Desarrollo del procedimiento cautelar
B) Modificación de medidas como consecuencia de alteraciones en el proceso principal
Detailed data on rehabilitation service team staffing levels, finances and caseloads were collected from the three case study sites. These data were used to test the feasibility of calculating detailed unit costs of VI rehabilitation services, specifically, the cost per hour of contact time with clients, the cost per hour of client-related work, the cost per hour worked and the cost per client. They were also used to calculate the amount of time spent on client-related work versus time spent on other duties. Data were collected on two specially designed forms asking for
information on (a) staffing levels and caseloads and (b) team finances. Completed forms were received from all three case study sites by 30th June 2014.
The forms requested detailed information about:
The total number of hours worked per typical week by staff in the team.
The total number of clients supported by the service in the previous 12 months.
The typical weekly mileage accumulated by the team.
The numbers of hours (or percentage of time) spent by the team on activities such as face to face contact with clients and client- related administrative duties.
Staff salaries and on-costs, direct and indirect revenue costs and capital charges.
Copies of the forms are included in Appendix 15.
Time spent on different activities
The manager of each case study team completed a form showing the number of hours worked by the team in a typical week and the hours per week spent on different activities (such as time spent in face to face contact providing support to clients or time spent on general office
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duties). Table 6.1 presents these data for each case study individually and the average across all three.
Table 6.1 Hours per week worked and percentage of time spent on different activities Case study A Case study B Case study C Average
Total hours a week 190
hours 225 hours 348 hours 254 hours Face to face contact with
clients
35% 46% 51% 44%
Other client-related time 30% 32% 32% 31%
Non-client-related time 35% 22% 17% 25%
Table 6.1 shows that the rehabilitation team in case study C is almost twice the size of case study A when measured in hours worked per week. The number of hours worked includes that of management and administrative staff as well as ROs.
Table 6.1 also shows that all three case studies spent about a third of their time on other client-related work (which includes preparing for visits, writing up case notes, travel time and client-related meetings with other professionals). On average, the sites spent 44 per cent of their time in face to face contact with clients, although this varied from 35 per cent in case study A to 51 per cent in case study C. The more detailed tables (Tables A14.1, A14.5, A14.9) in Appendix 14 show that when considering ROs’ time only, those in site C spend around 85 per cent of their time in face to face contact with clients; this is higher than the other two sites that spend 42 per cent and 53 per cent of their time with
clients. The administrative staff in site C, however, spend 83 per cent of their time on client-related work compared to none in the other two sites. Discussion in the focus groups (see Chapter 5) also showed that the ROs in case studies A and B did duty work (that is, answering the phone and taking new referrals); whereas they did not do so in case study C (a contracted out service). Time doing duty has been classified as non- client-related time in Table 6.1 as this work is not associated with clients
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already allocated to an RO. These differences in doing duty may account for at least some of the variation in the percentages of time spent on different activities. That is not to say, however, that case study C is a more efficient service because proportionately more time is spent with clients; it merely suggests that the costs of doing duty are being borne elsewhere, probably by local authority-based staff undertaking the duty that is done by ROs in case studies A and B.
Costs per hour worked
In addition to data on staff hours worked, each case study provided details on their annual budget. Annual budgets and the number of hours worked per year were combined to give estimates of the cost per hour worked, the cost per hour of face to face contact time and the cost per hour of client-related contact time.
Table 6.2 shows these costs per hour for each case study and the
average across all three. It also gives the ratio of time spent on different activities; these ratios simply present the information from Table 6.1 in a different format.
Table 6.2 Ratios of time spent and costs per hour Case study A Case study B Case study C Average
Ratio of direct to indirect time
- face to face contact - client-related work 1 : 1.85 1 : 0.54 1 : 1.16 1 : 0.28 1 : 0.97 1 : 0.21 1 : 1.33 1 : 0.34 Cost per hour worked by
the team
£28 £26 £22 £25
Cost per hour of face to face contact with clients
£80 £56 £43 £60
Cost per hour of client- related time
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The ratios of direct to indirect time show that, on average, for every one hour spent by rehabilitation teams in face to face contact with clients, a further 1.33 hours (approximately one hour and 20 minutes) is spent on other client and non-client-related work. Also, on average, for every hour spent on client-related work, a further 0.34 hours (about 20 minutes) is spent on non-client-related work. These ratios include work undertaken by all members of the rehabilitation teams, not just ROs.
On average, the cost per hour of work across the teams is £25.
However, it is often more useful to consider the cost per hour of face to face contact time or per hour of client-related time; these costs are, on average, £60 and £34 respectively. These costs take into account the fact that each period of time spent with a client involves a further period of time in preparation and follow-up work or other office duties.
Annual budgets and caseloads
Table 6.3 gives the annual budgets and caseloads for the three case studies, plus the average across all three.
Table 6.3 Annual budgets and caseloads Case study A Case study B Case study C Average
Total annual budget £237,985 £256,276 £336,241 £276,834
Annual caseload 282 2951 3322 n/a
The average annual budget was £276,834. Case study C reported a substantially larger budget; this is probably related to the larger number of hours worked by the team (see Table 6.1). Indeed, the cost per hour worked (given in Table 6.2) is similar in the three case studies.
The reported annual caseloads vary substantially, with case studies B and C having ten times the volume of case study A. The reason for this variation is the way in which caseloads are measured. In case study A, the 282 cases refer to individuals allocated to an RO, but do not include telephone calls by or on behalf of potential clients who were signposted
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elsewhere. In case study C, caseload was recorded as episodes of support. Therefore the caseload of 3322 refers to the number of episodes of support provided by ROs over the year. Clients could receive a number of episodes of support, each episode lasting up to eight hours. Thus the number of separate individuals receiving support in case study C is likely to be substantially less than 3322. This figure, however, was not available. The unit of measurement was less clear in case study B.
The intention was to calculate the cost per client based on the annual budgets and caseloads of the three case studies. Because of these differences in the measurement and recording of caseload, neither the cost per client nor an average caseload has been calculated.