When Marian Allen began a Best Value review of Cambridgeshire's mental health day services, there were worries that services known to be of high quality would show up as being too expensive.
Unit cost analysis is hardly a term likely to strike joy in the heart of most social workers. Predictably, when the prospect of looking at unit costs was raised in the course of our Best Value review of mental health day services, the response was one of suspicion. There was genuine fear that unit costs information would pull in the opposite direction from efforts to promote better quality services for users.
We had already started the review by carrying out extensive user consultation in the nine different day services that the council funds across the county. This consultation, together with what we know about the facilities offered by each of the services, had served to identify those centres that exemplified good practice. In these centres the level of user choice and involvement, the links into the local community, and the prevailing ethos of user empowerment were outstanding.
Having done this work, what more could a bean-counting approach offer? It was already clear that the three flagship services were the three most generously funded. Perhaps the unit costs analysis would show these centres as expensive. In a cash-strapped authority this could undermine our efforts to promote quality service.
However, there was no ducking the fact that the council's Best Value methodology required investigation of service costs and levels of service use. How could we make meaningful comparisons across nine highly diverse day centres, each serving different geographical areas? Misgivings aside, we attempted a fairly crude unit cost analysis, simply looking at the levels of use in relation to costs. It took two attempts to run the required user census. Our first attempt failed to pick up users attending community-based activities facilitated by the centres. It was important to give credit for these activities, which we are keen to encourage.
The results came as a pleasant surprise. The figures showed that of the three services we knew to provide excellent quality from the users' perspective, two also scored highly on cost-effectiveness and the third had average costs. Put simply, because the services were good, they were well-used and tended to perform well on unit costs.
This is not to say that the figures did not need closer investigation and judicious interpretation. They show that some of our smaller, rural projects have high unit costs. Equally, city centre projects had very high premises costs, which made their unit costs appear less impressive. Importantly, the results would not have been as meaningful had they been viewed in isolation from earlier work to consult users on quality issues.
There is little doubt the findings were helpful. They demonstrated a link between quality, good funding and cost effectiveness and a link between size and cost-effectiveness. They acknowledge the financial pressures associated with rural service provision. These findings will, we hope, assist the commissioning of day services once a new county-wide mental health trust goes live in April. The old adage that there are "lies, damned lies and statistics" did not hold water on this occasion.
Marian Allen is policy and review manager for Cambridgeshire Council.
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