Benefits bean counting

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.