In-house and external costs in #socialcare: a comparison

I have to confess that the words “Return on Investment” often make me want to roll my eyes.

This is not to say that I don’t think service delivery or innovation shouldn’t have some form of financial attractiveness attached to it in terms of better value for money or more for less.

It’s more that my eye-rolling is an outward expression of a feeling it’s quite easy to hide behind ROI as something that is very hard to robustly prove, either as a way of saying “no” or just to put off for a bit doing something someone may not necessarily want to do.

(There’s also a point here that it shouldn’t just be financial measures we consider in terms of value, but that’s a post for another day.)

Shifting on slightly from ROI, figures published by the English Community Care Association (via Community Care) on the costs of residential and home care provision both by one particular council and by external providers operating in that council’s area make for fascinating comparisons.

In older people’s residential care:

  • Gross total cost per week for external providers = £433.62
  • Gross total cost per week for in-house services = £839.20

For domiciliary care:

  • Gross hourly cost for external providers = £13.49
  • Gross hourly cost for in-house services = £34.19

Obviously, we should treat these figures with some caution, and remember that they arise only from one local authority (which could have a particular history which skews these figures).

But the gap between in-house and external provider costs suggests that, even for adjustments because of the methodology used, there’s an argument that external providers (most likely private and voluntary sectors, don’t forget) are considerably cheaper than in-house.

If anyone knows if there is similar data across a wider set, I’d love to know about it. In particular, if there is anything out there regarding voluntary sector costs compare to public and private sector costs, please let me know.


DPULO Ambassadors

I am in a fortunate position to be part of a programme that aims to build the strength and sustainability of disabled people’s user-led organisations (DPULOs – an acronym that could do with sharpening up a bit). This is so they can provide a strong voice for disabled people at a local level, as well as provide services to support disabled people to have more choice and control over every aspect of their lives (for example, employment, social care, health and leisure).

The programme has 4 key components: Ambassadors, Experts, the Facilitation Fund, and someone who links it all together (which is my role).

In this (personal) post, I wanted to briefly talk about the Ambassadors.

They are an absolutely vital part of the programme. They provide the “missing link” between the energy, ability and sheer inventiveness of local disabled people who want to make things better and the resource, scale and leverage/links that central and local government can provide.

Having met individually with each of the 12 Ambassadors involved in the programme, covering almost every area of England, last week they all came together for the first time. Some photos of the day are here.

It was a privilege to be in the room with so many people that had made such a difference in the work they do in the lives of disabled people. The expertise that each of the Ambassadors had – in areas as diverse as leisure and culture, disability hate crime, housing, employment, volunteering, enabling peer support, social care and health – was quite something.

Inevitably, in a programme that aims to support organisations as diverse as DPULOs, there is no template for what an Ambassador might do. Broadly, though, there are 3 areas they’ll focus on:

  1. Reacting to the queries, questions and requests that DPULOs ask of them. With their experience, expertise and networks, Ambassadors can support DPULOs to have the right conversation or right piece of information at the right time
  2. Being proactive and making the case for DPULOs. Not only that, but Ambassadors can talk with commissioners, businesses and local people to see what they’re doing to support DPULOs and suggest ways in which they can work together with them
  3. Making sure the Strengthening DPULOs programme is working as well as it can be. This includes making decisions on which applicants to the Facilitation Fund will receive a financial award and ensuring that all learning from the programme (and beyond) is captured and shared

There is no doubt it’s a demanding role. But having met each of the Ambassadors and learning about what they’ve done, I know we have the right people doing the business!

If you’d like to know more about the Ambassadors who are involved and snippets about their experiences, you can read about them here.

If you’d like to know more about the programme in general – and especially if you work for a Disabled People’s User-Led Organisation – then feel free to get in touch with me.

What community budgets can learn from the Right to Control and the Individual Budgets pilot

Nick Clegg today announced that Community Budgets are to be rolled out more extensively than they currently are. As Public Finance puts it:

Under Community Budgets, various different sources of funding are merged into a single ‘local bank account’. The current pilots are pooling money for tackling social problems around families with complex needs… [and Councils can] put forward plans for their own Community Budgets [so that] plans would be developed locally for the pooling of both central and local government budgets.

This is a good idea and follows similar ideas around pooling budgets that have been around for a while. It also creates a space in which services can be more personalised around individuals rather than individuals having to fit around services.

I’ve had the fortune to be involved in two programmes with the same intention to do this before, specifically (though not limited to) adult social care. The first was the Individual Budgets pilot (an evaluation of which is available here), which sought to pool budgets from adult social care, Access to Work, Independent Living Fund, Supporting People, Disabled Facilities Grant, and local integrated Community Equipment Services.

The second is the current Right to Control trailblazers, which seeks to pool budgets from adult social care, Access to Work, Independent Living Fund, Supporting People, Disabled Facilities Grant and Workchoice.

That the Right to Control trailblazers cover virtually the same funding streams as the IB pilots should give you an idea of what I’m going to say next: pooling budgets is not as easy as it looks.

I’ve written about 5 key areas the Right to Control trailblazers grappled with early on: detailed analysis starts here and covers issues like legislation and regulations, policy ‘versus’ process and public agencies working together.

So whilst I fully support Community Budgets – especially as they provide the potential for more personalised services for people, and particularly because I recognise them as reflecting the way public services will (need to) be delivered in the future – let’s not be under any illusions about how hard they’ll be to deliver.

Clegg et al. might not like it, but they’ll need brilliant public sector managers and leaders to make it happen. They’ll also need money, too.