How the National Care Costing Tool can boost commissioning

For politicians, the Holy Grail in public services is to cut costs and improve quality at the same. This appears to be not just counter-intuitive but downright impossible.

But the National Care Costing Tool is an attempt to do just that. Set up by the Regional Centres of Excellence (RCE), which was created by the Department for Communities and Local Government to help councils deliver more efficient services, the tool compares costs of independent residential and supported living care services for people with learning disabilities. The RCE says it will “transform the social care market” as well as helping service users and their carers to receive better support.

The tool was born from two similar projects that sprung up independently in the South West and South East.

The South West Centre of Excellence says it has already achieved £1.2m savings in six local authorities by using a “fair price” tool. With about £5.5bn spent by councils each year on adult social care, the possible savings across the UK are huge. It is no wonder that the national tool has attracted attention, and so far 71 local authorities are involved in a pilot project to test it.

The tool is a simple excel spreadsheet but the complicated bit is obtaining the information from learning disability services and attempting to produce a unit cost for care packages. This has created suspicion among providers, and there is a danger of upsetting existing relations – fair pricing for some may be seen as a “fix-up” by others.

John Adams is the general secretary of the Voluntary Organisations Disability Group, a representative body for some of the biggest charities in social care including Mencap, RNIB and Leonard Cheshire. Adams asked to be appointed to the board that oversees the project and is in the unique position of being able to speak for both providers and service users. “From the providers’ perspective the market is very immature, it doesn’t work that well,” he says. “The purchasers are essentially councils and health – to call it a market is a pretty false distinction.”

Despite some early reservations, Adams sees the project’s potential. “If we were purchasers, we’d be doing exactly the same thing,” he continues. “The tool is a framework for us to sit down together and really focus on individual disabled people, agree outcomes and what they will cost.”

Is the tool an opportunity to improve services as well as cutting costs? “I think it isWe’ve got some way to go, but it’s for that reason [improving quality] that I was willing to become engaged,” Adams says.

Amanda Lloyd from the South East Centre of Excellence is managing the pilot project. She initially had to learn hard lessons about dealing with businesses. “In the early days we met with a lot of anger from providers.”

“In the learning disability sector it’s particularly difficult because each care placement is so highly individual. We see the cost of placements varying from between £400 to £4,000 a week without any real understanding of why that should be the case.

“In some cases you’ve got some great providers out there who are doing excellent work and possibly not charging quite enough for it – other providers who are doing good work but charging over the odds.”

Lloyd is slowly managing to get providers on board, and believes a lot of savings can be made. “I have mentioned a figure of £100m, I think that might be a little bit optimistic. But it’s something to aim at, it’s an opportunity to make savings of that level.”

The council pilots have yielded some encouraging results. After using the tool for 20 clients in Sutton, learning disability commissioning officer Colm O’Flynn (pictured) is enthusiastic. “It’s is a godsend to commissioners,” he says. “It allows us to break down in fine detail what services are required for an individual, and a pricing on that basis. In the past it has been a case of finding a provider and negotiating a cost more or less blind in terms of seeing what services work.”

If the National Care Costing Tool, which will be rolled out in March next year, does achieve the impossible we can certainly expect to see similar projects set up for a whole range of care services.

Further information
More about the use of the toolkit in the South East at www.communitycare.co.uk/toolkit

This article appeared in the 13 December issue under the headline “Squaring the circle?”