupervisionforgroupleaders.Thiswas requiredbecausetheseleaderswereparticipatinginarandomisedcontrolledtrialandwererelativelyinexperiencedand werenotcertifiedleaders.Generally,supervisionforinexperiencedleaderswouldberecommendedonatermlybasis,with encouragementtoworkforleadercertification.FurtherdetailsofthestudyareavailablefromEdwardsetal.(2007).2 Althoughsetupcostsarenotitemisedinthetablebelow,theunitcostshavebeencalculatedwithandwithoutthese activities.Setupcostsincludeproducingtheprogrammekitsandalsothetrainingoftwoleaders,andtheirtraveland supervisiontime.Thetotalcostfortheseactivitieswas4,544andthetotaltimetakenwas53hours. Costsandunit 2010/2011value Notes estimation A.Capitalcosts 3,584 Capital costswere25percentoftotalcosts. premises B.Revenuecosts salariesandoncosts 7,363 Directsalaryandoncostsforrunningthegroupincludedthe recruitmentcosts(1,049),supervisioncosts(4,449)andgroup runningcosts(1,865).Theactivitiesincluded: 2groupleaderstorecruitparentsincludingtraveltime 2leaderstorunthegroup salaryingroupsessionpreparationtimefor2leaders supervisiontimefor2leadersincludingtravel trainercoststodeliversupervision C.Overheads 2,194 Telephonecosts(46),mileagecosts(750),clericalsupportcosts (99)andtransportandcrechecosts(1,299)wereincludedinthis cost. Venuecostsand refreshments 1,363 Venuecostsandrefreshments. Workingtime Lengthofprogramme 379.25hours 375.25hoursspentfor2leaderstoruntheprogramme. Unitcostsavailable2010/2011 Basedon8parentspergroup:totalcostsperchild(includingsetupcosts)1,813 (2,400);Basedon12parentspergroup: totalcostperchild(includingsetupcosts)1,209(1,600).
WebsterStratton,C.&Hancock,L.(1998)Trainingforparentsofyoungchildrenwithconductproblems:content,methodsandtherapeuticprocesses,in C.ESchaefer&J.M.Briesmeister(eds)HandbookofParentTraining,JohnWiley,NewYork.Vol.9,September. 2 Edwards,R.T.,Cilleachair,A.,Bywater,T.,Hughes,D.A.&Hutchings,J.(2007)Parentingprogrammeforparentsofchildrenatriskofdevelopingconduct disorder:costandeffectivenessanalyisis,BritishMedicalJournal,334,682688.
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6.11 Short break provision for disabled children and their families
ThecostsofshortbreakprovisionstudyundertakenbytheCentreforChildandFamilyResearch1estimatedtheaverage costtochildrenssocialcareofarangeofshortbreakservicesfordisabledchildrenandtheirfamilies.Thestudyuseda bottomupcostingmethodology,2whichusessocialcareactivitytimedataasthebasisforbuildingupunitcosts.See Holmes&McDermidinCurtis(2010)fordetailedinformationonmethodologicalissues.3 The services Shortbreakscanbedeliveredintheformofovernightstays,day,eveningandweekendactivities,andcantakeplaceinthe childsownhome,thehomeofanapprovedcarer,oraresidentialorcommunitysetting.4Arangeofservicesandtheir costswereidentifiedinthisstudy.
Servicetype Residential Familybased overnight Daycare Homesupport Homesitting Generalgroups Afterschoolclubs Weekendclubs Activityholidays
a b
Unit Perchildpernight (24hourperiod) Perchildpernight (24hourperiod) Perchildpersession (8hours) Perfamilyperhour Perfamilyperhour persession persession persession Perchildperbreak
Averagecost 2010/11value Meancost Mediancost 270 176 135 22 19 342 288 320 1,319 296 151 125 22 19 391 279 321 852
Range 2010/11value 72417 144233 102211 1826 1127 100632 246340 305333 117a3,805 b
Thiscostisfora2daybreak Thiscostisfora7daybreak
Holmes,L.,McDermid,S.&Sempik,J.(2009)Thecostsofshortbreakprovision:reporttotheDepartmentforChildren,SchoolsandFamilies. Loughborough:CentreforChildandFamilyResearch,LoughboroughUniversity. 2 Beecham,J..(2000)UnitCostsNotExactlyChildsPlay:AGuidetoEstimatingUnitCostsforChildrensSocialCare.University of Kent: Department of Health, Dartington Social Research Unit and the Personal Social Services Research Unit; Ward, H., Holmes, L., and Soper, J. (2008). Costs and consequences of placing children in care, London: Jessica Kingsley. 3 Holmes,L.&McDermid,S.(2010)TheCostsofShortBreakProvision,inCurtisL.(ed)UnitCostsofHealthandSocialCare2011,PersonalSocialServices ResearchUnit,UniversityofKent,Canterbury. 4 DepartmentforChildrenSchoolsandFamilies(2008)Aiminghighfordisabledchildren:shortbreaksimplementationguidance.London:Departmentfor Children,SchoolsandFamilies.
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The social care processes Thestudyalsocalculatedthecostsofsocialcareactivityassociatedwithprovidingshortbreakservicestodisabledchildren andtheirfamilies.1Thisincludedtheroutesbywhichfamilieswereabletoaccessshortbreakprovision,andanyongoing activityundertakentosupportthechildandfamilyonceinreceiptofshortbreakservices. Process OutofLondoncost Londoncost 2010/11value 2010/11value Referralandassessmentprocesses LocalCoreOffereligibilitymodels1 CommonAssessmentFramework InitialAssessment CoreAssessment ResourcePanelsforshortbreak services2 Ongoingsupport Ongoingsupport Reviews
a
Notavailable 191a 345a 519a 98a
12a Notavailable 316a 730a 54a
79b 199a
102b 268a
perprocessperchild permonthperchild
1 Local core offer eligibility model refers to an access route whereby a local authority offers the provision of a standardised package of short break services to a specific population of disabled children and young people, who meet an identified set of eligibility criteria.
2
Two of the three participating authorities used panels in deciding how resources may be most usefully deployed to support families. The out of London authority held panels once a fortnight and were attended by one social care senior manager. The London authority held their panel monthly and was attended by a larger number of social care professionals which included the district manager, two service managers and three unit managers.
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7. Hospital and other services

7.1NHSreferencecostsforhospitalservices 7.2NHSwheelchairs 7.3Localauthorityequipmentandadaptations 7.4Trainingcostsofhealthserviceprofessionals 7.5RapidResponseService 7.6Hospitalbasedrehabilitationcarescheme 7.7ExpertPatientsProgramme 7.8Reablementservice 7.9Publichealthinterventions
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7.1 NHS reference costs for hospital services

WehavedrawnontheNHSTrustandPrimaryCareTrustscombinedtoreportfromtheNHSReferenceCostsofselected adulthealthservices.1Allcostshavebeenupratedto2010/11levelsusingtheHCHSPay&Pricesinflator. Lower Upper National quartile quartile average Elective/nonelectiveHealthCareResourceGroup(HRG) data(averagecostperepisode) Electiveinpatientstays 3,484 2,070 2,931 Nonelectiveinpatientstays(longstays) 2,737 1,688 2,334 359 Nonelectiveinpatientstays(shortstays) 655 549 DaycasesHRGdata 453 Weightedaverageofallstays 815 686 Outpatientprocedures 101 Weightedaverageofalloutpatientprocedures 171 147 PALLIATIVECARE SpecialistInpatientpalliativecare 258 592 448 Hospitalspecialistpalliativecaresupport(inpatient) 60 137 122 Outpatientmedicalspecialistpalliativecareattendance 154 383 252 Outpatientnonmedicalspecialistpalliativecareattendance 72 208 115 A&ESERVICES(Weightedaverageofattendances) Accidentandemergencytreatmentsleadingtoadmitted(not admitted) 101(84) 171(123) 147(106) Minorinjuryservicesleadingtoadmitted(notadmitted) 35(43) 52(62) 49(55) 49(41) Walkinservicesleadingtoadmitted(notadmitted) 44(32) 50(44) PARAMEDICSERVICES Emergencytransfers 253 238 268 Averageofallparamedicservices(categoriesA,B&C) 234 205 255 N.B.Informationonmentalhealthservicecostsforadults andchildrenshealthservicescanbefoundintables2.1and 6.1ofthisreportrespectively.
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7.2 NHS wheelchairs

Informationaboutwheelchaircostsisbasedontheresultsofastudyofsixsitessupplyingwheelchairs(excluding wheelchairsforchildren).1Thestudyinformationwassupplementedwithnationaldatanotavailablefromthesites.Three maintypesareidentified:thosepropelledbyanattendantorselfpropelled;alightertypeofchairespeciallydesignedfor activeusersandpoweredwheelchairs.(Activeusersaredifficulttodefine,butthetermgenerallyreferstoindividualswho arepermanentlyrestrictedtoawheelchairbutareotherwisewellandhavehighmobilityneeds).Therangeofpurchase costsisveryhighforthelattertwotypes,rangingfrom175to977foractiveuserchairsand991to1,833forpowered chairs(1994/95pricesupratedtocurrentvalues).Thecostshaveallowedforthecostofmodificationsintheestimated capitalvalue,butthisisaveryapproximatemidrangefiguresospecificinformationshouldbeusedwhereverpossible. NocurrentinformationisavailableonthecostofNHSwheelchairsandthisinformationisbasedoninformationcollectedin 1994/1995,whichhasbeenupratedusingtheHCHSpricesinflator.Nextyear,thiswillbereplacedbynewinformation takenfromtheAdultSocialCareSurveywhichiscurrentlybeinganalysed(TheInformationCentre,2011).2 Typeofchair Totalvalue Annualcost Notes 2010/2011 2010/2011 Capitalcosts Capitalvaluehasbeenannuitisedoverfiveyearsata Selforattendantpropelled 248 60 discountrateof3.5percenttoallowfortheexpectedlife Activeuser 619 147 ofanewchair.Inpractice,50percentofwheelchairs Powered 1,238 295 suppliedhavebeenreconditioned,nothavingbeenworn outbythetimetheirfirstusersceasedtoneedthem. Revenuecosts Revenuecostsexcludetherapiststimebutincludethe Maintenance staffcostsofmaintenance.Thecostsincludeallcostsfor nonpowered 27 pressurerelief.Thecostofreconditioninghasnotbeen powered 107 includedinthecostofmaintenance. Agencyoverheads Noestimateofmanagementoverheadcostsisavailable. Theyarelikelytobeminimal. Unitcostsavailable2010/2011 87perselforattendantpropelledchairperyear;174 peractiveuserperchairperyear;402perpoweredchairper year.
1 2
PersonalcommunicationwithRichardMurray,NationalHealthServiceManagementExecutive,1995. TheInformationCentre(2011)UserSurveyGuidance201011,TheInformationCentre,Leeds.www.ic.nhs.uk/services/socialcare/socialcare collections/usersurveys/usersurveyguidance201011
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7.3 Local authority equipment and adaptations

Informationaboutthecapitalcostofinstallingequipmentandmakingadaptationstopropertyisbasedonabenchmark studyofthecostofaidsandadaptationsundertakenfortheDepartmentoftheEnvironmentbyErnst&Young.1The intentionwastoprovideillustrativeratherthanstatisticallyrepresentativecostsofinstallation.Fortylocalauthorities providedinformation.Majorvariationswerereported,probablyreflectingdifferencesinthescaleofworkundertaken.The medianratherthanthemeancostwasusedbyErnst&Youngtoovercomethespreadofreportedcosts.Allcostshave beeninflatedfrom1992pricesusingtheBCIS/ABIHouseRebuildingCostindex.2Althoughthisinformationisratherdated, theBCISAccessAuditPriceGuide,2002suggestedthattheupratedfigureswereinlinewithcurrentbuildingcosts.3Next year,thisinformationwillbereplacedbyinformationtakenfromtheAdultSocialCareSurveywhichiscurrentlybeing analysed(TheInformationCentre,2011).4 Theperiodoverwhichequipmentandadaptationsshouldbeannuitisedisopentodebate.Ideallyitshouldbeannuitised overtheusefullifeoftheaidoradaptation.Inmanycasesthisislinkedtothelengthoftimethepersonusingtheappliance isexpectedtoremainathome.Whereitisexpectedthatthehousewouldbeoccupiedbysomeoneelsewhowouldalso makeuseoftheadaptation,alongerperiodwouldbeappropriate.Clearly,thisisdifficulttodoinpractice.Manyhousing authoritieshaveproblemsmakingsurethatheavilyadapteddwellingsareoccupiedbypeoplewhocanmakeuseofthe adaptations.Accordingtogovernmentguidelinesonthediscountrate,thistableshowstheitemsannuitisedover10years at3.5percent. Equipmentor Meantotal Median total Range ofcosts Medianannual adaptation cost cost equipmentcost 3.5% Minimum Maximum discount Additionalheating Electricalmodifications Joinerywork(externaldoor) Entryphones Individualalarmsystems Grabrail Hoist Lowlevelbath Newbath/showerroom Redesignbathroom Redesignkitchen Relocationofbathorshower Relocationoftoilet Showeroverbath Showerreplacingbath Graduatedfloorshower Stairlift Simpleconcreteramp 429 438 507 359 380 94 934 531 7,774 1,423 2,873 1,059 864 945 2,582 2,395 2,611 646 397 512 602 487 445 52 2,608 665 14,895 3,332 3,949 2,023 1,726 878 2,433 2,957 3,293 384 144 58 261 215 211 4 378 355 3,785 473 694 178 169 209 467 1,277 2,271 66 4,936 3,908 1,244 3,051 958 422 8,037 1,441 34,063 7,570 6,623 10,557 4,069 2,385 4,340 6,662 7,279 2,734 48 62 72 59 54 6 310 79 1,771 396 470 241 205 104 289 352 391 46
1 2
Ernst&Young(1994)BenchmarkStudyoftheCostsofAidsandAdaptations,ReportNo.4,ReporttotheDepartmentoftheEnvironment,London. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 3 BuildingCostInformationService(2002)AccessAuditPriceGuide,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 4 TheInformationCentre(2011)UserSurveyGuidance201011,TheInformationCentre,Leeds.www.ic.nhs.uk/services/socialcare/socialcare collections/usersurveys/usersurveyguidance201011
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7.4 Training costs of health service professionals

Thisschemaprovidesabreakdownofthetrainingcostsincurredusingstandardestimationapproaches.1Theinvestment costsofeducationshouldalwaysbeincludedwhenevaluatingthecosteffectivenessofdifferentapproachestousing healthservicestaffsothatallthecostsimplicitinchangingtheprofessionalmixareconsidered.Forthemostpart,these investmentcostsarebornebythewiderNHSandindividualsundertakingthetrainingratherthantrusts,soevaluations whichareconcernedwithcoststotheproviderorganisationwouldincorporatetheseinvestmentcosts.Thisyear,thecosts havebeenupdatedinliaisonwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland (HEFCE).2 Thecomponentsofthecostoftraininghealthserviceprofessionalsare,forpreregistrationandpostgraduatetraining,the costsoftuition;infrastructurecosts(suchaslibraries);costsorbenefitsfromclinicalplacementactivities,andlost productioncostsduringtheperiodoftrainingwherestaffareawayfromtheirposts.Althoughfurthertrainingisavailable toallprofessionalsafterpreregistrationtoenablethemtoprogresstohighergrades,thecostofpostgraduatetrainingis onlyknownfordoctors. Thistableshowsdetailsofthetotalinvestmentincurredduringtheworkinglifeoftheprofessionalafterallowingforthe distributionofthecostsovertime.Thefinalcolumnshowstheexpectedannualcost. Preregistration Postgraduate Totals training Tuition Living Clinical Tuitionand Total Expected expenses/ placement replacement investment annualcost lost costs at3.5% production costs Scientificandprofessional 4,927 Physiotherapist NA 35,472 24,441 59,913 Notknown 4,911 Occupationaltherapist NA 35,472 24,441 59,913 Notknown 5,035 Speechandlanguagetherapist NA 35,472 24,441 59,913 Notknown 5,095 Dietician NA 35,472 24,441 59,913 Notknown 5,278 Radiographer NA 35,472 24,441 59,913 Notknown 6,574 Hospitalpharmacist NA 46,505 25,536 83,422 11,381 7,671 Communitypharmacist NA 46,505 25,536 97,348 25,307 Nurses 23,151 9,356 Nursingdegree NA 47,296 70,447 03 Doctors 147,791 55,987 19,546 Foundationofficer1 0 57,166 260,944 141,496 55,987 21,807 Foundationofficer2 31,231 57,166 292,175 141,496 55,987 26,329 Registrargroup 73,664 57,166 334,608 141,496 55,987 30,008 Associatespecialist 113,609 57,166 374,553 141,496 55,987 40,521 GP 227,786 57,166 488,730 141,496 55,987 44,827 Consultants 293,514 57,166 554,458 Socialworkers 57,452 6,474 14,156 21,378 Socialworkdegree NA 36,822
Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 2 ProvidedbytheDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 3 Currentlythebenefitsobtainedfromtheplacementsareassumedtobeequivalenttothecostsofprovidingtheplacement.
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7.5 Rapid Response Service

ThisschemaisbasedonaRapidResponseServicewhichservestheShepwayPrimaryCareTrustAreaslocatedat FolkestoneHospital.Itisdesignedtoprovidethelocalcommunitywithanalternativetohospitaladmissionorlongterm carewhereappropriate.Theinformationisbasedon2002/2003costsandupratedusingtheappropriateinflators. Costsandunit 2010/2011value Notes estimation A.Wages/salary 158,100peryear BasedonmedianAgendaforChange(AfC)salaries.Includesateamoftwo nurses(Band5),fiveclinicalsupportassistants(Band2),andtwonurse managers(Band7)(0.75wte)1 B.Salaryoncosts 36,702peryear Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. C.Qualifications Notknown D.Training Notknown Inhousetrainingisprovided.Thehealthcareassistantsoftenstudyto NVQlevel.Nocostsareavailable. E.Overheads TakenfromNHS(England)SummarisedAccounts.2Seeprefaceformore information. Management, Managementandothernoncarestaffcostswere19.1percentofdirect 37,207 administrationand caresalarycostsandincludedadministrationandestatesstaff. estatesstaff. Nonstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyinclude 81,037 coststotheproviderforoffice,travel/transportandtelephone,education andtraining,suppliesandservices(clinicalandgeneral),aswellasutilities suchaswater,gasandelectricity. F.Capitaloverheads 2,046peryear BasedonthenewbuildandlandrequirementsofNHSfacilities.3,4 One officehousesallthestaffandhotdeskingisused.Itisestimatedthatthe officemeasures25squaremetres.Capitalhasbeenannuitisedat3.5per cent. G.Equipmentcosts 1,410peryear Theservicesharesequipmentwithanothersothetotalcosthasbeen dividedequallyandannuitisedoverfiveyearstoallowfortheexpected lifeoftheequipment.Equipmentincludesfacsimilemachines,computers etc.Priceshavebeenupratedfrom2002/2003usingtheretailpriceindex. H.Travel 22,274peryear Caseload 7perweek Theaverageannualcaseloadis 364patients. Hoursandlengthof 7daysaweek(to Theservicewouldprovideanintensivepackageofcare,ifnecessary,over service includeweekends a24hourperiodtomeetcareneeds,andsupportcarersexperiencing andbankholidays) difficultyduetoillness.Itwouldbeavailablefor72hoursandreviewed 8.00am9.00pm daily,withthepossibilityofanextension,uptoamaximumof5daysin exceptionalcircumstances. (24hoursif required), 365daysperyear Patientcontacthours 9,646perannum Basedoninformationabouttypicalepisodesdeliveredtopatientsinone Lowcostepisode 5contacthours year. Alowcostepisodecomprises,onaverage,atotalof5contacthours. Highcostepisode 43patientcontact hours Ahighcostepisodecomprises,onaverage,atotalof43patientcontact hours. Unitcostsavailable2010/2011 35perdeliveredhour(excludescostforenhancedpayments,costofassessments,dischargeandtravelcosts);highcost episode1,505;lowcostepisode175;Averagecostpercase931.
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 3 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011.
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7.6 Hospitalbased rehabilitation care scheme

ThisPCTrunrehabilitationunit,basedinahospitalinKent,issupervisedbyanurseconsultantandhadjustundergonea serviceredesigntomeetthechangingneedsofthecommunitywhentheresearchwascarriedout.Theinformationwas collectedin2005/06andallcostshavebeenupratedusingtheHCHSinflators.Theunitismanagedbyamodernmatron, buthasastrongmultiprofessionalteamapproach.Theunitisdividedintothreesections.Thefirstistheassessmentarea, wherepatientsgoforbetween2472hoursonadmissiontohavetheirhealthcareneedscloselyobservedandidentified. Theythengototheprogressionarea,whichisforpatientswhoneedmoderatetohighnursingsupportwherethey undertakearehabilitationprogramme.Finally,whentheyareprogressingwell,theygototheindependentareabefore returninghome.Intotalthereare38bedsintheunit. Costsandunit 2010/2011value Notes estimation A.Wages/salary 843,470peryear Basedon salariesfor ateamofamodernmatron(Band8),3nurseteam managers(Band7),7(wte5.34)nursespecialists(Band6),8(wte6.31) nurses(band5),21(wte17.09)higherlevelclinicalsupportworkers(band 4),4(wte3.2)clinicalsupportworkers(band3)andasupport physiotherapist(Band3).1 B.Salaryoncosts 202,912peryear Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. C.Qualifications Notknown D.Overheads TakenfromNHS(England)SummarisedAccounts.2Seeprefaceformore information. Management, 199,859peryear Managementandothernoncarestaffcostswere19.1percentofdirect administrationand caresalarycostsandincludedadministrationandestatesstaff. estatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyinclude Nonstaff 435,295peryear coststotheproviderforoffice,travel/transportandtelephone,education andtraining,suppliesandservices(clinicalandgeneral),aswellasutilities suchaswater,gasandelectricity. E.Capitaloverheads 83,358peryear Includescapitaloverheadsrelatingtothebuildingandequipment. Hoursanddurationof 7daysaweek(to Ifnecessary,theserviceprovides anintensivepackageofcareover 24 service includeweekends hours. andbankholidays) 8.00am9.00pm (24hoursif required),365days peryear. Averagedurationof 14days Patientscanstayuptosixweeks,but averagedurationis14days. stay Caseloadperworker 30permonth Thetotalannualcaseloadwas358. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) Weeklyservicecostsperbed890;Averageannualcostperpatient4,930; Costofatypicalclientepisode1,781.
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London.
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7.7 Expert Patients Programme

SelfcaresupportinEnglandisbeingprovidedthroughabroadinitiativecalledtheExpertPatientsProgramme.This programmewasdeliveredlocallybyanetworkoftrainersandaround1400volunteertutorswithlongtermconditions. Coursesledbytrainerswhothemselveshaveachroniccondition,wereheldforanoptimumnumberof16peopleoversix weeklysessions.Thegroupswereledbytwolaytrainersorvolunteers. Theprogrammefocusesonfivecoreselfmanagementskills:problemsolving,decisionmaking,resourceutilisation, developingeffectivepartnershipswithhealthcareprovidersandtakingaction.Theprogrammeoffersatoolkitof fundamentaltechniquesthatpatientscanusetoimprovetheirqualityoflife.Itenablespatientswholivewithalongterm conditiontodeveloptheircommunicationskills,managetheiremotions,managedailyactivities,interactwiththe healthcaresystem,findhealthresources,planforthefuture,understandexercisingandhealthyeating,andmanage fatigue,sleep,pain,angeranddepression(DepartmentofHealth,2001).1,2 TheinformationforthisschemaisbasedonresearchcarriedoutbytheUniversityofYork.3,4Thecostperparticipantis 289.Thesecostsarebasedon2005dataandhavebeenupratedusingtheappropriateinflators. Costsandunit 2010/2011value Notes estimation A.Staffsalaries(including oncosts)andexpenses 4,295,662 IncludesEPPtrainersandcoordinators. B.Overheads: Publicitymaterial 455,078 Includesawarenessraising,staffmagazine,manuals,course books,website,intranet. Officeexpenditure 232,795 IncludesITandotherofficeexpenditure. Assessment 9,288 Assessmenttoensurequalityoftrainersandprogramme. C.Otheroverheads: 415,493 IncludesEPPstaffdays,venues(volunteersandstaff). Rental 349,193 RentalofpremisesforEPPsessions. D.Travel 24,864 Volunteertravelexpenses. Numberofparticipants 20,000 Participantswerearangeofpeoplelivingwithlongterm conditions. Lengthofprogramme 6weeks EPPcoursestakeplaceoversixweeks(2hoursaweek)and areledbypeoplewhohaveexperienceoflivingwithalong termcondition. Unitcostsavailable2010/2011 Costperparticipant289.
1 2
DepartmentofHealth(2001)TheExpertPatient:ANewApproachtoChronicDiseaseManagementinthe21stCentury,TheStationeryOffice,London. ExpertPatientsProgrammeCommunityInterestCompany,EPPPriceGuide2008/2009,London,www.expertpatients.co.uk. 3 Richardson,G.,Gravelle,H.,Weatherly,H.&Richie,G.(2005)Costeffectivenessofinterventionstosupportselfcare:asystematicreview,International JournalofTechnologyAssessmentinHealthCare,21,4,423432. 4 Richardson,G.,Kennedy,A.,Reeves,D.,Bower,P.,Lee,V.,Middleton,E.,Gardner,C.,Gately,C.&Rogers,A.(2008)CosteffectivenessoftheExpert PatientsProgramme(EPP)forpatientswithchronicconditions,JournalofEpidemiologyandCommunityHealth,62,361367.
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7.8 Reablement service

Adultsocialcareservicesareincreasinglyestablishingreablementservicesaspartoftheirrangeofhomecareprovision, sometimesalone,sometimesjointlywithNHSpartners.Typically,homecarereablementisashorttermintervention, oftenprovidedtotheuserfreeofcharge,andaimstomaximiseindependentlivingskills.Informationonthecostsofre ablementhavebeencollectedaspartofanevaluationatthePersonalSocialServicesResearchUnitatKent,in collaborationwiththeSocialPolicyResearchUnit,UniversityofYork(Glendinningetal.,2010).1Theschemabelow providestheaveragecostsacrossfourreablementservicesparticipatingintheevaluation.2Alltheserviceswerebasedout ofLondonandoneservicehadoccupationaltherapists(OTs)workingcloselywiththeteam.Costdatawereprovidedfor 2008/09andhavebeenupratedusingthePSSinflators. Costsperserviceuserforthefoursitesrangedfrom1,651to2,242at2010/2011prices. Costsandunit 2010/2011 Notes estimation value A.Salaryplusoncosts 2,412,820 Basedontotalsalary costsrangingfrom571,357to4,681,308 for reablementworkers.Salarycostaccountedforbetween61and62 percentoftotalcosts.OnesiteincludedOTsaswellasreablement workers. B.Directoverheads Administrativeand 889,776 Administrativeandmanagementcostsaccountedforbetween2and management 25percentofthetotalforthefoursites. Thecostsofuniformsandtrainingcostsareincludedhere.These Officeandtrainingcosts 47,918 accountedforonepercentofthetotal. C.Indirectoverheads 167,438 Indirectoverheadsincludegeneralmanagementandsupportservices suchasfinanceandhumanresourcedepartments.Thesewere4per centoftotalcostsandrangedfrom0.5to9percent. D.Capitaloverheads Buildingandlandcosts 6,339 Informationsuppliedbythelocalauthorityandannuitisedover60 yearsatadiscountrateof3.5percent. Equipmentcosts 2,670 Basedoninformationsuppliedbythelocalauthorityandcosted followinggovernmentguidelines(seeschemas7.2and7.3ofthis volume). E.Travel 402,109 Average travel costs forthefourlocalauthoritieswere10percentof totalcostsandrangedfrom1to12percent. Patientcontacthours 49hours Averageduration ofepisodeforthefoursiteswas49hours.Average episodesrangedfrom35to55hours. Ratioofdirecttoindirecttime on: Fiftytwopercentoftimewasspentincontactwithserviceusers.This Facetofacecontacts 1:0.94 wasbasedontheaveragenumberofworkinghoursof(179,174)and averageof92,566contacthours.. Numberofserviceusers 1,886 Theaveragenumberofserviceusersforthefoursiteswas1,886per annumrangingbetween429and3,500serviceusers. Unitcostsavailable2010/2011 22perhour;42perhourofcontact;averagecostperserviceuser,2,083.
Glendinning,C.,Jones,K.,Baxter,K.,Rabiee,P.,Curtis,L.,Wilde,A.,Arksey,H.&Forder,J.(2010)HomeCareReablementServices:Investigatingthe LongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 2 Althoughfivesitesparticipatedintheevaluation,oneofthesiteshadverydifferentcostsanddidnotprovidecompleteinformation.Thecostsforthis sitehavethereforebeenomitted.Thecostscontainedinthistableareconsideredtobetypicalofareablementservice.
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7.9 Public health interventions

Thesecostsaredrawnfromtworeports:Prioritisinginvestmentsinpublichealth(MatrixEvidenceandBazian,2008),1 commissionedbytheDepartmentofHealth,andAreviewofthecosteffectivenessofindividuallevelbehaviourchange interventionscommissionedbytheHealthandWellBeingAlliancegroup(NorthWestPublicHealthObservatory,2011).2Herewe presentthecostsofinterventionsforwhichtheeconomicevidenceoriginatedintheUK.Furtherinformationcanbefoundon PublicHealthInterventionsintheCostEffectivenessDatabase(PHICED)onthefollowinglink:www.yhpho.org.uk/PHICED/.All costshavebeentakendirectlyfromthereportsandupratedto2010/2011pricesusingtheappropriateinflators.Further informationonthespecificresearchstudiescanbefoundinthereportsnamedabove.
Intervention: Reducing long term absence in the workplace.

TheNICEpublichealthguidanceonManagementofLongtermSicknessandIncapacityforWorkprovidescostinformationfor threetypesofintervention:physicalactivityandeducation(10sessionsofphysiotherapyorphysicalactivityand10sessionsof CognitiveBehaviourTherapy(CBT)),workplaceintervention(usualcare,workplaceassessmentandworkmodificationsand communicationbetweenoccupationalphysicianandGPtoreachaconsensusonreturntowork)andphysicalactivityand educationalongwithaworkplacevisit(sessionsasbeforeplushalfadayoflinemanagerstime).
Intervention Physicalactivityand education Workplaceintervention Physicalactivityeducation andworkplacevisit Workplace intervention 545 Physiotherapy/physical activity 169 169 Cognitive behaviourtherapy 641 641 Workplace visit 48 Total 810 545 857
Alcohol intervention
Intervention:Briefinterventionshaveproventobeeffectiveandhavebecomeincreasinglyvaluableforthemanagementof individualswithincreasingandhighriskdrinking,fillingthegapbetweenprimarypreventioneffortsandmoreintensive treatmentforpersonswithseriousalcoholusedisorders.Thecostofdeliveringtenminutesbriefadviceforalcoholrangesfrom 14.50forapracticenurseto25foraGP(seetables10.6and10.8cofthispublication).
Reducing the incidence of sexually transmitted infections (STIs) and teenage pregnancy
Intervention:Individualriskcounselling,definedhereasonetooneinterventions,deliveredbyacounsellortoatriskgroups withtheaimofreducingincidenceofSTIsorriskybehaviour.Individualriskcounsellingcanbedeliveredthroughclinics (genitourinarymedicine,abortion,ordrugandalcoholmisuseclinics),communityhealthservices,GPsandothercommunityand nonhealthcaresettings.Thereviewsuggestedthatcounsellinginterventionscostbetween90and200perperson.
Reducing smoking and the harms from smoking

Intervention:Mediasupportedcampaigns:Thereviewsuggestedthatthereisstrongevidencethatmassmediacampaignsfor bothyoungandadultpopulationcostbetween0.30and2.30perperson.Estimatesofcostarehigherwhentheunitreceiving theinterventionisdefinedasthosepotentiallyexposedtothecampaign(2344).
Intervention:Drugtherapiesforsmokingcessation.Thiscanincludenicotinereplacementtherapy(NRT)(suchasnicotine patchesandgum),nicotinereceptorpartialantagonists(suchasvarenicline),opioidantagonists(suchasnaltrexone),clonidine, lobeline,orantidepressants(suchasbupropion).Thereisevidencethatdrugtherapy(bupropion,nicotinereplacementtherapy andvarenicline)hasamoderateeffectonsmokingcessation,particularlyinpeoplemotivatedtoquit.Thereisstrongeconomic evidencefromtheUKonthecostofNRT(53185perperson)bupriopion(101108perperson),andcombinationsofNRTand bupriopion(203209perperson). Intervention:Atenminuteopportunisticbriefadvicesessionforsmokingis25foraGPand14.50forapracticenurse(see tables10.6and10.8cofthispublication).
1 2
MatrixEvidence&Bazian(2008)Prioritisinginvestmentsinpublichealth,DepartmentofHealth,London. NorthWestPublicHealthObservatory(2011)Areviewofthecosteffectivenessofindividuallevelbehaviourchangeinterventions,HealthandWellbeing Alliance,Manchester.www.champspublichealth.com/writedir/0c65health_choices%20%20FINAL.pdf
8. Care packages
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8.1Communitycarepackagesforolderpeople 8.1.1Communitycarepackageforolderpeople:verylowcost 8.1.2Communitycarepackageforolderpeople:lowcost 8.1.3Communitycarepackageforolderpeople:mediancost 8.1.4Communitycarepackageforolderpeople:highcost 8.1.5Communitycarepackageforolderpeople:veryhighcost 8.2Carepackagesforolderpeople,peoplewithlearningdisabilities,peoplewithmental healthproblemsandpeoplewithphysicaldisabilities 8.2.1CarePackagesforolderpeople 8.2.2CarePackagesforpeoplewithlearningdisabilities 8.2.3CarePackagesforpeoplewithmentalhealthproblems 8.2.4CarePackagesforpeoplewithphysicaldisabilities 8.2Thecostofautism 8.2.1Childrenwithautism(preschool) 8.2.2Childrenwithlowfunctioningautism(ages017) 8.2.3Childrenwithhighfunctioningautism(ages017) 8.2.4Adultswithautism 8.4Servicesforchildrenincare 8.4.1Childrenincare:lowcostwithnoevidenceofadditionalsupportneeds 8.4.2Childrenincare:mediancostchildrenwithemotionalorbehavioural difficulties 8.4.3Childrenincare:highcostchildrenwithemotionalorbehavioural difficultiesandoffendingbehaviour 8.4.4Childrenincare:veryhighcostchildrenwithdisabilities,emotionalor behaviouraldifficultiesplusoffendingbehaviour 8.5YoungadultswithacquiredbraininjuryintheUK 8.6Palliativecareforchildrenandyoungpeople 8.6.1Shortillnesstrajectorycancer 8.6.2Longerlifeillnesstrajectories:cardiaccare 8.6.3Longerlifeillnesstrajectories:cysticfibrosis 8.6.4Longerlifeillnesstrajectories:childwithmultipledisabilities
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8.1 Community care packages for older people 8.1.1 Community care package for older people: very low cost
Thecarepackagedescribedinthisschemaisanexampleofacasewherethecoststothepublicpurseonhealthandsocial caresupportwereinthelowestdecileina2005homecaresampleof365cases.1Inthissample,whichhad35percentof intensivecaseswith10ormorehomecarehoursperweekcomparedwith26percentinEnglandasawhole,10percent ofcasesincurredgrosspubliccommunitycarecostsoflessthan50perweek.Carepackagecostsexcludethecostsof hospitalandanyuseofcarehomesforrespitecare.Socialwork/caremanagementcostswereincludedonlywherevisits fromasocialworkerduringthepreviousthreemonthswerereportedbytheindividual.GPvisitsdatawerenotcollectedso estimatesbasedonnationaldatahavebeenadded.Allcostshavebeenupratedwiththeappropriateinflators. Typicalcase MrsAwasan83yearoldwidowwholivedaloneinshelteredaccommodationbutreceivedhelpfromtwopeople,with mosthelpcomingfromanotherfamilymember. Functionalability MrsA.hadproblemswiththreeactivitiesofdailyliving:usingthestairs,gettingaroundoutside,andbathing.Herproblems stemmedfromapreviousstroke. Services Average Description Levelof service weekly cost (2010/2011) Socialcare TakenfromPSSEX12009/10,2theaveragecostforonehour Homecare 32 oflocalauthorityhomecarecosts32(Seetable11.6ofthis volume). Mealsonwheels 43 TakenfromPSSEX12009/10,2theaveragecostpermealon wheelswas6.00fortheLocalAuthorityand4.00forthe independentsector. Healthcare GP 7.40 11.7 Surgeryvisitsestimatedatonceeveryfourweeksbasedon minutes theGeneralPractitionerWorkloadSurvey,July2007.3 Accommodation 155 Basedontheweeklycostofshelteredaccommodation. Livingexpenses 156 TakenfromtheFamilyExpenditureSurvey(2010).4 Basedon oneretiredadulthousehold,mainlydependentonstate pensions. Totalweeklycostof 82 Excludesaccommodationandlivingexpenses. healthandsocialcare package 393 Allcosts.
Darton,R.,Forder,J.,Bebbington,A.,Netten,A.,Towers,AM.&Williams,J.(2006)AnalysistosupportthedevelopmentoftheRelativeNeedsFormula forOlderPeople,PSSRUDiscussionPaper2265/3,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. 3 TheInformationCentre(2007)2006/07UKGeneralPracticeWorkloadSurvey,PrimaryCareStatistics,TheInformationCentre,Leeds. 4 OfficeforNationalStatistics(2010)FamilySpending2010edition,OfficeforNationalStatistics,London,availableatwww.ons.gov.uk/ons/rel/family spending/familyspending/2010edition/index.html

2
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8.1.2 Community care package for older people: low cost

Thecarepackagedescribedinthisschemaisanexampleofacasewherethecoststothepublicpurseonhealthandsocial caresupportwereinthebottomquartileina2005homecaresampleof365cases.1Inthissample,whichhad35percent ofintensivecaseswith10ormorehomecarehoursperweekcomparedwith26percentinEnglandasawhole,25per centofcasesincurredgrosspubliccommunitycarecostsoflessthan95perweek.Carepackagecostsexcludethecostsof hospitalandanyuseofcarehomesforrespitecare.Socialwork/caremanagementcostswereincludedonlywherevisits fromasocialworkerduringthepreviousthreemonthswerereportedbytheindividual.GPvisitsdatawerenotcollectedso estimatesbasedonnationaldatahavebeenadded.Allcostshavebeenupratedusingtheappropriateinflators. Typicalcase MrsBwasa79yearoldwidowwholivedalonebutreceivedhelpfromtwopeople,mosthelpbeingprovidedbyafamily member. Functionalability MrsBhadproblemswiththreeactivitiesofdailyliving:usingthestairs,gettingaroundoutsideandbathing.Herproblems stemmedfromarthriticconditionsandcardiovasculardisease. Services Average Description Levelof service weekly cost Socialcare 128 4hoursper Basedon4hoursoflocalauthorityorganisedhome Homecare week care(Seetable11.6ofthisvolume). Privatehomecare 48 3hoursper Basedon3hoursofindependentlyprovidedhome week care(Seetable11.6ofthisvolume). Healthcare Communitynurse 5.30 20minutes Communitynursevisitsonceamonth(seetable10.1 ofthisvolume). GP 26 23.4 Homevisitsestimatedatonceeveryfourweeksbased minutes ontheGeneralPractitionerWorkloadSurvey,July 2007.2 Accommodation 79 Thenationalaverageweeklygrossrentforatwo bedroomhouseinthesocialhousingsectorincluding 7.36servicecharge.3 Livingexpenses 156 TakenfromtheFamilyExpenditureSurvey (2010, table 3.9E).4Basedononeretiredpersonhousehold,mainly dependentonstatepensions. Totalweeklycostof 207 Excludesaccommodationandlivingexpenses. healthandsocialcare package 442 Allcosts.
Darton,R.,Forder,J.,Bebbington,A.,Netten,A.,Towers,AM.&Williams,J.(2006)AnalysistosupportthedevelopmentoftheRelativeNeedsFormula forOlderPeople,PSSRUDiscussionPaper2265/3,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. 2 TheInformationCentre(2007)2006/07UKGeneralPracticeWorkloadSurvey,PrimaryCareStatistics,TheInformationCentre,Leeds. 3 Dataspring(2011)ReviewofResidentialRentandServiceCharge,TheCambridgeCentreforHousingandPlanningResearch,UniversityofCambridge. www.mpa.gov.uk/committees/finres/2011/0217/06/. 4 OfficeforNationalStatistics(2010)FamilySpending2010edition,OfficeforNationalStatistics,London,availableatwww.ons.gov.uk/ons/rel/family spending/familyspending/2010edition/index.html
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8.1.3 Community care package for older people: median cost

Thecarepackagedescribedinthisschemaillustratesthemedianpublicexpenditurecostsperweekonhealthandsocial caresupportina2005homecaresampleof365cases.1Inthissampletherewere35percentofintensivecaseswith10or morehomecarehoursperweekcomparedwith26percentinEnglandasawhole.Carepackagecostsexcludethecostsof hospitalandanyuseofcarehomesforrespitecare.Socialwork/caremanagementcostswereincludedonlywherevisits fromasocialworkerduringthepreviousthreemonthswerereportedbytheindividual.GPvisitsdatawerenotcollectedso estimatesbasedonnationaldatahavebeenadded.Allcostshavebeenupratedusingtheappropriateinflators. Typicalcase MrsDwasan80yearoldwidowlivingwithtwootherrelatives. Functionalability MrsDhadproblemswithfouractivitiesofdailyliving:usingthestairs,gettingaroundoutside,dressingandbathing. Services Average Description Levelof service weekly cost Socialcare Homecare 320 10hours Basedonthecostoflocalauthorityorganisedhome perweek care(Seetable11.6ofthisvolume). Healthcare Surgeryvisits estimatedatonceeveryfourweeksbased GP 7.40 11.7 ontheGeneralPractitionerWorkloadSurvey,July2007.2 minutes Accommodation 109 Privatelyrentedsharedthreebedroom house/bungalow.Basedontheaverage(private)rental incomeinEnglandinSeptember2011andadjustedto takeaccountofsharedsituation.3 Livingexpenses 156 LivingexpensestakenfromtheFamilyExpenditure Survey(2010,table3.9E),upratedto2010/2011price levels.4Basedononepersonretiredhouseholdmainly dependentonstatepensions. Totalweeklycostof 327 Excludesaccommodationandlivingexpenses. healthandsocialcare package 592 Allcosts.
Darton,R.,Forder,J.,Bebbington,A.,Netten,A.,Towers,AM.&Williams,J.(2006)AnalysistosupportthedevelopmentoftheRelativeNeedsFormula forOlderPeople,PSSRUDiscussionPaper2265/3,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. 2 TheInformationCentre(2007)2006/07UKGeneralPracticeWorkloadSurvey,PrimaryCareStatistics,TheInformationCentre,Leeds. 3 Rentright,AveragepriceforEngland,www.rentright.co.uk/00_00_00_3_00_rrpi.aspx 4 OfficeforNationalStatistics(2010)FamilySpending,2010,OfficeforNationalStatistics,London,availableatwww.statistics.gov.uk.
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8.1.4 Community care package for older people: high cost

Thecarepackagedescribedinthisschemaisanexampleofwherethecoststothepublicpurseonhealthandsocialcare supportwereinthetopquartileina2005homecaresampleof365cases.1Inthissample,whichhad35percentof intensivecaseswith10ormorehomecarehoursperweekcomparedwith26percentinEnglandasawhole,25percent ofcasesincurredgrosspubliccommunitycarecostsofover283perweek.Carepackagecostsexcludethecostsof hospitalandanyuseofcarehomesforrespitecare.Socialwork/caremanagementcostswereincludedonlywherevisits fromasocialworkerduringthepreviousthreemonthswerereportedbytheindividual.GPvisitsdatawerenotcollectedso estimatesbasedonnationaldatahavebeenadded.Allcostshavebeenupratedusingtheappropriateinflators. Typicalcase MrDwasa79yearoldwidowerwhoownedhisownhomeandlivedwithtwootherfriends.Oneofthesefriendsprovided himwithhelp. Functionalability MrDhadproblemswithsevenactivitiesofdailyliving:usingthestairs,gettingaroundoutsideandinsidethehouse,using thetoilet,transferringbetweenchairandbed,dressingandbathing.Hisproblemsstemmedfromarthriticconditionsanda previousstroke. Services Average Description Levelof service weekly cost Socialcare Homecare 320 10hoursperweek.Basedonlocalauthorityorganisedhomecare (Seeschema11.6ofthisvolume). Daycare 36 Attendedadaycentreaboutonceaweek.(Seeschema1.4ofthis volume). Privatehomecare 384 BasedonPSSEX12009/10 upratedusingthePSSPay&Prices Inflator.Costof24hoursofindependentlyprovidedhomecare (Seeschema11.6ofthisvolume). Healthcare Communitynurse 21 20mins Onceaweekvisitfromacommunitynurse(seeschema10.1of thisvolume). OT 42 TwovisitsweremadebytheOT(seeschema9.2ofthisvolume). GP 7.40 11.7mins Visits(surgery)estimatedatonceeveryfourweeksbasedonthe GeneralPractitionerWorkloadSurvey,July2007.2 Accommodation 78 Basedonthe annuitisedvalueofadetachedhouseandshared betweenthreepeople.TakenfromtheHalifaxPriceIndex,2nd quarter2011andupratedusingtheBCIS/ABIHouseBuildingPrice Index. Livingexpenses 212 Livingexpensestakenfromthe FamilyExpenditureSurvey(2010, table3.10E).3Basedononemanandonewomanretired household,mainlydependentonstatepensions. Totalweeklycostof 847 Excludesaccommodationandlivingexpensesandprivately healthandsocialcare purchasedhomecare. package 1,100 Allcosts
Darton,R.,Forder,J.,Bebbington,A.,Netten,A.,Towers,AM.&Williams,J.(2006)AnalysistosupportthedevelopmentoftheRelativeNeedsFormula forOlderPeople,PSSRUDiscussionPaper2265/3,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. 2 TheInformationCentre(2007)2006/07UKGeneralPracticeWorkloadSurvey,PrimaryCareStatistics,TheInformationCentre,Leeds. 3 OfficeforNationalStatistics(2010)FamilySpending2010edition,OfficeforNationalStatistics,London,availableatwww.ons.gov.uk/ons/rel/family spending/familyspending/2010edition/index.html
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8.1.5 Community care package for older people: very high cost
Thecarepackagecostsdescribedinthisschemaareanexampleofacasewherethecoststothepublicpurseonhealthand socialcaresupportwereinthetopdecileina2005homecaresampleof365cases.1Inthissample,whichhad35percent ofintensivecaseswith10ormorehomecarehoursperweekcomparedwith26percentinEnglandasawhole,10per centofcasesincurredgrosspubliccommunitycarecostsofover390perweek.Packagecostsexcludethecostsofhospital andanyuseofcarehomesforrespitecare.Socialwork/caremanagementcostswereincludedonlywherevisitsfroma socialworkerduringthepreviousthreemonthswerereportedbytheindividual.GPvisitsdatawerenotcollectedso estimatesbasedonnationaldatahavebeenadded.Allcostshavebeenupratedusingtheappropriateinflators. Typicalcase MrsEwasan82yearoldwomanwhowasmarriedandlivedwithherhusbandandanotherrelativeinherownhome.Her husbandprovidedmostsupport. Functionalability MrsEsufferedfromdementiaandneededhelpwithnineactivitiesofdailyliving:stairs,gettingaroundoutsideandinside thehouse,usingthetoilet,transferringbetweenchairandbed,dressing,bathing,washingandfeeding. Services Average Description Levelof service weekly costs Socialservices Homecare 960 30hoursperweekoflocalauthorityorganisedhomecare (Seeschema11.6ofthisvolume). Healthcare Communitynurse 21 20mins Onceaweekvisitfromacommunitynurse(seeschema10.1 ofthisvolume). GP 7.40 11.7mins Visits(surgery)estimatedatonceeveryfourweeksbasedon theGeneralPractitionerWorkloadSurvey,July2007.2 Accommodation 40 Basedontheannuitisedvalueofaterracedhouseandshared betweenthreepeople.TakenfromtheHalifaxPriceIndex, 2ndquarter2011andupratedusingtheBCIS/ABI HousebuildingPriceIndex. Livingexpenses 212 LivingexpensestakenfromtheFamilyExpenditureSurvey (2010,table3.10E).3Basedononemanretiredhousehold, notmainlydependentonstatepension. Totalweeklycostof 988 Excludesaccommodationandlivingexpenses. healthandsocialcare package 1,240 Allcosts.
Darton,R.,Forder,J.,Bebbington,A.,Netten,A.,Towers,AM.&Williams,J.(2006)AnalysistosupportthedevelopmentoftheRelativeNeedsFormula forOlderPeople,PSSRUDiscussionPaper2265/3,PersonalSocialServicesResearchUnit,UniversityofKent,Canterbury. 2 TheInformationCentre(2007)2006/07UKGeneralPracticeWorkloadSurvey,PrimaryCareStatistics,TheInformationCentre,Leeds. 3 OfficeforNationalStatistics(2010)FamilySpending2010edition,OfficeforNationalStatistics,London,availableatwww.ons.gov.uk/ons/rel/family spending/familyspending/2010edition/index.html
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8.2 Care packages for older people, people with learning disabilities, people with mental health problems and people with physical disabilities
Thecarepackagesdescribedinthefollowingschema(8.2.18.2.4)aredrawnfromtheNationalEvaluationoftheIndividual BudgetsPilotProjects(IBSEN).1Thisstudycollectedinformationonthesocialcareserviceuseof1001peoplerepresenting fourclientgroups:olderpeople,peoplewithlearningdisabilities,peoplewithmentalhealthproblemsandpeoplewith physicaldisabilities.Forthestudy,theserviceusersneedswerecategorisedascritical,substantialormoderateand informationwascollectedonaprespecifiedsetofservices;thetypeofaccommodationinwhichtheyusuallylived,the numberofhoursofhomecareanddaycarereceivedeachweekandthesocialsecuritybenefitstheyreceived.Theservices werecostedusinginformationcontainedinthisvolumewherepossible(seedetailsbelow)otherwisetheyhavebeentaken fromthePersonalSocialServicesExpenditurereturn(PSSEX1)(2009/2010)2andupratedusingthePSSpayandprices inflator.Asthestudydatabasedidnotspecifywhethertheserviceshadbeenprovidedbythelocalauthorityorprivate organisations,wehaveusedtheweightedaverageprice. Homecare:Thecostperhourforahomecareworkeris18(seetable11.6).AsthePSSEX1returndoesnotdistinguish betweenclientgroupsforhomecare,thecostofhomecareforadultsandolderpeoplehasbeenusedforallclientgroups. Thiscostislikelytobeanunderestimateforcertainclientgroups. Daycare:Fordaycare,assumptionshavetobemadeaboutthenumberoftimesserviceusersattendperweekasthePSS EX1expenditurereturnprovidestheaverageweeklycostfordaycare.Ithasthereforebeenassumedthatolderpeople, peoplewithmentalhealthproblemsandpeoplewithphysicaldisabilitiesattendonaveragethreedaysperweek,andthat peoplewithlearningdisabilitiesattendfivedaysperweek.Basedontheseassumptions,theaveragecostperclientdayfor olderpeopleandpeoplewithmentalhealthproblemsis29,2forpeoplewithlearningdisabilitiesthecostis54perday2 andforpeoplewithphysicaldisabilities,thecostofadaycaresessionis51.2 Benefitreceipt:AllbenefitreceiptwascostedusinginformationtakenfromtheDepartmentforWorkandPensions(DWP)3 andsummedtoprovideatotalforeachserviceuser.Benefitsincludedlongtermincapacitybenefit(91.40perweek), severedisabilitybenefit(53.65perweek),disability(mobility)benefit(49.85perweek),disabilitycareallowance(47.80 perweek),attendanceallowance,(lower/higherrate,47.80/71.40perweek),carersallowance(53.90perweek)and housingbenefit(65.45perweek). Accommodation:Informationwasavailableonwhethertheserviceuserlivedinaregisteredcarehome,sheltered accommodation,supportedliving,flats,privateaccommodationorrentedaccommodation,whethertheserviceuserlived aloneorinsharedaccommodationandhowmanybedroomswereintheaccommodation.Thedatadonotwhetherthe serviceuserlivedinaccommodationprovidedbythelocalauthorityorprivateorganisations.Wehavetakenthelowercost assumptionthattheaccommodationwasprovidedbyaprivatesectororganisation.Foreachclientgroup,theappropriate costwastakenfromthisvolumeorothernationalsourcessuchasRentright(www.rentright.co.uk/),awebsitewhich providestheaveragerentalcostsforEnglandforeachmonth,ortheHalifaxPriceIndexwhichprovidesaveragepricesfor privatelyownedaccommodationinEngland.Sometimesjudgementsweremadeaboutthetypeofaccommodation accordingtothelevelofneedoftheserviceuser.Forexample,forpeoplewithphysicaldisabilities,whereacarehomewas specified,itwasassumedthatthiswasahighdependencycarehome(seetable5.1).Similarly,whenaflatwasspecified andthelevelofneedwascriticalorsubstantial,thecostofspecialneedsflatswereapplied(seetable5.3).Whenthe accommodationtypewassupportedliving,whenthelevelofneedwascritical,itwasassumedthatthisalsowasacare home,otherwisethecostofshelteredaccommodationwasused.Costsforresidentialcareandsupportedlivingforall clientgroupsweretakenfromtherelevantsectionsofthisvolume.
1 Glendinning,C.,Challis,D.,Fernandez,J.,Jacobs,S.,Jones,K.,Knapp,M.,Manthorpe,J.,Moran,N.,Netten,A.,Stevens,M.andWilberforce,M.(2008) EvaluationoftheIndividualBudgetsPilotProgramme:FinalReport,SocialPolicyResearchUnit,UniversityofYork,York.
2 3
TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. DepartmentforWorkandPensions(2011)SocialSecurityBenefitUprating,www.dwp.gov.uk/docs/benefitrates2011.pdf.
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8.2.1 Care packages for older people

TwohundredandeightyonepeopleintheIBSENstudywereover65(28%ofthewholesample),with39havingcritical needs,171havingsubstantialneedsand71moderateneeds.Theaveragetotalcostforthewholesamplewas259per weekwith10percentincurringcostsoflessthan110and10percentmorethan497. Service/need Averageweeklycosts Numberof Description group 2010/2011 users Homecare Critical 273 18users Fortytwopercentofthesampleofolderpeoplereported Substantial 142 74users theuseofhomecare.Theaverageweeklycostforcritical Moderate 144 26users userswas273comparedto144forthosewith moderateneeds.Theaverageweeklycostforall118 serviceuserswas162(9hoursperweek). Total 162 118users Daycare Critical: 99 4users Twelvepercentoftheolderparticipantsreportedtheuse Substantial 64 24users ofdaycare.Theaverageweeklycostforall35userswas Moderate 51 7users 65perweek. Total 65 35users Benefits Critical 113 15users Thirtysevenpercentreportedreceivingbenefits.Intotal, Substantial 78 66users thecostofbenefitsreceivedbycriticalserviceuserswas Moderate 88 24users 113comparedto88formoderateserviceusers.The totalaverageweeklycostforall105userswas86. Total 86 105users Accommodation Critical 165 39users Thecostofaccommodationforthosewithmoderate Substantial 136 171users needswas6perhigherthanthosewithcriticalneeds.The Moderate 175 71users averageweeklycostforaccommodationwas151. Total 151 281users TotalCosts Critical 345 39users Theaverageweeklycostforallserviceuserswas259. Substantial 238 171users Supportcostsforcriticalserviceuserswere32percent Moderate 262 71users higherthancostsformoderateserviceusers. Total 259 281users
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8.2.2 Care packages for people with learning disabilities

TwohundredandsixtypeopleintheIBSENstudyhadlearningdisabilities(26%ofthewholesample),with76having criticalneeds,159substantialneedsand25moderateneeds.Theaveragecostforthissamplewas302perweekwith 10percentincurringcostsoflessthan181and10percentmorethan1,267. Service/need Averageweeklycosts Numberof Description group 2010/2011 users Homecare Critical 362 28users Fortysixpercentofthesampleofpeoplewith Substantial 355 47users learningdisabilitiesreportedtheuseofhomecare.Of Moderate 252 2users those,theaverageweeklycostforcriticaluserswas 362comparedto252forthosewithmoderate needs.Theaverageweeklycostforall77serviceusers Total 355 77users was355. Daycare Critical 301 18users Twentyeightpercentofthewholesampleofpeople Substantial 45 51users withlearningdisabilitiesreportedtheuseofdaycare. Moderate 32 3user Theaverageweeklycostwas50acrossthe72users. Total 50 72users Benefits Critical 129 68users Seventysevenpercentreportedreceivingbenefits.In Substantial 127 119users total,thevalueofbenefitsreceivedbycriticalservice Moderate 135 12users userswas129comparedto135formoderate serviceusers.Thetotalaverageweeklycostforall199 userswas128. Total 128 199users Accommodation Critical 193 76users Thecostofaccommodationforthosewithcritical Substantial: 167 159users needswas193comparedtothecostofthosewith Moderate 69 25users moderateneedsof69.Theaverageweeklycostfor thewholesampleofpeoplewithlearningdisabilities was166. Total 166 260users TotalCosts Critical 373 76users Theaverageweeklycostforallserviceuserswas Substantial 290 159users 302.Supportcostsforcriticaluserswere135per Moderate 159 25users centhigherthancostsformoderateserviceusers. Total 302 260users
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8.2.3 Care packages for people with mental health problems

OnehundredandfortythreepeopleintheIBSENstudyhadmentalhealthproblems(14%ofthewholesample),with 22havingcriticalneeds,96havingsubstantialneedsand25moderateneeds.Theaveragecostforthese143people was423perweekwith10percentincurringcostsoflessthan183and10percentincurringcostsofmorethan 479perweek. Service/need Averageweeklycosts Numberof Description group 2010/2011 users Homecare Critical 95 4users Sevenpercentofpeoplewithmentalhealthproblems Substantial 232 5users werereceivinghomecare.Theaverageweeklycost Moderate 72 1user forcriticaluserswas95comparedto72for moderateusers.Theaverageweeklycostforall10 serviceuserswas162. Total 162 10users Daycare Critical 66 5users Fourteenpercentofpeoplewithmentalhealth Substantial 69 13users problemswerereceivingdaycare.Theaverageweekly Moderate 63 2users costwas68acrossallusersofdaycare. Total 68 20users Benefits Critical 133 17users Seventysevenpercentserviceuserswerereceiving Substantial 144 73users benefits.Intotal,thevalueofbenefitsreceivedby Moderate 102 20users criticalserviceuserswas133comparedto102for moderateserviceusers.Thetotalaverageweeklycost forall110userswas134. Total 134 110users Accommodation Critical 183 22users Thecostofaccommodationforthosewithcritical Substantial 194 96users needswas183comparedtothecostofthosewith Moderate 157 25users moderateneedsof157.Theaverageweeklycost acrossalluserswas184. Total 184 143users TotalCosts Critical 303 22users Theaverageweeklycostforallserviceuserswas Substantial 496 96users 423.Criticalserviceusershadcostsof303 Moderate 247 25users comparedtomoderateserviceuserswhoseweekly costswere247. Total 423 143users
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8.2.4 Care packages for people with physical disabilities

ThreehundredandseventeenpeopleintheIBSENstudyhadphysicaldisabilities(32%ofthewholesample),with52 havingcriticalneeds,245havingsubstantialneedsand20moderateneeds.Theaveragecostforthisgroupwas633 perweek,with10percentofserviceusersincurringcostsoflessthan261and10percentmorethan1,089 Service/need Averageweeklycosts Numberof Description group 2010/2011 users Homecare Critical 348 31users Fiftysixpercentofthetotalsampleofpeoplewith Substantial 257 136users physicaldisabilitiesreceivedhomecare.Theaverage Moderate 115 9user weeklycostforuserswithcriticalneedswas348 comparedto115forthosewithmoderateneeds. Theaverageweeklycostforallusersofhomecare Total 265 176users (176people)was265. Daycare Critical 133 8users Twelvepercentofthepeoplewithphysicaldisabilities Substantial 140 27users werereceivingdaycare.Thevalueofdaycare Moderate 207 2users receivedbymoderateuserswas56percenthigher thancriticalusers.Theaverageweeklycostwas142 forall37usersofdaycare). Total 142 37users Benefits Critical 119 72users Ninetyfourpercentofserviceuserswerereceiving Substantial 161 230users benefits.Intotal,thecostofbenefitsreceivedby Moderate 152 17users criticalserviceuserswas119perweekcomparedto 152formoderateserviceusers.Thetotalaverage weeklycostforall297serviceuserswas162. Total 162 297users Accommodation Critical 741 52users Theaverageweeklycostofaccommodationforthose Substantial 234 245users withcriticalneedswas741comparedto234for Moderate 234 20users thosewithmoderateneeds.Theaverageweeklycost was317. Total 317 317users TotalCosts Critical 1,134 52users Theaverageweeklycarepackagecostforallservice Substantial 542 245users userswas633perweek.Criticalserviceusershad Moderate 435 20users costsof1,134comparedtomoderateserviceusers whoseweeklycostswere435. Total 633 317users
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8.3 The cost of autism

Thereisgrowingevidenceontheeconomicburdenofautismspectrumdisorders(ASD).Autismhaslifetimeconsequences witharangeofimpactsonthehealth,economicwellbeing,socialintegrationandqualityoflifeofindividualswiththe disorder,theirfamiliesandpotentiallytherestofsociety.Manyofthoseimpactscanbeexpressedaseconomiccosts. InterventionsandservicescurrentlyusedtotreatorsupportchildrenandadultswithASDincludeservicesprovidedby medicalpractitioners,nurses,dieticians,psychologists,speechandlanguagetherapists,teachersandvariousprovidersof complementaryandalternativemedicine,suchasmusictherapy,aromatherapy,homeopathicremedies,naturopathic remedies,manipulativebodytherapiesandspiritualhealing.Thesetreatments,servicesandsupportsallimposecosts eithertothestateortoavoluntarysectororganisationortothefamiliesofpeoplewithASDwhohavetopayforthemout oftheirownpockets. Herewepresentcostinformationtakenfromtworesearchstudies,thefirstofwhichfocusesonpreschoolchildrenand providestheserviceandwidersocietalcostsintheUK(Barrettetal.,2010).1Itlookedattheservicesreceivedby152pre schoolchildrenwithautism,reportedfamilyoutofpocketexpensesandproductivitylosses,andexploredtherelationship betweenfamilycharacteristicsandcosts. ServiceusedatawerecollectedusingamodifiedversionoftheChildandAdolescentServiceUseSchedule(CASUS),which wasdevelopedbytheauthorsinpreviousstudiesandadaptedforthepurposeofthisstudyonthebasisofexpertopinion andpilottestingduringthestartupphaseofthestudy.Thiswasusedtocollectdataontheuseofspecialist accommodationsuchasfosterandrespitecare,educationordaycarefacilitiesattended,allmedicationprescribedforthe individualchild,allhospitalcontacts,andallcommunityhealth,educationandsocialcareservices,includingnonstatutory provision.Schoolbasedserviceswerenotrecordedseparatelyinordertoavoiddoublecountingthecostsofthoseservices includedintheoverallcostoftheeducationfacilityandbecauseparentsmaynotalwaysbeawareoftheiruse.Inaddition, parentswereaskedtoreportdetailsoftimeoffworkduetotheirchildsillness,andexpenditureonanyspecialist equipmentorotherextraordinarycosts,suchashomeadaptations,conferenceortrainingattendanceandoverseastravel thatwereadirectresultoftheirchildsautism.Informationfromthisstudyisfoundin8.3.1. ThesecondstudyprovidestheannualcostsforchildrenandadultswithlowfunctioningandhighfunctioningASD(i.e. withandwithoutanintellectualdisability).TheresearchcarriedoutbyKnappetal.(2007,2009)2,3estimatedthefullcosts ofautismspectrumdisorders(ASDs)intheUnitedKingdomusingdataon146childrenand91adults.Inthesampleof childrenwithautism,agesrangedfrom3to17,withameanof10.28years(standarddeviation3.17)andamedianageof 10.Dataweretakenfromavarietyofsources,including:nationalsurveys,publishedresearch,previousstudiesbythe InstituteofPsychiatryandexpertadvice.Thepurposeofthestudywastoexaminetheservice,familyandothereconomic consequencesofautismintheUK,bothforchildrenandadults,withASDs,withandwithoutanintellectualdisability.See Tables8.3.2to8.3.4forcostsfromthisstudy.
1Barrett,B.,Byford,S.,Sharac,J.,Hudry,K.,Leadbitter,K.,Temple,K.,Aldred,C.,Slonims,V.,Green,J.&thePACTConsortium(2010)ServiceandWider SocietalCostsofPreSchoolChildrenwithAutismintheUK,KingsCollegeLondon,UniversityCollegeLondon,UniversityofManchester,Newcastle University,StockportPrimaryCareTrust,GuysHospitalLondon,andthePACTConsortium,UK(notpubliclyavailable). 2 Knapp,M.,Romeo,R.&Beecham,J.(2007)TheEconomicConsequencesofAutismintheUK,ReporttotheFoundationforPeoplewithLearning Disabilities,London. 3 Knapp,M.,Romeo,R.&Beecham,J.(2009)EconomiccostofautismintheUK,Autism,13,3,May,317336.
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8.3.1 Children with autism (preschool)

InformationforthisschemahasbeentakenfromBarrettetal.(2010)1.Allcostspresentedwerefor2006/2007andhave thereforebeenupratedto2010/2011usingtheappropriateinflators. Thistablereportstheserviceandwidersocietalcostsforthesixmonthspriortointerviewforpreschoolchildrenwith autism.Themeantotalservicecostswere2,850,equivalentto475permonthandover5,700peryear.Almosthalfthe costs(45percent)wereforeducationandchildcare,41percentwereforcommunityhealthandsocialservices,and12per centforhospitalservices.Astotalcostsvariedsubstantiallybetweenthechildreninthestudy(range346to6,740over sixmonths).Box1belowpresentscasestudiesoflowandhighcostcases. Onaverage,familiesspentanadditional248asaresultoftheirchildsillnessoverthesixmonthspriortointerview(range 0to3,663).Fiftyonepercentoffamiliesreportedtakingsometimeoffworkduetotheirchildsillnessoverthesix months,associatedwithproductivitylossesof300perfamily.Totalcostsincludingallservices,familycostsand productivitylosseswereestimatedover3,000oversixmonths,equivalenttoover550permonth.
Total costs per child for the six months prior to interview (, n=152)
Mean SD Totalservice cost % Total cost %
Accommodation 17 231 0.60 0.52 Hospitalbasedhealthservices 335 491 11.80 9.76 Communityhealthandsocialservices 1,188 995 41.60 34.58 Medication 17 87 0.62 0.52 Voluntarysectorservices 33 89 1.20 0.97 Educationandchildcare 1,260 901 44.20 37.37 Totalservicecosts 2,850 1,377 100.00 83.72 Outofpocketexpenses 248 550 7.36 Productivitylosses 300 688 8.92 Totalcosts 3,398 1,841 100.00 Box1Casestudiesoflowandhighcostcases Highcost6,740oversixmonths ChildHattendsamainstreamnurseryparttimeandaspecialistplaygrouponedayaweek.Hespentthreenightsinhospital followingagrommetoperation,andhadtwooutpatientappointmentswiththeear,noseandthroatspecialistbeforeandafter theoperation.ChildHhadmonthlyvisitstohisGP,regularcontactwiththepracticenurseandhishealthvisitor,andweekly contactswithaspeechandlanguagetherapistatthelocalhealthcentre.Inaddition,hehadcontactwithacommunity paediatricianandaportageworker. Lowcost346oversixmonths ChildIdoesnotattendanyformaleducationorchildcare,spendingallhistimeathomewithhismother.Hehadonevisittoa paediatricianatthelocalhospital,butdidnothaveanyotherhospitalcontactsoruseanyservicesinthecommunity.
1 Barrett,B.,Byford,S.,Sharac,J.,Hudry,K.,Leadbitter,K.,Temple,K.,Aldred,C.,Slonims,V.,Green,J.&thePACT(2011) ServiceandWiderSocietalCostsofVeryYoungChildrenwithAutism,theJournalofAutismandDevelopmentalDisorders, Epub 2011 Nov 1.
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8.3.2 Children with lowfunctioning autism (ages 0 17)

TheresearchcarriedoutbyKnappetal.(2007,2009)1,2estimatedthefullcostsofautismspectrumdisorders(ASDs)inthe UnitedKingdomusingdataon146children. ThetablebelowsummarisestheaveragecostperchildwithlowfunctioningASD,whetherlivingwiththeirfamiliesorliving inaresidentialorfostercareplacement.Costsareorganisedunderanumberofdifferentserviceandsupportheadings. Familyexpenseswerealsoincludedand,whereappropriate,costswereimputedforthelostemploymentofparents.The tabledistinguisheschildreninthreedifferentagegroups.TheannualcostsforchildrenwithlowfunctioningASDwhoare livinginresidentialorfosterplacementsareestimatedtobe18,151(ifaged03),45,506(aged411)and70,131(aged 1217).Forthetwoolderagegroups,thelargestcontributorstothesetotalsarethecareplacementsthemselves,and specialeducation.Theauthorsnotedthat,giventheavailabilityofdata,residentialspecialschoolcostsmayhavebeen underestimated. CostsforchildrenwithlowfunctioningASDwholivewithfamiliesaremuchlower:4,869(ifaged03),31,254(aged4 11)and45,390(aged1217).Forthetwoolderagegroupsthelargestcontributorstothesetotalsarespecialeducation, andhealthandsocialcareservices(includinghospitalandrespitecare).
Average annual cost per child with lowfunctioning ASD

Livinginresidentialorfostercare placement Ages03 17,495 656 Ages411 25,192 967 7,747 Ages1217 35,806 1,780 449 Livinginprivatehouseholdswith family Ages03 Ages411 Ages1217 656 967 7,747 3,169 1,780 449 4,131 30,962 1,118 17 108
Residential/foster careplacement Hospitalservices Otherhealthand socialservices Respitecare
Specialeducation 10,252 30,962 10,252 Educationsupport 1,328 1,118 1,328 Treatments 20 17 20 Helpfromvoluntary 945 organisations Benefits 4,213 4,486 4,486 Lostemployment 2,339 2,339 (parents) Totalannualcost 18,151 45,506 70,131 656 26,768 40,904 (excludingbenefits) Totalannualcost 18,151 45,506 70,131 4,869 31,254 45,390 (includingbenefits) Note:Expenditureonsocialsecurity/welfarebenefitscouldpartlydoublecountthecostsoflostemploymentforparents, whichiswhytwototalsareprovidedabove.
Knapp,M.,Romeo,R.&Beecham,J.(2007)TheEconomicConsequencesofAutismintheUK,ReporttotheFoundationforPeoplewithLearning Disabilities,London. 2 Knapp,M.,Romeo,R.&Beecham,J.(2009)EconomiccostofautismintheUK,Autism,13,3,May,317336.
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8.3.3 Children with highfunctioning autism (ages 017)

TheresearchcarriedoutbyKnappetal.(2007,2009)1,2estimatedthefullcostsofautismspectrumdisorders(ASDs)inthe UnitedKingdomusingdataon146children. Asinschema8.3.2,thetablebelowdistinguishescostsunderanumberofdifferentserviceandsupportheadings.The studyassumedthatallchildrenwithhighfunctioningASDlivewiththeirparents.Averagecostsrangefrom1,887to 24,177perannum.
Average annual cost per child with high functioning ASD

Livinginprivatehouseholdwithfamily Ages03 Ages411 Ages1217 871 871 1,361 1,361 1,361 7,301 7,301 13,099 13,099 611 611 166 166 526 526 526 242 242 1,361 23,651 23,651 1,887 24,177 24,177
Hospitalservices Otherhealthandsocialservices
Respitecare Specialeducation Educationsupport Treatments Helpfromvoluntaryorganisations Benefits Lostemployment(parents) Totalannualcost(excludingbenefits) Totalannualcost(includingbenefits) Note:Expenditureonsocialsecurity/welfarebenefitscouldpartlydoublecountthecostsoflostemploymentforparents, whichiswhytwototalsareprovidedabove.
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8.3.4 Adults with autism

TheresearchcarriedoutbyKnappetal.(2007,2009)1,2estimatedthefullcostsofautismspectrumdisorders(ASDs)inthe UnitedKingdomusingdataon146children.TheestimatedannualcostsforadultswithhighandlowfunctioningASDare presentedbelow.ImputedcostsforlostemploymentareincludedforboththeindividualswithASDandforparents,where theseareappropriate.Costsarearrangedbyplaceofresidence. ForanadultwithhighfunctioningASD,itisestimatedthattheannualcostoflivinginaprivatehousehold(withorwithout family)is36,460.Asizeablepartofthis(21,617)istheimputedcostoflostemploymentfortheindividualwithASD(and hencealsolostproductivitytotheeconomy).Partofthat(notseparatelyidentifiedhere)wouldbelosttaxrevenuetothe Exchequer. Costsforhighfunctioningadultsinsupportedlivingsettingsorcarehomesaremuchhigher(95,694and98,735per annumrespectively)andtheproportionattributabletolostemploymentislower.Thelargestcostelementineachcaseis foraccommodation,andincludesthecostsofstaffemployedinthosesettingsorsupportingtheresidents. Forlowfunctioningadults,themeanannualcosts(excludingbenefitsbutincludinglostemployment)risewithincreased supportintheaccommodationforthoselivinginprivatehouseholdsfrom48,256to110,786forthoseinhospitalcare.
Average annual cost per adult with ASD

AdultswithhighfunctioningASD Private Supporting Residential household People care 1,669 66,191 69,232 871 871 871 545 545 545 Private household 98 793 AdultswithlowfunctioningASD Supporting Residential Hospital People care 66,190 69,232 168 38 84,647 525 649 4,063 954 1,226 70 930 3,719 70 84,647 25,102
Accommodation Hospital services Otherhealth andsocial services Respitecare Dayservices Adulteducation Employment support Treatments Familyexpenses Lost employment (parents) Subtotal Lost employment (personwith ASD) Total(excluding benefits) Benefits Total(including benefits)
2,496 3,237 166 2,121 4,131
2,496 3,237 166
2,496 3,237 166
1,723 4,208 1,609 565 70 2,441 4,131
15,236 22,188
73,506 22,188
76,547 22,188
15,638 25,102
73,196 25,102
74,637 25,102
37,424 37,424
95,694 95,694
98,735 98,735
40,739 7,517 48,256
98,298 4,845 103,142
99,739 4,845 104,584
109,749 1,037 110,786
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8.4 Services for children in care

Thefollowingtablespresentillustrativecostsofchildrenincarereflectingarangeofcircumstances.Informationfrom practitionersandmanagers,gatheredinthecourseofdevelopingunitcostsforsocialworkprocesses,indicatedthatthe prevalenceofchildrenorcombinationsofthemarelikelytohaveanimpactonthecostofplacements:disabilities; emotionalorbehaviouraldifficulties;andoffendingbehaviour.1Unaccompaniedasylumseekingchildrencomprisea furthergroupwhosecircumstances,ratherthantheirattributes,engenderadifferentpatternofcosts.Inanypopulationof lookedafterchildren,therewillbesomechildrenwhohavenoneoftheseadditionalsupportneeds.Authoritieswitha higherproportionofchildrenwithoutadditionalneedswillincurloweraveragecostsperlookedafterchild.However,in realitytheiroverallexpenditureonchildrensservicesmaybegreater,forsuchauthoritiesmayplaceahigherproportionof theirwholepopulationofchildreninneedawayfromhomethandothosewithbetterdevelopedfamilysupportservices. ThestudybyWardandcolleaguesidentifieddifferentcombinationsofadditionalsupportneeds.Therewerefivesimple groupsofchildrenwhodisplaynoneoroneoftheattributesexpectedtoaffectcosts,andsixcomplexgroupsofchildren whodisplaytwoormoreadditionalsupportneeds.Inthesampleof478children,129(27percent)showednoevidenceof additionalsupportneeds,215(45percent)displayedone;124(26percent)childrendisplayedcombinationsoftwo;anda verysmallgroupofchildren(2percent)displayedcombinationsofthreeormore. Thecarepackagecostsforchildrendescribedinthetablesillustrateanexampleofthesupportreceivedbyachildinsome ofthesegroups,takenfromthestudysample.Costsrelatetotimeperiodsstatedineachtable.
Ward,H.,Holmes,L.&Soper,J.(2008)CostsandConsequencesofPlacingChildreninCare,JessicaKingsleyPublishers,London.
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8.4.1 Children in care: lowcost with no evidence of additional support needs

ChildAisaboyagedfourteenwithnoevidenceof additionalsupportneeds.Thetableshowsthetotalcostincurredby socialservicesandotheragenciesfromFebruary2000toOctober2001,upratedusingthePSSPay&Pricesinflator.ChildA becamelookedafterattheageofsix,astheresultofneglect.Acareorderwasobtainedin1992.Sincethenhehasbeen placedwiththesamelocalauthorityfostercarers,aplacementthathadlastedeightyearsbythestartofthestudy.InJune 2001,hiscasewastransferredtotheleavingcareteam.Reviewswereheldatsixmonthlyintervalsandhiscareplanwas updatedeverysixmonths.Heattendedsixmonthlydentalappointmentsandanannuallookedafterchildmedical.During thetimeperiodshownabove,thisyoungpersonattendedweekly,hourlongphysiotherapysessionsasaresultofaneck injury.Hecompletedhisstatutoryschoolinginsummer2001andobtainedsevenGCSEs,attendingmainstreamschooluntil Summer2000wherehethenprogressedtofurthereducationtostartanAlevelcourse. ChildAhadarelativelyinexpensiveplacementwithlocalauthorityfostercarers.Heincurredsomeeducationalcosts,in thatheattendedschool,andsomehealthcarecosts,buttherewasnoexceptionalexpenditure.Pleasenotethatthese figureshavebeenrounded.Whereappropriate,theoriginalinformationhasbeenadjustedtotakeaccountofAgendafor Changesalaries. Process CosttoLA Total Costtoothers Total Careplanning 137x3 412 169 x3 507 41,517 54 x3 162 Maintainingtheplacement 540x87weeks minus6,8511 Review 466x3+132 1,412 Legal 5.403x87weeks 471 104 x87weeks 870 Transitiontoleavingcare 1,328 1,328 Costofservices 7,695 Mainstreamschooling 275 perday 802 FEcollege 264perday 8.606x3 26 Dentist 307 30 Lookedafterchildmedical 54x87weeks 4,698 Physiotherapy(homevisit) Total 45,140 14,790
Costincludespaymentmadefortheplacementandallactivitytosupporttheplacement.Thereisareductionincostasaresultofreducedactivityonce theplacementhaslastedformorethanoneyear. 2 Anadditionalcostisincurredforthefirst16+review. 3 Thecostofobtainingacareorderhasbeendividedoverthetotalnumberofweeksbetweenadmissionandthechildseighteenthbirthday. 4 Selwyn,J.,Sturgess,W.,Quinton,D.&Baxter,C.(2003)CostsandOutcomesofNonInfantAdoptions,ReporttotheDepartmentofHealth,Hadley CentreforAdoptionandFosterCareStudies,UniversityofBristol. 5 Basedonthecostofasecondaryschoolplace.Calculatedbydividingtotalsecondaryschoolexpenditurebythetotalnumberofpupilsontheroll,andby thetotalnumberofdaysofpupilcontact(190).DepartmentforEducation(2011)Section251dataarchive:Outturndatadetailedlevel200809onwards, outturnsummary200910,DepartmentforEducation,Londonandtable1AAllSchools:pupilswithstatementsofspecialeducationalneeds. 6 Berridge,D.,Beecham,J.,Brodie,I.,Cole,T.,Daniels,H.,Knapp,M.&MacNeill,V.(2002)CostsandConsequencesofServicesforTroubledAdolescents: AnExploratory,AnalyticStudy,UniversityofLuton,Luton. 7 Basedontheunitcostofasurgeryconsultationwithageneralpractitioner(seeSchema10.8b).
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8.4.2 Children in care: median cost children with emotional or behavioural difficulties
BetweenFebruary2000andApril2001,ChildBwasplacedwithlocalauthorityfostercarers(withintheareaofthe authority).Shethenchangedtoanotherplacementwithlocalauthorityfostercarerswithintheareaoftheauthority.A careorderwasobtainedforthisyoungpersonwhenshefirstbecamelookedafterinMarch1995.Duringthetimeframe threereviewmeetingswereheldandhercareplanwasalsoupdatedonthreeoccasions.ChildBattendedmainstream schoolandfromDecember2000untilJune2001shereceivedsupportfromapersonalteachingassistantforfourhoursa week.Thisyoungpersonattendedsixmonthlydentalappointmentsandalsoherannuallookedafterchildmedical.ChildB alsoreceivedspeechtherapyuntilJuly2001.Followingaselfharmincidentshewastakentotheaccidentandemergency departmentandwasreferredtoaclinicalpsychologistandbeganweeklysessionsinSeptember2000. Coststosocialservicesarerelativelylow,largelybecauseshewasplacedwithlocalauthorityfostercarerswithinauthority throughoutthestudyperiod,andnotconsidereddifficulttoplace.Therewererelativelyhighcoststootheragencies, designedtomeetbothherhealthandeducationalneeds.Pleasenotethatthesefigureshavebeenrounded.Where appropriate,theoriginalinformationhasbeenadjustedtotakeaccountofAgendaforChangesalaries. Process CosttoLA Costtoothers Unitcosts Total Unitcosts Total Careplanning 137 x3 412 169x3 507 38,291 Maintainingtheplacement 495x87weeksminus 5,118plus3271 Findingsubsequentplacement 234 234 Review 466 x3 1,398 54x3 162 Legal 6.602 x87weeks 574 12.103x87 1,053 Costofservices Mainstreamschooling 8,559 274perday Dentist 8.605x3 26 306 Lookedafterchildmedical 30 54x60weeks Speechtherapy 3,249 135x52weeks Clinicalpsychologist 7,020 1477 Hospitalaccidentandemergencyvisit 147 (admitted) 445(4hrsper Personalteachingassistant 4,358 weekfor25 weeks) Total 40,910 25,110
Costincludesthepaymentmadefortheplacementsandallactivitytosupporttheplacements.Thereisareductionincostasaresultofreducedactivity forthefirstplacementwhichhaslastedformorethanoneyear.Thereisanincreaseincostinthefirstthreemonthsofthesecondplacementdueto increasedsocialworkeractivity. 2 Thecostofobtainingacareorderhasbeendividedoverthetotalnumberofweeksbetweenadmissionandthechildseighteenthbirthday. 3 Selwyn,J.,Sturgess,W.,Quinton,D.&Baxter,C.(2003)CostsandOutcomesofNonInfantAdoptions,ReporttotheDepartmentofHealth,Hadley CentreforAdoptionandFosterCareStudies,UniversityofBristol. 4 Basedonthecostofasecondaryschoolplace.Calculatedbydividingtotalsecondaryschoolexpenditurebythetotalnumberofpupilsontheroll,andby thetotalnumberofdaysofpupilcontact(190).DepartmentforEducation(2011)Section251dataarchive:Outturndatadetailedlevel200809onwards, outturnsummary200910,DepartmentforEducation,Londonandtable1AAllSchools:pupilswithstatementsofspecialeducationalneeds. 5 Berridge,D.,Beecham,J.,Brodie,I.,Cole,T.,Daniels,H.,Knapp,M.&MacNeill,V.(2002)CostsandConsequencesofServicesforTroubledAdolescents: AnExploratory,AnalyticStudy,UniversityofLuton,Luton. 6 Basedontheunitcostofasurgeryconsultationwithageneralpractitioner(seeSchema10.8b) 7 DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459.
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8.4.3 Children in care: high cost children with emotional or behavioural difficulties and offending behaviour
ChildCwasagedfifteenatthestartofthestudy.Hefirstbecamelookedafterattheageofeleven,whenhisparents neededrespite.Priortothestartofthestudyhewasplacedinsecureaccommodationonfiveseparateoccasions.Hehad alsobeenplacedinvariousresidentialhomes,schoolsandfosterplacements,manyofwhichhadbrokendown.Asa consequence,hehadbeenclassifiedasdifficulttoplace.Duringthestudyperiod(74weeks),ChildCexperiencedten differentplacements.Healsorefusedallstatutorymedicalanddentalappointments;furthermore,herefusedanymental healthsupport.ChildCdidnotcompletehisstatutoryschooling,asaresultofnumerousexclusionsandnonattendance. Priortothestartofthestudyhehadahistoryofoffending:thiscontinuedthroughoutthestudy,withhimcommittingten furtheroffences.Heceasedbeinglookedafterinsummer2001whenherefusedtoreturntoanyplacementprovidedby thelocalauthority. Thecoststosocialserviceswererelativelyhigh,bothbecauseofanumberofoutofauthority,residentialplacements providedbyindependentsectoragenciesandduetoninechangesofplacement.Thereweresubstantialcoststoother agencies(YouthOffendingTeamandthePolice)asaresultofhisoffendingbehaviour.Additionalhealthcarecostswere notincurredforthisyoungmanbecauseofhisrefusaltoengageintheservicesofferedtohim.Pleasenotethatthese figureshavebeenrounded.Whereappropriate,theoriginalinformationhasbeenadjustedtotakeaccountofAgendafor Changesalaries. Process CosttoLA Total Costtoothers Total Careplanning 137x2 274 164 x2 327 268,242 54 x74weeks2 Maintainingtheplacement 267,041plus 4,006 1,2001 Ceasedbeinglookedafter 301 301 Findsubsequentplacements 8,8793 8,879 Review 466+930 1,396 197 x2 394 4 Costofservices YOTinvolvement/criminalcosts 1,1105 x74weeks 82,183 Total 279,094 86,910
Thiscostincludesthepaymentmadefortheplacementandallactivitytosupporttheplacements.Thereisanincreaseincostinthefirstthreemonths ofaplacementduetoincreasedsocialworkeractivity. ChildCceasedbeinglookedafterinJuly2001,thereforethetimeperiodbeingcostedis74weeks. 3 ChildCexperiencedninechangesofplacementduringthetimeframeofthestudy. 4 Therearenoadditionaleducationcostsbecausetheseareincludedinthecostsoftheplacementsinprocessthree. 5 Liddle,M.(1998)WastedLives:CountingtheCostofJuvenileOffending,NationalAssociationfortheCareandResettlementofOffenders(NACRO), London.

2
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8.4.4 Children in care: very high cost children with disabilities, emotional or behavioural difficulties plus offending behaviour
ChildDexperiencedninedifferentplacementsfromFebruary2000toOctober2001.Initiallyhewasplacedinan independentsectoragencyresidentialunitwitheducationfacilities.InMarch2000,hewasplacedwithindependentsector fostercarers,againoutofarea.Hethenexperiencedthreefurtherplacements,alloutoftheindependentsectorarea authorityandallprovidedbyindependentsectororganisations:anotherresidentialunit,thenanotherfosterplacement, thenathirdresidentialplacement.InSeptember2000hewasplacedovernightinasecureunitwithintheauthority.He thenhadthreeindependentsectorplacements;fostercarers,aresidentialunit,andaspecialisedonebeddedresidential unitinDecember2000.Thisplacementwasalsooutoftheareaoftheauthority.Reviewmeetingswereheldsixmonthly andhiscareplanwasalsoupdatedeverysixmonths.Thisyoungpersonattendedtheeducationprovisionintwodifferent residentialunitsupuntilsummer2000,whenhewaspermanentlyexcluded.Hethenstartedsessionswithahometutorin October2000.Duringthegiventimeperiod,heattendedsixmonthlydentalappointmentsandhislookedafterchild medical.HealsoattendedweeklysessionswithaclinicalpsychologistfromOctober2000onwards.InSeptember2000,he wasaccusedofacriminaloffence;thepolicewereinvolved,buthewasnotconvicted. Thesecostsaremarkedlyhigherthanforthemajorityofotherchildreninthesample.ChildDhadbecomedifficulttoplace; andincreasingamountsofsocialworktimehadtobespentonfindingtherareplacementsthatwerepreparedtoaccept him.Thecostsofchangingplacementswerecalculatedatover1,000permove.Pleasenotethatthesefigureshavebeen rounded.Whereappropriate,theoriginalinformationhasbeenadjustedtotakeaccountofAgendaforChangesalaries. Process CosttoLA Total Costtoothers Total Careplanning 69 x3 207 169x3 507 Maintainingtheplacement 510,536plus1,3101 511,846 Findingsubsequentplacements Review Legal Transitiontoleavingcare Costofservices Hometuition Permanentexclusion Dentist Lookedafterchildmedical Clinicalpsychologist Policecostsforcriminaloffence Total 11,454 931 x3 3.503 x87weeks 1,328 11,454 2,793 299 1,328 92x82 399x3 6.204x87weeks 445perhour 1486 8.605x3 307 135perhourfor52 weeks 2288 739 1,196 540
527,926
8,280 148 26 30 7,020 228 18,714
Thecostincludesthepaymentmadefortheplacementsandallactivitytosupporttheplacements.Thereisanincreaseincostinthefirstthreemonths ofaplacementduetoincreasedsocialworkeractivity. 2 ChildDexperiencedeightchangesofplacementduringthetimeframeofthestudy. 3 Thecostofobtainingacareorderhasbeendividedoverthetotalnumberofweeksbetweenadmissionandthechildseighteenthbirthday. 4 Selwyn,J.,Sturgess,W.,Quinton,D.&Baxter,C.(2003)CostsandOutcomesofNonInfantAdoptions,ReporttotheDepartmentofHealth,Hadley CentreforAdoptionandFosterCareStudies,UniversityofBristol. 5 Berridge,D.,Beecham,J.,Brodie,I.,Cole,T.,Daniels,H.,Knapp,M.&MacNeill,V.(2002)CostsandConsequencesofServicesforTroubledAdolescents: AnExploratory,AnalyticStudy,UniversityofLuton,Luton. 6 Parsons,C.&Castle,F.(1998)ThecostofschoolexclusioninEngland,InternationalJournalofInclusiveEducation,2,4,277294. 7 Basedontheunitcostofasurgeryconsultationwithageneralpractitioner(seeSchema10.8c). 8 Liddle,M.(1998)WastedLives:CountingtheCostofJuvenileOffending,NationalAssociationfortheCareandResettlementofOffenders(NACRO), London.
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8.5 Young adults with acquired brain injury in the UK

Acquiredbraininjury(ABI)isanondegenerativeinjurytothebrainoccurringsincebirth,includingbothopenandclosed headinjuries.ABIincludesarangeofdiagnosesorcauses,includingstrokesortumours.Headinjurythroughtraumaisa commoncauseamongyoungadults.ABIisnotthoughttoaffectlifeexpectancyaftertheinitialacutephase,sothe prevalenceoflongtermbraindamageishighat100150per100,000population,implyingatotalof60,00090,000people intheUK(www.rhn.org.uk). AstudycarriedoutbythePersonalSocialServicesResearchUnitwasundertakentoidentifythehealthandsocialcare servicesusedbyyoungadultsaged1825yearswithacquiredbraininjury(ABI)andtheassociatedcosts.1Thestudy identifiedtheannualincidenceofABIinthisagegroup,andthentrackedtheyoungadults'likelyprogressthroughfour supportrelatedstages:trauma,stabilisation,rehabilitationandreturntothecommunity.Byidentifyingthenumbersusing differenttreatmentlocationsandservicesateachstage,apictureofserviceuseandcostscouldbebuiltupoveranotional 12monthperiodfollowinginjury.Allcostshavebeenupratedto2010/2011pricesusingtheHCHSPayandPricesInflator. FourbroadgroupsofyoungpeoplewithABIwereidentifiedbytheirlocationandthecommunitycarestageasfollows: Group1comprisesthelargestproportionofthosesustainingbraininjuriesandincludesthosewhoattendA&EwithABI orspendshortperiodsinahospitalwardandthenreturnhome.Asmallproportion,perhapsjustoneinfive,willhave followupappointmentsarrangedatanoutpatientclinicorwiththeirGP.Thisgroupwillgenerallyhavehadamildhead injuryandnolongertermdisability,although20percentofthisgroupmaycontinuetohaveresidualsymptomssix monthsafterinjury. Group1:Averagecostperperson=292perannum. PeopleinGroup2arealsolikelytohavereturnedtotheirownhomeswithinayear,butaremoreseriouslydisabledand relyonpersonalcaresupportprovidedbyspouses,parentsorotherinformalcarers.Thisgroupmayincludethosewho aredischargedhomefromlongertermresidentialrehabilitation(34%ofpatientsdischarged),fromacutebraininjury units(25%)andfromneurosurgeryunits(23%).Itislikelythatatleast40percentofthemwillrequireatleastparttime supportorsupervisionfrominformalcarers. Group2:Averagecostsperperson=20,863perannum. ThethirdgroupofyoungadultswithABIarethosewhosepathwaytowardstheendofayearwillseethemlivingin supportedaccommodationwithformal(paid)personalcarers.Somewillhavebeendischargedstraightfromhospital andsomewillhavestayedinarehabilitationfacilitypriortotheirmovetosupportedliving.Oneinfouroftheseyoung adultswillneedovernightsupervision,andthreeinfourwillneedatleastparttimesupervisionduringtheday.The numberofyoungadultsmaybequitehigh,butsomewillmoveontomoreindependentliving.Otherswillneedthistype ofsupportformanyyearstocome.Forcostestimates,ithasbeenassumedthisgroupwillliveincommunitybased housingwithlowstaffinglevelsduringthedayandsleepinginstaffatnight.Inadditiontopersonalcare,theyarealso likelytouseoutpatientclinicsandcommunitybasedtherapists.Personalcarecosts(estimatedatanaverageof8hours overnightsleepinginand6hoursduringtheday)wouldamountto529perweek.Useofcommunitybasedtherapy andhealthcareserviceswouldaddanother618bytheendofthenotional12monthperiod. Group3:Averagecostperperson=39,999perannum. Thefourthgroupincludesyoungadultswhoarelikelytobeamongthemostseverelydisabled.Althoughsomewillbe supportedathome,itisestimatedthat310willberesidentinnursinghomesforyoungadults,specialistABIresidential units,inlongerstayhospitalwardsorinmentalhealthunits.Theyarelikelytohavebeenthemostseverelyinjured. Someoftheprincipalindependentproviderscontactedforthisresearchreportedcurrentpricesforresidential placementsofupto3,079perweek,oftenjointlyfundedbyhealthandsocialservices.Nursinghomesandyoung disabilityunitsarelikelytobelesscostly.However,nursinghomecaremaynotbeappropriateforpeoplewithsevere ABIrelateddisabilityastheretendtobefewqualifiedstaffandlowinputfromlocalcommunitybasedteamsor specialistdoctors. Group4:Averagecostperperson=41,215perannum.
Beecham,J.,Perkins,M.,Snell,T.&Knapp,M.(2009)TreatmentpathsandcostsforyoungadultswithacquiredbraininjuryintheUnitedKingdom,Brain Injury,23,1.3038.
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8.6 Palliative care for children and young people

TheGovernmentsmanifestocommitmenttoimprovepalliativecareservicesin2006(Cochraneetal.,2007)1resultedinan independentreviewofchildrenspalliativecareserviceswhichwascommissionedbytheSecretaryofStateforHealth (CraftandKillen,2007).2Thisindependentreviewwasbasedonfindingsfromawideconsultationwithstakeholders, includingchildrenandyoungpeopleandtheirfamilies,commissionersandprovidersofservices,alongwithcommissioned researchfromDepartmentofHealthAnalysisandtheYorkHealthEconomicsConsortium. InformationforthisschemahasbeendrawnfromtheworkcarriedoutbytheYorkHealthEconomicsConsortiumpublished in2007(Lowsonetal,2007)3whichprovidesexamplesofillnesstrajectoriesandtheresultingunitcostsforchildrenin needofpalliativecare.Allcostshavebeenupratedusingtheappropriateinflatorsinordertoprovidecurrentprices.See Lowsonetal.(2007)formoreinformationonthecostbenefitsofusingcommunitycareinsteadofhospitalservices.
8.6.1 Short illness trajectory: cancer

ThisgenericpathwaywasdevelopedforachildwithcancerfromdataprovidedbySargentCancerCareforChildrenand CancerandLeukaemiainChildhood(CLICSargent).Itwastriangulatedwithinformationcollectedduringfocusgroupsfrom twoparents,bothofwhosechildrenhaddied,onefromaformofleukaemia,thesecondfrombonecancer. Achildwithcancer Duringoneyear 7,034 Threeinpatientstays 663 Onewardattendancepermonth 3,880 Onedaycareepisodeperfortnight 8,335 Onehomevisitperweek,includingintensivebereavementsupport Subtotalhealth 19,912 Itwasassumedthatthechilddiedathomewithintensivecommunitysupport Itwasassumedthattherewasnouptakeofrespitecare Itwasassumedthattherewerenocostsaccruingtoeducationandsocialservices Assumptionsrefinancialburden: 13,807 Onefamilymembergivesuppaidemployment 6,885 Significantfinancialcosttofamily
Cochrane,H.,Liyanage,S.Nantambi,R.(2007)PalliativeCareStatisticsforChildrenandYoungAdults,DepartmentofHealth,London. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_074459. 2 Craft,A.andKillen,S.(2007)PalliativeCareServicesforChildrenandYoungPeopleinEngland,DepartmentofHealth,London. www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_074698.pdf 3 Lowson,K.,Lowson,P.andDuffy,S.(2007)IndependentReviewofPalliativeCareServicesforChildrenandYoungPeople:EconomicStudy,FinalReport, YorkHealthEconomicsConsortium,DepartmentofHealthIndependentReviewTeam,London.
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8.6.2 Longer life illness trajectories: cardiac care

Thispathwayhasbeendevelopedfromatypicalpatientbeingtreatedbyacommunitybasedteam.Theinformationwas providedbyparentsatafocusgroup. Achildwithacardiacconditionaged15months Inoneyear 2,345 Inpatientstayof5daysinlocalhospitalforrespiratoryinfection 47,613 Inpatientstayof4weeksinpaediatriccardiacunitincluding1weekinPICU 2,345 Inpatientstayof6daysinlocalhospitalforviralinfection 74,147 Inpatientstayof6weeksinpaediatriccardiacunitincluding2weeksinPICU 1,990 Oneoutpatientvisitpermonthtolocalteam 8,335 Onehomevisitperweekbycommunityteam 345 Onetelephonecontactperweek Subtotalhealth 137,120 3,560 Thechildattendsapreschoolspecialneedsnursery 5,960 Useswheelchairandhashomeequipment Assumptionsre.respitecare(basedonfocusgroupsandpublishedevidence): 15,255 15daysperannumathospice 7,898 6hoursperweekathome Totalhealth,respiteandsocialcarecosts 146,640 Assumptionsre.financialburdenonfamily Familyinreceiptofcarerallowance 13,807 Onefamilymembergivesuppaidemployment 6,885 Significantfinancialcosttofamily
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8.6.3 Longer life illness trajectories: cystic fibrosis

Thispathwayhasbeendevelopedfromatypicalpatientbeingtreatedbyacommunitybasedteam.Theinformationwas providedbyparentsatafocusgroup. Achildwithcysticfibrosisaged5years Inoneyear: 7,884 Twoinpatientstaysinlocalhospitalforreceiptofintravenousantibiotics Oneoutpatientvisitpermonthtolocalteamcomprisingconsultantpaediatrician 9,648 andconsultantrespiratorypaediatrician 389 Fourvisitsperyeartospeechandlanguagetherapist 4,168 Onehomevisitperfortnightbycommunityteam 345 Onetelephonecontactperweek 22,435 Subtotalhealth Thechildattendsmainstreamschoolwithsupport Useswheelchairandhashomeequipment. Assumptionsre.respitecare(basedonfocusgroupsandpublishedevidence): 15daysperannumathospice 6hoursperweekathome Totalhealth,respiteandsocialcarecosts Assumptionsre.financialburdenonfamily Onefamilymembergivesuppaidemployment Significantfinancialcosttofamily 6,564 5,960 15,255 7,898 53,133 13,807 6,885
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8.6.4 Longer life illness trajectories: child with multiple disabilities

Thispathwayhasbeendevelopedfromatypicalpatientbeingtreatedbyacommunitybasedteam.Theinformationwas providedbyparentsatafocusgroup. Anolderchildwithcomplexandmultipleneeds: Childhasrenalproblemsandseizures,withvisualimpairmentandlearningdifficulties. Thechildandfamilyisincontactwithfivespecialities: Paediatricendocrinology Paediatricgastroenterology Neurosurgery Ophthalmology Childpsychiatry Inoneyear: 15,347 Oneinpatientstayintertiarycentreforneurosurgery 1,108 Oneinpatientstaysfordentalextraction 8,622 Oneoutpatientvisitperweekforbloodtests 1,990 Oneoutpatientvisitpermonthforspecialistreviews 285 TwoCTscans 743 TwoMRIscans 328 ThreeEEGs 1,689 Fourvisitsperyeartoclinicalpsychologist 389 Fourvisitsperyeartospeechandlanguagetherapist 1,923 Onefacetofacevisitpermonthbycommunityteam 3,847 Onehomevisitperfortnightbycommunityteam 172 Onetelephonecontactperfortnightwithcommunityteam Subtotalhealth 36,443 3,526 Thechildattendsaschoolforchildrenwithspecialeducationalneeds 5,960 Useswheelchairandhashomeequipment Assumptionsre.respitecare(basedonfocusgroupsandpublishedevidence) 15,255 15daysperannumathospice 7,898 6hoursperweekathome Totalhealth,respiteandsocialcarecosts 69,083 Assumptionsre.financialburden Familyinreceiptofcarerallowance 13,807 Onefamilymembergivesuppaidemployment 6,885 Significantfinancialcosttofamily
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II. COMMUNITYBASED HEALTH CARE STAFF
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9. Scientific and professional

9.1Communityphysiotherapist 9.2NHScommunityoccupationaltherapist 9.3Communityspeechandlanguagetherapist 9.4Communitychiropodist/podiatrist 9.5Clinicalpsychologist 9.6Communitypharmacist
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9.1 Community physiotherapist

UsingdatafromtheNHSReferenceCosts,,1themeanaveragecostforaonetoonecontactinphysiotherapyservicesfor2010/2011was 47,withtheminimumrangefor25percentofservicesbeing34andthemaximum55.CostshavebeenupratedusingtheHCHSPay &Pricesinflator. Costsandunit 2010/2011value Notes estimation A.Wages/salary 22,700peryear BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand 5(forqualifiedAlliedHealthProfessionals)oftheJanuaryMarch2011NHSStaff Earningsestimates.Medianfulltimeequivalenttotalearningswhichincludebasic salaryplushoursrelatedpay,overtime,occupationpayments,locationpayments, andotherpaymentsincludingredundancypayorpaymentofnoticeperiodswere 24,100.2SeesectionVforinformationonmeansalaries. B.Salaryoncosts 5,352peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Qualifications 4,927peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenet 3 al.(1998). CurrentcostinformationhasbeenprovidedbytheDepartmentof HealthandtheHigherEducationFundingCouncilforEngland(HEFCE).4Seethe prefaceformoreinformationonqualificationsandalsoschema7.4fordetails. D.Overheads TakenfromNHS(England)SummarisedAccounts.5Seeprefaceformore information. Management, 5,358peryear Managementandothernoncarestaffcostswere19.1percentofdirectcare administrationand salarycostsandincludedadministrationandestatesstaff. estatesstaff Nonstaff 11,670peryear Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gas andelectricity. E.Capitaloverheads 2,611peryear BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto 6,7 reflectshareduseofbothtreatmentandnontreatmentspace. Capitalcosts havebeenannuitisedover60yearsatadiscountrateof3.5percent. F.Travel Noinformationavailableonaveragemileagecoveredpervisit.Currentguideline forreimbursement:54pencepermileupto3,500miles,18penceover3,500 miles.8 Workingtime 41.3weeksperannum Includes29daysannualleave,8daysstatutoryleaveand11.6dayssickness 9,10 37.5hoursperweek leave. Assumes5study/trainingdays.Unitcostsbasedon1549hoursperannum. Ratioofdirectto Noinformationavailableontheproportionoftimespentwithclients.Seeprevious indirecttime editionsofthisvolumeforsourcesofinformation. Durationofcontact Nocurrentinformationavailableonthelengthofcontact.Seepreviouseditionsof thisvolumeforsources. Londonmultiplier 1.20x(AtoB) AllowsforthehighercostsassociatedwithworkinginLondon.6,7,11 1.40xE 6,7,11 NonLondonmultiplier 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 31(34)perhour.
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2011)MileagePaymentsReview,NHSEmployers,Leeds. www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 9 NHSEmployers(2005)AgendaforChange:NHSTermsandConditionsofServiceHandbook,NHSEmployers,London. 10 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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9.2 NHS community occupational therapist

UsingdatafromtheNHSReferenceCosts,1themeanaveragecostforaonetoonecontactofoccupationaltherapyservicesfor 2010/2011was74withtheminimumrangefor25percentoftheservicesbeing50andthemaximum83.Costshavebeenuprated usingtheHCHSPay&Pricesinflator. Costsandunit 2010/2011value Notes estimation A.Wages/salary 22,700peryear BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand5 (forqualifiedAlliedHealthProfessionals)oftheJanuaryMarch2011NHSStaff Earningsestimates.Medianfulltimeequivalenttotalearningswhichincludebasic salaryplushoursrelatedpay,overtime,occupationpayments,locationpayments,and otherpaymentsincludingredundancypayorpaymentofnoticeperiodswere 24,100.2SeesectionVforinformationonmeansalaries. B.Salaryoncosts 5,352peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Qualifications 4,911peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. 3 (1998). CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthand theHigherEducationFundingCouncilforEngland(HEFCE).4Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails. D.Overheads TakenfromNHS(England)SummarisedAccounts.5Seeprefaceformoreinformation. Management, administrationand 5,338peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary estatesstaff costsandincludedadministrationandestatesstaff. Nonstaff 11,670peryear Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe providerforoffice,travel/transportandtelephone,educationandtraining,supplies andservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. E.Capitaloverheads 2,611peryear BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedtoreflect shareduseofbothtreatmentandnontreatmentspace.6,7Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. F.Travel Noinformationavailableonaveragemileagecoveredpervisit.Currentguidelinefor 8 reimbursement:54pencepermileupto3,500miles,18penceover3,500miles. 9 Workingtime 41.3weeksper Includes29daysannualleaveand8daysstatutoryleave. Assumes5study/training annum daysand11.6dayssicknessleave.10Unitcostsbasedon1549hoursperannum. 37.5hoursperweek Ratioofdirectto Noinformationavailableontheproportionoftimespentwithclients.Seeprevious indirecttime editionsofthisvolumeforsourcesofinformation. Durationofcontacts Noinformationavailableondurationofcontacts.Seepreviouseditionsofthisvolume forsourcesofinformation. Londonmultiplier 1.20x(AtoB) AllowsforthehighercostsassociatedwithworkinginLondon.6,7,11 1.40xE NonLondonmultiplier 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon.6,7,11 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 31(34)perhour.
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 9 NHSEmployers(2005)AgendaforChange:NHSTermsandConditionsofServiceHandbook,NHSEmployers,London. 10 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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9.3 Community speech and language therapist

UsingdatafromtheNHSReferenceCosts,,1themeanaveragecostforaonetoonecontactofspeechandlanguagetherapyservicesfor 2010/2011was79,withtheminimumrangefor25percentoftheservicesbeing56andthemaximum90.Costshavebeenuprated usingtheHCHSPay&Pricesinflator. 2010/2011value Notes Costsandunitestimation A.Wages/salary 22,700peryear BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChange Band5(forqualifiedAlliedHealthProfessionals)oftheJanuaryMarch2011NHS StaffEarningsestimates.Medianfulltimeequivalenttotalearningswhich includebasicsalaryplushoursrelatedpay,overtime,occupationpayments, locationpayments,andotherpaymentsincludingredundancypayorpaymentof 2 noticeperiodswere24,100. SeesectionVforinformationonmeansalaries. B.Salaryoncosts 5,352peryear Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. C.Qualifications 5,035peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNetten etal.(1998).3CurrentcostinformationhasbeenprovidedbytheDepartmentof 4 HealthandtheHigherEducationFundingCouncilforEngland(HEFCE). Seethe prefaceformoreinformationonqualificationsandalsoschema7.4fordetails. D.Overheads TakenfromNHS(England)SummarisedAccounts.5Seeprefaceformore information. Management,administration 5,358peryear Managementandothernoncarestaffcostswere19.1percentofdirectcare andestatesstaff salarycostsandincludedadministrationandestatesstaff. Nonstaff 11,670peryear Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecosts totheproviderforoffice,travel/transportandtelephone,educationand training,suppliesandservices(clinicalandgeneral),aswellasutilitiessuchas water,gasandelectricity. E.Capitaloverheads 2,611peryear BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto reflectshareduseofbothtreatmentandnontreatmentspace.6,7Capitalcosts havebeenannuitisedover60yearsatadiscountrateof3.5percent. F.Travel Noinformationavailableonaveragemileagecoveredpervisit.Currentguideline forreimbursement:54pencepermileupto3,500miles,18penceover3,500 miles.8 Workingtime 41.3weeksper Includes29daysannualleaveand8daysstatutoryleave.9Assumes5study/ annum trainingdaysand11.6dayssicknessleave.10Unitcostsbasedon1549hoursper 37.5hoursper annum. week Ratioofdirecttoindirect Noinformationavailableontheproportionoftimespentwithclients.See time previouseditionsofthisvolumeforsourcesofinformation. Durationofcontacts Noinformationavailableonthedurationofcontacts.Seepreviouseditionsof thisvolumeforsourcesofinformation. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithworkinginLondon.6,7,11 1.40xE NonLondonmultiplier 0.97x(AtoB) AllowsforthehighercostsassociatedwithworkinginLondon.6,7,11 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 31(34)perhour.
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 9 NHSEmployers(2005)AgendaforChange:NHSTermsandConditionsofServiceHandbook,NHSEmployers,London. 10 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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9.4 Community chiropodist/podiatrist

UsingdatafromtheNHSReferenceCosts,1themeanaveragecostforacontactinchiropody/podiatryservicesfor 2010/2011was39withtheminimumrangefor25percentofservicesbeing31andthemaximum45.Costshavebeen inflatedusingtheHCHSPay&PricesInflator.
Costsandunitestimation A.Wages/salary 2010/2011value 22,700peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendafor ChangeBand5(forqualifiedAlliedHealthProfessionals)oftheJanuary March2011NHSStaffEarningsestimates.Medianfulltimeequivalent totalearningswhichincludebasicsalaryplushoursrelatedpay, overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiodswere 24,100.2Aspecialistchiropodist/podiatristisonBand6.SeeNHS WorkforceSummaryformoreinformation.3SeesectionVfor informationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. Qualificationcostsarenotavailable. TakenfromNHS(England)SummarisedAccounts.4Seeprefacefor moreinformation. Managementandothernoncarestaffcostswere19.1percentof directcaresalarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.They includecoststotheproviderforoffice,travel/transportandtelephone, educationandtraining,suppliesandservices(clinicalandgeneral),as wellasutilitiessuchaswater,gasandelectricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,but adjustedtoreflectshareduseofbothtreatmentandnontreatment space.5,6Capitalcostshavebeenannuitisedover60yearsatadiscount rateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Current guidelineforreimbursement:54pencepermileupto3,500miles,18 penceover3,500miles.7 Includes29daysannualleaveand8daysstatutoryleave.8Assumes5 study/trainingdaysand11.6dayssicknessleave.9Unitcostsbasedon 1549hoursperannum. Noinformationavailableontheproportionoftimespentwithclients. Seepreviouseditionsofthisvolumeforsourcesofinformation. AllowsforthehighercostsassociatedwithworkinginLondon.5,6,10 AllowsforthelowercostsassociatedwithworkingoutsideLondon. 5,6,10
B.Salaryoncosts C.Qualifications D.Overheads Management, administrationandestates staff Nonstaff
E.Capitaloverheads
2,611peryear
F.Travel
Workingtime
41.3weeksperannum 37.5hoursperweek
Ratioofdirecttoindirect time Londonmultiplier NonLondonmultiplier Unitcostsavailable2010/2011 31perhour.
1.19x(AtoB) 1.40xE 0.97x(AtoB)
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 TheInformationCentre(2008)WorkforceSummaryChiropodyandPodiatry,October2008Englandonly,NHSWorkforceReviewTeam,The InformationCentre,Leeds. 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 8 NHSEmployers(2005)AgendaforChange:NHSTermsandConditionsofServiceHandbook,NHSEmployers,London. 9 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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9.5 Clinical psychologist

Costsandunitestimation A.Wages/salary 2010/2011value 45,300peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendafor ChangeBand8a(forqualifiedAlliedHealthProfessionals)ofthe JanuaryMarch2011NHSStaffEarningsestimates.Medianfulltime equivalenttotalearningswhichincludebasicsalaryplushoursrelated pay,overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiodswere 46,600.1SeesectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. Qualificationcostsarenotavailable. TakenfromNHS(England)SummarisedAccounts.2Seeprefacefor moreinformation. Managementandothernoncarestaffcostswere19.1percentof directcaresalarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.They includecoststotheproviderforoffice,travel/transportandtelephone, educationandtraining,suppliesandservices(clinicalandgeneral),as wellasutilitiessuchaswater,gasandelectricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,but adjustedtoreflectshareduseofbothtreatmentandnontreatment space.3,4Capitalcostshavebeenannuitisedover60yearsatadiscount rateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Current guidelineforreimbursement:54pencepermileupto3,500miles,18 penceover3,500miles.5 Includes29daysannualleaveand8daysstatutoryleave.6Assumes5 study/trainingdaysand11.6dayssicknessleave.7Unitcostsbasedon 1549hoursperannum. BasedontheNationalChildandAdolescentMentalHealthService Mappingdataandreturnsfromover500principalclinical psychologists,44.5percentoftimewasspentondirectclinicalwork.8 AllowsforthehighercostsassociatedwithworkinginLondon.3,4,9
B.Salaryoncosts C.Qualifications D.Overheads Management,administration andestatesstaff Nonstaff
E.Capitaloverheads
2,283peryear
F.Travel
Workingtime
41.3weeksperannum 37.5hoursperweek 1:1.25 1.19x(AtoB) 1.41xE 0.97x(AtoB)
Ratiosof: facetofacecontacttoall activity Londonmultiplier
NonLondonmultiplier AllowsforthelowercostsassociatedwithworkingoutsideLondon.3,4,9 Unitcostsavailable2010/2011 60perhour;135perhourofclientcontact(includesAtoE).
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 3 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 5 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 6 NHSEmployers(2005)AgendaforChange:NHSTermsandConditionsofServiceHandbook,NHSEmployers,London. 7 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 8 DepartmentofHealth(2002)NationalChildandAdolescentMentalHealthServiceMappingData,DepartmentofHealth,London. 9 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
138
9.6 Community pharmacist

Costsandunitestimation A.Wages/salary B.Salaryoncosts C.Qualifications Preregistrationtraining 2010/2011value 38,000peryear 9,452peryear 7,671peryear 9,063peryear 19,740peryear 4,025peryear Notes TakenfromtheCostofServiceInquiryReport(COSI)1andconfirmed withthePharmaceuticalServicesNegotiatingCommittee(PSNC).2 Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. Qualificationcostshavebeencalculatedusingthemethoddescribedin Nettenetal.(1998).3Currentcostinformationhasbeenprovidedbythe DepartmentofHealthandtheHigherEducationFundingCouncilfor England(HEFCE).4Seetheprefaceformoreinformationonqualifications andalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.5Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirect caresalarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.They includecoststotheproviderforoffice,travel/transportandtelephone, educationandtraining,suppliesandservices(clinicalandgeneral),as wellasutilitiessuchaswater,gasandelectricity. Basedonthenewbuildandlandrequirementsofapharmacy,plus additionalspaceforsharedfacilities.6,7Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Current guidelineforreimbursement:54pencepermileupto3,500miles,18 penceover3,500miles.8 Includes29daysannualleaveand8daysstatutoryleave.9Assumes5 study/trainingdaysand11.6dayssicknessleave.10Unitcostsbasedon 1650hoursperannum. Ratiosareestimatedonthebasisthat40percentoftimeisspenton directclinicalactivities(includesadvicetopatientsandtravel),40per centoftimeondispensaryserviceactivitiesand20percentoftimeon nonclinicalactivities.11 AllowsforthehighercostsassociatedwithworkinginLondon.6,7,12
D.Overheads Management, administrationandestates staff Nonstaff E.Capitaloverheads
F.Travel
Workingtime
Ratioofdirecttoindirect timeon: directclinicalactivities patientrelatedactivities Londonmultiplier
41.3weeksper annum 40hoursperweek 1:1.50 1:0.25
1.19x(AtoB) 1.31xE NonLondonmultiplier 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon.6,7,12 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 48(53)perhour;120(133)perhourofdirectclinicalactivities;60(66)perhourofpatientrelatedactivities.
PricewaterhouseCoopersLLP(2011)CostofServiceInquiryforCommunityPharmacy,DepartmentofHealth&PharmaceuticalServicesNegotiating Committee,London.www.dh.gov.uk/en/Healthcare/Primarycare/Communitypharmacy/Communitypharmacycontractualframework/DH_128128 PersonalcommunicationwiththePharmaceuticalServicesNegotiatingCommittee(2011). 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 9 NHSEmployers(2005)AgendaforChange:NHSTermsandConditionsofServiceHandbook,NHSEmployers,London. 10 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 11 PersonalcommunicationwiththeGreaterManchesterWorkforceDevelopmentCorporation(2003). 12 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
2
139
10. Nurses and doctors

10.1Communitynurse(includesdistrictnursingsister,districtnurse) 10.2Nurse(mentalhealth) 10.3Healthvisitor 10.4Nursespecialist(community) 10.5Clinicalsupportworkernursing(community) 10.6Nurse(GPpractice) 10.7Nurseadvanced(includesleadspecialist,clinicalnursespecialist,seniorspecialist) 10.8aGeneralpractitionercostelements 10.8bGeneralpractitionerunitcosts 10.8cGeneralpractitionercommentary
141
10.1 Community nurse (includes district nursing sister, district nurse)

UsingdatafromtheNHSReferenceCosts, themeanaveragecostforafacetofacecontactindistrictnursingservicesfor2010/2011was40,withthe minimumrangefor25percentofservicesbeing33andthemaximum44.CostshavebeenupratedusingtheHCHSPay&Pricesinflator.
1
Costsandunit estimation
A.Wages/salary
2010/2011value
32,600peryear
Notes
BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand6 oftheJanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses. Medianfulltimeequivalenttotalearningswhichincludebasicsalaryplushours relatedpay,overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiodswere34,300.2See sectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenet al.(1998).3CurrentcostinformationhasbeenprovidedbytheDepartmentof HealthandtheHigherEducationFundingCouncilforEngland(HEFCE).4Seethe prefaceformoreinformationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.5Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary costsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gas andelectricity. Basedonthenewbuildandlandrequirementsofcommunityhealthfacilities,but adjustedtoreflectshareduseofbothtreatmentandnontreatmentspace.6,7 Capitalcostshavebeenannuitisedover60yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Currentguideline forreimbursement:54pencepermileupto3,500miles,18penceover3,500 miles.8 Includes29daysannualleaveand8daysstatutoryleave.9Assumes5study/ trainingdaysand11.6dayssicknessleave.10Unitcostsbasedon1549hoursper annum. Astudyreportedthatadistrictnursevisits(includingtravel)accountedfor69per centoftotaltimewith83percentoftimespentonpatientrelatedtasksand17 percentonnonpatientrelatedtasks.11BasedontheMcKinseyreport,12the mediannumberofvisitsperdaycarriedoutbydistrictnurseswas5.6in2008.No informationisavailableonthedurationofavisit. AllowsforthehighercostsassociatedwithworkinginLondon.6,7,13
D.Overheads Management, administrationand estatesstaff Nonstaff
E.Capitaloverheads
2,256peryear
F.Travel
Workingtime
41.3weeksperannum 37.5hoursperweek 1:0.45 1:0.20
Ratioofdirecttoindirect timeon: homevisits patientrelatedwork Londonmultiplier
1.19x(AtoB) 1.40xE NonLondonmultiplier 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon.6,7,13 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 44(50)perhour;64(73)perhourofhomevisiting (includingtravel); 53(60)perhourofpatientrelatedwork
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 9 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 10 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 11 CountyDurhamandTeesValley(2005)Workload,CapacityandSkillMixinSedgefieldLocalityTeams,FinalReport,SedgefieldIntegratedTeams. www.dhcarenetworks.org.uk/_library/Resources/ICN/Workload,%20Capacity%20and%20Skill%20Mix%20Sedgefield%20integrated%20teams_Final%20R eport.pdf. 12 TheDepartmentofHealth(2010)AchievingworldclassproductivityintheNHS,2009/102013/14:theMcKinseyreport,DepartmentofHealth,London. www.dh.gov.uk/en/FreedomOfInformation/Freedomofinformationpublicationschemefeedback/FOIreleases/DH_116520. 13 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
142
10.2 Nurse (mental health)

Costsandunit estimation A.Wages/salary 2010/2011value 25,500peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand5ofthe JanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses.Medianfulltime equivalenttotalearnings,whichincludebasicsalaryplushoursrelatedpay,overtime, occupationpayments,locationpayments,andotherpaymentssuchasredundancypayor paymentofnoticeperiods,were29,100.1SeesectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. 2 (1998). CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandthe HigherEducationFundingCouncilforEngland(HEFCE).3Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycosts andincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. Basedonthenewbuildandlandrequirementsofcommunityhealthfacilities,butadjusted 5,6 toreflectshareduseofbothtreatmentandnontreatmentspace. Capitalcostshave beenannuitisedover60yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Currentguidelinefor reimbursement:54pencepermileupto3,500miles,18penceover3,500miles.7 Includes29daysannualleaveand8daysstatutoryleave.8Assumes5study/trainingdays and11.6dayssicknessleave.9Unitcostsbasedon1549hoursperannum.
E.Capital overheads F.Travel Workingtime
2,256peryear
41.3weeksper annum 37.5hoursper week 1:0.89 1:0.33 1.19x(AtoB) 1.40xE 0.97x(AtoB)
Ratioofdirectto indirecttimeon: facetoface contacts patientrelated work Londonmultiplier
BasedontheNationalChildandAdolescentMentalHealthServiceMappingdataand returnsfromover500gradeGnurses,45percentoftimewasspentondirectclinicalwork, 13percentonconsultationandliaison,8percentontrainingandeducation,4percenton researchandevaluation,23percentonadminandmanagement,7percentonotherwork. Seventeenpercentwasspentontier1workandthiswasassumedtobespreadacrossall typesofactivityforthepurposeoftheanalysis.10 AllowsforthehighercostsassociatedwithworkinginLondon.5,6,11
NonLondon AllowsforthelowercostsassociatedwithworkingoutsideLondon.5,6,11 multiplier Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 34(40)perhour;65(76)perhouroffacetofacecontact;46(54)perhourofpatientrelatedwork.
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 10 DepartmentofHealth(2002)NationalChildandAdolescentMentalHealthServiceMappingData,DepartmentofHealth,London. 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
143
10.3 Health visitor

UsingdatafromtheNHSReferenceCosts, themeanaveragecostforafacetofacecontactinhealthvisitingservicesfor2010/2011was43,withthe minimumrangefor25percentofservicesbeing31andthemaximum49.CostshavebeenupratedusingtheHCHSPay&Pricesinflator. Notes Costsandunitestimation 2010/2011value A.Wages/salary 32,600peryear BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand6ofthe JanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses.Medianfulltime equivalenttotalearningswhichincludebasicsalaryplushoursrelatedpay,overtime, occupationpayments,locationpayments,andotherpaymentssuchasredundancypayor 2 paymentofnoticeperiodswere34,300. SeesectionVforinformationonmeansalaries. B.Salaryoncosts 8,005peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployerscontribution tosuperannuation. 3 C.Qualifications 9,356peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998). CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandtheHigher 4 EducationFundingCouncilforEngland(HEFCE). Seetheprefaceformoreinformationon qualificationsandalsoschema7.4fordetails. 5 D.Overheads TakenfromNHS(England)SummarisedAccounts. Seeprefaceformoreinformation. Management, Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycostsand 7,756peryear administrationandestates includedadministrationandestatesstaff. staff Nonstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe 16,892peryear providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. E.Capitaloverheads 2,256peryear Basedonthenewbuildandlandrequirementsofcommunityhealthfacilities,butadjustedto 6,7 reflectshareduseofbothtreatmentandnontreatmentspace. Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. F.Travel Noinformationavailableonaveragemileagecoveredpervisit.Currentguidelinefor 8 reimbursement:54pencepermileupto3,500miles,18penceover3,500miles. 9 Workingtime 41.3weeksperannum Includes29daysannualleaveand8daysstatutoryleave. Assumes5study/trainingdaysand 10 37.5hoursperweek 11.6dayssicknessleave. Unitcostsbasedon1549hoursperannum. Ratioofdirecttoindirect Notimeuseinformationiscurrentlyavailableforhealthvisitors.However,assumingthata timeon: healthvisitorcarriesoutthesamenumberofhomevisitsasadistrictnurse,astudyreported thatadistrictnursevisits(includingtravel)accountedfor69percentoftotaltimewith83per 11 Homevisits centoftimespentonpatientrelatedtasksand17percentonnonpatientrelatedtasks. 1:0.45 12 BasedontheMcKinseyreport, themediannumberofvisitsperdaycarriedoutbydistrict Patientrelatedwork 1:0.20 nurseswas5.6in2008.Noinformationisavailableonthedurationofavisit. 6,7,13 Londonmultiplier 1.20x(AtoB) AllowsforthehighercostsassociatedwithworkinginLondon. 1.41xE 6,7,13 NonLondonmultiplier 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets)
1
44(50)perhour;64(73)perhourofhomevisiting;53(60)perhourofpatientrelatedwork.
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2011)MileagePaymentsReview,NHSEmployers,Leeds. www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 9 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 10 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 11 CountyDurhamandTeesValley(2005)Workload,CapacityandSkillMixinSedgefieldLocalityTeams,FinalReport,SedgefieldIntegratedTeams. www.dhcarenetworks.org.uk/_library/Resources/ICN/Workload,%20Capacity%20and%20Skill%20Mix%20Sedgefield%20integrated%20teams_Final%20R eport.pdf. 12 TheDepartmentofHealth(2010)AchievingworldclassproductivityintheNHS,2009/102013/14:theMcKinseyreport,DepartmentofHealth,London. www.dh.gov.uk/en/FreedomOfInformation/Freedomofinformationpublicationschemefeedback/FOIreleases/DH_116520. 13 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
144
10.4 Nurse specialist (community)

Costsandunit estimation A.Wages/salary 2010/2011value 32,600peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand6 oftheJanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses. Medianfulltimeequivalenttotalearningswhichincludebasicsalaryplushours relatedpay,overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiodswere34,300.1See sectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).2CurrentcostinformationhasbeenprovidedbytheDepartmentofHealth andtheHigherEducationFundingCouncilforEngland(HEFCE).3Seetheprefacefor moreinformationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary costsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasand electricity. Basedonthenewbuildandlandrequirementsofcommunityhealthfacilities,but adjustedtoreflectshareduseofbothtreatmentandnontreatmentspace.5,6Capital costshavebeenannuitisedover60yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Currentguidelinefor 7 reimbursement:54pencepermileupto3,500miles,18penceover3,500miles. 8 Includes29daysannualleaveand8daysstatutoryleave. Assumes5study/training 9 daysand11.6dayssicknessleave. Unitcostsbasedon1549hoursperannum.
E.Capitaloverheads
2,256peryear
F.Travel Workingtime
41.3weeksper annum 37.5hoursperweek Ratioofdirectto Nocurrentinformationavailable.Seepreviouseditionsofthisvolumeforsourcesof indirecttime information. Durationofcontact Nocurrentinformationavailable. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithworkinginLondon.5,6,10 1.40xE NonLondonmultiplier 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon.5,6,10 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 44(50)perhour.
1 2
TheInformationCentre(2011)NHSStaffEarningsJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
145
10.5 Clinical support worker nursing (community)

Costsandunitestimation A.Wages/salary 2010/2011value 15,600peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChange Band2oftheJanuaryMarch2011NHSStaffEarningsestimatesforunqualified Nurses.Medianfulltimeequivalenttotalearningswhichincludebasicsalary plushoursrelatedpay,overtime,occupationpayments,locationpayments, andotherpaymentssuchasredundancypayorpaymentofnoticeperiods were18,500.1SeesectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. TakenfromNHS(England)SummarisedAccounts.2Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirectcare salarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyinclude coststotheproviderforoffice,travel/transportandtelephone,educationand training,suppliesandservices(clinicalandgeneral),aswellasutilitiessuchas water,gasandelectricity. Basedonthenewbuildandlandrequirementsofcommunityhealthfacilities, butadjustedtoreflectshareduseofbothtreatmentandnontreatment space.3,4Itisassumedthatanauxiliarynurseusesonesixthofthetreatment spaceusedbyadistrictnurse.Capitalcostshavebeenannuitisedover60years atadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Current guidelineforreimbursement:54pencepermileupto3,500miles,18pence 5 over3,500miles. Includes29daysannualleaveand8daysstatutoryleave.6Assumes11.6days sicknessleave.7Unitcostsbasedon1586hoursperannum. Notimeuseinformationiscurrentlyavailableforclinicalsupportworkers. Assumingthataclinicalsupportworkercarriesoutthesamenumberofhome visitsasadistrictnurse,astudyreportedthatadistrictnursevisits(including travel)accountedfor69percentoftotaltimewith83percentoftimespent onpatientrelatedtasksand17percentonnonpatientrelatedtasks.8Based 9 ontheMcKinseyreport, themediannumberofvisitsperdaycarriedoutby districtnurseswas5.6in2008.Noinformationisavailableonthedurationofa visit. AllowsforthehighercostsassociatedwithworkinginLondon.3,4,10
B.Salaryoncosts D.Overheads Management, administrationandestates staff Nonstaff
E.Capitaloverheads
915peryear
F.Travel
Workingtime Ratioofdirecttoindirect timeon: Homevisits Patientrelatedwork
Londonmultiplier
NonLondonmultiplier AllowsforthelowercostsassociatedwithworkingoutsideLondon.3,4,10 Unitcostsavailable2010/2011 20perhour;29perhourofhomevisiting;24perhourofpatientrelatedwork.
1.19x(AtoB), 1.41xE 0.97x(AtoB)
1 2 3
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 5 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 6 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 7 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 8 CountyDurhamandTeesValley(2005)Workload,CapacityandSkillMixinSedgefieldLocalityTeams,FinalReport,SedgefieldIntegratedTeams. www.dhcarenetworks.org.uk/_library/Resources/ICN/Workload,%20Capacity%20and%20Skill%20Mix%20Sedgefield%20integrated%20teams_Final%20R eport.pdf. 9 TheDepartmentofHealth(2010)AchievingworldclassproductivityintheNHS,2009/102013/14:theMcKinseyreport,DepartmentofHealth,London. www.dh.gov.uk/en/FreedomOfInformation/Freedomofinformationpublicationschemefeedback/FOIreleases/DH_116520. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
146
10.6 Nurse (GP practice)

Costsandunitestimation A.Wages/salary 2010/2011value 25,500peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChange Band5oftheJanuaryMarch2011NHSStaffEarningsestimatesforQualified Nurses.Medianfulltimeequivalenttotalearningswhichincludebasicsalary plushoursrelatedpay,overtime,occupationpayments,locationpayments,and otherpaymentssuchasredundancypayorpaymentofnoticeperiodswere 29,100.1SeesectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNetten 2 etal.(1998). CurrentcostinformationhasbeenprovidedbytheDepartmentof HealthandtheHigherEducationFundingCouncilforEngland(HEFCE).3Seethe prefaceformoreinformationonqualificationsandalsoschema7.4fordetails. CalculatedastheratioofGPexpensesonemployeestoofficeandgeneral business,premises&otherexpenses.(Seetable17ofGPEarnings&Expenses 2009/2010).4 CalculatedastheratioofGPpracticenursesalarycoststonetremunerationof GPsalaryandbasedonnewbuildandlandrequirementsforaGPpractitioners suiteandannuitisedover60yearsatadiscountrateof3.5percent.5,6
Noinformationavailableonaveragemileagecoveredpervisit.Currentguideline forreimbursement:54pencepermileupto3,500miles,18penceover3,500 miles.7 Workingtime 41.3weeksperannum Includes29daysannualleaveand8daysstatutoryleave.8Assumes5 9 37.5hoursperweek study/trainingdaysand11.6dayssicknessleave. Unitcostsbasedon1549 hoursperannum. Ratioofdirecttoindirect Basedonproportionoftimespentonsurgeryconsultations(67.9%),phone timeon: consultations(5.2%),clinics(2.5%)andhomeandcarehomevisits(1.2%). facetofacecontacts 1:0.30 Patientdirecttoindirectcontactratiosallocateallnoncontacttimetoall contacttime.Takenfromthe2006/07UKGeneralPracticeWorkloadSurvey.10 Durationofcontact 15.5minutes Persurgeryconsultation.Basedonthe2006/07UKGeneralPracticeSurvey.10 Patientcontacts 60perweek Averagenumberofconsultationsperweek.10 Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondoncomparedtothenational 5,6,11 1.50xE averagecost. NonLondonmultiplier 0.97xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedto thenationalaveragecost.5,6,11 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 33(39)perhour;43(51)perhouroffacetofacecontact.
D.Overheads Office&GeneralBusiness Premises Other E.Capitaloverheads Buildings F.Travel
4,701peryear 6,321peryear 5,209peryear 3,693peryear
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheInformationCentre(2011)GPEarningsandExpenses2009/2010,TheInformationCentre,Leeds. www.ic.nhs.uk/webfiles/publications/007_Primary_Care/General_Practice/investmentgp0611/Investment_in_General_Practice_2010_11_v2.0.pdf. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 10 TheInformationCentre(2007)2006/07UKGeneralPracticeWorkloadSurvey,PrimaryCareStatistics,TheInformationCentre,Leeds. 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
2 1
147
10.7 Nurse advanced (includes lead specialist, clinical nurse specialist, senior specialist)1
Costsandunitestimation A.Wages/salary Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand7ofthe JanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses.Medianfulltime equivalenttotalearningswhichincludebasicsalaryplushoursrelatedpay,overtime, occupationpayments,locationpayments,andotherpaymentssuchasredundancypayor 2 paymentofnoticeperiodswere40,200. SeesectionVforinformationonmeansalaries. B.Salaryoncosts 9,667peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. 3 C.Qualifications 9,356peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998). CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandtheHigher 4 EducationFundingCouncilforEngland(HEFCE). Seetheprefaceformoreinformationon qualificationsandalsoschema7.4fordetails. 5 D.Overheads TakenfromNHS(England)SummarisedAccounts. Seeprefaceformoreinformation. Management,administration 9,257peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycostsand andestatesstaff includedadministrationandestatesstaff. Nonstaff 20,162peryear Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. E.Capitaloverheads 3,468peryear Basedonthenewbuildandlandrequirementsofcommunityhealthfacilities,butadjustedto 6,7 reflectshareduseoftreatmentandnontreatmentspace. Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. 8 Workingtime 41.3weeksperannum Includes29daysannualleaveand8daysstatutoryleave. Assumes5study/trainingdaysand 9 37.5hoursperweek 11.6dayssicknessleave. Unitcostsbasedon1549hoursperannum. Lengthofconsultation: Informationprovidedby27nursepractitionersworkinginprimarycarecontactedabout surgery 15minutes durationofconsultations.Venningetal.(2000)foundthatnursepractitionersspentamean home 25minutes of11.57minutesfacetofacewithpatients(SD5.79mins)andanadditional1.33minutesper 10 telephone 6minutes patientingettingprescriptionssigned. 11 Ratioofdirecttoindirect Informationprovidedby27nursepractitionersontimeuse. Surgeryconsultations58per timeon: cent,homevisits0.4percentandtelephoneconsultations6.4percent.Gettingprescriptions facetofacecontacts signed1.4percent.Traveltimetohomevisitswasnegligible(0.1%).Anotherstudyfound 1:0.71 patientcontact(incl. that60percentofanursepractitioner/clinicalnursespecialiststimewasspentonclinical 1:0.55 12 telephone) activities. Anotherstudyontheroleofnursespecialistsinepilepsyfoundthatclinical 13 activitiesaccountedfor40percentofthetime. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaverage 6,7,14 1.50xE cost. NonLondonmultiplier 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothenational 6,7,14 averagecost. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 53(59)perhour;91(101)perhourinsurgery;82(91) perhourofclientcontactcost;23(25)persurgeryconsultation. 2010/2011value 38,800peryear
AtermfornursepractitionersspecificallyhasnotbeendevelopedduetothegreatvariationintheuseofthetermNP.Personalcorrespondencewiththe RCNNPAdviserhassuggestedthatthebestmatchistheAdvanceNurseprofile(Band7). 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 10 Venning,P.,Durie,A.,Roland,M.,Roberts,C.&Leese,B.(2000)Randomisedcontrolledtrialcomparingcosteffectivenessofgeneralpractitionersand nursepractitionersinprimarycare,BritishMedicalJournal,320,10481053. 11 Curtis,L.A.andNetten,A.P.(2007)Thecostsoftraininganursepractitionerinprimarycare:theimportanceofallowingforthecostofeducationand trainingwhenmakingdecisionsaboutchangingtheprofessional.JournalofNursingManagement,15(4).pp.449457.ISSN09660429. 12 Ball,J.(2005)MaxiNurses.AdvancedandSpecialistNursingRoles,ResultsfromaSurveyofRCNMembersinAdvancedandSpecialistNursingRoles, RoyalCollegeofNursing,London. 13 Higgins,S.,Lanfear,J.&Goodwin,M.(2006)Qualifyingtheroleofnursespecialistsinepilepsy:datafromdiariesandinterviews,BritishJournalof NeuroscienceNursing,2,5,239245. 14 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
148
10.8a General practitioner cost elements

Costsandunit estimation A.Netremuneration 2010/2011value 109,400peryear Notes(forfurtherclarificationseeCommentary) Averagenetprofitafterexpensesin2009/10forEngland.1Seecommentary10.8c. Ithasnotbeenpossibletoagreeaninflatortoprovideestimatednetremuneration for2010/11. Amountallocatedforoutofhourscare.2 Onaveragein2010eachFTEequivalentpractitioner(excludingGPregistrars&GP 3 retainers)employed0.55FTEpracticestaff(directpatientcareonly). EstimatedusingthecarallowanceforGPregistrarsandisunchangedsincelast year.4ThisisbasedonAAinformationaboutthefullcostofowningandrunninga carandallowsfor10,000miles.Averagecostpervisitis5.Travelcostsare includedintheannualandweeklycostbutexcludedfromcostsperminuteandjust addedtocostofahomevisit. Otherpracticeexpensesareestimatedonthebasisoffinalexpenditurefiguresfrom 2 theDHfor2010/11. Practiceexpensesexcludeallexpenditureondrugs.See commentary10.8c. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).5CurrentcostinformationhasbeenprovidedbytheDepartmentofHealth andtheHigherEducationFundingCouncilforEngland(HEFCE).Seetheprefacefor moreinformationonqualificationsandalsoschema7.4fordetails. Thiscostcomprisesanamountforthegenericcurriculum,thepostgraduate centresinfrastructure,andstudyleave.Includedalsoarethecostsofthecourse organisers,administrativesupport,trainersworkshops,vocationaltrainingand internalcoursesforGPtutors.Excludedarethecostsofrunningthelibraryand postgraduatecentres.6 BasedonnewbuildandlandrequirementsforaGPpractitionersuite.Capitalcosts havebeenannuitisedover60yearsatadiscountrateof3.5percent.7,8Takenfrom 2 finalexpenditurefiguresfromtheDH andadjustedtoallowforequipment allocatedtodirectcarestaff.Expenditureoncomputerequipmentisusedasa proxyforannuitisedcapital.Seecommentary10.8c. BasedonfinalexpenditurefiguresfromtheDHfor2010/11.2Overheadsinclude PrimaryCareOrganisation(PCO)administeredfunds,demandmanagementand recruitmentandretention.Seecommentary10.8c. Derivedfromthe2006/07UKGeneralPracticeWorkloadSurvey.9Numberofhours forafulltimeGPPartner.Allowsfortimespentperyearonannualleave,sickleave andstudyleave.Unitcostsbasedon1931hoursperannum. Basedonproportionoftimespentonsurgeryconsultations(44.5%),phone consultations(6.3%),clinics(6.3%)andhomeandcarehomevisitsincludingtravel time(8.6%).Patientdirecttoindirectcontactratiosallocateallnoncontacttimeto allcontacttime.Surgeryandhomevisitmultipliersallocatetraveltimetohome visits.Takenfromthe2006/07UKGeneralPracticeWorkloadSurvey. Basedonthe2006/07UKGeneralPracticeWorkloadSurvey,thetimespentona homevisitjustincludestimespentinthepatientshome.Onaverage12minutes hasbeenassumedfortravellingpervisit.Thistraveltimehasbeenallowedforin theestimationoftheratioofdirecttoindirecttimespentonhomevisits.See commentary10.8c.
B.Practiceexpenses: outofhours directcarestaff travel other
C.Qualifications
40,521peryear
D.Ongoingtraining
2,382peryear
E.Capitalcosts: premises equipment
12,784peryear 922peryear
F.Overheads
6,214peryear
Workingtime
43.5weeksper annum 44.4hoursperweek Ratioofdirecttoindirect time: surgery/clinic/phone 1:0.57 consultations homevisits 1:1.61 Consultations: surgery 11.7minutes clinic 17.2minutes telephone 7.1minutes homevisit 11.4minutes Unitcostsfor2010/2011aregiveninschema10.8b
TheInformationCentre(2011)GPEarningsandExpenses2009/2010,TheInformationCentre,Leeds. www.ic.nhs.uk/webfiles/publications/007_Primary_Care/General_Practice/investmentgp0611/Investment_in_General_Practice_2010_11_v2.0.pdf. 2 TheInformationCentre(2011)InvestmentinGeneralPractice2006/07to2010/11England,Wales,NorthernIrelandandScotland,Summarytablefor England,TheInformationCentre,Leeds. 3 TheInformationCentre(2011)GeneralPracticeStaff2010,TheInformationCentre,Leeds. 4 InformationprovidedbyDepartmentofHealth,2010. 5 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 6 PersonalcommunicationwiththeLondonDeanery,2006. 7 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 8 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 9 TheInformationCentre(2007)2006/07UKGeneralPracticeWorkloadSurvey,PrimaryCareStatistics,TheInformationCentre,Leeds.
149
10.8b General practitioner unit costs

Unitcost2010/2011 Includingdirect carestaffcosts Withqualification Without costs qualification costs 233,531 193,000 121 100 186 153 3.10 2.50 5.20 4.30 36 30 53 22 121 44 18 99 42.703 413 Excludingdirectcarestaffcosts With qualification Without costs qualificationcosts 201,236 104 160 2.70 4.40 31 46 19 104 160,715 83 127 2.10 3.50 25 36 15 82
Annual(includingtravel) PerhourofGMSactivity1 Perhourofpatientcontact1 Persurgery/clinicminute1 Perhomevisitminute1 Persurgeryconsultationlasting 11.7minutes1 Perclinicconsultationlasting17.2 minutes1 Pertelephoneconsultationlasting 7.1minutes1 Perhomevisitlasting23.4minutes (includestraveltime)2 Prescriptioncostsperconsultation (netingredientcost) Prescriptioncostsperconsultation (actualcost)
NB.Lastyear,somepracticenurseactivitywasincludedinotherpracticeexpenses.Thisyear,thisactivityhasbeenmovedtothecosts whichincludedirectcarestaff.
1 2
Inordertoprovideconsistentunitcosts,thesecostsexcludetravelcosts. Allowsfor12minutetraveltime.Previousestimatesincludedprescriptioncosts.Thesehavenowbeenexcludedtoprovideconsistencywithother consultationcosts. 3 PersonalcommunicationwiththeInformationCentre,2011.
150
10.8c General practitioner commentary

GeneralnoteaboutGPexpenditure.TheGeneralMedicalServicecontract(GMS)1introducedin2003,wasdesignedto improvethewaythatPrimaryCareservicesarefunded,andtoallowpracticesgreaterflexibilitytodeterminetherangeof servicestheywishtoprovide,includingoptingoutofadditionalservicesandoutofhourscare. Allowingforwholetimeequivalence(wte).TheNHSInformationCentrehasestimatedthatthenumberofFTE practitioners(excludingGPregistrarsandGPretainers)hasincreasedfrom32,111in2009to35,120in2010.2 AllowingforexpenditurenotassociatedwithGPactivity.Wehaveexcludedexpenditurerelatedtodispensingand medication. Directcarestaff.1Onaveragein2010,eachFTEequivalentpractitioner(excludingGPregistrars&GPretainers)employed 0.55FTEpracticestaff.Alldirectcarestaffhavebeencostedatthesamelevelasaband5GPpracticenurse(seeschema 10.5). Otherpracticeexpenses.ThesearebasedonpaymentsmadeforenhancingservicessuchasthePrimaryCare ModernisationFundandChildhoodImmunisation.ItalsoincludesotherpaymentsforimprovedqualitysuchasChronic DiseaseManagementAllowancesandSustainedQualityAllowances. Prescriptioncosts.Averageprescriptioncostsperconsultationare42.70(NetIngredientCost:NIC).NICisthebasiccost ofthedrug,whileActualCostistheNIClesstheassumedaveragediscountplusthecontainerallowance(andplusoncost forappliancecontractors).ThesearebasedoninformationaboutannualnumbersofconsultationsperGP,estimatedby usingthenumberofGPsfor2010andtheannualnumberofconsultationsperGP(5,956in2007/08),3,4numberof prescriptionsperGP(25,658in2010)5andtheaverageactualtotalcostperGPprescriptionhasremainedat8.66at2010 pricesor9.37perNIC.6Thenumberofprescriptionsperconsultation(4.78)hashardlychangedsince2008/09andthe increaseisalmostcertainlyduetothefactthatithasnotbeenpossibletoupdateinformationonconsultationssince 2007/08. Qualifications.Theequivalentannualcostofpreregistrationandpostgraduatemedicaleducation.Theinvestmentin traininghasbeenannuitisedovertheexpectedworkinglifeofthedoctor.7Postgraduateeducationcostscalculatedusing informationprovidedbytheDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE).8This includesthecostofthetwoyearfoundationprogramme,twoyearsonaGeneralPracticeVocationalTrainingScheme(GP VTS)andafurtheryearasageneralpracticeregistrar.9 Computerequipment.Ideally,thisshouldincludeanannuitisedfigurereflectingthelevelofcomputerequipmentinGP surgeries.However,thefigurepresentedintheschemarepresentstheyearlyamountallocatedtoITexpenditureduring 2009/10.ThishasbeentakenfromthefinalexpenditurefiguresfromtheDepartmentofHealth.PCOsratherthanpractices nowfundthepurchase,maintenance,upgrading,runningandtrainingcostsofcomputersystems. Overheads.Thisincludesexpenditureoncentrallymanagedadministrationsuchasrecruitmentandretention,demand managementandexpenditurerelatingtoGPallowancessuchaslocumallowancesandretainerschemepayments. Activity.The2006/07UKGeneralPracticeWorkloadSurveyprovidesanoverviewoftheentireworkloadandskillmixof generalpracticesintheUKin2006/07.Staffinarepresentativesampleof329practicesacrosstheUKcompleteddiary sheetsforoneweekinSeptemberorDecember.Asthesurveywastargetedatworkinthepractice,itexcludesworkdone elsewhere,aswellasanyworkidentifiedasoutofhours(OOH)notrelatingtotheGMS/PMS/PCTMSpracticecontract.In ordertoconverttheannualhoursworkedintoweeks,theaveragenumberofhoursworkedonGMSdutieswasused.On thisbasiswteGMPswork43.5weeksayearfor44.4hoursperweek.
NHSEmployers(2003)GeneralMedicalServicesContract,NHSEmployers,London. www.nhsemployers.org/PayAndContracts/GeneralMedicalServicesContract/Pages/Contract.aspx. 2 TheInformationCentre(2011)GeneralPracticeStaff2010,TheInformationCentre,Leeds. 3 HippisleyCox,J.,Fenty,J.&Heaps,M.(2007)TrendsinConsultationRatesinGeneralPractice1995to2006:AnalysisoftheQResearchDatabase.Final ReporttotheInformationCentreandDepartmentofHealth,TheInformationCentre,Leeds. 4 NofurtherworkonthenumberofGPconsultationssince2007/08. 5 PersonalcorrespondencewiththeInformationCentre,2009. 6 PersonalcorrespondencewithPrescribingSupportandPrimaryCareServices,2010,HealthandSocialCareInformationCentre(HSCIC). 7 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 8 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 9 NHSEmployers(2006)ModernisingMedicalCareers:ANewErainMedicalTraining,NHSEmployers,London.
151
III. COMMUNITYBASED SOCIAL CARE
153
11. Social care staff

11.1Socialworkteamleader/seniorpractitioner/seniorsocialworker 11.2Socialworker(adult) 11.3Socialworker(children) 11.4Socialworkassistant 11.5Approvedsocialworker 11.6Homecareworker 11.7Communityoccupationaltherapist(localauthority) 11.8Homecaremanager 11.9Familysupportworker
154
155
11.1 Social work team leader/senior practitioner/senior social worker

Costsandunit estimation A.Salary 2010/2011value 38,328peryear Notes Theaveragesalaryforasocialworkteamleaderwas35,410for2007/08.1Asnonewsalary estimatesareavailable,thishasbeeninflatedtoreflectthepayincrementsforsocialworkers reportedintheLocalGovernmentEarningsSurveys2009,220103and2011.4 B.Salaryoncosts 11,074peryear Employersnationalinsuranceisincludedplus18 percentofsalaryforcontributionto superannuation.5 C.Qualifications 21,378peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998).6 CurrentcostinformationisdrawnfromresearchcarriedoutbyCurtisetal.(2011).7 D.Ongoingtraining TheGeneralSocialCareCouncil setsoutarequirementthatallsocialworkers,asaconditionof theirthreeyearlyrenewalofregistration,shouldengageindevelopmentactivitytomeetapost registrationteachingandlearningrequirementof15daysor90hours.8Nocostsareavailable. E.Overheads Directoverheads 14,327peryear Directoverheadswere29percentofdirectcaresalarycosts.Theyincludecoststotheprovider foradministrationandmanagement,aswellasforoffice,trainingandutilitiessuchaswater,gas andelectricity. Indirectoverheads 7,904peryear Indirectoverheadswere16percentofdirectcaresalarycosts.Theyincludegeneral managementandsupportservicessuchasfinanceandhumanresourcedepartments.9 F.Capitaloverheads 1,943peryear Basedonthenewbuildandlandrequirementsforalocalauthorityofficeandsharedfacilitiesfor waiting,interviewsandclericalsupport.10,11Capitalcostshavebeenannuitisedover60yearsata discountrateof3.5percent. G.Travel Noinformationavailableonaveragemileagecoveredpervisit.SeeNationalAssociationfor VoluntaryandCommunityActionwebsiteformileageallowance.12 Workingtime 40.8weeksper Includes29daysannualleaveand8statutoryleavedays.13Tendaysforstudy/trainingand9.2 annum37.5hours dayssicknessleavehavebeenassumedbasedonaverageofallsocialworksectorsfor perweek 2009/2010.14Unitcostsarebasedon1529hoursperannum. Ratiosofdirectto Ratiosareestimatedonthebasisthatforseniorpractitionersandseniorsocialworkers, 72per indirecttimeon: centoftimeisspentonclientrelatedactivitiesincludingdirectcontact(29%),caserelated recording(19%),caserelatedworkinownagency(12%)andcaserelatedinteragencywork clientrelatedwork 1:0.39 facetofacecontact 1:2.45 (12%).Amanagerinadultservicesandchildrensservicesspends70percentand49percentof timeonclientrelatedwork,respectively.15 Domiciliaryv. Itisnotpossibletoestimateacostpervisitasthereisnoinformationavailableonthenumberor office/clinicvisit durationofvisits. Londonmultiplier 1.16xA1.49xE AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaveragecost.1,10,11 NonLondon 0.96xA0.96xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothenational multiplier averagecost.1,10,11 Unitcostsavailable2010/2011(costswithqualificationsgiveninbrackets) 48(62)perhour;67(87)perhourofclientrelatedwork(includesAtoE);166 (214)perFacetofacecontact(IncludesAtoE).
1 2
LocalGovernmentAssociationAnalysisandResearch(2008)LocalGovernmentEarningsSurvey2007,LocalGovernmentAnalysisandResearch,London. LocalGovernmentAssociationAnalysisandResearch(2009)LocalGovernmentEarningsSurvey2008,LocalGovernmentAssociation,London. 3 LocalGovernmentAssociationAnalysisandResearch(2010)LocalGovernmentEarningsSurvey2009,LocalGovernmentAssociation,London. 4 LocalGovernmentAssociationAnalysisandResearch(2011)LocalGovernmentEarningsSurvey2010,LocalGovernmentAssociation,London. 5 Thurley,D.(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. 6 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 7 Curtis,L.Moriarty,J.&Netten,A.(2011)Thecostsofqualifyingasocialworker,BritishJournalofSocialWork,doi: 10.1093/bjsw/bcr113. http://bjsw.oxfordjournals.org/content/early/2011/08/22/bjsw.bcr113.short?rss=1. 8 TheBritishAssociationofSocialWorkers(2011)SocialWorkCareers,TheBritishAssociationofSocialWorkers.www.basw.co.uk/socialworkcareers/ 9 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 10 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 11 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 12 NationalAsssociationforVoluntaryandCommunityAction.LocalAuthorityMileageRates2010/2011.NAVCA,2011www.navca.org.uk/localvs/scales. 13 DepartmentofHealth,SocialServicesandPublicSafety(2003)TheNewNHS/HPSSPaySystem,AnOverview,March2003,DepartmentofHealth,Social ServicesandPublicSafety,London. 14 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2009,www.lga.gov.uk/lga/core/page.do?pageId=9851777. 15 Baginsky,M.,Moriarty,J.,Manthorpe,J.,Stevens,M.,MacInnes,T.&Nagendran,T.(2010)SocialWorkersWorkloadSurvey,Messagesfromthe Frontline,Findingsfromthe2009SurveyandInterviewswithSeniorManagers,ChildrensWorkforceDevelopmentCouncil,KingsCollege,Universityof London,NewPolicyInstitute.
156
11.2 Social worker (adult services)

Costsandunitestimation A.Salary 2010/2011value 30,441peryear Notes 1 InformationtakenfromtheLocal GovernmentEarningsSurvey2011 showedthatthemean basicsalaryforasocialworkerwas30,441.Themeangrosssalarywas31,685.(The informationprovideddoesnotdistinguishbetweenthesalaryofanadultorofachildrens socialworker). Employersnationalinsuranceisincludedplus18percentofsalaryforemployers 2 contributiontosuperannuation. 3 QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998). 4 CurrentcostinformationisdrawnfromresearchcarriedoutbyCurtisetal.(2011). TheGeneralSocialCareCouncilsetsoutarequirementthatallsocialworkers,asacondition oftheirthreeyearlyrenewalofregistration,shouldengageindevelopmentactivitytomeeta 5 postregistrationteachingandlearningrequirementof15daysor90hours. Nocostsare available. Directoverheadswere29percentofdirectcaresalarycosts.Theyincludecoststothe providerforadministrationandmanagement,aswellasforoffice,trainingandutilitiessuch aswater,gasandelectricity. Indirectoverheadswere16percentofdirectcaresalarycosts.Theyincludegeneral 6 managementandsupportservicessuchasfinanceandhumanresourcedepartments. Basedonthenewbuildandlandrequirementsforalocalauthorityofficeandsharedfacilities 7,8 forwaiting,interviewsandclericalsupport. Capitalcostshavebeenannuitisedover60 yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.SeeNationalAssociationfor 9 VoluntaryandCommunityActionwebsiteformileageallowance. 10 Includes29daysannualleaveand8statutoryleavedays. Tendaysforstudy/trainingand9.2 11 dayssicknessweretakenin2009/2010. Unitcostsarebasedon1529hoursperannum.
B.Salaryoncosts C.Qualifications D.Ongoingtraining
E.Overheads Directoverheads Indirectoverheads F.Capitaloverheads
G.Travel Workingtime Ratiosofdirecttoindirect timeon: clientrelatedwork facetofacecontact
40.8 weeksperannum 37.5hoursperweek 1:0.39 1:3.00
Ratiosareestimatedonthebasisthat72percentoftimeisspentonclientrelatedactivities includingdirectcontact(25%),caserelatedrecording(23%),caserelatedworkinownagency 12 (10%)andcaserelatedinteragencywork(14%). Facetofacecontactisnotagoodindicator ofinputtoclients. Domiciliaryv.office/clinicvisit Itisnotpossibletoestimateacostpervisitasthereisnoinformationavailableonthe numberordurationofvisits. 1,8,9 Londonmultiplier 1.10xA1.49xE AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaveragecost. NonLondonmultiplier 0.96xA0.96xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothenational 1,8,9 averagecost. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 38(53)perhour;53(74)perhour ofclientrelatedwork;152 (212)perhouroffacetofacecontact(includesAtoE).
1 2 3
LocalGovernmentAssociationAnalysisandResearch(2011)LocalGovernmentEarningsSurvey2010/2011,LocalGovernmentAssociation,London. Thurley,D.(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 Curtis,L.Moriarty,J.&Netten,A.(2011)Thecostsofqualifyingasocialworker,BritishJournalofSocialWork,doi: 10.1093/bjsw/bcr113. http://bjsw.oxfordjournals.org/content/early/2011/08/22/bjsw.bcr113.short?rss=1. 5 TheBritishAssociationofSocialWorkers(2011)SocialWorkCareers,TheBritishAssociationofSocialWorkers.www.basw.co.uk/socialworkcareers/ 6 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 7 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 8 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 9 NationalAsssociationforVoluntaryandCommunityAction.LocalAuthorityMileageRates2010/2011.NAVCA,2011www.navca.org.uk/localvs/scales. 10 DepartmentofHealth,SocialServicesandPublicSafety(2003)TheNewNHS/HPSSPaySystem,AnOverview,March2003,DepartmentofHealth,Social ServicesandPublicSafety,London. 11 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2009,www.lga.gov.uk/lga/core/page.do?pageId=9851777. 12 Baginsky,M.,Moriarty,J.,Manthorpe,J.,Stevens,M.,MacInnes,T.&Nagendran,T.(2010)SocialWorkersWorkloadSurvey,Messagesfromthe Frontline,Findingsfromthe2009SurveyandInterviewswithSeniorManagers,ChildrensWorkforceDevelopmentCouncil,KingsCollege,Universityof London,NewPolicyInstitute.
157
11.3 Social worker (childrens services)

Costsandunitestimation A.Salary Notes 1 InformationtakenfromtheLocal GovernmentEarningsSurvey2011 showedthatthemean basicsalaryforasocialworkerwas30,441.Themeangrosssalarywas31,685. (Informationprovideddoesnotdistinguishbetweenthesalaryofanadultandchildrens socialworker). B.Salaryoncosts 8,644peryear Employersnationalinsuranceisincludedplus18percentofsalaryforemployers 2 contributiontosuperannuation. 3 C.Qualifications 21,378peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998). 4 CurrentcostinformationisdrawnfromresearchcarriedoutbyCurtisetal.(2011). D.Ongoingtraining TheGeneralSocialCareCouncilsetsoutarequirementthatallsocialworkers,asacondition oftheirthreeyearlyrenewalofregistration,shouldengageindevelopmentactivitytomeet 5 apostregistrationteachingandlearningrequirementof15daysor90hours. Nocostsare available. E.Overheads Directoverheadswere29percentofdirectcaresalarycosts.Theyincludecoststothe Directoverheads 11,335peryear providerforadministrationandmanagement,aswellasforoffice,trainingandutilitiessuch aswater,gasandelectricity. Indirectoverheadswere16percentofdirectcaresalarycosts.Theyincludegeneral 6 managementandsupportservicessuchasfinanceandhumanresourcedepartments. Indirectoverheads 6,254peryear F.Capitaloverheads 1,943peryear Basedonthenewbuild andlandrequirementsforalocalauthorityofficeandshared 7,8 facilitiesforwaiting,interviewsandclericalsupport. Capitalcostshavebeenannuitised over60yearsatadiscountrateof3.5percent. G.Travel Noinformation availableonaveragemileagecoveredpervisit.SeeNationalAssociationfor 9 VoluntaryandCommunityActionwebsiteformileageallowance. 10 Workingtime 41.8weeksperannum Includes29daysannualleaveand8statutoryleavedays. Tendaysforstudy/trainingand 11 37.5hoursperweek anaverageof9.2daysforsicknessweretakenin2009/2010. Unitcostsarebasedon1529 hoursperannum. Ratiosofdirecttoindirect Ratiosareestimatedonthebasisthat72percentoftimeisspentonclientrelatedactivities timeon: includingdirectcontact(26%),caserelatedrecording(23%),caserelatedworkinown 12 1:0.39 agency(12%)andcaserelatedinteragencywork(12%). Facetofacecontactisnotagood clientrelatedwork indicatorofinputtoclients.InastudycommissionedbytheDepartmentofHealth,itwas facetofacecontact 1:2.85 foundthat66percentofachildrenssocialworkerstimewasspentonclientrelated 13 activities. Londonmultiplier 1.46xE AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaverage 1,7,8 cost. NonLondonmultiplier 0.96xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothe 1,7,8 nationalaveragecost. Unitcostsavailable2010/2011(thecostswithqualificationscostsaregiveninbrackets) 38(53)perhour;53(74)perhourofclientrelatedwork;146(204)perhouroffacetofacecontact(includesAtoE). 2010/2011value 30,441peryear
1 2
LocalGovernmentAssociationAnalysisandResearch(2011)LocalGovernmentEarningsSurvey2010/2011,LocalGovernmentAssociation,London. Thurley,D.(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 Curtis,L.Moriarty,J.&Netten,A.(2011)Thecostsofqualifyingasocialworker,BritishJournalofSocialWork,doi: 10.1093/bjsw/bcr113. http://bjsw.oxfordjournals.org/content/early/2011/08/22/bjsw.bcr113.short?rss=1. 5 TheBritishAssociationofSocialWorkers(2011)SocialWorkCareers,TheBritishAssociationofSocialWorkers.www.basw.co.uk/socialworkcareers/ 6 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 7 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 8 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 9 NationalAsssociationforVoluntaryandCommunityAction.LocalAuthorityMileageRates2010/2011.NAVCA,2011www.navca.org.uk/localvs/scales. 10 DepartmentofHealth,SocialServicesandPublicSafety(2003)TheNewNHS/HPSSPaySystem,AnOverview,March2003,DepartmentofHealth,Social ServicesandPublicSafety,London. 11 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2010,www.lga.gov.uk/lga/core/page.do?pageId=9851777. 12 Baginsky,M.,Moriarty,J.,Manthorpe,J.,Stevens,M.,MacInnes,T.&Nagendran,T.(2010)SocialWorkersWorkloadSurvey,Messagesfromthe Frontline,Findingsfromthe2009SurveyandInterviewswithSeniorManagers,ChildrensWorkforceDevelopmentCouncil,KingsCollege,Universityof London,NewPolicyInstitute. 13 DepartmentofHealth(2001)TheChildreninNeedCensus2001NationalAnalyses,www.dh.gov.uk/qualityprotects/work_pro/analysis1.htm.
158
11.4 Social work assistant

Costsandunitestimation A.Salary 2010/2011 value 22,214per year 6,110peryear 8,214peryear 4,532peryear Notes InformationtakenfromtheLocal GovernmentEarningsSurvey20111 showedthatthemeanbasicsalaryforasocialworkassistantwas22,214. Themeangrosssalarywas23,101. Employersnationalinsuranceisincludedplus18percentofsalaryfor contributiontosuperannuation.2 Directoverheadswere29percentofdirectcaresalarycosts.Theyinclude coststotheproviderforadministrationandmanagement,aswellasfor office,trainingandutilitiessuchaswater,gasandelectricity. Indirectoverheadswere16percentofdirectcaresalarycosts.They includegeneralmanagementandsupportservicessuchasfinanceand humanresourcedepartments.3 Basedonthenewbuildandlandrequirementsforalocalauthorityoffice andsharedfacilitiesforwaiting,interviewsandclericalsupport.4,5Capital costshavebeenannuitisedover60yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.See NationalAssociationforVoluntaryandCommunityActionwebsitefor mileageallowance.6 Includes29daysannualleaveand8statutoryleavedays.7Fivedaysfor study/trainingand9.2dayssicknessleavehavebeenassumedfor 2009/2010basedontheaverageforallsocialworksectors.8Unitcostsare basedon1566hoursperannum. Nocurrentinformationisavailableabouttheproportionofsocialwork assistanttimespentonclientrelatedoutputs.Seepreviouseditionsofthis volumeforsourcesofinformation. AllowsforthehighercostsassociatedwithLondoncomparedtothe nationalaveragecost.1,4,5 AllowsforthelowercostsassociatedwithworkingoutsideLondon comparedtothenationalaveragecost.1,4,5
B.Salaryoncosts C.Overheads Directoverheads Indirectoverheads
D.Capitaloverheads
1,943peryear
E.Travel
Workingtime
Ratiosofdirecttoindirect timeon: clientrelatedwork facetofacecontact Londonmultiplier NonLondonmultiplier
41.8weeksper annum 37.5hoursper week 1.16xA1.49x D 0.96xD
Unitcostsavailable2010/2011 27perhour.
1 2
LocalGovernmentAssociationAnalysisandResearch(2011)LocalGovernmentEarningsSurvey2010/2011,LocalGovernmentAssociation,London. Thurley,D.(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. 3 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 NationalAsssociationforVoluntaryandCommunityAction.LocalAuthorityMileageRates2010/2011.NAVCA,2011www.navca.org.uk/localvs/scales. 7 DepartmentofHealth,SocialServicesandPublicSafety(2003)TheNewNHS/HPSSPaySystem,AnOverview,March2003,DepartmentofHealth,Social ServicesandPublicSafety,London. 8 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2010,www.lga.gov.uk/lga/core/page.do?pageId=9851777.
159
11.5 Approved social worker

Anapprovedsocialworker(ASW)isasocialworkerwithresponsibilityforassessingsomeonesneeds,careandtreatmentunderthe MentalHealthAct1983(MHA).TheASWplaysakeyroleindecidingwhethersomeonewithmentalhealthproblemscanbecaredforin 1 thecommunity,orwhethertheyshouldbeadmittedtohospital. Costsandunitestimation 2010/2011value Notes A.Salary 35,829peryear Theaveragesalaryforanapprovedsocialworkerwas35,829peryear. InformationbasedonasurveycarriedoutbytheDepartmentofHealthof30 authoritiesandupratedusingthePSSInflator.Wagelevelsreflecttheaverage levelofwagespaidin27authorities.2 B.Salaryoncosts 10,662peryear Employersnationalinsuranceisincludedplus18percentofsalaryfor employerscontributiontosuperannuation.3 C.Qualifications 21,378peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenet al.(1998).4CurrentcostinformationisdrawnfromresearchcarriedoutbyCurtis etal.(2011).5 D.Overheads Directoverheadswere29percentofdirectcaresalarycosts.Theyincludecosts Directoverheads 13,378peryear totheproviderforadministrationandmanagement,aswellasforoffice,training andutilitiessuchaswater,gasandelectricity. Indirectoverheads 7,381peryear Indirectoverheadswere16percentofdirectcaresalarycosts.Theyinclude generalmanagementandsupportservicessuchasfinanceandhumanresource departments.6 E.Capitaloverheads 1,943peryear Basedonthenewbuildandlandrequirementsforalocalauthorityofficeand sharedfacilitiesforwaiting,interviewsandclericalsupport.7,8Capitalcostshave beenannuitisedover60yearsatadiscountrateof3.5percent. F.Travel Noinformationavailableonaveragemileagecoveredpervisit.SeeNational 9 AssociationforVoluntaryandCommunityActionwebsiteformileageallowance. 10 Workingtime 40.9weeksper Includes29daysannualleaveand8statutoryleavedays. Tendaysfor 11 annum study/trainingand9.2dayssicknessleavehavebeenassumedfor2010/2011. 37.5hoursper Unitcostsarebasedon1534hoursperannum. week Clientrelatedwork Informationwastakenfromastudycarriedoutof237mentalhealthsocial Ratioofdirecttoindirect workers(ofwhich162wereapprovedsocialworkers).Datawerecollectedusing timeon: asemistructuredquestionnaireanddiarytoproduceinformationonworking patterns.Itwasfoundthatduringaweek,theaveragenumberofhoursspenton facetoface 1:1.56 undertakingassessmentsforASWswas5.6,inmeetings6.2hours, writing/administration12.1hoursandASWsspent12hoursoncall.2 Londonmultiplier 1.20xA1.55xE RelativeLondoncostsaredrawnfromthesamesourceasthebasedataforeach 2,7,8 costelement. NonLondonmultiplier 0.93xA0.96xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedto thenationalaveragecost.2,7,8 Unitcostsavailable2010/2011(costswithqualificationsincludedinbrackets) 45(59)perhour;115(151)perhouroffacetofacecontact
1 2
www.mind.org.uk/Information/Booklets/Other/GettingthebestfromyourASW.htm PersonalcommunicationwiththeDepartmentofHealth,2009. 3 Thurley,D.(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. 4 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 5 Curtis,L.Moriarty,J.&Netten,A.(2011)Thecostsofqualifyingasocialworker,BritishJournalofSocialWork,doi: 10.1093/bjsw/bcr113. http://bjsw.oxfordjournals.org/content/early/2011/08/22/bjsw.bcr113.short?rss=1. 6 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 9 NationalAsssociationforVoluntaryandCommunityAction.LocalAuthorityMileageRates2010/2011.NAVCA,2011www.navca.org.uk/localvs/scales. 10 DepartmentofHealth,SocialServicesandPublicSafety(2003)TheNewNHS/HPSSPaySystem,AnOverview,March2003,DepartmentofHealth,Social ServicesandPublicSafety,London. 11 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2010,www.lga.gov.uk/lga/core/page.do?pageId=9851777.
160
11.6 Home care worker

Thisschemaprovidesinformationonthecostsofahomecareworker.SalaryinformationistakenfromtheNationalMinimumDataset forSocialCare(SkillsforCare,2011). BasedonPSSEX12009/2010, themeanhourlycostofallhomecareincludingLAfundedhome careandindependentprovision,was18.ThiscanbecomparedwiththemeanhourlycostofLAhomecareof32andameanhourly costof16forindependentsectorprovision.SeeJones(2005)forfindingsaboutthecostsofindependentlyprovidedhomecare.3 Costsandunit 2010/2011value Notes estimation A.Wages/salary 12,948peryear ThemedianannualsalaryforacareworkerinJune2011was12,948(6.50perhour). Aseniorhomecareworkerwouldearn16,212peryear(7.10perhour).1 B.Salaryoncosts 3,256peryear Employersnationalinsuranceisincludedplus18percentofsalaryforemployers contributiontosuperannuation.4 C.Overheads Directoverheads 4,699peryear Directoverheadswere29percentofdirectcaresalarycosts.Theyincludecoststothe providerforadministrationandmanagement,aswellasforoffice,trainingandutilities 5 suchaswater,gasandelectricity. Indirectoverheads 2,523perhour Indirectoverheadswere16percentofdirectcaresalarycosts.Theyincludegeneral 5 managementandsupportservicessuchasfinanceandhumanresourcedepartments. D.Travel Noinformationavailableonaveragemileagecoveredpervisit.SeeNational AssociationforVoluntaryandCommunityActionwebsiteformileageallowance.6 Workingtime 40.6weeksperannum Includes29daysannualleave,8daysstatutoryleave,9.2daysofsicknessand5days 37.5hoursperweek fortraining.7Afewoftheauthoritiesalsoallowedtimeofffortraining.Unitcostsare basedonthemediannumberofhoursworkedbyhomecareworkersin2008(1,304).8 Ratiosofdirectto Nocurrentinformationavailableontheproportionoftimespentwithclients.Itis indirecttimeon: 1:0.25 likelyhoweverthatif19percentofahomecareworkerstimeisspenttravelling(see durationofvisitbelow),8theproportionoftotaltimespentwithclientsis approximately80percent. Durationofvisit Justoverhalfoflocalauthorityfundedvisitslasted30minutes.Sixteenpercentof visitswere15minutesand19percentofahomecareworkerstimewasspent travelling.9 Typicalhomecare 12.4hoursperweek Basedonastudyofcommunitycarepackages,ithasbeenestimatedthatonaverage package 6.6hoursareworkedweekdaysbetween9a.m.and5p.m.,0.16hoursweekdaysafter 5p.m.,and0.55hourseachonSaturdayandSunday.8 Unsocialhours 1.2 Weekdays8p.mto10p.m multipliers 1.5 Saturday 2.0 Sundaysandbankholidays 1.3 Evenings Unitcostsavailable2010/2011 18perweekdayhour(22perhourweekdayevenings;27perhourSaturdays;36perhourSundays);22perhourfacetoface weekdaycontact(27perhourweekdayevenings;33perhourSaturdays;45perhourSundays)(IncludesAtoD).
1
SkillsforCare(2011)TheNationalMinimumDatasetforSocialCare(NMDSSC)andDataProtection:GuidanceforEmployers,SkillsforCare.www.nmds sconline.org.uk/help/Article.aspx?id=22. 2 TheInformationCentre(2010)PSSEX12009/10,TheInformationCentre,Leeds. 3 Jones,K.(2005)Thecostofprovidinghomecare,inL.Curtis&A.Netten(eds)UnitCostsofHealthandSocialCare2005,PersonalSocialServices ResearchUnit,UniversityofKent,Canterbury. 4 Thurley,D.(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. 5 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 6 NationalAsssociationforVoluntaryandCommunityAction,LocalAuthorityMileageRates2010/2011.NAVCA,2011www.navca.org.uk/localvs/scales. 7 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2010,www.lga.gov.uk/lga/core/page.do?pageId=9851777. 8 TheInformationCentre(2010)CommunityCareStatistics2008,HomeCareServicesforAdults,England,TheInformationCentre,Leeds. 9 UnitedKingdomHomeCareAssociation(UKHCA)(2011)AnoverviewoftheUKdomiciliarycaresector,HomeCareAssociationLimited. www.ukhca.co.uk/pdfs/domiciliarycaresectoroverview.pdf.
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11.7 Community occupational therapist (local authority)

Costsandunit estimation A.Wages/salary 2010/2011value 31,562peryear Notes InformationtakenfromtheLocal GovernmentEarningsSurvey 20111showedthatthemeanbasicsalaryforanoccupational therapistwas31,562.Themeangrosssalarywas32,570. Employersnationalinsuranceisincludedplus18percentof salaryforemployerscontributiontosuperannuation.2 Qualificationcostshavebeencalculatedusingthemethod describedinNettenetal.(1998).3Currentcostinformationhas beenprovidedbytheDepartmentofHealthandtheHigher EducationFundingCouncilforEngland(HEFCE).4Seethepreface formoreinformationonqualificationsandalsoschema7.4for details. Directoverheadswere29percentofdirectcaresalarycosts. Theyincludecoststotheproviderforadministrationand management,aswellasforoffice,trainingandutilitiessuchas water,gasandelectricity. Indirectoverheadswere16percentofdirectcaresalarycosts. Theyincludegeneralmanagementandsupportservicessuchas financeandhumanresourcedepartments.5 Basedonthenewbuildandlandrequirementsforalocal authorityofficeandsharedfacilitiesforwaiting,interviewsand clericalsupport.6,7Capitalcostshavebeenannuitisedover60 yearsatadiscountrateof3.5percent. Workingtime41.5weeksperannum37.5hoursperweek Includes29daysannualleaveand8statutoryleavedays.8Ten daysforstudy/trainingand9.2dayssicknessleavehavebeen assumed.9Unitcostsarebasedon1566hoursperannum.
D.Overheads Directoverheads Indirectoverheads
E.Capitaloverheads
1,943peryear
F.Workingtime
Ratioofdirectto indirecttimeon: clientcontact
Nocurrentinformationisavailableontheproportionoftime spentwithclients.Seepreviouseditionsofthisvolumefor sourcesofinformation. Londonmultiplier 1.09xA1.57xE AllowsforthehighercostsassociatedwithLondoncomparedto thenationalaveragecost.1,6,7 NonLondonmultiplier 0.97xE Allowsforthelowercostsassociatedwithworkingoutside Londoncomparedtothenationalaveragecost.1,6,7 Unitcostsavailable2010/2011(costsincludingtraininggiveninbrackets) 39(42)perhour;76(82)perhourofclientcontact(includesAtoE).
1 2
LocalGovernmentAssociationAnalysisandResearch(2011)LocalGovernmentEarningsSurvey2010/2011,LocalGovernmentAssociation,London. Thurley,D.(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 DepartmentofHealth,SocialServicesandPublicSafety(2003)TheNewNHS/HPSSPaySystem,AnOverview,March2003,DepartmentofHealth,Social ServicesandPublicSafety,London. 9 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2010,www.lga.gov.uk/lga/core/page.do?pageId=9851777.
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11.8 Home care manager

SalaryinformationinthisschemaistakenfromtheNationalMinimumDatasetforSocialCare(NMDSSC)1andhasbeen basedonthesalaryofaRegisteredManager.
Costsandunit estimation A.Wages/salary B.Salaryoncosts C.Qualifications D.Overheads: Direct Indirect 2010/2011value 28,000peryear 7,892peryear 10,409peryear 5,743peryear Notes MediansalaryforahomecaremanagerhasbeentakenfromtheNational MinimumDatasetforSocialCare(NMDSSC).1 Employersnationalinsuranceisincludedplus18percentofsalaryforemployers contributiontosuperannuation.2 Noinformationavailable. Directoverheadswere29percentofdirectcaresalarycosts.Theyincludecoststo theproviderforadministrationandmanagement,aswellasforoffice,trainingand utilitiessuchaswater,gasandelectricity. Indirectoverheadswere16percentofdirectcaresalarycosts.Theyinclude generalmanagementandsupportservicessuchasfinanceandhumanresource departments.3 BasedonthenewbuildandlandrequirementsofanNHSofficeandshared facilitiesforwaiting,interviewsandclericalsupport.4,5Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.SeeNational AssociationforVoluntaryandCommunityActionwebsiteformileageallowance.6 Includes29daysannualleaveand8statutoryleavedays.7Tendaysfor 8 study/trainingand9.2dayssicknessleavehavebeenassumed. Unitcostsare basedon1526hoursperannum. Ratiosareusedtoestimatethefullcostofdirectandindirecttimerequiredto delivereachoutput.Thestudyfoundthatcaremanagersspent24percentoftheir timeindirectcontactwiththeserviceuserandcarerandanadditional40percent onclientrelatedactivities.Twentyfivepercentoftimewasspentonnonclient relatedadministrativetaskssuchasdealingwithtelephoneenquiries,lunch/breaks andtraining.11.1percentwasspentontravellingtoserviceusers,carersand meetings.9 Averagenumberofvisitsperweekperworker.9 9 Averagedurationofvisits. Numberofcasespercaremanager.9 AllowsforthehighercostsassociatedwithLondoncomparedtothenational 4,5 averagecost. RelativeLondoncostsaredrawnfromthesamesourceasthebasedataforeach 4,5 costelement.
E.Capitaloverheads
1,943peryear
Ratiosofdirectto indirecttimeon: clientrelatedwork facetofacecontact
Frequencyofvisits Durationofvisits Caseloadperworker Londonmultiplier NonLondonmultiplier
9perweek 45minutes 14 1.25xA1.49xE 0.97xE
Unitcostsavailable2010/2011 35perhour;55perhourofclientrelatedwork;146perhouroffacetofacecontact;74percaseperweek(includesAtoE);41per homevisit(includesAtoF).
SkillsforCare(2011)TheNationalMinimumDatasetforSocialCare(NMDSSC)andDataProtection:GuidanceforEmployers,SkillsforCare.www.nmds sconline.org.uk/help/Article.aspx?id=22. 2 Thurley,D.(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. 3 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 4 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 5 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 6 NationalAsssociationforVoluntaryandCommunityAction,LocalAuthorityMileageRates2010/2011.NAVCA,2011www.navca.org.uk/localvs/scales. 7 DepartmentofHealth,SocialServicesandPublicSafety(2003)TheNewNHS/HPSSPaySystem,AnOverview,March2003,epartmentofHealth,Social ServicesandPublicSafety,London. 8 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2009,www.lga.gov.uk/lga/core/page.do?pageId=9851777. 9 Weinberg,A.,Williamson,J.,Challis,D.&Hughes,J.(2003)Whatdocaremanagersdo?Astudyofworkingpracticeinolderpeoplesservices,British JournalofSocialWork,33,901919.
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11.9 Family support worker

Familysupportworkersprovideemotionalandpracticalhelpandadvicetofamilieswhoareexperiencinglongorshort termdifficulties.Informationhasbeendrawnfromastudyonfamilysupportworkerswhoworkwithcarersofpeoplewith schizophrenia.1 Costsandunit 2010/2011value Notes estimation A.Wages/salary 22,784peryear InformationtakenfromtheLocal GovernmentEarningsSurvey2008 showed thatthemeansalaryforafamilysupportworkerwas21,296.2Asnonew salaryestimatesareavailable,thishasbeeninflatedtoreflectthepay incrementsforsocialworkersreportedintheLocalGovernmentEarnings Surveys2009,320104and2011.5 B.Salaryoncosts 6,286peryear Employersnationalinsuranceisincludedplusemployerscontributionto superannuation(18%).6 C.Training Noinformationavailable. D.Overheads DirectOverheads 8,430peryear Directoverheadswere29percentofdirectcaresalarycosts.Theyincludecosts totheproviderforadministrationandmanagement,aswellasforoffice, trainingandutilitiessuchaswater,gasandelectricity.7 IndirectOverheads 4,651peryear Indirectoverheadswere16percentofdirectcaresalarycosts.Theyinclude generalmanagementandsupportservicessuchasfinanceandhumanresource departments.7 Workingtime 41.7weeksper Includes29daysannualleaveand8statutoryleavedays.8Fivedaysforstudy/ annum trainingand9.2dayssickleaveperannumhavebeenassumed.9Unitcostsare 37.5hoursper basedon1563hoursperannum. week Ratiosofdirectto Directcontactwithclients,includingpracticalsupport,emotionalsupportand indirecttimeon: timespentinsupportgroups,occupied59percentoftheirtime.Therestofthe clientrelatedwork 1:0.7 timewasspentonliaisonwithotheragencies(13%),travelling(14%),staff development(5%)andadministrationandother(9%).1 Londonmultiplier 1.16xA AllowsforthehighercostsassociatedwithLondoncomparedtothenational averagecost. Unitcostsavailable2010/2011(costsincludingtraininggiveninbrackets) 27perhour;46perhourofclientrelatedwork.
Davies,A.,Huxley,P.,Tarrier,N.&Lyne,D.(2000)FamilySupportWorkersofCarersofPeoplewithSchizophrenia,UniversityofManchesterandMaking Space. 2 LocalGovernmentAssociationAnalysisandResearch(2008)LocalGovernmentEarningsSurvey2007,LocalGovernmentAnalysisandResearch,London. 3 LocalGovernmentAssociationAnalysisandResearch(2009)LocalGovernmentEarningsSurvey2008,LocalGovernmentAssociation,London. 4 LocalGovernmentAssociationAnalysisandResearch(2010)LocalGovernmentEarningsSurvey2009,LocalGovernmentAssociation,London. 5 LocalGovernmentAssociationAnalysisandResearch(2011)LocalGovernmentEarningsSurvey2010,LocalGovernmentAssociation,London. 6 Thurley(2011)LocalGovernmentPensionScheme,2010onwards,HouseofCommons.www.parliament.uk/briefingpapers/SN05823.pdf. 7 BasedoninformationtakenfromSelwynetal.(2009)AdoptionandtheInteragencyFee,UniversityofBristol,BristolandGlendinningetal.(2010)Home CareReablementServices:InvestigatingtheLongerTermImpacts,FinalReport,UniversityofYork,PSSRUKent,DepartmentofHealth,London. 8 DepartmentofHealth,SocialServicesandPublicSafety(2003)TheNewNHS/HPSSPaySystem,AnOverview,March2003,DepartmentofHealth,Social ServicesandPublicSafety,London. 9 LocalGovernmentAssociation(2011)SicknessAbsenceandCausesSurvey2010,www.lga.gov.uk/lga/core/page.do?pageId=9851777.
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12. Health and social care teams

12.1NHScommunitymentalhealthteam(CMHT)forolderpeoplewithmentalhealth problems 12.2Communitymentalhealthteamforadultswithmentalhealthproblems 12.3Crisisresolutionteamforadultswithmentalhealthproblems 12.4Assertiveoutreachteamforadultswithmentalhealthproblems 12.5Earlyinterventionteamforadultswithmentalhealthproblems 12.6GenericsingledisciplinaryCAMHSteam 12.7GenericmultidisciplinaryCAMHSteam 12.8DedicatedCAMHSteam 12.9TargetedCAMHSteam
167
12.1 NHS community mental health team (CMHT) for older people with mental health problems
BasedoninformationtakenfromtheOlderPeoplesMentalHealthMappingframework,1,2,3themeanaveragecostforall communitymentalhealthteamsforolderpeoplewithmentalhealthproblemsin2010/2011was128perfacetofacecontact. CostshavebeenupratedusingtheHCHSPay&Pricesinflator. Costsandunit 2010/2011value Notes estimation A.Wages/salary 32,647peryear BasedonmediansalariesforAgendaforChange(AfC)bands.4Weightedtoreflect inputofcommunitynurses(43%),socialworkers/approvedsocialworkers(12%), consultants(6%)andothers.Weightedaveragesalariesforeachtypeofworker weremultipliedbytheproportionofthattypeofworkerintheteamtoproducea genericCMHT(OP)workersalary.1 B.Salaryoncosts 8,622peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. TakenfromNHS(England)SummarisedAccounts.5Seeprefaceformore C.Overheads information. 7,882peryear Management, Managementandothernoncarestaffcostswere19.1percentofdirectcare administrationand salarycostsandincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo 17,168peryear Nonstaff theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gas andelectricity. D.Capitaloverheads 2,238peryear BasedonthenewbuildandlandrequirementsofanNHSofficeandshared facilitiesforwaiting,interviewsandclericalsupport.6,7Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. Workingtime 41.3weeksperannum Includes29daysannualleaveand8daysstatutoryleave.8Twelvedayssickness 37.5hoursperweek leaveand5study/trainingdaysareassumed.9Basedon1549workinghours. Ratiosofdirectto Nocurrentinformationontimeuseisavailable.Seepreviouseditionsofthis indirecttime volumeforsourcesofinformation. Frequencyofvisits 8 Averagenumberofvisitsperweekperworker. Durationofvisits 60minutes Averagedurationofvisits. CaseloadperCMHT 32casespercarestaff Basedonmentalhealthcombinedmappingdata.1In2008/09therewasanaverage of389casesperserviceand32casesperyearpergenericCMHT. Londonmultiplier 1.19x(AtoB) AllowsforhighercostsassociatedwithworkinginLondon.6,7,10 1.45xE NonLondon 0.97x(AtoB)0.97xE AllowsforlowercostsassociatedwithworkingoutsideLondon.6,7,10 multiplier Unitcostsavailable2010/2011 44perhourperteammember;68,557annualcostofteammember;2,142averagecostpercase.
CareServicesImprovementPartnership,MentalHealthStrategies(2009)CombinedMappingFramework, http//www.mhcombinedmap.org/reports/aspx. 2 Lingard,J.&Milne,A.(2004)CommissionedbytheChildren,OlderPeople&SocialCarePolicyDirectorate,IntegratingOlderPeoplesMentalHealth Services,CommunityMentalHealthTeamsforOlderPeople,www.olderpeoplesmentalhealth.csip.org.uk/silo/files/integratingopmhservices.pdf 3 MentalHealthStrategies(2009)2008/09NationalSurveyofInvestmentinAdultMentalHealthServices,MentalHealthStrategiesfortheDepartmentof Health,London. 4 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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12.2 Community mental health team for adults with mental health problems
Composedofprofessionalsfromawiderangeofdisciplines,communitymentalhealthTeams(CMHTs)areintendedtoprovidean 1 effectivelocalmentalhealthservicethatprioritisesthosewhoseproblemsaresevereandlongterm. Thisyear,informationhasbeen 2 takenfromthementalhealthcombinedmappingwebsite andisbasedondatareceivedfrom787serviceproviders.Therewere,on 3 average,15carestaffperteam.NHSReferenceCosts reportthatthemeanaveragecostperfacetofacecontactwithacommunity mentalhealthteamforadultswithmentalhealthproblemswas139.CostshavebeenupratedusingtheHCHSPay&PricesInflator. Costsandunit 2010/2011value Notes estimation A.Wages/salary 28,933peryear BasedonmediansalariesforAgendaforChange(AfC)bands.4Weightedtoreflectinput ofcommunitynurses(31%),socialworkers/approvedsocialworkers(18%),consultants (6%)OTsandphysiotherapists(5%),carersupport(5%)andothers.Weightedaverage salariesforeachtypeofworkerweremultipliedbytheproportionofthattypeofworker 2 intheteamtoproduceagenericCMHTworkersalary. Volunteershavebeencosted usingtheminimumwageof5.93perhour. B.Salaryoncosts 7,351peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Qualifications Informationnotavailableforallcarestaff. DOverheads TakenfromNHS(England)SummarisedAccounts.5Seeprefaceformoreinformation. Management, 6,930peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycosts administrationand andincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe Nonstaff 15,094peryear providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. E.Capitaloverheads 2,238peryear BasedonthenewbuildandlandrequirementsofanNHSofficeandsharedfacilitiesfor 6,7 waiting,interviewsandclericalsupport. Capitalcostshavebeenannuitisedover60 yearsatadiscountrateof3.5percent. Workingtime 41.3wksperannum Includes29daysannualleaveand8daysstatutoryleave.8Twelvedayssicknessleaveand 9 37.5hrsperweek 5study/trainingdaysareassumed. Basedon1549workinghours. Ratioofdirectto Nocurrentinformationontimeuseisavailable.Seepreviouseditionsofthisvolumefor indirecttime sourcesofinformation. CaseloadperCMHT 24casesperCMHT Basedonmentalhealthcombinedmappingdata.1In2008/09,therewasanaverageof 404casesperserviceand24casesperyearpergenericCMHT. Londonmultiplier 1.19x(AtoB)1.45x AllowsforhighercostsassociatedwithworkinginLondon.6,7,10 E NonLondon 0.97x(AtoB)0.97x AllowsforthelowercostsassociatedwithworkingoutsideLondon.6,7,10 multiplier E Unitcostsavailable2010/2011 39perhourperteammember;60,546annualcostofteammember;2,523averagecostpercase.
MentalHealthStrategies(2009)2008/09NationalSurveyofInvestmentinAdultMentalHealthServices,MentalHealthStrategiesfortheDepartmentof Health,London. 2 CareServicesImprovementPartnership,MentalHealthStrategies(2009)CombinedMappingFramework, http//www.mhcombinedmap.org/reports/aspx. 3 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 4 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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12.3 Crisis resolution team for adults with mental health problems
Crisisresolutionisanalternativetoinpatienthospitalcareforserviceuserswithseriousmentalillness,offeringflexible,homebased 1 care24hoursaday,sevendaysaweek.Informationhasbeentakenfromthementalhealthcombinedmappingwebsite andisbasedon 2 datareceivedfrom270serviceproviders.Therewere,onaverage,17carestaffperteam.NHSReferenceCosts reportthatthemean averagecostforacrisisresolutionteamfor2010was184perteamcontactandtheminimumfor25percentofserviceswas140and themaximum213.CostshavebeenupratedusingtheHCHSPay&PricesInflator.Seethe2008/09NationalSurveyofInvestmentin 3,4 AdultMentalHealthServicesandMcCroneetal.(2008)formoreinformationonCrisisResolutionTeams.
Costsandunit estimation A.Wages/salary 2010/2011value 29,315peryear Notes
BasedonmediansalariesforAgendaforChange(AfC)bands.5Weightedaveragesalaries foreachtypeofworkerweremultipliedbytheproportionofthattypeofworkerinthe teamtoproduceagenericcrisisresolutionworkersalary.Teamsincludedmedicalstaff, nurses,psychologists,socialworkers,socialcareandothertherapists.1 B.Salaryoncosts 7,338peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Training Nocostsavailable.Crisisresolutionworkinvolvesamajorreorientationforstaffwho havebeenaccustomedtoworkingindifferentways. TakenfromNHS(England)SummarisedAccounts.6Seeprefaceformoreinformation. D.Overheads 7,000peryear Management, Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycosts administrationand andincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe 15,248peryear Nonstaff providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. E.Capitaloverheads 2,283peryear BasedonthenewbuildandlandrequirementsofanNHSofficeandsharedfacilitiesfor waiting,interviewsandclericalsupport.7,8Costshavebeenannuitisedover60yearsata discountrateof3.5percent. Workinghoursofteam 41.3weeksperannum Includes29daysannualleaveand8daysstatutoryleave.9Twelvedayssicknessleaveand members 37.5hoursperweek 5study/trainingdaysareassumed.10Basedon1549workinghours.Weightedtoreflect teamcomposition. Servicehours 24hoursperday Ingeneral,theteamshouldoperatesevendaysaweek,24hoursperdaythroughoutthe 7daysperweek year.Thiscanbedoneiftwoshiftsadayarescheduledformorningsandafternoons.11 Durationofepisode 27days TheNationalSurveyreportedthat27dayswastheaveragedurationofepisode.Themean longesttimethatteamsstayinvolvedis75.6days.12 Caseload 36casesperservice Basedonmentalhealthcombinedmappingdata1averagecaseloadsfor2008/09were36 2casespercarestaff casesperserviceand2casesperyearpercrisisresolutionteammember. Londonmultiplier 1.19x(AtoB)1.39xE AllowsforhighercostsassociatedwithworkinginLondon.7,8,13 NonLondonmultiplier 0.97x(AtoB)0.96xE AllowsforlowercostsassociatedwithworkingoutsideLondon.7,8,13 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 39perhourperteammember;61,184annualcostofteammember;30,592 averagecostpercase.
CareServicesImprovementPartnership,MentalHealthStrategies(2009)CombinedMappingFramework,http//www.mhcombinedmap.org/ reports/aspx. 2 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 3 McCrone,P.Dhanasiri,S.,Patel,A.,Knapp,M.,LawtonSmith,S.(2008)PayingthePrice,ThecostofmentalhealthcareinEnglandto2026,KingsFund, London. 4 MentalHealthStrategies(2009)2008/09NationalSurveyofInvestmentinAdultMentalHealthServices,MentalHealthStrategiesfortheDepartmentof Health,London. 5 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 6 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 7 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 8 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 9 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 10 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 11 TheSainsburyCentreforMentalHealth(2010)MentalHealthTopics,CrisisResolution, www.centreformentalhealth.org.uk/pdfs/crisis_resolution_mh_topics.pdf. 12 Onyett,S.,Linde,K.,Glover,G.etal.(2007)CrisisResolutionandInpatientMentalHealthCareinEngland,UniversityofDurham. 13 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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12.4 Assertive outreach team for adults with mental health problems
Assertiveoutreachteamsprovideintensivesupportforpeoplewithseverementalillnesswhoaredifficulttoengageinmoretraditional 1 2 services. Informationhasbeentakenfromthementalhealthcombinedmappingwebsite andisbasedondatareceivedfrom248 serviceproviders.Seethe2008/09NationalSurveyofInvestmentinAdultMentalHealthServicesandMcCroneetal.(2008)formore 3,4 informationonthisservice.
NHSReferenceCosts5reportthemeanaveragecostforanassertiveoutreachteamcontactfor2010was127.Costshavebeenuprated usingtheHCHSPay&Pricesinflator.
Costsandunit estimation A.Wages/salary 2010/2011value 27,700peryear Notes BasedonmediansalariesforAgendaforChange(AfC)bands. Weightedaveragesalariesforeach typeofworkerweremultipliedbytheproportionofthattypeofworkerintheteamtoproducea genericAssertiveOutreachTeamworkersalary.Teamsincludeddoctors,nurses,psychologists, 2 socialworkers,socialcare,othertherapistsandvolunteers. Employersnationalinsuranceisincludedplus14percentofsalaryforemployerscontribution tosuperannuation. 7 TakenfromNHS(England)SummarisedAccounts. Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycostsand includedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststotheprovider foroffice,travel/transportandtelephone,educationandtraining,suppliesandservices(clinical andgeneral),aswellasutilitiessuchaswater,gasandelectricity. 8,9 BasedonthenewbuildandlandrequirementsofanNHSofficeandsharedfacilities. Capital costshavebeenannuitisedover60yearsatadiscountrateof3.5percent. Oftheassertiveoutreachteamcontacts,68percentwerefacetofacewiththepatient,13per centwerebytelephone,11percentofallattemptsatcontactwereunsuccessfulandafurther6 percentinvolvedcontactwiththecarer(facetofaceorbyphone).Ofthefacetofacecontacts withpatients,63percenttookplaceinthepatientshomeorneighbourhood,27percentin 10 servicesettingsand10percentinothersettings. 11 Includes29daysannualleaveand8daysstatutoryleave. Twelvedayssicknessleaveand5 12 study/trainingdaysareassumed. Basedon1549workinghours. Workinghoursofmostservicesareflexible,although24hourservicesarerare. Medianduration ofcontact.Assertiveoutreachstaffexpecttoseetheirclientsfrequentlyandto stayincontact,howeverdifficultthatmaybe.Typicallystudieshaveshownthatatleast95per 10 centofclientsarestillincontactwithservicesevenafter18months. 2 Basedonmentalhealthcombinedmappingdata, averagecaseloadsfor2008/09were72cases perserviceand7casesperyearperassertiveoutreachteammember. 8,9,13 AllowsforthehighercostsassociatedwithworkinginLondon.
6
B.Salaryoncosts C.Overheads Management, administrationand estatesstaff Nonstaff D.Capitaloverheads Ratioofdirectcontactto totalcontacttime: facetofacecontacts
2,238peryear 1:0.48
Workinghoursofteam members Servicehours Durationofcontact
41.3weeksperannum 37.5hoursperweek 24hoursperday 30minutes
Caseload
72casesperservice 7casespercarestaff Londonmultiplier 1.19x(AtoB) 1.39xE 8,9,13 NonLondonmultiplier 0.97x(AtoB)0.96xE AllowsforlowercostsassociatedwithworkingoutsideLondon. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 37perhourperteammember;55 perhourofpatientcontact;58,011 annualcostofteammember;8,287 averagecostpercase.
1 2
SainsburyCentreforMentalHealth(2001)MentalHealthTopics,AssertiveOutreach,SainsburyCentreforMentalHealth(updated2003),London. CareServicesImprovementPartnership,MentalHealthStrategies(2009)CombinedMappingFramework,http//www.mhcombinedmap.org/ reports/aspx. 3 MentalHealthStrategies(2009)2008/09NationalSurveyofInvestmentinAdultMentalHealthServices,MentalHealthStrategiesfortheDepartmentof Health,London. 4 McCrone,P.Dhanasiri,S.,Patel,A.,Knapp,M.,LawtonSmith,S.(2008)PayingthePrice,ThecostofmentalhealthcareinEnglandto2026,KingsFund, London. 5 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 6 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 7 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 8 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 9 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 10 Wright,C.,Burns,T.,Billings,J.,Muijen,M.Priebe,S.Ryrie,I.,Watts,J.&White,I.(2003)AssertiveoutreachteamsinLondon:modelsofoperation, BritishJournalofPsychiatry,183,2,132138. 11 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 12 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 13 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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12.5 Early intervention team for adults with mental health problems
Earlyinterventionisaserviceforyoungpeopleaged1435duringthefirstthreeyearsofapsychoticillness.Theyprovidearangeof services,includingantipsychoticmedicationsandpsychosocialinterventions,tailoredtotheneedsofyoungpeoplewithaviewto 1 2 facilitatingrecovery. Staffandcaseloadinformationforthisschemahasbeentakenfromthementalhealthcombinedmappingwebsite 3 andisbasedondatareceivedfrom150serviceproviders.NHSReferenceCosts reportthemeanaveragecostforanearlyintervention teamcontactfor2010was177,withtheminimumrangefor25percentofservicesbeing148andthemaximum194.Seethe 4 2008/09NationalSurveyofInvestmentinAdultMentalHealthServices andMcCroneetal(2008)formoreinformationonEarly 5 InterventionTeams.
Costsandunit estimation A.Wages/salary 2010/2011value 29,656 peryear Notes Based onmediansalariesforAgendaforChange(AfC)bands.6Weightedaveragesalariesfor eachtypeofworkerweremultipliedbytheproportionofthattypeofworkerintheteamto produceagenericassertiveoutreachteamworkersalary.Teamsincludeddoctors,nurses, psychologists,socialworkers,socialcare,othertherapistsandvolunteers.2Lossofearnings basedontheminimumwagehasbeenassumedforvolunteers.7 Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. SainsburyCentreforMentalHealth runsaparttimepostgraduatecertificate(EIP)overaone yearperiodwhichincludes20daysofteaching.8 TakenfromNHS(England)SummarisedAccounts.9 Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycostsand includedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. BasedonthenewbuildandlandrequirementsofanNHSofficeandsharedfacilities.10,11 Capitalcostshavebeenannuitisedover60yearsatadiscountrateof3.5percent. Includes29daysannualleaveand8daysstatutoryleave.12Twelvedayssicknessleaveand5 study/trainingdaysareassumed.13Basedon1549workinghours.Weightedtoreflectteam composition. Teamstendtooperate9.00a.m. 5.00p.m.butsomeflexibilityisbeingplanned. Basedonmentalhealthcombinedmappingdata.2 Caseloaddatafor2008/09were98cases perserviceand9casesperearlyinterventionteammember. Noinformationavailable AllowsforhighercostsassociatedwithworkinginLondon.9,10,14
B.Salaryoncosts C.Training D.Overheads Management, administrationand estatesstaff Nonstaff E.Capitaloverheads Workingtimeper staffmember Servicehours Caseload Ratioofdirectto indirecttime Londonmultiplier
7,439 peryear
7,085peryear 15,432peryear 2,238 peryear 41.3weeksperyear 37.5hoursperweek
98casesperservice 9casespercarestaff
1.19x(AtoB) 1.39xE NonLondon 0.97x(AtoB)0.96x AllowsforlowercostsassociatedwithworkingoutsideLondon.9,10,14 multiplier E Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 40perhour.61,850annualcostofteammember;6,872costpercase.
SainsburyCentreforMentalHealth(2003)AWindowofOpportunity:APracticalGuideforDevelopingEarlyInterventioninPsychosisServices,Briefing 23,SainsburyCentreforMentalHealth,London. 2 CareServicesImprovementPartnership,MentalHealthStrategies(2009)CombinedMappingFramework, http//www.mhcombinedmap.org/reports/aspx. 3 www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 4 MentalHealthStrategies(2009)2008/09NationalSurveyofInvestmentinAdultMentalHealthServices,MentalHealthStrategiesfortheDepartmentof Health,London. 5 McCrone,P.Dhanasiri,S.,Patel,A.,Knapp,M.,LawtonSmith,S.(2008)PayingthePrice,ThecostofmentalhealthcareinEnglandto2026,KingsFund, London. 6 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 7 Directgov(2011)TheNationalMinimumWageRates,www.direct.gov.uk/en/Employment/Employees/TheNationalMinimumWage/DG_10027201. 8 SainsburyCentreforMentalHealth(2004)PostgraduateCertificateinEarlyInterventionforPsychosis,SainsburyCentreforMentalHealth,London. 9 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 10 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 11 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 12 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 13 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 14 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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12.6 Generic singledisciplinary CAMHS team

Theseteamsprovideservicesforchildrenandyoungpeoplewithparticularproblemsrequiringparticulartypesofinterventionand 1 withinadefinedgeographicalarea. Staff,caseloadandcostinformationhasbeentakenfromtheChildandAdolescentMentalHealth 2,3 Service(CAMHS) mappingdatabase,andisbasedonreturnsfrom2,094teamsofwhich60teamsweregenericsingledisciplinary teams.Thestaffintheseteamsarealmostexclusivelyclinicalpsychologists,educationalpsychologistsandothertherapists.The exceptionsareteamsofprimarymentalhealthworkerswhichfocusonpsychologicaltherapies.Thereisanaveragestaffratioof4.13 wteperteam(excludingadministrativestaffandmanagers).Costshavebeenupratedto2010/2011pricelevelsusingtheappropriate inflators. Costsandunitestimation 2010/2011value Notes A.Wages/salaryplus 38,469peryear AveragesalaryforsinglegenericteammemberbasedonNationalChildand 2,3 oncosts AdolescentMentalHealthServicecostdata. B.Overheads TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformore information. Management, 7,348peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary administrationand costsandincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo Nonstaff 16,003peryear theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasand electricity. C.Capitaloverheads 2,237peryear BasedonthenewbuildandlandrequirementsofanNHSofficeandshared facilities.5,6Capitalcostshavebeenannuitisedover60yearsatadiscountrateof 3.5percent.Basedontheassumptionthateachteamhasonesharedoffice. Workingtime 42weeksperyear Includes29daysannualleaveand8daysstatutoryleave.7Twelvedayssickness 8 37.5hoursperweek leaveand5study/trainingdaysareassumed. Basedon1575workinghours. Weightedtoreflectteamcomposition. Ratioofdirecttoindirect InformationtakenfromNationalChildandAdolescentMentalHealthService timeon: Mappingdata.2StaffactivitywasreportedattheteamlevelbyStrategicHealth patientrelatedwork 1:0.63 Authority(SHA)averagingasfollows:educationandtraining(9%),researchand facetofacecontact 1:1.06 evaluation(5%),administrationandmanagement(23%),consultationandliaison (13%)andclinical(49%). Durationofepisode 26percentofcaseslasted4weeksorless,25percentfor13weeksorless,18per centfor26weeksorless,16percentfor52weeksorlessand15percentformore than52weeks. Caseloadperteam 60casesperteam Basedon60teamsandacaseloadof3,604.2 Londonmultiplier 1.19xA AllowsforhighercostsassociatedwithworkinginLondon.5,6,9 1.39xC NonLondonmultiplier 0.97xA AllowsforlowercostsassociatedwithworkingoutsideLondon.5,6,9 0.96xC Unitcostsavailable2010/2011 41perhourperteammember;66perhourperpatientrelatedactivity;84perhourperteammemberfacetofacecontact;4,409 averagecostpercase.
YoungMinds (2001) GuidanceforPrimaryCareTrusts,ChildandAdolescentMentalHealth:itsImportanceandhowtocommissionacomprehensive service,Appendix3:KeyComponents,ProfessionalsandFunctionsofTieredChildandAdolescentMentalHealthServices, ChildandAdolescentMental HealthServices,www.youngminds.org.uk/pctguidance/app3.php. 2 ChildandAdolescentMentalHealthServicemapping(2009)DurhamUniversity&DepartmentofHealth,www.childrensmapping.org.uk/ 3 TheCAMHSteamcostdataarenolongerbeingcollectedsoinformationforthisschemahasbeenupratedthisyear. 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 8 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 9 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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12.7 Generic multidisciplinary CAMHS team

Staffmix,timeuse,caseloadandcostinformationforthisschemahasbeentakenfromtheChildandAdolescentMentalHealthService 1,2 (CAMHS) mappingdatabase,andisbasedonreturnsfrom2,094teamsofwhich421teamsweregenericmultidisciplinary.Generic teamsprovidethebackboneofspecialistCAMHSprovision,ensuringarangeoftherapeuticinterventionswereavailabletochildren, youngpeopleandfamilieslocally.Multidisciplinarygenericteams,asthenameimplies,werelargelystaffedbyarangeofmentalhealth professionals.Theaveragesizeofmultidisciplinaryteamswas10.9wte(excludingadministrativestaffandmanagers).Costshavebeen upratedto2010/2011pricelevelsusingtheappropriateinflators. Costsandunit 2010/2011value Notes estimation A.Wages/salaryplus 51,394peryear Averagesalaryplusoncostsforagenericmultidisciplinaryteammemberbasedon oncosts NationalChildandAdolescentMentalHealthServicecostdata.Theteams(excluding administrativeandunqualifiedstaff)includednurses(22%),doctors(18%),socialworkers (9%),clinicalpsychologists(15%),childpsychotherapists(5%),occupationaltherapists(2 %),mentalhealthworkers(10%),familytherapists(5%),educationalpsychologists(1%) andotherqualifiedtherapistsandcarestaff(13%).1,2 B.Overheads TakenfromNHS(England)SummarisedAccounts.3Seeprefaceformoreinformation. Management, 9,816peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycosts administrationand andincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe Nonstaff 21,301peryear providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. C.Capitaloverheads 2,237peryear BasedonthenewbuildandlandrequirementsofanNHSofficeandsharedfacilities.4,5 Capitalcostshavebeenannuitisedover60yearsatadiscountrateof3.5percent.Based ontheassumptionthateachteamhasonesharedoffice. , Workingtime 42weeksper Includes29daysannualleave,8statutoryleavedaysand12dayssicknessleave.6 7 year Assumes6study/trainingdays.Workinghoursweightedtoreflectteamcomposition.Unit 45.73hoursper costsbasedon1,933hoursworkinghoursperyear. week Ratioofdirectto InformationtakenfromNationalChildandAdolescentMentalHealthServiceMapping 1 indirecttimeon: data. StaffactivitywasreportedattheteamlevelbyStrategicHealthAuthority(SHA) averagingasfollows:educationandtraining(9%),researchandevaluation(5%),adminand 1:0.63 patientrelatedwork management(23%),consultationandliaison(13%)andclinical(49%). facetofacecontact 1:1.06 Durationofepisode 19percentofcaseslastedfor4weeksorless,21percentfor13weeksorless,19percent (allCAMHSteams) for26weeksorless,17percentfor52weeksorlessand25percentformorethan52 weeks. Caseloadperteam 191casesper Basedon421teamsand80,386cases.1 team 4,5,8 Londonmultiplier 1.19xA AllowsforhighercostsassociatedwithworkinginLondon. 1.39xC NonLondonmultiplier 0.97xA AllowsforlowercostsassociatedwithworkingoutsideLondon.4,5,8 0.96xC Unitcostsavailable2010/2011 44perhourperteammember;72costperhourperteammemberforpatientrelatedactivities;90costperhourperteammember forfacetofacecontact;4,823averagecostpercase.
ChildandAdolescentMentalHealthServicemapping(2009)DurhamUniversity&DepartmentofHealth,www.childrensmapping.org.uk/ TheCAMHSMappingdataarenolongerbeingcollectedsoinformationforthisschemahasbeenupratedthisyear. 3 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 4 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 5 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 6 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 7 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 8 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).

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12.8 Dedicated CAMHS team

DedicatedCAMHSworkersarefullytrainedchildandadolescentmentalhealthprofessionalswhoareoutpostedinteamsthatarenot specialistCAMHSteamsbuthaveawiderfunction,suchasayouthoffendingteamoragenericsocialworkchildrensteam.The informationforthisschemaisbasedonNationalChildandAdolescentMentalHealthService(CAMHS)mappingstaffrelatedandcost , informationfrom2,094teamsofwhich133werededicatedteams.1 2Therewasanaveragestaffratioof2.2wteperteam(excluding administrativestaffandmanagers).Costshavebeenupratedto2010/2011pricelevelsusingtheappropriateinflators.
Costsandunit estimation A.Wages/salaryplus oncosts
2010/2011value 37,718peryear
Notes Averagesalaryplusoncostsforateammemberworkinginadedicatedteam basedonNationalChildandAdolescentMentalHealthServiceMappingdataand onthe128dedicatedteams.1,2Theteamsincludednurses(27%),doctors(3%), clinicalpsychologists(16%),educationalpsychologists(3%),socialworkers(6%) childpsychotherapists(2%),mentalhealthworkers(28%)andothertherapists andcarestaff(15%). TakenfromNHS(England)SummarisedAccounts.3Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirectcare salarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecosts totheproviderforoffice,travel/transportandtelephone,educationand training,suppliesandservices(clinicalandgeneral),aswellasutilitiessuchas water,gasandelectricity. BasedonthenewbuildandlandrequirementsofanNHSofficeandshared facilities.4,5Capitalcostshavebeenannuitisedover60yearsatadiscountrateof 3.5percent.Basedontheassumptionthateachteamhasonesharedoffice. Includes29daysannualleave,8statutoryleavedaysand12dayssicknessleave. 6,7 Assumes6study/trainingdays.Workinghoursweightedtoreflectteam composition.Basedon1,586hoursworkinghoursperyear. InformationtakenfromNationalChildandAdolescentMentalHealthService Mappingdata.1StaffactivitywasreportedattheteamlevelbyStrategicHealth Authority(SHA)averagingasfollows:educationandtraining(9%),researchand evaluation(5%),adminandmanagement(23%),consultationandliaison(13%) andclinical(49%). 30percentofcaseslastedfor4weeksorless,30percentfor13weeksorless, 19percentfor26weeksorless,11percentfor52weeksorlessand10percent formorethan52weeks. Basedon133teamsand4,596cases.1
B.Overheads Management, administrationand estatesstaff Nonstaff C.Capitaloverheads
2,237peryear
Workingtime
Ratioofdirectto indirecttimeon: patientrelatedwork facetofacecontact Lengthofepisode
42weeksper year 37.7hoursper week 1:0.63 1:1.06
Caseload
35casesper team Londonmultiplier 1.19xA AllowsforhighercostsassociatedwithworkinginLondon.4,5,8 NonLondonmultiplier 0.97xA AllowsforlowercostsassociatedwithworkingoutsideLondon.4,5,8 Unitcostsavailable2010/2011 40perhourperteammember;65perhourofpatientrelatedactivity,82perhouroffacetofacecontact,3,881average costpercase.
ChildandAdolescentMentalHealthService(CAMHS)Mapping(2009)DurhamUniversity&DepartmentofHealth,www.childrensmapping.org.uk/. TheCAMHSMappingdataarenolongerbeingcollectedsoinformationforthisschemahasbeenupratedthisyear. 3 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 4 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 5 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 6 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 7 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 8 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).

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12.9 Targeted CAMHS team

Theseteamsprovideservicesforchildrenandyoungpeoplewithparticularproblemsorforthoserequiringparticulartypes oftherapeuticinterventions.TheinformationforthisschemaisbasedonNationalChildandAdolescentMentalHealth Service(CAMHS)mappingdataandreturnsfrom2,094teamsofwhich335werededicatedteams.1,2Theaveragestaffratio was4.2wteperteam(excludingadministrativestaffandmanagers).Costshavebeenupratedto2010/2011pricelevels usingtheappropriateinflators.
Costsandunit estimation A.Wages/salaryplus oncosts 2010/2011 value 40,203per year Notes AveragesalaryforateambasedonNationalChildandAdolescentMentalHealth ServiceMappingdata.1,2Teamsincludednurses(20%),doctors(6%),social workers(15%),clinicalpsychologists(22%),educationalpsychologists(1%),child psychotherapists(3%),familytherapists(4%)andothertherapistsandcarestaff (29%).1 TakenfromNHS(England)SummarisedAccounts.3Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirectcare salarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gas andelectricity. BasedonthenewbuildandlandrequirementsofanNHSofficeandshared facilities.4,5Capitalcostshavebeenannuitisedover60yearsatadiscountrateof 3.5percent.Basedontheassumptionthateachteamhasonesharedoffice. Includes29daysannualleave,8statutoryleavedaysand12dayssicknessleave. 6,7 Workinghoursweightedtoreflectteamcomposition.Unitcostsbasedon1,599 hoursworkinghoursperyear. InformationtakenfromNationalChildandAdolescentMentalHealthService Mappingdata.StaffactivitywasreportedattheteamlevelbyStrategicHealth Authority(SHA)averagingasfollows:educationandtraining(9%),researchand evaluation(5%),adminandmanagement(23%),consultationandliaison(13%) andclinical(49%). 22percentofcaseslastedfor4weeksorless,24percentfor13weeksorless,18 percentfor26weeksorless,16percentfor52weeksorlessand20percentfor morethan52weeks. Basedon335teamsand15,653cases.1
B.Overheads Management, administrationand estatesstaff Nonstaff C.Capitaloverheads
7,679peryear 16,725per year
2,237peryear
Workingtime
Ratioofdirectto indirecttimeon: patientrelatedwork facetofacecontact Durationofepisode
42weeksper year 37.9hoursper week 1:0.63 1:1.06
Caseload
47casesper team Londonmultiplier 1.19xA AllowsforhighercostsassociatedwithworkinginLondon.4,5,8 NonLondonmultiplier 0.97xA AllowsforlowercostsassociatedwithworkinginLondon.4,5,8 Unitcostsavailable2010/2011 41perhourperteammember;68costperhourperteammemberforpatientrelatedactivities;86costperhourperteam memberforfacetofacecontact;5,973averagecostpercase.
ChildandAdolescentMentalHealthService(CAMHS)mapping(2009)DurhamUniversity&DepartmentofHealth,www.childrensmapping.org.uk/. TheCAMHSMappingdataarenolongerbeingcollectedsoinformationforthisschemahasbeenupratedthisyear. 3 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 4 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 5 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 6 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 7 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 8 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).

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IV. HOSPITALBASED HEALTH CARE STAFF
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13. Scientific and professional

13.1Hospitalphysiotherapist 13.2Hospitaloccupationaltherapist 13.3Hospitalspeechandlanguagetherapist 13.4Dietitian 13.5Radiographer 13.6Hospitalpharmacist 13.7Alliedhealthprofessionalsupportworker
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13.1 Hospital physiotherapist

UsingdatafromtheNHSReferenceCosts,1themeanaveragecostforanonconsultantled(nonadmitted)followupphysiotherapy attendancein2010was36withtheminimumfor25percentofservicesbeing27andthemaximum40.Costshavebeenuprated usingtheHCHSPay&Pricesinflator.
Costsandunit estimation A.Wages/salary 2010/2011value 22,700 peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand5oftheJanuary March2011NHSStaffEarningsforqualifiedAlliedHealthProfessionals.Medianfulltimeequivalent totalearnings,whichincludebasicsalaryplushoursrelatedpay,overtime,occupationpayments, locationpayments,andotherpaymentssuchasredundancypayorpaymentofnoticeperiods,were 2 24,100. MorespecialistgradesrangefromAfCband6to8Cforaphysiotherapistspecialistto consultant.SeesectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployerscontributionto superannuation. 3 QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998). CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandtheHigherEducation 4 FundingCouncilforEngland(HEFCE). Seetheprefaceformoreinformationonqualificationsand alsoschema7.4fordetails. 5 TakenfromNHS(England)SummarisedAccounts. Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycostsand includedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststotheproviderfor office,travel/transportandtelephone,educationandtraining,suppliesandservices(clinicaland general),aswellasutilitiessuchaswater,gasandelectricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedtoreflectshareduse 6,7 ofbothtreatmentandnontreatmentspace. Noallowancehasbeenmadeforthecostof equipment.Capitalcostshavebeenannuitisedover60yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Currentguidelinefor 8 reimbursement:54pencepermileupto3,500miles,18penceover3,500miles. 9 Includes29daysannualleaveand8daysstatutoryleave. Assumes5study/trainingdaysand12 10 dayssicknessleave. Unitcostsbasedon1549hoursperannum. Nocurrentinformationavailable. Surgeryconsultation. Clinicconsultations. Telephoneconsultations. 11 Allbasedoninformationtakenfromthe2006/07GeneralPracticeWorkloadSurvey. 6,7,12 AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaveragecost.
5,352 peryear 4,927 peryear
D.Overheads Management, administrationand estatesstaff Nonstaff E.Capitaloverheads
5,330peryear 11,782peryear 4,541 peryear
F.Travel Workingtime Ratioofdirectto indirecttime Durationofcontacts 41.3weeksperannum 37.5hoursperweek 32.9minutes 23.3minutes 13.1minutes 1.19x(AtoB) 1.46xE 0.97xE
Londonmultiplier NonLondonmultiplier
AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothenational 6,7,12 averagecost. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 32(35)perhour.
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 9 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 10 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 11 TheInformationCentre(2007)2006/07UKGeneralPracticeWorkloadSurvey,PrimaryCareStatistics,TheInformationCentre,Leeds. 12 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
182
13.2 Hospital occupational therapist

UsingdatafromtheNHSReferenceCosts,1themeanaveragecostforanonconsultantled(nonadmitted)followupoccupational therapyattendancein2010was60withtheminimumfor25percentofservicesbeing38andthemaximum65.Costshavebeen upratedusingtheHCHSPay&Pricesinflator. 2010/2011value Notes Costsandunitestimation A.Wages/salary 22,700peryear BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChange Band5oftheJanuaryMarch2011NHSStaffEarningsforqualifiedAlliedHealth Professionals.Medianfulltimeequivalenttotalearnings,whichincludebasic salaryplushoursrelatedpay,overtime,occupationpayments,location payments,andotherpaymentssuchasredundancypayorpaymentofnotice periods,were24,100.2MorespecialistgradesrangefromAfCband6to8Bfor anOccupationalTherapistSpecialisttoConsultant(seesectionVforsalary information).3 B.Salaryoncosts 5,352peryear Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. C.Qualifications 4,911peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenet al.(1998).4CurrentcostinformationhasbeenprovidedbytheDepartmentof 5 HealthandtheHigherEducationFundingCouncilforEngland(HEFCE). Seethe prefaceformoreinformationonqualificationsandalsoschema7.4fordetails. D.Overheads TakenfromNHS(England)SummarisedAccounts.6Seeprefaceformore information. Management, 5,330peryear Managementandothernoncarestaffcostswere19.1percentofdirectcare administrationand salarycostsandincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecosts Nonstaff 11,782peryear totheproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gas andelectricity. E.Capitaloverheads 4,541peryear BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto reflectshareduseofbothtreatmentandnontreatmentspace.7,8Noallowance hasbeenmadeforthecostofequipment.Capitalcostshavebeenannuitised over60yearsatadiscountrateof3.5percent. Workingtime 41.3weeksperannum Includes29daysannualleaveand8daysstatutoryleave.9Assumes5study/ 37.5hoursperweek trainingdaysand12dayssicknessleave.10Unitcostsbasedon1549hoursper annum. Ratioofdirecttoindirect time Nocurrentinformationavailable. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondoncomparedtothenational 7,8,11 1.35xE averagecost. NonLondonmultiplier 0.97xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedto 7,8,11 thenationalaveragecost. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 32(35)perhour.
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 NHSEmployers(2006)PayCircular(AfC)1/2006.PayandconditionsforNHSstaffcoveredbytheAgendaforChangeAgreement,NHSEmployers, London. 4 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 5 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 6 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 7 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 8 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 9 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 10 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
183
13.3 Hospital speech and language therapist

UsingdatafromtheNHSReferenceCosts,1themeanaveragecostforanonconsultantled(nonadmitted)followupspeechand languagetherapyattendancein2010was68,withtheminimumfor25percentofservicesbeing35andthemaximum71.Costs havebeenupratedusingtheHCHSPay&Pricesinflator. 2010/2011value Notes Costsandunit estimation A.Wages/salary 22,700peryear BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand5of theJanuaryMarch2011NHSStaffEarningsforqualifiedAlliedHealthProfessionals. Medianfulltimeequivalenttotalearnings,whichincludebasicsalaryplushours relatedpay,overtime,occupationpayments,locationpayments,andotherpayments suchasredundancypayorpaymentofnoticeperiods,were24,100.2Morespecialist gradesrangefromAfCband6to8Cforaspecialistspeechandlanguagetherapistto consultant(seesectionVforsalaryinformation).3 B.Salaryoncosts 5,352peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Qualifications 5,035peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).4CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthand 5 theHigherEducationFundingCouncilforEngland(HEFCE). Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails. 6 D.Overheads TakenfromNHS(England)SummarisedAccounts. Seeprefaceformoreinformation. Management, 5,330peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary administrationand costsandincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe Nonstaff 11,782peryear providerforoffice,travel/transportandtelephone,educationandtraining,supplies andservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. E.Capitaloverheads 3,465peryear BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedtoreflect shareduseofbothtreatmentandnontreatmentspace.7,8Noallowancehasbeen madeforthecostofequipment.Capitalcostshavebeenannuitisedover60yearsata discountrateof3.5percent. Workingtime 41.3weeksperannum Includes29daysannualleaveand8daysstatutoryleave.9Assumes5study/training 10 37.5hoursperweek daysand12dayssicknessleave. Unitcostsbasedon1549hoursperannum. Ratioofdirectto indirecttime Nocurrentinformationavailable. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaverage 1.35xE cost.7,8,11 NonLondon 0.97xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothe multiplier nationalaveragecost.7,8,11 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 31(35)perhour.
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 NHSEmployers(2006)PayCircular(AfC)1/2006.PayandconditionsforNHSstaffcoveredbytheAgendaforChangeAgreement,NHSEmployers, London. 4 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 5 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 6 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 7 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 8 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2010. 9 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 10 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
184
13.4 Dietitian
Costsandunit estimation A.Wages/salary 2010/2011value 22,700peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand5ofthe JanuaryMarch2011NHSStaffEarningsforqualifiedAlliedHealthProfessionals.Median fulltimeequivalenttotalearnings,whichincludebasicsalaryplushoursrelatedpay, overtime,occupationpayments,locationpayments,andotherpaymentssuchas 1 redundancypayorpaymentofnoticeperiods,were24,100. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).2CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandthe 3 HigherEducationFundingCouncilforEngland(HEFCE). Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycosts andincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedtoreflect 5,6 shareuseofbothtreatmentandnontreatmentspace. Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Currentguidelinefor reimbursement:54pencepermileupto3,500miles,18penceover3,500miles.7 Includes29daysannualleaveand8daysstatutoryleave.8Assumes5study/trainingdays and12dayssicknessleave.9Unitcostsbasedon1549hoursperannum.
3,535peryear
41.3weeksper annum 37.5hoursper week
Ratioofdirectto indirecttime
Nocurrentinformationavailable. Londonmultiplier 1.19x(AtoB)1.38 AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaverage 5,6,10 xE cost. NonLondon 0.97xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothe 5,6,10 multiplier nationalaveragecost. Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 31(35)perhour.

1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
185
13.5 Radiographer
UsingdatafromtheNHSReferenceCosts,1themeanaveragecostforaradiotherapyinpatientwas243andforaregulardayornight casewas146.Anoutpatientcontactwas114.CostshavebeenupratedusingtheHCHSPay&Pricesinflator. Costsandunit 2010/2011value Notes estimation A.Wages/salary 22,700peryear BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand 5oftheJanuaryMarch2011NHSStaffEarningsforQualifiedHealthProfessionals. Medianfulltimeequivalenttotalearnings,whichincludebasicsalaryplushours relatedpay,overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiods,were24,100.2 MorespecialistgradesrangefromAfCband6to8Cforaradiographerspecialistto consultant. B.Salaryoncosts 5,352peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Qualifications 5,278peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenet al.(1998).3CurrentcostinformationhasbeenprovidedbytheDepartmentof 4 HealthandtheHigherEducationFundingCouncilforEngland(HEFCE). Seethe prefaceformoreinformationonqualificationsandalsoschema7.4fordetails. D.Overheads TakenfromNHS(England)SummarisedAccounts.5Seeprefaceformore information. Management, 5,330peryear Managementandothernoncarestaffcostswere19.1percentofdirectcare administrationand salarycostsandincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo Nonstaff 11,782peryear theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gas andelectricity. E.Capitaloverheads 6,853peryear BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto 6,7 reflectshareduseofbothtreatmentandnontreatmentspace. Capitalcosts havebeenannuitisedover60yearsatadiscountrateof3.5percent. Workingtime 41.3weeksperannum Includes29daysannualleaveand8daysstatutoryleave.8Assumes5study/ 37.5hoursperweek trainingdaysand12dayssicknessleave.9Unitcostsbasedon1549hoursper annum. Ratioofdirectto indirecttime Nocurrentinformationavailable. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondoncomparedtothenational 1.38xE averagecost.6,7,10 NonLondonmultiplier 0.97xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedto thenationalaveragecost.6,7,10 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 34(37)perhour.
DepartmentofHealth(2011)NHSReferenceCosts20092010, www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459. 2 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
186
13.6 Hospit al pharmacist

Costsandunit estimation A.Wages/salary 2010/2011value 30,500peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand6of theJanuaryMarch2011NHSStaffEarningsestimates.Medianfulltimeequivalent totalearningswhichincludebasicsalaryplushoursrelatedpay,overtime,occupation payments,locationpayments,andotherpaymentssuchasredundancypayorpayment 1 ofnoticeperiodswere32,700. MorespecialistgradesrangefromAfCband7to8D forapharmacistspecialisttoconsultant. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. 2 (1998). CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthand theHigherEducationFundingCouncilforEngland(HEFCE).3Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary costsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe providerforoffice,travel/transportandtelephone,educationandtraining,supplies andservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. Basedonthenewbuildandlandrequirementsofapharmacy,plusadditionalspacefor sharedfacilities.5,6Capitalcostshavebeenannuitisedover60yearsatadiscountrate of3.5percent. Noinformationavailableonaveragemileagecoveredpervisit.Currentguidelinefor 7 reimbursement:54pencepermileupto3,500miles,18penceover3,500miles. 8 Includes29daysannualleaveand8daysstatutoryleave. Assumes4study/training days(30hours)and12dayssicknessleave.Unitcostsbasedon1565hoursper annum.9 Ratiosareestimatedonthebasisthat50percentoftimeisspentondirectclinical patientactivities,20percentoftimeondispensaryactivitiesand30percentonnon 10 clinicalactivity.
41.7weeksper annum 37.5hoursper week 1:1 1:0.43 1.19x(AtoB) 1.37xE 0.97xE
Ratioofdirectto indirecttimeon: directclinicalpatient time patientrelated activities Londonmultiplier
AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaverage cost.5,6,11 NonLondonmultiplier AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothe nationalaveragecost.5,6,11 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 41(46)perhour;82(92)percostofdirectclinicalpatienttime(includestravel);59(91)percostofpatientrelatedactivities.
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 NHSEmployers(2011)MileagePaymentsReview, www.nhsemployers.org/PayAndContracts/AgendaForChange/mileage/Pages/Mileagepaymentsreview.aspx 8 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 9 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London. 10 PersonalcommunicationwiththeGreaterManchesterWorkforceDevelopmentCorporation(2003). 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
2 1
187
13.7 Allied health professional support worker

Alliedhealthprofessionalsupportworkersprovidevitalassistancetohealthcareprofessionalsindiagnosing,treatingand caringforpatients.Theyworkinavarietyofsettingsdependingontheirrole,suchasinpatientshomes,aGPclinicorina hospitaldepartment.1 Costsandunit 2010/2011value Notes estimation A.Wages/salary 17,600peryear BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChange Band3oftheJanuaryMarch2011NHSStaffEarningsestimatesforunqualified alliedhealthprofessionals.Medianfulltimeequivalenttotalearnings,which includebasicsalaryplushoursrelatedpay,overtime,occupationpayments, locationpayments,andotherpaymentssuchasredundancypayorpaymentof noticeperiods,were18,400.2 B.Salaryoncosts 3,985 peryear Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. C.Qualifications 0 Trainingcostsareassumedtobezero,althoughmanytakeNVQcourses. 3 D.Overheads TakenfromNHS(England)SummarisedAccounts. Seeprefaceformore information. Management, 4,123peryear Managementandothernoncarestaffcostswere19.1percentofdirectcare administrationand salarycostsandincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecosts Nonstaff 8,979peryear totheproviderforoffice,travel/transportandtelephone,educationand training,suppliesandservices(clinicalandgeneral),aswellasutilitiessuchas water,gasandelectricity. E.Capitaloverheads 2,970 peryear BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto reflectshareduseofbothtreatmentandnontreatmentspace.4,5Capitalcosts havebeenannuitisedover60yearsatadiscountrateof3.5percent. Workingtime 42.3weeksper Includes29daysannualleave,8daysstatutoryleaveand12dayssickness annum leave.6,7Nostudy/trainingdayshavebeenassumed.Unitcostsbasedon1585 37.5hoursper hoursperannum. week Ratioofdirectto indirecttime Nocurrentinformationavailable. Londonmultiplier 1.19 x(AtoB) AllowsforthehighercostsassociatedwithLondoncomparedtothenational 1.34xE averagecost.4,5,8 NonLondon 0.97xE AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedto multiplier thenationalaveragecost.4,5,8 Unitcostsavailable2010/2011 24perhour.
1 2
NHSCareers(2011)ClinicalSupportstaff,NationalHealthService,London.www.nhscareers.nhs.uk/details/Default.aspx?Id=1871. TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 4 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 5 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 6 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 7 TheInformationCentre(2010)ResultsoftheNHSSicknessAbsenceSurvey2009,NHSEmployers,London.
189
14. Nurses
14.1Nurseteammanager(includeswardmanagers,sistersandclinicalmanagers) 14.2Nurseteamleader(includesdeputyward/unitmanager,wardteamleader,senior staffnurse 14.3Nurse,dayward(includesstaffnurse,registerednurse,registeredpractitioner) 14.4Nurse,24hourward(includesstaffnurse,registerednurse,registered practitioner) 14.5Clinicalsupportworker(hospital)
190
191
14.1 Nurse team manager (includes ward manager, sister and clinical manager)
Costsandunit estimation A.Wages/salary 2010/2011value 38,800peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand7 oftheJanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses.Basic salaryplushoursrelatedpay,overtime,occupationpayments,locationpayments, andotherpaymentssuchasredundancypayorpaymentofnoticeperiodswas 40,200.1Itdoesnotincludeanylumpsumallowancesanditisassumedthatno unsocialhoursareworked.SeesectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).2CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthand 3 theHigherEducationFundingCouncilforEngland(HEFCE). Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary costsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasand electricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto reflectshareduseofofficespaceforadministration,andrecreationalandchanging facilities.5,6Treatmentspacehasnotbeenincluded.Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. Includes29daysannualleaveand8daysstatutoryleave.7Assumes5study/training 8 daysand12dayssicknessleave. Unitcostsbasedon1549hoursperannum. BasedontheMcKinseyreportcommissionedbytheDepartmentofHealthin2009,9 hospitalnursesareestimatedtospent41percentoftheirtimeonpatientcarewith 59percentoftheirtimespentonnonpatientactivitiessuchaspaperworkand administration,handingoverandcoordination,discussionwithothernurses,and preparingmedication(awayfrompatients). AllowsforthehighercostsassociatedwithworkinginLondon.5,6,10
E.Capitaloverheads
2,306peryear
Workingtime Ratioofdirectto indirecttimeon: facetofacecontacts
41.3weeksperannum 37.5hoursperweek 1:1.44
Londonmultiplier
1.19x(AtoB) 1.37xE NonLondonmultiplier 0.96xE AllowsforthelowercostsassociatedwithworkingoutsideLondon.5,6,10 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 52(58)perhour;129(142)perhourofpatientcontact.
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 6 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 7 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 8 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 9 TheDepartmentofHealth(2010)AchievingworldclassproductivityintheNHS,2009/102013/14:theMcKinseyreport,DepartmentofHealth,London. www.dh.gov.uk/en/FreedomOfInformation/Freedomofinformationpublicationschemefeedback/FOIreleases/DH_116520. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
192
14.2 Nurse team leader (includes deputy ward/unit manager, ward team leader, senior staff nurse)
Costsandunit estimation A.Wages/salary 2010/2011value 32,600peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand 6oftheJanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses. Medianfulltimeequivalenttotalearnings,whichincludebasicsalaryplushours relatedpay,overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiodswere34,300.1 SeesectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenet al.(1998).2CurrentcostinformationhasbeenprovidedbytheDepartmentof HealthandtheHigherEducationFundingCouncilforEngland(HEFCE).3Seethe prefaceformoreinformationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirectcare salarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gas andelectricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto reflectshareduseofofficespaceforadministration,andrecreationaland changingfacilities.5,6Treatmentspacehasnotbeenincluded.Capitalcostshave beenannuitisedover60yearsatadiscountrateof3.5percent. Includes29daysannualleaveand8daysstatutoryleave.7Assumes5 study/trainingdaysand12dayssicknessleave.8Unitcostsbasedon1549hours perannum. BasedontheMcKinseyreportcommissionedbytheDepartmentofHealthin 2009,9hospitalnursesareestimatedtospent41percentoftheirtimeonpatient carewith59percentoftheirtimespentonnonpatientactivitiessuchas paperworkandadministration,handingoverandcoordination,discussionwith othernurses,andpreparingmedication(awayfrompatients). AllowsforthehighercostsassociatedwithworkinginLondon.5,6,10
E.Capitaloverheads
2,306peryear
Workingtime
Ratioofdirectto indirecttimeon: facetofacecontacts
41.3weeksper annum 37.5hoursper week 1:1.44
Londonmultiplier
1.19x(AtoB) 1.37xE NonLondonmultiplier 0.96xE AllowsforthelowercostsassociatedwithworkingoutsideLondon.5,6,10 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 44(50)perhour;107(122)perhourofpatientcontact.
1 2
193
14.3 Nurse, day ward (includes staff nurse, registered nurse, registered practitioner)
Costsandunit estimation A.Wages/salary 2010/2011value 25,500peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand5 oftheJanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses. Medianfulltimeequivalenttotalearnings,whichincludebasicsalaryplushours relatedpay,overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiodswere29,100.1See sectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).2CurrentcostinformationhasbeenprovidedbytheDepartmentofHealth andtheHigherEducationFundingCouncilforEngland(HEFCE).3Seetheprefacefor moreinformationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary costsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasand electricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto reflectshareduseofofficespaceforadministration,andrecreationalandchanging facilities.5,6Treatmentspacehasnotbeenincluded.Capitalcostshavebeen annuitisedover60yearsatadiscountrateof3.5percent. Includes29daysannualleaveand8daysstatutoryleave.7Assumes5study/training daysand12dayssicknessleave.8Unitcostsbasedon1549hoursperannum.
E.Capitaloverheads
1,411peryear
Workingtime
Londonmultiplier
NonLondon AllowsforthelowercostsassociatedwithworkingoutsideLondon.5,6,10 multiplier Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 34(40)perhour;82(97)perhourofpatientcontact.
1.19x(AtoB) 1.34xE 0.96xE
BasedontheMcKinseyreportcommissionedbytheDepartmentofHealthin2009,9 hospitalnursesareestimatedtospent41percentoftheirtimeonpatientcarewith 59percentoftheirtimespentonnonpatientactivitiessuchaspaperworkand administration,handingoverandcoordination,discussionwithothernurses,and preparingmedication(awayfrompatients). AllowsforthehighercostsassociatedwithworkinginLondon.5,6,10
1 2
194
14.4 Nurse, 24hour ward (includes staff nurse, registered nurse, registered practitioner)
Costsandunit estimation A.Wages/salary 2010/2011value 25,500peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendaforChangeBand 5oftheJanuaryMarch2011NHSStaffEarningsestimatesforQualifiedNurses. Medianfulltimeequivalenttotalearnings,whichincludebasicsalaryplushours relatedpay,overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiods,were29,100.1 SeesectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenet al.(1998).2CurrentcostinformationhasbeenprovidedbytheDepartmentof HealthandtheHigherEducationFundingCouncilforEngland(HEFCE).3Seethe prefaceformoreinformationonqualificationsandalsoschema7.4fordetails. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformore information. Managementandothernoncarestaffcostswere19.1percentofdirectcare salarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gas andelectricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,butadjustedto reflectshareduseofofficespaceforadministration,andrecreationaland changingfacilities.5,6Treatmentspacehasnotbeenincluded.Capitalcostshave beenannuitisedover60yearsatadiscountrateof3.5percent. Includes29daysannualleaveand8daysstatutoryleave.7Assumes5study/ trainingdaysand12dayssicknessleave.8Unitcostsbasedon1549hoursper annum. BasedontheMcKinseyreportcommissionedbytheDepartmentofHealthin 2009,9hospitalnursesareestimatedtospent41percentoftheirtimeonpatient carewith59percentoftheirtimespentonnonpatientactivitiessuchas paperworkandadministration,handingoverandcoordination,discussionwith othernurses,andpreparingmedication(awayfrompatients). AllowsforthehighercostsassociatedwithworkinginLondon.5,6,10
E.Capitaloverheads
1,411peryear
Workingtime
Londonmultiplier
NonLondon AllowsforthelowercostsassociatedwithworkingoutsideLondon.5,6,10 multiplier Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 34(40)perhour;82(97)perhourofpatientcontact.
1.19x(AtoB) 1.34xE 0.96xE
1 2
195
14.5 Clinical support worker (hospital)
Costsandunit estimation A.Wages/salary 2010/2011value 15,600peryear Notes BasedonthemedianfulltimeequivalentbasicsalaryforAgendafor ChangeBand2oftheJanuaryMarch2011NHSStaffEarnings estimatesforunqualifiednurses.Medianfulltimeequivalenttotal earnings,whichincludebasicsalaryplushoursrelatedpay,overtime, occupationpayments,locationpayments,andotherpaymentssuchas redundancypayorpaymentofnoticeperiodswere18,500.1See sectionVforinformationonmeansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryfor employerscontributiontosuperannuation. Noprofessionalqualificationsassumed. TakenfromNHS(England)SummarisedAccounts.2Seeprefacefor moreinformation. Managementandothernoncarestaffcostswere19.1percentof directcaresalarycostsandincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.They includecoststotheproviderforoffice,travel/transportand telephone,educationandtraining,suppliesandservices(clinicaland general),aswellasutilitiessuchaswater,gasandelectricity. BasedonthenewbuildandlandrequirementsofNHSfacilities,but adjustedtoreflectshareduseofofficespaceforadministration,and recreationalandchangingfacilities.3,4Treatmentspacehasnotbeen included.Itisassumedthatauxiliarynursesuseonesixthofanoffice. Capitalcostshavebeenannuitisedover60yearsatadiscountrateof 3.5percent. Includes29daysannualleaveand8daysstatutoryleave.5Assumes12 dayssicknessleave.6Unitcostsbasedon1575hoursperannum.
B.Salaryoncosts C.Qualifications D.Overheads Management, administrationand estatesstaff Nonstaff D.Capitaloverheads
42.3weeksper annum 37.5hoursper week Ratioofdirectto indirecttime Londonmultiplier 1.19x(AtoB) 1.35xD NonLondonmultiplier 0.96xD Unitcostsavailable2010/2011 20perhour.
Workingtime
Nocurrentinformationavailable.Seepreviouseditionsofthisvolume forsourcesofinformation. AllowsforthehighercostsassociatedwithworkinginLondon.3,4,7 AllowsforthelowercostsassociatedwithworkingoutsideLondon.3,4,7
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 3 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 4 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 5 NHSEmployers(2008)AgendaforChange,TermsandConditionsofService,NHSStaffCouncil.www.aop.org.uk/uploads/uploaded_files/HOC/08 04_afc_t_c_handbook_v2.pdf 6 TheInformationCentre(2011)SicknessAbsenceRatesintheNHS:OctoberDecember2010,NHSEmployers,London. 7 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
15. Doctors
15.1Foundationhouseofficer1 15.2Foundationhouseofficer2 15.3Registrargroup 15.4Associatespecialist 15.5Consultant:medical 15.6Consultant:surgical 15.7Consultant:psychiatric
199
15.1 Foundation house officer 1

TheFoundationProgrammeisatwoyear,generalpostgraduatemedicaltrainingprogrammewhichiscompulsoryforallnewlyqualified medicalpractitionersintheUK.TheFoundationProgrammeformsthebridgebetweenmedicalschoolandspecialist/generalpractice training.1 Costsandunit 2010/2011value Notes estimation A.Wages/salary 32,200peryear TakenfromtheJanuaryMarch2011NHSStaffEarningsestimatesforMedicalStaff Groups.Basedonthemeanfulltimeequivalenttotalearnings,whichincludebasicsalary plushoursrelatedpay,overtime,occupationpayments,locationpayments,andother paymentssuchasredundancypayorpaymentofnoticeperiods.Themeanbasicsalary was22,600.2SeesectionVforinformationonmediansalaries. B.Salaryoncosts 7,898peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Qualifications 19,546peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).3CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandthe 4 HigherEducationFundingCouncilforEngland(HEFCE). Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails.Forhospitaldoctors,post graduatestudyconsistsofatwoyearFoundationProgramme.5Duringthefirstyear, traineesholdonlyprovisionalregistrationwiththeGeneralMedicalCouncil,full registrationbeinggrantedonsuccessfulcompletionofthefirstyear. D.Overheads TakenfromNHS(England)SummarisedAccounts.6Seeprefaceformoreinformation. Management, 7,659peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycosts administrationand andincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe Nonstaff 16,681peryear providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. E.Ongoingtraining 2,382peryear Thiscostcomprisesanamountforthegenericcurriculum,thepostgraduatecentres infrastructureandstudyleave.Includedalsoarethecostsofthecourseorganisers,admin support,trainersworkshops,vocationaltrainingandInternalcoursesforGPtutors. Excludedarethecostsofrunningthelibraryandpostgraduatecentres.7 F.Capital 3,297peryear BasedonthenewbuildandlandrequirementsofNHSfacilities.8,9Adjustmentshavebeen overheads madetoreflectshareduseofadministrationandrecreationalfacilities,including accommodationfornighttimeduties.Treatmentspacehasnotbeenincluded.Capital costshavebeenannuitisedover60yearsatadiscountrateof3.5percent. Workingtime 44.4weeksper Includes25daysannualleaveplus8statutoryleavedays.10Assumes5dayssicknessleave. annum Nostudy/trainingdayshavebeenassumed.UndertheEuropeanWorkingTimeDirective 48hoursper (EWTD),themajorityoffoundationofficers(Year1)arenowworkingupto48hoursper week week,19.7percentareworkingupto56hoursand11.3percentareworking40hours.11 Unitcostsarebasedon2131hoursperannum. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondon.8,9,12 1.38xF NonLondon 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon.8,9,12 multiplier 0.97xF Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 33(42)perhour(48hourweek).28(36)perhour(56hourweek).39(50)perhour(40hourweek).(IncludesAtoF).
1 2
NationalHealthService(2011)TheFoundationProgramme,www.foundationprogramme.nhs.uk/pages/home. TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 NationalHealthService(2008)ModernisingMedicalCareers,NationalHealthService,London. 6 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 7 PersonalcommunicationwiththeLondonDeanery,2006. 8 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 9 BasedonpersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 10 NHSEmployers(2006)JuniorDoctorsTerms&ConditionsofService,NHSEmployers,London. 11 ProvidedbytheDepartmentofHealth,2009. 12 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
200
15.2 Foundation house officer 2

TheFoundationProgrammeisatwoyear,generalpostgraduatemedicaltrainingprogrammewhichiscompulsoryforallnewlyqualified medicalpractitionersintheUK.TheFoundationProgrammeformsthebridgebetweenmedicalschoolandspecialist/generalpractice 1 training Costsandunit 2010/2011value Notes estimation A.Wages/salary 41,200peryear TakenfromtheJanuaryMarch2011NHSStaffEarningsestimatesforMedicalStaff Groups.Basedonthemeanfulltimeequivalenttotalearnings,whichincludebasic salaryplushoursrelatedpay,overtime,occupationpayments,locationpayments, andotherpaymentssuchasredundancypayorpaymentofnoticeperiods.Themean basicsalarywas29,1002SeesectionVforinformationonmediansalaries. B.Salaryoncosts 10,310peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Qualifications 21,807peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).3CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthand 4 theHigherEducationFundingCouncilforEngland(HEFCE). Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails.Forhospitaldoctors, postgraduatestudyconsistsofatwoyearFoundationProgramme.5Duringthefirst year,traineesholdonlyprovisionalregistrationwiththeGeneralMedicalCouncil,full registrationbeinggrantedonsuccessfulcompletionofthefirstyear. D.Overheads TakenfromNHS(England)SummarisedAccounts.6Seeprefaceformoreinformation. Management, 9,838peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalary administrationand costsandincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststo Nonstaff 21,428peryear theproviderforoffice,travel/transportandtelephone,educationandtraining, suppliesandservices(clinicalandgeneral),aswellasutilitiessuchaswater,gasand electricity. E.Ongoingtraining 2,382peryear Thiscostcomprisesanamountforthegenericcurriculum,thepostgraduatecentres infrastructure,andstudyleave.Includedalsoarethecostsofthecourseorganisers, adminsupport,trainersworkshops,vocationaltrainingandInternalcoursesforGP tutors.Excludedarethecostsofrunningthelibrarypostgraduatecentres.7 F.Capitaloverheads 3,297peryear BasedonthenewbuildandlandrequirementsofNHSfacilities.8,9 Workingtime 44.4weeksper Includes25daysannualleaveplus8statutoryleavedays.10 Assumes5dayssickness annum leave.Nostudy/trainingdayshavebeenassumed.UndertheEuropeanWorkingTime 48hoursper Directive(EWTD),themajorityoffoundationofficers(Y2)arenowworkingupto48 week hoursperweek.22.3percentareworkingupto56hoursand13percentareworking 11 40hours. Unitcostsarebasedon2131hoursperannum. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondon.8,9,12 1.38xF NonLondonmultiplier 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon.8,9,12 0.97xF Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 42(52)perhour(48hourweek).36(44)perhour(56hourweek).50(63)perhour(40hourweek).(IncludesAtoF).
1 2
NationalHealthService(2011)TheFoundationProgramme,www.foundationprogramme.nhs.uk/pages/home. TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 3 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 4 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 5 NationalHealthService(2008)ModernisingMedicalCareers,NationalHealthService,London. 6 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 7 PersonalcommunicationwiththeLondonDeanery,2006. 8 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 9 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 10 NHSEmployers(2006)JuniorDoctorsTerms&ConditionsofService,NHSEmployers,London. 11 ProvidedbytheDepartmentofHealth,2009. 12 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
201
15.3 Registrar group

Intermsofstaffnumbers,thelargestgroupofdoctorsistheregistrargroup(registrars,seniorregistrars,specialistregistrars(SpRs)and specialtyregistrars(STRs)). Costsandunit 2010/2011 Notes estimation value A.Wages/salary 55,600per TakenfromtheJanuaryMarch2011NHSStaffEarningsestimatesformedicalstaffgroups. year Basedonthemeanfulltimeequivalenttotalearnings,whichincludebasicsalaryplushours relatedpay,overtime,occupationpayments,locationpayments,andotherpaymentssuchas redundancypayorpaymentofnoticeperiods.Themeanbasicsalarywas37,700.1See sectionVforinformationonmediansalaries. B.Salaryoncosts 14,169per Employersnationalinsuranceisincludedplus14percentofsalaryforemployers year contributiontosuperannuation. C.Qualifications 26,329per QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998).2 year CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandtheHigher EducationFundingCouncilforEngland(HEFCE).3Seetheprefaceformoreinformationon qualificationsandalsoschema7.4fordetails.Specialtyregistrartraininginvolvesthreeyears fulltimepostgraduatetrainingwithatleasttwooftheyearsinaspecialtytraining 4,5 programme. D.Overheads TakenfromNHS(England)SummarisedAccounts.6Seeprefaceformoreinformation. Management, 13,325per Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycostsand administrationand year includedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe Nonstaff 29,024per providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. year E.Ongoingtraining 2,382peryear Thiscostcomprisesanamountforthegenericcurriculum,thepostgraduatecentres infrastructure,andstudyleave.Includedalsoarethecostsofthecourseorganisers,admin support,trainersworkshops,vocationaltrainingandInternalcoursesforGPtutors.Excluded 7 arethecostsofrunningthelibraryandpostgraduatecentres. F.Capitaloverheads 3,297peryear BasedonthenewbuildandlandrequirementsofNHSfacilities.8,9Adjustmentshavebeen madetoreflectshareduseofadministrationandrecreationalfacilities,including accommodationfornighttimeduties.Treatmentspacehasnotbeenincluded.Capitalcosts havebeenannuitisedover60yearsatadiscountrateof3.5percent. Workingtime 41.4weeksper Includes30daysannualleave,statutoryleavedays,10studytrainingdays.4Assumes5days annum sicknessleave.UndertheEuropeanWorkingTimeDirective(EWTD),themajorityofspecialist 48hoursper registrarsarenowworkingupto48hoursperweek.34percentareworkingupto56hours 10 week and3.9percentareworking40hours. Unitcostsarebasedon1987hoursperannum. 8,9,11 Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondon. 1.38xF NonLondon 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon.8,9,11 multiplier 0.97xF Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 59(73)perhour(48hourweek).51(62)perhour(56hourweek).71(87)perhour(40hourweek).(IncludesAtoF).
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 NationalHealthService(2008)ModernisingMedicalCareers,NationalHealthService,London. 5 NHSEmployers(2008)TermsandConditionsofServiceforSpecialtyDoctorsEngland(2008),NHSEmployers,London. 6 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 7 PersonalcommunicationwiththeLondonDeanery,2006. 8 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 9 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 10 ProvidedbytheDepartmentofHealth,2009. 11 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
202
15.4 Associate specialist

Anassociatespecialistisadoctorwhohastrainedandgainedexperienceinamedicalorsurgicalspecialtybuthasnotbecomea consultant.Thesedoctorsusuallyworkindependentlybutwillbeattachedtoaclinicalteamledbyaconsultantintheirspecialty.Some ofthemarelistedontheGMCsspecialistregisterandareeligibletotakeonaconsultantpost.Thereasonswhytheydonotinclude:a wishtoconcentrateonclinicalworkandtoavoidtheadministrativepressuresofaconsultantpost;adesiretohaveabetterwork/life balance;and,insomecases,alackofopportunitytoaccesshighertrainingposts.Theydo,however,takepartinthefullrangeofclinical 1,2,3 work,includingteachingjuniordoctors.
Costsandunit estimation A.Wages/salary 2010/2011 value 89,400peryear Notes TakenfromtheJanuaryMarch2011 NHSStaffEarningsestimatesforMedicalStaffGroups.Based onthemeanfulltimeequivalenttotalearnings,whichincludebasicsalaryplushoursrelatedpay, overtime,occupationpayments,locationpayments,andotherpaymentssuchasredundancypay orpaymentofnoticeperiods.Themeanbasicsalarywas78,200.4SeesectionVforinformation onmediansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployerscontributionto superannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998).5 CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandtheHigherEducation FundingCouncilforEngland(HEFCE).6Seetheprefaceformoreinformationonqualificationsand alsoschema7.4fordetails.AssociateSpecialisttraininginvolvesatleastfouryearsfulltimepost graduatetraining,atleasttwoofwhichwillbeinaspecialtytrainingprogramme.7 TakenfromNHS(England)SummarisedAccounts.8 Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycostsand includedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststotheproviderfor office,travel/transportandtelephone,educationandtraining,suppliesandservices(clinicaland general),aswellasutilitiessuchaswater,gasandelectricity. Thiscostcomprisesanamountforthegenericcurriculum,thepostgraduatecentres infrastructure,andstudyleave.Includedalsoarethecostsofthecourseorganisers,administrative support,trainersworkshops,vocationaltrainingandInternalcoursesforGPtutors.Excludedare thecostsofrunningthelibraryandpostgraduatecentres.9 BasedonthenewbuildandlandrequirementsofNHSfacilities.10,11Adjustmentshavebeenmade toreflectshareduseofadministrationandrecreationalfacilities,includingaccommodationfor nighttimeduties.Treatmentspacehasnotbeenincluded.Capitalcostshavebeenannuitisedover 60yearsatadiscountrateof3.5percent. Includes30daysannualleave,8statutoryleavedays,10studytrainingdays.4Assumes5days sicknessleave.Theworkingweekcomprisesofabasic40hourweekmadeupoftenprogrammed activitiesoffourhours.Fordetailsofoncallrates,seeNHSEmployers,Termsandconditionsof serviceforspecialtydoctorsEngland(2008).4Unitcostsbasedon1656hoursperannum. AllowsforthehighercostsassociatedwithLondon.10,11,12
D.Overheads Management, administrationand estatesstaff Nonstaff E.Ongoingtraining
F.Capitaloverheads
3,292peryear
Workingtime
41.4weeksper annum 40hoursper week Londonmultiplier 1.19x(AtoB) 1.39xF NonLondon 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondon.10,11,12 multiplier 0.97xF Unitcostsavailable2010/2011(costsincludingqualifications giveninbrackets) 113(131)percontracthour.
BritishMedicalAssociation(2008)StaffandAssociateSpecialistsCommitteeNewsletter,www.bma.org.uk/news/branch_newsletters/staff associates_newsletter/sascnewsletter1008.jsp BritishMedicalAssociation(2008)YourContract,YourDecision,BMAStaffandAssociateSpecialistsGroup,www.bma.org.uk/images/ SASCContractSummary_tcm41157757.pdf. 3 BritishMedicalAssociation(2009)GlossaryofDoctors,www.bma.org.uk/patients_public/whos_who_healthcare/glossdoctors.jsp 4 TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. 5 Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 6 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 7 NationalHealthService(2008)ModernisingMedicalCareers,NationalHealthService,London. 8 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 9 PersonalcommunicationwiththeLondonDeanery,2006. 10 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 11 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 12 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
2
203
15.5 Consultant: medical

Costsandunit estimation A.Wages/salary 2010/2011 value 117,700per year Notes TakenfromtheJanuaryMarch2011NHSStaffEarningsestimatesforMedicalStaffGroups.Based onthemeanfulltimeequivalenttotalearnings,whichincludesbasicsalaryplushoursrelatedpay, overtime,occupationpayments,locationpayments,andotherpayments,includingredundancypay orpaymentofnoticeperiods.Themeanbasicsalarywas89,400.1SeesectionVforinformationon mediansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployerscontributionto superannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal.(1998).2 CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandtheHigherEducation 3 FundingCouncilforEngland(HEFCE). Seetheprefaceformoreinformationonqualificationsand alsoschema7.4fordetails.Consultantsspend2yearsasafoundationhouseofficerand6yearsas aspecialtyregistrarinahospitalsetting. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycostsand includedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststotheproviderfor office,travel/transportandtelephone,educationandtraining,suppliesandservices(clinicaland general),aswellasutilitiessuchaswater,gasandelectricity. Thiscostcomprisesanamountforthegenericcurriculum,thepostgraduatecentres infrastructure,andstudyleave.Includedalsoarethecostsofthecourseorganisers,adminsupport, trainersworkshops,vocationaltrainingandInternalcoursesforGPtutors.Excludedarethecosts 5 ofrunningthelibraryandpostgraduatecentres. BasedonthenewbuildandlandrequirementsofNHSfacilities.6,7Includesshareduseof consultationandexaminationareas,anddesignatedsecretarialofficespace.Capitalcostshave beenannuitisedover60yearsatadiscountrateof3.5percent. Includes30daysannualleaveand8statutoryleavedays.Assumes10study/trainingdays,and5 dayssicknessleave.Thenewcontractaimedtoreducethenumberofhoursthatconsultants worked,includingaligningwiththeWorkingTimeDirectiveandbasedfundingassumptionson consultantsworkinganaverage43.3hours.Atypicalcontractisbasedon10.83programmed activitieswhichare4hoursinlength.8Unitcostsarebasedon1797hoursperannum. Nocurrentinformationavailableonpatientrelatedactivity.Seepreviouseditionsofthis publicationforsourcesofinformation. AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaveragecost.6,7,9
30,812per year 44,827per year
28,366per year 61,781per year 2,382per year
E.Ongoingtraining
F.Capitaloverheads
3,967per year 41.4weeks perannum 43.4hours perweek
Workingtime
Ratioofdirectto indirecttimeon: patientrelated activity Londonmultiplier
1.19x(AtoB) 1.39xF NonLondon 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothenational multiplier 0.97xF averagecost.6,7,9 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 137(162)percontracthour.
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 PersonalcommunicationwiththeLondonDeanery,2006. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 BasedonpersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 TheInformationCentre(2006)NewConsultantContract:ImplementationSurvey,TheInformationCentre,London. 9 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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15.6 Consultant: surgical

Costsandunit estimation A.Wages/salary 2010/2011value 117,700per year Notes TakenfromtheJanuaryMarch2011NHSStaffEarningsestimatesforMedicalStaffGroups. Basedonthemeanfulltimeequivalenttotalearnings,whichincludesbasicsalaryplus hoursrelatedpay,overtime,occupationpayments,locationpayments,andotherpayments suchasredundancypayorpaymentofnoticeperiods.Themeanbasicsalarywas89,400.1 SeesectionVforinformationonmediansalaries. Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. (1998).2CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandthe 3 HigherEducationFundingCouncilforEngland(HEFCE). Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails.Consultantsspend2yearsasa foundationhouseofficerand6yearsasaspecialtyregistrarinahospitalsetting. TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformoreinformation. Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycosts andincludedadministrationandestatesstaff. Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. Thiscostcomprisesanamountforthegenericcurriculum,thepostgraduatecentres infrastructureandstudyleave.Includedalsoarethecostsofthecourseorganisers,admin support,trainersworkshops,vocationaltrainingandInternalcoursesforGPtutors. 5 Excludedarethecostsofrunningthelibraryandpostgraduatecentres. 6,7 BasedonthenewbuildandlandrequirementsofNHSfacilities. Includesshareduseof consultationandexaminationareas,anddesignatedsecretarialofficespace.Capitalcosts havebeenannuitisedover60yearsatadiscountrateof3.5percent. Includes30daysannualleaveand8statutoryleavedays.Assumes10study/trainingdays, and5dayssicknessleave.Thenewcontractaimedtoreducethenumberofhoursthat consultantsworked,includingaligningwiththeWorkingTimeDirectiveandbasedfunding assumptionsonconsultantsworkinganaverage43.4hours.Atypicalcontractisbasedon 10.83programmedactivitieswhichare4hoursinlength.8Unitcostsarebasedon1797 hoursperannum. Nocurrentinformationavailableonpatientrelatedactivity.Seepreviouseditionsofthis publicationforsourcesofinformation.
D.Overheads Management, administrationand estatesstaff Nonstaff E.Ongoingtraining
2,382peryear
F.Capitaloverheads
3,967peryear
Workingtime
41.4weeksper annum 43.4hoursper week
Ratioofdirectto indirecttimeon/in: patientrelated activity operatingtheatre Londonmultiplier
1.19x(AtoB) AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaverage 1.39xF cost.6,7,9 NonLondon 0.97x(AtoB) AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothe multiplier 0.97xF nationalaveragecost.6,7,9 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 136(161)percontracthour.
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 PersonalcommunicationwiththeLondonDeanery,2006. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 TheInformationCentre(2006)NewConsultantContract:ImplementationSurvey,TheInformationCentre,London. 9 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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15.7 Consultant: psychiatric

Costsandunit estimation A.Wages/salary 2010/2011value 117,700per year Notes TakenfromtheJanuaryMarch2011NHSStaffEarningsestimatesforMedicalStaffGroups. Basedonthemeanfulltimeequivalenttotalearningsfortheconsultantnewcontract whichincludesbasicsalaryplushoursrelatedpay,overtime,occupationpayments,location payments,andotherpaymentssuchasredundancypayorpaymentofnoticeperiods.The meanbasicsalarywas89,400.1SeesectionVforinformationonmediansalaries. B.Salaryoncosts 30,812peryear Employersnationalinsuranceisincludedplus14percentofsalaryforemployers contributiontosuperannuation. C.Qualifications 44,827peryear QualificationcostshavebeencalculatedusingthemethoddescribedinNettenetal. 2 (1998). CurrentcostinformationhasbeenprovidedbytheDepartmentofHealthandthe HigherEducationFundingCouncilforEngland(HEFCE).3Seetheprefaceformore informationonqualificationsandalsoschema7.4fordetails.Consultantsspend2yearsasa foundationhouseofficerand6yearsasaspecialtyregistrarinahospitalsetting. D.Overheads TakenfromNHS(England)SummarisedAccounts.4Seeprefaceformoreinformation. Management, 28,366peryear Managementandothernoncarestaffcostswere19.1percentofdirectcaresalarycosts administrationand andincludedadministrationandestatesstaff. estatesstaff Nonstaffcostswere41.6percentofdirectcaresalarycosts.Theyincludecoststothe Nonstaff 61,781peryear providerforoffice,travel/transportandtelephone,educationandtraining,suppliesand services(clinicalandgeneral),aswellasutilitiessuchaswater,gasandelectricity. E.Ongoingtraining 2,382peryear Thiscostcomprisesanamountforthegenericcurriculum,thepostgraduatecentres infrastructure,andstudyleave.Includedalsoarethecostsofthecourseorganisers,admin support,trainersworkshops,vocationaltrainingandInternalcoursesforGPtutors. 5 Excludedarethecostsofrunningthelibraryandpostgraduatecentres. 6,7 F.Capitaloverheads 3,967peryear BasedonthenewbuildandlandrequirementsofNHSfacilities. Includesshareduseof consultationandexaminationareas,anddesignatedsecretarialofficespace.Capitalcosts havebeenannuitisedover60yearsatadiscountrateof3.5percent. Workingtime 41.4weeksper Includes30daysannualleaveand8statutoryleavedays.Assumes10study/trainingdays, annum and5dayssicknessleave.Thenewcontractaimedtoreducethenumberofhoursthat 43.4hoursper consultantsworked,includingaligningwiththeWorkingTimeDirectiveandbasedfunding week assumptionsonconsultantsworkinganaverage43.4hours.Atypicalcontractisbasedon 10.83programmedactivitieswhichare4hoursinlength.8Unitcostsarebasedon1797 hoursperannum. Ratioofdirectto InformationtakenfromastudycarriedoutbytheInstituteofPsychiatrybasedona 9 indirecttimeon: responserateof41.3percentofasampleof500consultants. Theproportionofworking facetofacecontacts 1:1.58 timespentondifferentactivitieswasestimatedasfollows:facetofacesettingsincluding contactwithpatients,carryingoutassessmentsandcontactwithfamilymembers34per cent.Otherpatientrelatedactivitiesaddedafurther9.5percentformeetingswithpatients patientrelated 1:0.95 activity orfamily.Timespentteachinghasbeendisregardedandnoncontacttimehasbeentreated asanoverheadontimespentinpatientcontact. Londonmultiplier 1.19x(AtoB) AllowsforthehighercostsassociatedwithLondoncomparedtothenationalaverage 1.39xF cost.6,7,10 NonLondon 0.97x(AtoE) AllowsforthelowercostsassociatedwithworkingoutsideLondoncomparedtothe multiplier 0.97xF nationalaveragecost.6,7,10 Unitcostsavailable2010/2011(costsincludingqualificationsgiveninbrackets) 137(162)percontracthour;267(316)perpatientrelatedhour;353(418)perhourpatientcontact(includesAtoF).
1 2
TheInformationCentre(2011)NHSStaffEarningsEstimatesJune2011,TheInformationCentre,Leeds. Netten,A.,Knight,J.,Dennett,J.,Cooley,R.&Slight,A.(1998)DevelopmentofaReadyReckonerforStaffCostsintheNHS,Vols1&2,PersonalSocial ServicesResearchUnit,UniversityofKent,Canterbury. 3 PersonalcommunicationwiththeDepartmentofHealthandtheHigherEducationFundingCouncilforEngland(HEFCE)(2011). 4 TheAuditCommission(2010)NHS(England)(2010)SummarisedAccounts20092010,NHS,London. 5 PersonalcommunicationwiththeLondonDeanery,2006. 6 BuildingCostInformationService(2011)SurveysofTenderPrices,RoyalInstituteofCharteredSurveyors,KingstonuponThames. 7 PersonalcommunicationwiththeDepartmentforCommunitiesandLocalGovernment,2011. 8 TheInformationCentre(2006)NewConsultantContract:ImplementationSurvey,TheInformationCentre,London. 9 RoyalCollegeofPsychiatrists(2003)WorkloadandWorkingPatternsinConsultantPsychiatrists,CollegeResearchUnit,RoyalCollegeofPsychiatrists, London. 10 DepartmentofHealthestimate(2011)basedontheMarketForcesFactor(MFF).
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V. SOURCES OF INFORMATION
16.Inflationindices 17.NHSStaffEarningEstimates 18.Glossary 19.References 20.Indexofreferences 21.Listofusefulsources 22.Listofitemsfrompreviousvolumesnotincludedinthisreport
209
16. Inflation indices 16.1 The BCIS house rebuilding cost index and the retail price index
BCIScalculatestheHouseRebuildingCostindexfortheAssociationofBritishInsurers(ABI).Theindexisbasedonanaverageofhouse typesandcannotthereforereflectchangesinallratesfromthehouserebuildingcosttablesasregionaltrends,labourandmaterials contentsdiffer. TheretailpriceindexisameasureofinflationpublishedmonthlybytheOfficeforNationalStatistics.Itmeasuresthe changeinthecostofabasketofretailgoodsandservices.
2 1
Year
BCIS/ABI RebuildingCost index(1988=100) 154.6 165.7 176.6 183.8 191.3 206.1 219.8 228.7 243.5 236.9 239.5 %increase index (1986/87=100) 167.7 171.3 175.1 180.0 184.0 188.2 193.7 199.9 208.5 212.6 222.7
RetailPrice %increase 2.1 2.1 2.2 2.8 2.2 2.3 2.9 3.2 4.3 2.0 4.8
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
3.8 7.2 6.6 4.1 4.1 7.7 6.7 4.0 6.5 2.7 1.1
16.2 The Hospital & Community Health Services (HCHS) index

Hospitalandcommunityhealthservices(HCHS)payandpriceinflationisaweightedaverageoftwoseparateinflationindices:thepay costindex(PCI)andthehealthservicecostindex(HSCI).ThePCImeasurespayinflationintheHCHS.ThePCIisitselfaweightedaverage ofincreasesinunitstaffcostsforeachofthestaffgroupswithintheHCHSsector.Paycostinflationtendstobehigherthanpay settlementinflationbecauseofanelementofpaydriftwithineachstaffgroup.Paydriftisthetendencyfortheretobeagradualshiftup theincrementalscales,andisadditionaltosettlementinflation.Theestimateofpayinflatorforthecurrentyearisbasedoninformation suppliedbytheDepartmentofHealthandonpayawardsofNHSstaff.TheHSCIiscalculatedmonthlytomeasurethepricechangefor eachof40subindicesofgoodsandservicespurchasedbytheHCHS.Thesubindicesareweightedtogetheraccordingtotheproportion oftotalexpenditurewhichtheyrepresenttogivetheoverallHSCIvalue.Thepaycostindexandthehealthservicecostindexare weightedtogetheraccordingtotheproportionofHCHSexpenditureoneach.ThisprovidesanHCHScombinedpayandpricesinflation figure.
Year
2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11
1
Pay&Pricesindex (1987/8=100) 196.5 206.5 213.7 224.8 232.3 240.9 249.8 257.0 267.0 268.6 276(E)
Hospital&CommunityHealthServices (HCHS) Annualpercentageincreases Prices3 Pay3 0.3 7.2 0.1 8.3 0.9 5.0 1.5 7.3 1.0 4.5 1.9 4.7 3.0 4.1 1.8 3.5 5.2 3.0 1.3 1.8 2.8 2.8(E)
BuildingCostInformationService(2011)IndicesandForecasts,RoyalInstituteofCharteredSurveyors,KingstonuponThames. www.bcis.co.uk/site/scripts/documents_info.aspx?categoryID=2&documentID=27. 2 Sourcewww.statistics.gov.uk/StatBase.Accessed20July2011. 3 ProvidedbytheDepartmentofHealth,2011.
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16.3 Gross domestic product (GDP) deflator and the tender price index for public sector buildings
For nonstaff revenue, Her Majestys Treasurys (HMT) GDP deflator is a measure of general inflation in the domestic economy. HMT producestheGDPdeflatorfromdataprovidedbytheONSandextendstheseriestofutureyearsbyapplyingforecastsoftheinflation rate.TheBCISPUBSECTenderPriceindex(PUBSEC)isusedbytheOfficeforNationalStatistics(ONS)todeflatecapitalexpenditurein healthandsocialcare.
Year
PersonalSocialServicesPrices/Gross DomesticProductDeflator4Annual percentageincrease 2.78 1.81 3.36 2.87 2.77 1.63 2.97
2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11
TenderPriceindexforPublicSectorBuilding (nonhousing)(PUBSEC)5 Index(1995=100) %increase 156 7.2 166 6.4 170 2.7 187 9.8 191 2.2 172 10.3 169 (E) 1.5 (E)
16.4 The PSS annual percentage increases for adult services (all sectors)
ThePSSPayannualpercentageincreasesarecalculatedusingdataonratesofhourlypaychangeforeachoccupationgroup inthePSSsectorfromtheAnnualSurveyofHoursandEarnings(ASHE),publishedbyOfficeforNationalStatistics(ONS).6 The following occupation groups are used for analysis: managers, social workers, nurses, occupational therapists, community,careworkers,childcare.Inadditiontwosupportgroupswereidentified:admin/officeandancillarystaff.Asit wasnotpossibletocollectdetaileddataonallstaffworkinginthesegroups,itwasassumedthattheirpayincreaseswere inlinewiththeaverageforEngland.ThesepaychangeswereweightedbytheproportionofPSSstaffineachgroupandthe differentpaylevelsofeachgroupi.e.thatoccupationgroupsshareofthetotalPSSpaybill.Paychangesfor2010/11are projectedusinganaverageofthedeflatedpaychangesinthepastthreeyears.Thisassumesthatpayincreasesnextyear willbeinlinewiththeprevioustrend. ThePSSPay&Prices(includingcapital)iscalculatedbytakingtheweightedsumofthreeindices:payindex,capitalindex andnonstaffrevenueindexandthePSSPay&Prices(excludingcapital)iscalculatedbytakingtheweightedsumoftwo indices:payindexandnonstaffrevenueindex. Year PSSallsectors,adultsonly1 Annualpercentageincreases Pay&Prices(excluding Pay&Prices(including Pay capital) capital) 2003/04 3.9 4.3 4.1 2004/05 3.8 4.2 3.9 2005/06 3.2 3.7 3.4 2006/07 4.8 4.6 5.1 2007/08 3.0 3.9 3.0 2008/09 2.5 2.4 2.4 2009/10 2.1 0.2 2.2 2010/11 2.9(E) 2.4(E) 3.1(E)
4 5
ProvidedbytheDepartmentofHealth,2011. ProvidedbytheDepartmentofHealth,2011. 6 ThisworkcontainsstatisticaldatafromONSwhichisCrowncopyrightandreproducedwiththepermissionofthecontrollerofHMSOandQueens PrinterforScotland.TheuseoftheONSstatisticaldatainthisworkdoesnotimplytheendorsementoftheONSinrelationtotheinterpretationor analysis.
211
16.5 The PSS annual percentage increases for adult local authority services
Year Pay&Prices(excluding capital) 3.8 4.2 3.5 4.6 3.2 2.4 1.8 3.1(E) PSSlocalauthority,adultsonly7 Annualpercentageincreases Pay&Prices(including capital) 3.9 4.3 3.6 4.5 3.5 2.4 1.3 2.8(E) Pay 3.9 4.3 3.6 4.7 3.2 2.3 1.9 3.0(E)
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11
16.6 The PSS annual percentage increases for adult and childrens services (all sectors)
Year Pay&Prices(excluding capital) 3.9 3.8 3.2 4.7 2.8 2.2 2.1 2.9(E) PSSallsectors,adultsandchildren1 Annualpercentageincreases Pay&Prices(including capital) 4.3 4.3 3.6 4.6 3.7 2.4 0.6 2.5(E) Pay 4.1 4.0 3.4 5.0 3.0 2.4 2.2 3.1(E)
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11
16.7 The PSS annual percentage increases for local authority adult and childrens services
Year
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11
PSSlocalauthority,adultsandchildren1 Annualpercentageincreases Pay&Prices(excluding Pay &Prices(including capital) capital) 3.6 3.9 4.3 4.5 3.4 3.6 4.4 4.4 2.9 3.3 2.2 2.4 1.8 1.4 2.9(E) 2.8 (E)
Pay 3.8 4.5 3.5 4.6 3.0 2.3 1.9 3.0(E)
ProvidedbytheDepartmentofHealth,2011.
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17. NHS Staff Earning Estimates

17.1 Basic pay and earnings for unqualified and qualified nurses
Meanbasicsalary perfulltime equivalent1 Unqualifiednurses Band1 Band2 Band3 Qualifiednurses Band4 Meantotal earningsper fulltimeequivalent2 Medianfulltime equivalentbasic 3 salary Medianfulltime equivalenttotal earnings Averageworked FTEinsample4
Band5 29,900 25,500 139,304 Band6 35,500 32,600 89,691 Band7 41,000 38,800 49,974 Band8a 47,300 44,600 9,957 Band8b 55,700 51,700 3,023 Band8c 68,700 61,200 1,005 Band8d 80,400 73,400 245 Band9 Source:InformationCentreforHealthandSocialCare(2011)NHSStaffEarningsEstimates,JanuarytoMarch2011.Processedusingdata takenfromtheElectronicStaffRecordDataWarehouse,asatJune2011.
13,900 15,400 17,800 20,000 25,100 31,300 37,500 44,100 52,300 61,900 73,400
15,300 19,200 21,500 23,700
14,000 15,600 18,200 19,900
14,400 18,500 20,700 22,700 29,100 34,300 40,200 46,600 55,100 65,300 76,700
100 30,045 26,760 245
17.2 Basic pay for unqualified and qualified allied health professionals (AHPs)
Thisgroupincludesqualifiedscientific,therapeuticandtechnicalstaffwithin:chiropody/podiatry,dietetics,occupationaltherapy, orthoptics/optics,physiotherapy,radiography,art,musicanddramatherapy,speechandlanguagetherapy. Meanbasicsalary Meantotal Medianfulltime Medianfulltime Averageworked perfulltime earningsper equivalentbasic equivalenttotal FTEinsample4 1 3 equivalent fulltime salary earnings 2 equivalent
UnqualifiedAHPs Band1 Band2 Band3 QualifiedAHPs Band4
Band5 25,600 22,700 11,307 Band6 32,800 30,500 21,501 Band7 40,100 40,200 17,455 Band8a 47,500 45,300 4,623 Band8b 57,400 54,500 1,408 Band8c 66,500 65,300 401 Band8d Band9 Source:InformationCentreforHealthandSocialCare(2011)NHSStaffEarningsEstimates,JanuarytoMarch2011,Processedusingdata takenfromtheElectronicStaffRecordDataWarehouse,asatJune2011.
15,400 17,500 20,500 23,000 30,000 37,600 44,500 53,400 63,700
16,300 18,500 21,300
15,600 17,600 20,800
16,300 19,400 21,200 24,100 32,700 40,200 46,600 55,900 67,100
2,325 4,630 1,439
1 2
MeanbasicsalaryiscalculatedbydividingthetotalamountofbasicpayearnedbystaffinthegroupbythetotalworkedFTEforthosestaff. Thisincludesbasicsalary,plushoursrelatedpay,overtime,occupationpayments,locationpayments,andotherpaymentsincludingredundancypayor paymentofnoticeperiods. 3 ThemedianiscalculatedbyrankingindividualsFTEbasicpay,andtakingthemidpoint.Itisconsideredamorerobustindicatoroftypicalpaythanthe mean. 4 ThisisthetotalFTEforallpaymentsmadeinthequarterlyperiod,dividedby3togiveamonthlyaverage.
213
17.3 Basic pay and earnings for medical staff groups

Meanbasic salaryper 1 fulltimeequivalent Meantotal earningsper fulltime 2 equivalent Median fulltime equivalent basicsalary3 Median fulltime equivalent total earnings Average workedFTE insample4
Foundationyear1/House 22,600 32,200 22,400 31,400 6,124 Officer Foundationyear2/Senior 29,100 41,200 27,800 41,700 7,390 HouseOfficer Registrargroup 37,700 55,600 37,400 53,400 33,191 Consultants(old 85,100 101,500 80,200 92,200 1,171 contract) Consultants(new 89,400 117,700 89,400 109,300 33,891 contract) Associatespecialist 78,200 89,400 74,300 80,900 2,531 Staffgrade 62,800 69,100 74,700 61,600 815 Specialtydoctors 57,200 68,700 55,800 62,200 4,423 Source:InformationCentreforHealthandSocialCare(2011)NHSStaffEarningsEstimates,JanuarytoMarch2011.Processedusingdata takenfromtheElectronicStaffRecordDataWarehouse,asatJune2011. Generalnotes a. Inspectionofdatasuggeststhatdiscretionarypointpaymentsaresometimesincludedwithbasicpayforconsultants. b. ThesefiguresrepresentpaymentsmadeusingtheElectronicStaffRecordtoNHSStaffwhoaredirectlypaidbyNHS organisations.Itdoesnotinclude,forexample,elementsofpayforclinicalstaffwhicharepaidtotheindividualbyuniversities, orothernonNHSorganisationsprovidingNHScare. c. Figuresroundedtothenearest100. d. FiguresbasedondatafromallNHSorganisationswhoareusingESR(twoFoundationTrustshavenottakenupESR).
1 2
MeanbasicsalaryiscalculatedbydividingthetotalamountofbasicpayearnedbystaffinthegroupbythetotalworkedFTEforthosestaff. Thisincludesbasicsalary,plushoursrelatedpay,overtime,occupationpayments,locationpayments,andotherpaymentsincludingredundancypayor paymentofnoticeperiods. 3 ThemedianiscalculatedbyrankingindividualsFTEbasicpay,andtakingthemidpoint.Itisconsideredamorerobustindicatoroftypicalpaythanthe mean. 4 ThisisthetotalFTEforallpaymentsmadeinthequarterlyperiod,dividedby3togiveamonthlyaverage.
214
18. Glossary
AgencyoverheadsOverheadcostsbornebymanagingagency. AnnuitisingConvertingacapitalinvestment(suchasthecostofabuilding)intotheannualequivalentcostfortheperiod duringwhichtheinvestmentisexpectedtolast. ChildandAdolescentMentalHealthServices(CAMHS)isanameforNHSprovidedservicesforchildreninthemental healtharenaintheUK.IntheUKtheyareoftenorganisedarounda4Tierssystem.Tier3servicesaretypically multidisciplinaryinnatureandthestaffcomefromarangeofprofessionalbackground. CapitaloverheadsBuildings,fixturesandfittingsemployedintheproductionofaservice. CarepackagecostsTotalcostofallservicesreceivedbyapatientperweek. CostfunctionanalysisStatisticalanalysisusingamultivariatetechniquedesignedtosimultaneouslyteaseoutthemany influencesoncost. DepartmentforWorkandPensions(DWP)isthelargestgovernmentdepartmentintheUnitedKingdom,createdonJune 8,2001fromthemergeroftheemploymentpartoftheDepartmentforEducationandEmploymentandtheDepartmentof SocialSecurityandheadedbytheSecretaryofStateforWorkandPensions,aCabinetposition. DirectoverheadsDaytodaysupportforaservice,suchasimmediatelinemanagement,telephone,heatingand stationery. DiscountingAdjustingcostsusingthetimepreferenceratespreadoveraperiodoftimeinordertoreflecttheirvalueata baseyear. DurablesItemssuchasfurnitureandfittings. IndirectoverheadsOngoingmanagingagencycostssuchaspersonnel,specialistsupportteamsandfinancialmanagement. LongtermTheperiodduringwhichfixedcostssuchascapitalcanbevaried. MarginalcostThecostofanadditionalunitofaservice. OncostsEssentialassociatedcostssuchasemployersnationalinsurancecontributionsonsalaries. OpportunitycostThevalueofthealternativeuseoftheassetstiedupintheproductionoftheservice. PeraveragestayCostperpersonofatypicalstayinaresidentialfacilityorhospital. PerclienthourCostofprovidingtheserviceforonehourofpatientattendance.Thisallowsforcostsoftimenotspentwith clientsandallocatesthecostsofthistimetothetimespentwithclients. PerclinicvisitCostofattendingtooneclientinaclinic.Thisallowsforoveralltimespentonnonclinicalactivityand allocatesthistothetotaltimespentwithclientsinanysetting. PerconsultationCostperattendanceinaclinicorsurgery.Thisalsoallowsforoveralltimespentonnonclinicalactivity andallocatesthistothetotaltimespentwithclients. PerexampleepisodeCostofatypicalepisodeofcare,comprisingseveralhoursofaprofessionalstime. PerhomevisitCostofonevisittoaclientathome.Thisincludesthecostoftimespenttravellingtothevisit.Italsoallows foroveralltimespentonnonclinicalactivityandallocatesthistothetotaltimespentwithclientsinanysetting. PerhourinclinicCostofonehourspentbyaprofessionalinaclinic.Thisallowsforoveralltimespentonnonclinical activityandallocatesthistothetotaltimespentwithclientsinanysetting.
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PerhourofclientcontactCostofonehourofprofessionaltimespentattendingtoclients.Thisalsoallowsforthecostsof timenotspentwithclientsandallocatesthecostsofthistimetothetimespentwithclients. PerhourofclientrelatedworkHourlycostoftimespentonactivitiesdirectlyrelatedtotheclient.Thisisnotnecessarily timespentinfacetofacecontactwiththeclient. Perhourofdirectoutputs(teams)Costofonehourofteamactivitywhichresultsinameasurableactivitybyany member(s)oftheteam. PerhouroffacetofacecontactHourlycostoftimespentinfacetofacecontactwithclients.Thisalsoallowsforthecosts oftimenotspentwithclientsandallocatesthecostsofthistimetothetimespentwithclients. PerhourofhomevisitingCostofonehourspentbyaprofessionalundertakingvisitstoclientsathome.Thisincludesthe costoftimespenttravelling.Italsoallowsforoveralltimespentonnonclinicalactivityandallocatesthistothetotaltime spentwithclientsinanysetting. PerhourofpatientrelatedworkorperpatientrelatedhourHourlycostoftimespentonactivitiesdirectlyrelatedtothe patient.Thisisnotnecessarilytimespentinfacetofacecontactwiththepatient. PerhourondutyHourlycostoftimespentbyahospitaldoctorwhenonduty.Thisincludestimespentoncallwhennot actuallyworking. PerhourworkedHourlycostoftimespentbyahospitaldoctorwhenworking.Thismaybeduringthenormalworkingday orduringaperiodofoncallduty. PerinpatientdayCostperpersonofonedayinhospital. PerpatientdayCostperpersonofreceivingaserviceforoneday. PerpermanentresidentweekTotalweeklycostofsupportingapermanentresidentofaresidentialfacility. Perplaceperday(nursery)Costofonechildattendinganurseryforoneday. PerprocedureCostofaprocedureundertakeninaclinicorsurgery.Thisalsoallowsforoveralltimespentonnonclinical activityandallocatesthistothetotaltimespentwithclients. PerprofessionalchargeablehourHourlycostofservicesprovidedwhenpaidforbytheclient.Thisalsoallowsforthecosts oftimenotspentwithclientsandallocatesthecostsofthistimetothetimespentwithclients. PerresidentweekCostperpersonperweekspentinaresidentialfacility. Persession(daycare)Costperpersonofeachmorningorafternoonattendanceinadaycarefacility. PersessionperclientCostperpersonofonetreatmentsession. PershorttermresidentweekTotalweeklycostofsupportingatemporaryresidentofaresidentialfacility. PricebaseTheyeartowhichcostinformationrefers. Ratioofdirecttoindirecttimespenton:clientrelatedwork/directoutputs/facetofacecontact/cliniccontacts/home visitsTherelationshipbetweenthetimespentondirectactivities(suchasfacetofacecontact)andtimespentonother activities.Forexample,iftheratiooffacetofacecontacttootheractivitiesis1:1.5,eachhourwithaclientrequires2.5 paidhours. RevenuecostsSuppliesandservicesotherthansalariesincurredintheproductionofaservice. RevenueoverheadsVariablesupportservices,suppliesandotherexpenditureincurredintheproductionofaservice. SchemaFrameworkandcontentsofcostsynopsisforeachservice.
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ShorttermTheperiodduringwhichdurableassetscannotbeimmediatelyaddedtoorremovedfromtheexistingstockof resources. SSMSSSocialServicesManagementandSupportServices:OverheadcostsincurredbyalocalauthorityasdefinedbyCIPFA guidelines.Theseincludeindirectoverheadssuchasfinanceandpersonnelfunctions. TimepreferencerateTherateatwhichfuturecostsorbenefitsarevaluedincomparisontocurrentorbaseyearscostsor benefits.
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225
20. Index of References

Allen,C.,10 AssociationofDirectorsofAdultSocialServices,220 Atkin,K.,216 AuditCommission,5,40,41,57,83,95,96,133,134, 135,136,137,138,141,142,143,144,145,147,167, 168,169,170,171,172,173,174,175,181,182,183, 184,185,186,187,191,192,193,194,195,199,200, 201,202,203,204,205,216 Baginsky,M.,155,156,157,216 Ball,J.,147,216 Barrett,B.,5,40,45,57,113,114,216,218,220 Barthel,D.W.,11 Barton,P.,31,216 Bauld,L.,216 Baumann,M.,31 Bumker,T.,10 Bazian,6 Beecham,J.,5,10,11,19,25,26,41,61,62,63,74,76, 82,86,113,115,116,117,119,120,122,123,216, 217,219,220,222 Bernard,M.,10 Berridge,D.,74,119,120,122,216 Bond,G.R.,42,216 BritishMedicalAssociation,202,216 BuildingCostInformationService,10,27,28,36,37,38, 39,40,45,57,64,67,69,70,74,75,93,95,133,134, 135,136,137,138,141,142,143,144,145,146,147, 148,155,156,157,158,159,161,162,167,168,169, 170,171,172,173,174,175,181,182,183,184,185, 186,187,191,192,193,194,195,199,200,201,202, 203,204,205,208,216,217 Burns,T.,42,217 Callaghan,L.,10 Cape,J.,217 CareServicesImprovementPartnership,167,168,169, 170,171,217 Castle,F.,122,221 CentreforInnovationinPrimaryCare,217 CharteredInstituteofPublicFinanceandAccountancy (CIPFA),74,75,217 Chemist&Druggist,217 ChildHealthCAMHSandMaternityMapping,172,173, 217 Chisholm,D.,217 Clare,R.,217 Clover,B.,5 Cochrane,H.,124,217 Craft,A.,124,217 Croucher,K.,10 Curtis,L.,11,15,19,84,98,155,156,157,159,217,218 Darton,R.,11,103,104,105,106,107,217,221 Dataspring,217 Davies,A.,163,217 Dennett,J.,57,79,94,133,134,135,138,141,142,143, 144,146,147,148,150,155,156,157,159,161,181, 182,183,184,185,186,191,192,193,194,199,200, 201,202,203,204,205,221 DepartmentforChildren,SchoolsandFamilies,84,86, 217,219 DepartmentforCommunitiesandLocalGovernment,11 DepartmentforEducation,74,75 DepartmentforEducationandSkills,76,78,82,217 DepartmentforWorkandPensions,61,62,63,217 DepartmentofHealth,5,6,11,25,35,42,56,73,74,75, 82,91,97,98,99,119,120,122,124,137,142,148, 150,155,156,157,158,159,160,161,162,163,167, 168,169,170,171,172,173,174,175,199,200,201, 208,209,210,216,217,218,219,220,221,222 DisabilityAlliance,25,26,27,36,37,218 Dobbs,J.,218 Dobson,B.,69,218,222 Drummond,M.F.,11 Dunnell,K.,218 Edwards,R.T.,85,218 Emerson,E.,5,61,62,63,218,219 Ernst&Young,93,218 Evans,S.,11 ExpertPatientsProgrammeCommunityInterest Company,97,218 Felce,D.,61,62,63,218 Finn,W.,74,75,218 Glendinning,C.,5,98,108,218 Goodyer,I.M.,40,218 GovernmentStatisticalService,218 Greco,V.,82,219 Griffiths,P.,219 Hallam,A.,218,219 Hancock,L.,85,222 HarrowerWilson,C.,219 Heywood,F.,11 Hicks,L.,74,75 Higgins,S.,147,219 HippisleyCox,J.,150,219 Hirst,M.,216 HMGovernment,19 Holmes,L.,19,84,86,219 Hyde,C.,219 Hyde,M.,11 InformationCentre,15,25,26,27,28,36,37,38,39,40, 41,45,57,64,68,92,95,96,103,104,105,106,107, 108,133,134,135,136,137,138,141,142,143,144, 145,146,147,148,149,150,160,167,168,169,170, 171,172,173,174,175,181,182,183,184,185,186, 187,191,192,193,194,195,199,200,201,202,203, 204,205,211,212,219 Jackson,G.,219 Jeffreys,L.A.,219 Jones,K.,98,160,218,219 Kavanagh,S.,25,26,219 Killen,S.,124,217 Knapp,M.,5,6,11,25,26,46,61,62,63,74,76,79,113, 115,116,117,119,120,122,123,216,217,218,219, 220 Kuyken,W.,45,220
226
Laing&Buisson,11,25,26,220 Laing,W.,220 Laming,LordH.,19 Levin,E.,220 Liddle,M.,121,122,220 Lingard,J.,167,220 LocalGovernmentAssociation,155,156,157,158,161, 163,220 LocalGovernmentAssociationAnalysisandResearch, 155,156,157,158,161,163,220 Lowson,K.,6,124,220 Mahon,J.,77,220 Mahoney,F.I,11 Mansell,J.,61,62,63,220 MatrixEvidence,6 McCrone,P.,79,220 McDermid,S.,86 McGurk,S.,42,220 MentalHealthStrategies,167,168,169,170,171,217, 220 Middleton,S.,69,218,222 Milne,A.,167,220 Morris,J.N.,11 Mueser,K.,42,220 NAAPS,15 NationalAuditOffice,45,220 NationalCouncilforPalliativeCare,6 NationalHealthService,92,199,200,201,202,220 NationalTreatmentAgencyforSubstanceMisuse,53,54, 55,56,220 Netten,A.,6,10,11,25,26,57,74,75,79,94,103,104, 105,106,107,133,134,135,138,141,142,143,144, 146,147,148,150,155,156,157,159,161,181,182, 183,184,185,186,191,192,193,194,199,200,201, 202,203,204,205,217,218,219,221,222 NHSEmployers,40,45,57,83,133,134,135,136,137, 138,141,142,143,144,145,146,147,150,167,168,

169,170,171,172,173,174,175,181,182,183,184, 185,186,187,191,192,193,194,195,199,200,201, 202,219,221 Nihira,K.,62,63,221 OfficeforNationalStatistics,29,103,104,105,106,107, 209,221 Ofsted,47 Onyett,S.,169,221 Parsons,C.,122,221 Reilly,S.,38,39 Renton,A.,221 Rentright,105,221 Richardson,G.,97,219,222 RoyalCollegeofPsychiatrists,205,222 SainsburyCentreforMentalHealth,170,171,221,222 Schneider,J.,25,26,42,216,219,222 Selwyn,J.,6,119,120,122,222 SesamiResearchandPracticePartnership,42,222 Shah,A.,6,44 Simpson,S.,41,222 SkillsforCare,222 Smith,N.,69,222 SocialPolicyandSocialWorkSubjectCentre,222 Thornicroft,G.,42,222 Vallelly,S.,11 Venning,P.,147,222 vonAbendorff,R.,222 Ward,H.,19,84,118,222 Webb,S.,220 WebsterStratton,C.,85,222 Weinberg,A.,162,222 West,P.,217 Williams,J.,103,104,105,106,107,217,222 Wright,C.,222 YoungMinds,172,223
227
21. List of useful sources

AdultMentalHealthServiceMapping:www.durham.ac.uk/service_mapping TheAMHservicemappingaimstocontributetowardstheimprovementofmentalhealthservicesforadultsand providesinformationontheadultservicesavailablenationally.Fromthiswehavebeenabletomakecostestimates forthemultidisciplinaryteamsfoundinchapter10. AuditCommission:www.auditcommission.gov.uk BlackwellPublishing:www.blackwell.com BlackwellPublishingisoneoftheworldslargestjournalpublisherswithinphysicalsciences,lifesciences,medicine, socialsciencesandhumanities. BuildingCostInformationService:www.bcis.co.uk/site/index.aspx BCISistheUKsleadingproviderofcostandpriceinformationforconstructionandpropertyoccupancy. CareQualityCommission:www.cqc.org.uk/ TheCareQualityCommissionisthenewhealthandsocialcareregulatorforEnglandandreplacestheHealthcare Commission,CommissionforSocialCareInspectionandtheMentalHealthActCommissionwhichallceasedtoexist on31March2009. CentreforChildandFamilyResearch:www.lboro.ac.uk/departments/ss/staff/ward.html CentreforHealthRelatedStudies: www.bangor.ac.uk/research/rae_egs/groups_by_school.php.en?SchoolID=0770&SchName=School%20of%20Healthcare %20Sciences ChildandAdolescentMentalHealthMappingService:www.camhsmapping.org.uk Thiswebsiteprovidesinformationspecificallyonthementalhealthservicesavailabletochildrenandadolescents. CharteredInstituteofPublicFinanceandAccountancy(CIPFA):www.cipfastats.net TheCIPFAStatisticalInformationService(SIS)wasestablishedasapartnershipbetweenindividualauthoritiesand CIPFA.SIShasbeenundertakingdetailedannualsurveysoflocalauthorityoperationsformorethanacentury,andthe CIPFAStatisticsstillremaintheonlyimpartialandcomprehensiveaccountoftheextentandachievementsofeach individualCouncil.Surveysareconductedinthefollowingareas:education,environmentalservices,environmental health,housing,leisure,planning,publicprotection,socialservices,transport. ConsultantService(HealthandSocialCare):www.matrixrcl.co.uk DaycareCostsSurvey2011,www.daycaretrust.org.uk/pages/childcarecostssurveys.html. DepartmentforChildren,SchoolsandFamilies:www.dcsf.gov.uk DepartmentforWorkandPensions:www.dwp.gov.uk FamilyResourceSurvey:research.dwp.gov.uk/asd/frs/ FederationofOphthalmic&DispensingOpticians:www.fodo.com HealthandSocialCareInformationCentre(HSCIC):www.ic.nhs.uk TheInformationCentreforhealthandsocialcare(IC)isaSpecialHealthAuthoritysetupon1April2005totakeover mostDHstatisticalcollectionanddisseminationandsomefunctionsoftheformerNHSInformationAuthority.This includesinformationonPersonalSocialServicesExpenditure.
228
HospitalEpisodeStatistics(HES):www.hesonline.nhs.uk ThisisthenationalstatisticaldatawarehouseforEnglandofthecareprovidedbyNHShospitalsandforNHShospital patientstreatedelsewhere.HESisthedatasourceforawiderangeofhealthcareanalysisfortheNHS,Government andmanyotherorganisationsandindividuals.TheHESdatabaseisarecordleveldatabaseofhospitaladmissionsand iscurrentlypopulatedbytakinganannualsnapshotofasubsetofthedatasubmittedbyNHSTruststotheNHSWide ClearingService(NWCS).Quarterlyinformationisalsocollected.Aseparatedatabasetableisheldforeachfinancial year,containingapproximately11millionadmittedpatientrecordsfromallNHSTrustsinEngland. Intute:www.intute.ac.uk/socialsciences Intuteisafreeonlineserviceprovidingaccesstowebresourcesforeducationandresearch,evaluatedandselectedby anetworkofsubjectspecialists. JosephRowntreeFoundation:www.jrf.org.uk Thiswebsiteprovidesinformationonhousingandcare. Laing&Buisson:www.laingbuisson.co.uk Laing&Buisson,anindependentcompany,providesauthoritativedata,statistics,analysisandmarketintelligenceon theUKhealth. LocalGovernmentEarningsSurvey:www.lga.gov.uk/lga/core/page.do?pageId=1956061 LondonSchoolofEconomics,PersonalSocialServicesResearchUnit:www.lse.ac.uk/collections/PSSRU/ NationalCouncilforPalliativeCare:www.ncpc.org.uk NationalInstituteforHealthandClinicalExcellence:www.nice.org.uk NationalPrescribingCentre:www.npc.co.uk/prescribing/ PersonalSocialServicesExpenditureData(PSSEX1data): www.ic.nhs.uk/pubs/persocservexp2005/detailed_unit_costs_bycouncil PSSRUatLSE,LondonSchoolofEconomicsandPoliticalScience:www.lse.ac.uk/collections/PSSRU PubMed:www.pubmedcentral.nih.gov/ ReferenceCosts:www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_123459 ThiswebsitegivesdetailsonhowandonwhatNHSexpenditurewasused.TheReferenceCosts/ReferenceCosts IndexpublicationistherichestsourceoffinancialdataontheNHSeverproduced.Asinpreviousyears,itsmain purposeistoprovideabasisforcomparisonwithin(andoutside)theNHSbetweenorganisations,anddowntothe levelofindividualtreatments. SocialCareInstituteforExcellence:www.scie.org.uk SocialCareOnline:www.sciesocialcareonline.org.uk/ SocialPolicyResearchUnit,UniversityofYork:www.york.ac.uk/inst/spru YoungMinds:www.youngminds.org.uk YoungMindsisanationalcharitycommittedtoimprovingthementalhealthofallchildrenandyoungpeople.
229
22. List of items from previous volumes not included in this volume
Articles 2001 Childcarecostsinsocialservices IndependentsectorhomecareprovidersinEngland Unitcostsformulticountryeconomicevaluations 2002 Anursepractitionerservicefornursingandresidentialcare Thecostsofchildandadolescentpsychiatricinpatientunits ThenewPSSEX1returnonexpenditureandunitcosts MappingmentalhealthservicesinEngland DevelopinghealthaccountsfortheUnitedKingdom 2003 Thecostsofintermediatecareschemes TheRapidResponseServices Referencecosts 2004 Thecostsofadoption Thecostsofundertakingcoreassessments Thedevelopmentofunitcostsforsocialworkprocesses EstimatingtheunitcostsforHomeStartsupport 2005 Thecostofprovidinghomecare Personalsocialservicespayandpricesindex TypicalcostsofSureStartlocalprogrammeservices 2006 GuestEditorialConductingandinterpretingmultinationaleconomicevaluations:themeasurementofcosts Thecostsofanintensivehomevisitingprogrammeforvulnerablefamilies DirectpaymentsratesinEngland Trainingcostsofpersoncentredplanning Thebakersdozen:unitcostsandfunding 2007 Thecostsoftelecare:frompilotstomainstreamimplementation TheHealthBASKETProject:documentingthebenefitbasketandevaluatingservicecostsinEurope Recordingprofessionalactivitiestoaideconomicevaluationsofhealthandsocialcareservices 2008 GuesteditorialNationalScheduleofReferenceCostsdata:communitycareservices TheChallengesofestimatingtheunitcostofgroupbasedtherapies CostsandusersofIndividualBudgets 2009 GuesteditorialEconomicsandCochraneandCampbellmethods:theroleofunitcosts EstimatingunitcostsforDirectPaymentsSupportOrganisations TheNationalDementiaStrategy:potentialcostsandimpacts
230
SCIEsworkoneconomicsandtheimportanceofinformalcare
2010 Thecostsofshortbreakprovision TheimpactofthePOPPprogrammeonchangesinindividualserviceuse TheScreenandTreatprogramme:aresponsetotheLondonbombings Expectedlifetimecostsofsocialcareforpeopleaged65andoverinEngland Schema 2006 Adolescentsupportworker Educationalsocialworkteammember Behaviouralsupportserviceteammember Learningsupportserviceteammember 2007 Allchildrensservicewithdrawn,butreinstatedin2010 2008 Paramedicandemergencyambulanceservices 2009 Costofmaintainingadrugsmisuseronamethadonetreatmentprogramme Unpaidcare 2010 Voluntaryresidentialcareforolderpeople NursingLedInpatientUnit(NLIU)forintermediatecare Localauthorityshelteredhousingforolderpeople Housingassociationshelteredhousingforolderpeople Localauthorityveryshelteredhousingforolderpeople Housingassociationveryshelteredhousingforolderpeople Localauthorityresidentialcare(staffedhostel)forpeoplewithmentalhealthproblems Localauthorityresidentialcare(grouphome)forpeoplewithmentalhealthproblems Voluntarysectorresidentialcare(staffedhostel)forpeoplewithmentalhealthproblems Privatesectorresidentialcare(staffedhostel)forpeoplewithmentalhealthproblems AcuteNHShospitalservicesforpeoplewithmentalhealthproblems NHSlongstayNHShospitalservicesforpeoplewithmentalhealthproblems Voluntary/nonprofitorganisationsprovidingdaycareforpeoplewithmentalhealthproblems Shelteredworkschemesforpeoplewithmentalhealthproblems Villagecommunitiesforpeoplewithlearningdisabilities Thecostsofcommunitybasedcareoftechnologydependentchildren

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Curtis Unit Costs Healthcare Pssru 2011

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Unit Costs of Health & Social Care 2011

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Workoverthepastyearhasfocusedonupdatingmanyoftheprocessesweusetoprovidetheseestimatesandtoensure theyareascloseaspossibletotodaysservicecosts.Wehaveoverhauledthedatabaseswhichunderpinmanyofthe calculations,transferredtomoreflexiblepublicationsoftwareand,ofcourse,redesignedthefrontcover.

Whats new in the publication this year?

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Improvements to routine data

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Clinical psychologist Thisyear,wehavebasedthecostofaClinicalPsychologistonahighersalarypoint;AgendaforChangeBand8aratherthan Band7.WehavelearntthatBand7isconsideredtobeatransitiongradetofullspecialistpractitionerstatus.

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

The cost of extra care housing

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Table 1: Cost per resident, per week

50.93 21.17 2.41 1.41 0.00 0.00 73.80 173.98

157.12 77.67 22.14 3.52 612.00 634.29 81.80 1241.70

Unit Costs of Health and Social Care 2011

Figure 1: Distribution of components of costs of extra care housing

Note:Housingmanagementandsupportincludeorganisingactivitieswherethiswasspecifiedandhousingsupporttasks suchasgeneralcounselling,advice,andassistancewithdomestictasksandcleaning.Housingsupportcostsaccountedfor2 percentofthetotaloverall.

Table 2: Distribution of costs by service

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Shared Lives model for care and support

Unit Costs of Health and Social Care 2011

Funding Shared Lives placements

Overallaverage carecost(per week) 361

Management charge (perweek) 58

Allinpriceforlongterm placement,including boardandlodging Careandsupportinlong term

Totalaveragecost (perweek) 419

Unit Costs of Health and Social Care 2011

Table 2: Potential savings

Some case studies of people Shared Lives has helped

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Box 1: Laming recommendations

atallpointswhereconcernsaboutachildssafetyarereceived,ensuringintake/dutyteamshavesufficienttrainingandexpertisetotake referralsandthatstaffhaveimmediate,onsitesupportavailablefromanexperiencedsocialworker.Localauthoritiesshouldtake appropriateactiontoimplementthesechanges.

highqualitysupervisionfocusedoncaseplanning,constructivechallengeandprofessionaldevelopment. 19. TheDepartmentforChildren,SchoolsandFamiliesmuststrengthenWorkingTogethertoSafeguardChildren,andChildrensTrusts musttakeappropriateactiontoensure:

Unit Costs of Health and Social Care 2011

Table 1: Unit costs per hour1

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

1. Services for older people

Unit Costs of Health and Social Care 2011

Unit Costs of Health and Social Care 2011

1.1 Private sector nursing homes for older people

Unit Costs of Health and Social Care 2011

1.2 Private sector residential care for older people

Unit Costs of Health and Social Care 2011

1.3 Local authority residential care for older people

Unit Costs of Health and Social Care 2011

1.4 Local authority day care for older people

Unit Costs of Health and Social Care 2011

1.5 Extra care housing for older people

Unit Costs of Health and Social Care 2011