Cost effectiveness of pilot self-assessment sites in community care services in England
Clarkson P Australian Health Review, 37, 666-674. 2013

OBJECTIVE:
Self-assessment has been advocated in community care but little is known of its cost effectiveness in practice. We evaluated cost effectiveness of pilot self-assessment approaches.

METHODS:
Data were collected from 13 pilot projects in England, selected by central government, between October 2006 and November 2007. These were located within preventative services for people with low-level needs, occupational therapy, or assessment and care management. Cost effectiveness, over usual care, was assessed by incremental cost-effectiveness ratios (ICERs), in British pounds per unit gain in assessment satisfaction. A public-sector perspective was adopted; the provider costs of the agencies taking part.

RESULTS:
At 2006-07 prices, including start-up and on-going costs, only three pilots demonstrated cost effectiveness. Two pilots in assessment and care management had ICERs of £3810 and £755 per satisfaction gained, well below a benchmark from a trial of usual assessment of £18296 per satisfaction gained. When extrapolating uptake to numbers accessing assessments over 1 year, one occupational therapy pilot, of £123/satisfaction gained, also fell below this benchmark in sensitivity analysis. There was less evidence for preventative services.

CONCLUSIONS AND IMPLICATIONS:
Most pilot projects were not cost effective. However, self assessment is potentially cost effective in assessment and care management and occupational therapy services. Better quality cost data from pilot sites would have permitted more detailed analysis. Measuring downstream effects in terms of users’ well being from receipt of self-assessment would also be beneficial.

Cost-effectiveness of a pilot social care service for UK military veterans
Clarkson P Journal of Care Services Management, 7, 95-106. 2014

This paper investigates the cost-effectiveness of a pilot social care service for military veterans, a group relatively ill-served by traditional forms of social and health care. The service involved caseworkers signposting veterans, experiencing multiple difficulties, to sources of advice designed to assist with issues such as employment and training, education, debt, legal problems, and housing. Routinely generated data were collected on 202 veterans, concerning their characteristics, types of problem, and resources identified, and on a sub-set (n = 21) of these, regarding their outcomes in terms of well-being, measured by routine administration of the General Health Questionnaire. Costs, in terms of caseworkers’ time commitments, were modelled across this sample of veterans. The additional costs as against the additional effects of the service, against usual care (the standard primary care response to this population), were modelled in terms of the Incremental Cost Effectiveness Ratio. There was a statistically significant reduction in symptoms after receipt of the service at an average cost of £155 per unit improvement in well-being. Analysis of uncertainty revealed a high probability of cost-effectiveness when set against a benchmark value of standard social care for adults. These findings are discussed in terms of the future priority given to the after-care of veterans, in particular regarding social care interventions, which remain under-evaluated.

Home Care in Dementia: Critical Components for Effectiveness
Challis D, Clarkson P, Sutcliffe C, et al Personal Social Services Research Unit, Manchester. 2019

Most people with dementia live in private households and promoting their wellbeing is a key policy objective. However, little is known about the most appropriate or effective forms of home care, taking into account the views of service users and their carers. Home care has become an area of increasing concern in recent years in terms of availability, quality, cost and effectiveness. This mixed methods study will investigate the effectiveness of home care for people with dementia. First, using data from an evidence synthesis of relevant literature, metrics relating to process and effectiveness will be calculated for specialist home care support for people with dementia, generic forms of home care and service receipt which is a mix of the two. Second, a naturalistic study will follow up people receiving different forms of home care over a 6-month period. Post-hoc analysis will estimate the relative effectiveness and cost by comparing each approach. Third, the views of carers about home care support to people with dementia will be canvassed using themes identified in the literature review. Data will be analysed both qualitatively and quantitatively. An established Public, Patient and Carer Involvement Group will contribute to the study.

Social care in prison: emerging practice arrangements consequent upon the introduction of the 2014 Care Act
Challis D, Tucker S, Hargreaves C, et al British Journal of Social Work, 48, 6, 1627–1644. 2018

This research will give local authorities’ a framework of evidence to inform the delivery of social care for prisoners, both while in prison and on release. In particular it will provide information on the nature and extent of prisoners’ social care needs and the range and cost of the services required to meet these. As such it has the potential to help councils deliver the Care Act reforms in an efficient manner and improve prisoners’ independence, well-being, rehabilitation and risk of re-offence. The overall study has three main strands. Strand 1 will scope prisoners’ social care needs via interviews with approximately 350 inmates in Lancashire. Stand 2 will use a Balance of Care approach (a strategic planning tool) involving staff workshops and cost modelling to identify the options for service provision. Strand 3 will constitute a national survey of local authorities in England to identify the arrangements councils have put in place to meet their responsibilities for prisoners under the Care Act, including how they identify prisoners with social care needs, deliver assessments, develop care and support plans and provide/procure services. The findings will be shared with a wide range of stakeholders via a multi- faceted knowledge exchange programme.

Targeting, care management and preventative services for older people: The cost-effectiveness of a pilot self-assessment approach in one local authority
Clarkson P British Journal of Social Work, 40, 2255-2273. 2010

As social services councils face a more constrained economic environment and as eligibility criteria tighten, the issue of targeting becomes increasingly relevant. This paper presents findings from a pilot project in one local authority that aimed to target access to assessment for older people with low-level needs who would normally have fallen under eligibility thresholds. Self-assessment was used as a tool whereby these older people could identify, with assistance, their preferences for a range of preventative services. Via a randomised design, the study evaluated the costs and benefits, in terms of reported satisfaction, of the approach compared with the usual care management assessment. Although self-assessed cases were offered more advice as to a wider range of preventative services, which generated greater costs, total costs were lower for this group. This cost saving arose from the use of staff with a lower unit cost who also spent less time on administrative duties and gathering information. Satisfaction with self-assessment was comparable to a professional assessment, therefore representing a cost-effective approach. The project offers evidence of how councils can target resources through assessment and how self-assessment approaches may be appropriately configured to offer value for these users whilst also generating resource savings.