Cost effectiveness of pilot self-assessment sites in community care services in England
Paul Clarkson A B , Christian Brand A , Jane Hughes A , David Challis A , Sue Tucker A and Michele Abendstern AA Personal Social Services Research Unit (PSSRU), University of Manchester, Faculty of Medical and Human Sciences, Dover Street Building, Oxford Road, Manchester M13 9PL, UK.
B Corresponding author. Email: paul.clarkson@manchester.ac.uk
Australian Health Review 37(5) 666-674 https://doi.org/10.1071/AH13056
Submitted: 13 March 2013 Accepted: 19 August 2013 Published: 28 October 2013
Abstract
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.
What is known about this topic? A consumer case for self assessment in community social care has been advanced and policy in England has advocated the approach. The cost effectiveness of such approaches is not known.
What does this paper add? This paper suggests that implementing a self-assessment approach in assessment and care management and occupational therapy services is potentially cost effective taking account of a range of assumptions concerning uptake.
What are the implications for practitioners? For policy makers, these data suggest self assessment could provide enhanced user satisfaction with the assessment process at a relatively modest investment. For agencies implementing the approach, better quality data systems are needed that can track costs and impacts to evaluate the approach further.
Additional keywords: assessment, care management, economic analysis, individualised care, occupational therapy, preventative services.
References
[1] National Institute on Consumer-Directed Long Term Care Services. Principles of consumer-directed home & community based services. Washington, DC: National Council on Aging and World Institute on Disability; 1996.[2] Yeatman A, Dowsett GW, Fine M, Gursansky D. Individualization and the delivery of welfare services: Contestation and complexity. Basingstoke, Hampshire: Palgrave Macmillan; 2009.
[3] Department of Health Victoria. Strengthening assessment and care planning: a guide for HACC assessment services in Victoria. Melbourne: Victorian Government Department of Health.
[4] Department of Health England. Prioritising need in the context of putting people first: a whole system approach to eligibility for social care. London: Department of Health; 2010.
[5] MacDonald C. Self-assessment models, practice and tools within disability support services. Needs Assessment Service Coordination Association (NASCA)/New Zealand Ministry of Health; 2010.
[6] Department of Health Victoria. Strengthening assessment and care planning: a guide for HACC assessment services in Victoria. Melbourne: Victorian Government Department of Health; 2011.
[7] Newman L, Biedrzycki K, Baum F. Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services. Aust Health Rev 2012; 36 125–9.
| Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services.Crossref | GoogleScholarGoogle Scholar | 22624630PubMed |
[8] Griffiths P, Ullman R, Harris R. Self-assessment of health and social care needs by older people. London: King’s College, London; 2005.
[9] Qureshi H. Self assessment: how does it work, is it effective and how can it be promoted? 2006. Available from: http://www.ripfa.org.uk/images/downloads/outline_02.pdf [Verified January 2013]
[10] Disabled Living Foundation. Ask Sara; 2013. Available from: http://www.asksara.org.uk/ [Verified January 2013]
[11] Barnes C, McCarthy M, Comerford S. Assessment, accountability and independent living. Coventry: Coventry Independent Living Group/Coventry Social Services; 1995.
[12] Priestley M. Discourse and resistance in care assessment: Integrated living and community care. Br J Soc Work 1998; 28 659–73.
| Discourse and resistance in care assessment: Integrated living and community care.Crossref | GoogleScholarGoogle Scholar |
[13] Gershon P. Releasing resources to the front line. London: HM Treasury; 2004.
[14] Slade M, Leese M, Cahill S, Thornicroft G, Kuipers E. Patient-rated mental health needs and quality of life improvement. Br J Psychiatry 2005; 187 256–61.
| Patient-rated mental health needs and quality of life improvement.Crossref | GoogleScholarGoogle Scholar | 16135863PubMed |
[15] Challis D, Clarkson P, Warburton R. Performance indicators in social care for older people. Aldershot, UK: Ashgate Publishing; 2006.
[16] English Department of Health. Independence, well-being and choice, Cm 6499. London: The Stationery Office; 2005.
[17] English Department of Health. Transforming social care, LAC(DH) (2008)1. London: Department of Health; 2008.
[18] British Society of Rehabilitation Medicine. Transforming community equipment and wheelchair services position statement of the British Society of Rehabilitation Medicine; 2008. Available from: http://www.bsrm.co.uk/Consultation/BSRM-StatementOn-TCEWS-08July08.pdf [Verified January 2013]
[19] Government HM. Putting people first. London: Her Majesty’s Government; 2007.
[20] English Department of Health. Community care in the next decade and beyond: policy guidance. London: Department of Health; 1990.
[21] Applebaum R, Austin C. Long term care case management: Design and evaluation. New York: Springer Publishing Company; 1990.
[22] Golden RL, Tropman P. The search for the perfect assessment. In: Applebaum R, White M, editors. Key issues in case management around the globe. pp. 67–76. San Francisco, CA: American Society on Aging; 2000.
[23] Katz S, Akpom CA. Index of ADL. Med Care 1976; 14 116–8.
| Index of ADL.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE283hvVOnuw%3D%3D&md5=d162e5b203813476343df0529d17e27dCAS | 132585PubMed |
[24] Abendstern M, Sutcliffe C, Hughes J, Clarkson P, Unell J, Challis D. Satisfaction with adult social care assessment: the development of a measure. Research Policy and Planning 2012; 29 95–114.
[25] English Department of Health. Fair access to care services, LAC (2002) 13. London: Department of Health; 2002.
[26] Curtis L, Netten A. Unit costs of health and social care 2006. Cantebury, UK: University of Kent, Personal Social Services Research Unit; 2007.
[27] Drummond MF, Sculpher MJ, Torrance GW, O’Brien B, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd edn. Oxford: Oxford University Press; 2005.
[28] O’Brien BJ, Drummond MF, Labelle RJ, Willan A. In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care. Med Care 1994; 32 150–63.
| In search of power and significance: issues in the design and analysis of stochastic cost-effectiveness studies in health care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c7jtlOrtA%3D%3D&md5=3f6a1c2a47c36c65143bd7f6b4ca43afCAS | 8302107PubMed |
[29] Challis D, Clarkson P, Williamson J, Hughes J, Venables D, Burns A, Weinburg A. The value of specialist clinical assessment of older people prior to entry to care homes. Age Ageing 2004; 33 25–34.
| The value of specialist clinical assessment of older people prior to entry to care homes.Crossref | GoogleScholarGoogle Scholar | 14695860PubMed |
[30] National Institute for Health and Clinical Excellence (NICE). Guide to the methods of technology appraisal. London: NICE; 2004.
[31] The Information Centre for Health and Social Care. Community care statistics 2008–09: social services activity report, England. London: The Information Centre; 2010.
[32] NHS Information Centre for Health and Social Care. Personal social services survey of adults receiving community equipment and minor adaptations in England, 2007–2008. Leeds: NHS Information Centre; 2008.
[33] Abendstern M, Hughes J, Clarkson P, Tucker S, Challis D. Self-assessment processes within care management: Learning from pilot projects. J Soc Work 2013; 13 267–86.
| Self-assessment processes within care management: Learning from pilot projects.Crossref | GoogleScholarGoogle Scholar |
[34] Tucker S, Brand C, O’Shea S, Abendstern M, Clarkson P, Hughes J, Wenborn J, Challis D. An evaluation of the use of self-assessment for the provision of community equipment and adaptations in English local authorities. Br J Occup Ther 2011; 74 119–28.
| An evaluation of the use of self-assessment for the provision of community equipment and adaptations in English local authorities.Crossref | GoogleScholarGoogle Scholar |
[35] English Department of Health. Common assessment framework for adults: a summary of the consultation on proposals to improve information sharing around multi-disciplinary assessment and care planning. London: Department of Health; 2009.
[36] Tulloch AJ, Moore V. A randomized controlled trial of geriatric screening and surveillance in general practice. J R Coll Gen Pract 1979; 29 733–42.
| 1:STN:280:DyaL3c7ktVWiug%3D%3D&md5=7fe1f048e11d156fbea1598938438cf2CAS | 536982PubMed |
[37] Chase RB. Where does the customer fit in a service operation? Harv Bus Rev 1978; 56 137–42.
| 1:STN:280:DyaE1M%2Fks1yjsA%3D%3D&md5=e54210df159d12133eac1c4df268610eCAS | 10239167PubMed |
[38] Williams B. Patient satisfaction: a valid concept? Soc Sci Med 1994; 38 509–16.
| Patient satisfaction: a valid concept?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c3ktVGmuw%3D%3D&md5=e1390cc7c6e8c6e2241cf8fb0ced3f8bCAS | 8184314PubMed |
[39] Wiersma D, van Busschbach J. Are needs and satisfaction of care associated with quality of life? Eur Arch Psychiatry Clin Neurosci 2001; 251 239–46.
| Are needs and satisfaction of care associated with quality of life?Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FpvVGrtA%3D%3D&md5=56c954085953bc9817992a0fc4e863e6CAS | 11829211PubMed |
[40] Linder-Pelz S. Toward a theory of patient satisfaction. Soc Sci Med 1982; 16 577–82.
| Toward a theory of patient satisfaction.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaL383ltVSisA%3D%3D&md5=d422cbadc9decff8adf7846943a8e6e4CAS | 7100990PubMed |
