Desarrollo del procedimiento cautelar
B) Criterios para acordarla
This section has presented data on the unit costs of VI rehabilitation services. The original aim of this part of the research was to use data from the national survey to provide a ballpark figure for the costs of different service models. As this was not feasible, we used survey data plus additionally collected data from the three case study sites to
undertake more detailed calculations of unit costs.
Limitations
One obvious limitation of the unit costs calculated using the national survey data is that not all services provided complete data. In particular, few services provided information on both total annual costs and
caseload, or on staffing levels and caseload. Furthermore, in relation to caseload data, it is clear that annual caseload is not recorded
consistently across all services. For example, the minimum caseload recorded in the national survey was 16 clients per year and the
maximum 2000, and in the case studies was 282 and 3322. Because of these differences, the cost per client has not been presented in this report.
A further limitation in the calculations is that no account was taken of the cost of initial VI rehabilitation officer qualifications or ongoing training.
7The caseload data were not split into two distinct groups that clearly reflected
153
These costs are important as they are an integral part of becoming an RO. As an example, Curtis (2013) includes £25,430 per year for initial qualification costs for social workers but no costs for ongoing training as these were not available. Including qualification costs of £25,430 per year adds around 40 per cent to the unit costs of adult social workers (see Curtis, 2013, Table 11.2). The published unit costs given in Table 6.5 below exclude qualification and ongoing training costs to ensure the comparisons are valid.
The detailed bottom up calculation of unit costs is based on only three case study sites. To be more confident in the generalizability of the
costs, these calculations should be repeated for a larger number of sites. They should also be repeated for in-house and contracted out services separately, especially if tasks such as doing duty are carried out by team members in some services and not in others.
Finally, and perhaps most importantly, the unit costs reported give an estimate of the costs of services only; no information is given about the outcomes for clients. Therefore these costs tell us nothing about the cost-effectiveness (the value for money) of the services.
Summary and discussion of findings
The unit costs calculated vary according to the methods used and by case study site. Cost per hour of contact time in the case studies ranged between £43 and £80. Cost per hour worked by the teams ranged from £22 to £28.
From Table 6.4, the mean annual budget (£220,624) reported by the 28 services that responded to this question in the national survey is lower than the annual budget estimated from staffing levels given in the
national survey (£302,219). However, both are comparable to the range of total annual budgets reported by the case studies (£237,985,
£256,276 and £336,241). The similarity of each of these results (at around £220,000 to £340,000 per year) suggests they are reasonably reliable.
Tables 6.1 and 6.2 showed the time spent by case study site teams on client and non-client-related activities varied, perhaps in part due to the
154
time spent doing duty in case studies A and B. To test the impact on unit costs of doing duty, the time and salary costs of doing general admin tasks in case studies A and B were excluded. Details are given in Appendix 14. In summary, unit costs in sites A and B reduced by between £2 and £4 an hour. The percentage of time spent on client- related activities increased in both sites, as would be expected, with percentages in case study B closely mirroring those in case study C. The issue of doing duty (and its associated costs) should be revisited in any future evaluation.
To place the unit costs of VI rehabilitation teams in context, Table 6.5 gives a range of related costs to which they can be compared. The unit costs in Table 6.5 are all reported in Unit Costs of Health and Social
Care 2013 (Curtis, 2013). Table 6.5 includes unit costs of re-ablement
services, occupational and physiotherapists, and mental health nurses. For example, the average cost per hour of contact time with a home care re-ablement service is estimated as £43, compared to an average for VI rehabilitation teams of £60. The ratio of face to face contact time to other client and non-client-related duties for re-ablement teams is 1:0.94 (not shown in the table) compared to an average ratio for the case study sites of 1:1.33. VI rehabilitation service and re-ablement service costs in Table 6.5 include the costs of all team members (that is, management and administrative staff as well as front-line workers) whereas those for occupational and physiotherapists and the mental health nurse are based on the costs of that member of staff only. Once again, these unit costs take no account of effectiveness and so are not a comparison of the relative cost-effectiveness of services.
155
Table 6.5 Comparison of unit costs of VI rehabilitation services and other community services
Type of service Unit of service Unit cost
2012/13
Unit cost 2013/14*
VI rehabilitation service Per hour - £25
Per hour of contact time
- £60
Per hour of client- related work
- £34
Re-ablement service Per hour £22 £23
Per hour of contact time
£42 £43
Community OT (LA) Per hour £41 £42
Community OT (NHS) Per hour £30 £31
Community physiotherapist
Per hour £30 £31
Nurse (mental health) Per hour £35 £36
Per hour of contact time £65 £66 Per hour of patient-related work £46 £47
All costs reported exclude qualification and ongoing training costs * 2012/13 prices and pay uprated by 3.3 per cent and two per cent respectively. Using the same methods as Curtis (2013, page 251), percentages for inflating costs are calculated from an average of the past three years available in Table 16.2 The Hospital & Community Health Services (HCHS) Index.
There are a number of lessons for a future full evaluation that can be drawn from the experience of calculating the unit costs presented in this chapter. These lessons are discussed in Chapter 7. In brief, care should be taken over the measurement of caseload and simple data collection forms can provide sufficient detail to calculate basic unit costs. These unit costs can then be applied to data on the staff time spent with study participants.
157