Adults

Services and service user profiling

The table below sets out an overview of Supporting People (SP) services in Medway. It indicates the wide variations in unit cost and variable levels of provision across the range of client groups.

This section will also examine the current composition of clients including gender, age and ethnicity, across the range of provision. At the time of writing, the data were incomplete, although relevant information is now being collected. This section will also look at current usage, i.e. occupancy levels, and draw some conclusions about service demand. Again, information gathering is at an early stage.

Service profiling and benchmarking services

Table one sets out the overall profile of units supplied, by client group, relative to the region and nationally. These figures do not reflect the cost or scope of provision but focus on the numbers of clients assisted.

The table indicates a higher than average supply of services (figures marked in bold) to the following groups relative to the rest of the region. While the council will be basing levels of provision on assessed needs in Medway, its strategy must also take account of areas where levels of provision are significantly lower or higher than the regional and national average.

• Levels of generic floating support services are twice as high as the regional average. This is flexible support that can be applied to a wide range of clients outside the context of supported housing schemes. While the high cost of these schemes must be examined through the review process, the council is comfortable with a focus on this kind of support.
• Provision of units for homeless families with support needs is 50 per cent higher than the regional average.
• Provision of units to support people with a physical or sensory disability is nearly twice the regional average. This situation may have occurred because scheme costs that may in other authorities be born by the primary care health trust have been covered through SP in Medway. There is clearly a need for more analysis and benchmarking in this area.
• Units to support people with alcohol problems are 50 per cent higher than the regional average, although the figure is still very low.
• Provision of support for single people with support needs (particularly accommodation based) is 50 per cent higher than the regional average.
• Provisions for young people at risk and for young people leaving care are also slightly higher than the regional average.

The table indicates a lower than average supply to the following groups:

• for older people with support needs the supply is about 60 per cent of the regional average,
• for people with learning disabilities provision is around 50 per cent of the regional average,
• for people with mental health problems the supply figure is less than half the regional average,
• overall the numbers of units provided by Medway Council across the board is about 10 per cent lower than the regional average.

These figures may just reflect a different needs profile in the Medway area but it is important to understand these variations and be able to either justify them or address them in the implementation plan.

Service supply analysis

Table two below sets out provision for each different client group in the area, with a short description of the support provided and an indication of annual turnover. Table three sets out the supply of floating support schemes.

The council will aim to provide a range of support:

Medway Council has worked hard to ensure that nomination arrangements are in place to maximise access to provision through statutory services. A nomination agreement has been developed along with a referral process but the SP Team is still not confident that all vacancies are properly notified and that scheme waiting lists reflect Medway’s re-housing priorities. This is a particular problem in a large number of sheltered housing schemes.

Another issue for the strategy is the lack of move-on from schemes and it must address this problem if the council is going to support the maximum number of people using available resources.

Move-on

The demand for move-on was assessed in June and July 2004 and returns from support service providers are set out below. Figures indicate that there were 165 people who were ready to move out of supported housing into more independent accommodation. This accounts for over 60 per cent of residents living in supported housing schemes. There is clearly a need for allocations policies which enable these moves to take place, ensuring that Medway Council is able to assist as many people as possible.

The costs of services

Medway received grant from the Department of Communities and Local Government (DCLG) of £6,258,903 in 2004/2005. Per head of population this is lower than the south-east average and significantly lower than the national average.

The Medway benchmarking initiative.

Medway Council has been proactive in inviting neighbouring authorities to benchmark service costs and provision. The group has agreed a framework for comparing service costs and will eventually provide a more sophisticated basis for cost comparison than unit costs alone.

Comparative unit costs

Table four sets out the unit cost of provision as compared with the regional and national costs. Higher than average costs are indicated in bold and lower than average costs are indicated in italics. The SP Team will continue to prioritise high cost schemes for early review. The following services are significantly more expensive than services for similar client groups in the region:

• the cost of supporting people with physical or sensory disabilities is around twice the regional average and the figures indicate significantly higher floating support costs;
• support for refugees is roughly in line with the national average but over twice as high as the regional average;
• Medway Council spends around 30 per cent more on single people with support needs, generic floating support and young people leaving care than the regional average;
• Medway Council spends around 25 per cent more on young people at risk than the regional average.

Medway Council spends less than others on the following services:

• older people with support needs - less than a third of the regional average;
• people with alcohol problems - about 30 per cent less than the regional average;
• people with learning disabilities - around 25 per cent less than the regional average.

Overall Medway spends around 15 per cent less than the regional average on SP and around two thirds of the national average.

Cross Authority (CA) provision

Cross boundary schemes must be seen in the context of a wider analysis of provision and needs across Kent.

• Provision for offenders or people at risk of offending is one and a half times the regional average. Unit costs are twice as high and services for those with mental health problems are four times the regional average.
• For people at risk of domestic violence, numbers are lower than the regional average because no floating support schemes are offered to this group.
• Provision for refugees, although low, is still 10 times the regional average.

In terms of costs:

• accommodation for mentally disordered offenders is over 10 times higher than the regional average;
• accommodation costs for offenders or people at risk of offending is three times the regional average;
• Medway spends around 25 per cent more on dealing with domestic violence than the regional average.

Value for money

Value for money is a relative concept and very complex to assess within the support sector. Medway’s approach is to analyse the cost and price of the service and compare this to our assessment of quality.

To assist in the assessment process we have designed our own spreadsheet, which allows us to separate service direct costs from overheads. From this we are able to identify, unit cost per hour, number of hours per user per week, average hourly staff salary.

• We will use comparisons to identify services, which appear well outside the cost band occupied by similar services.
• We will investigate cases where costs are a long way from the average as to ensure that the results are not based on erroneous data or calculations. We will examine claims by providers that their services are somehow better or inherently more expensive that those of other providers.
• We will not use cost comparisons to drive all provider prices down to those of the lowest costs regardless of quality.

We will not assume that high costs are problematic. We will also not assume that low costs are sustainable. A table containing a variance of acceptable costs for each client group will be produced to assist providers to achieve value for money. This will be devised using local data.

Table 1 - SP units per 1,000 population, with comparable regional and national figures

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Notes:

• These figures represent the number of SP units available per 1,000 head of population.  
• In each case, this is total population, rather than the population in each client group.
• Figures relate to the Platinum Cut submission and to the 2002 population estimates.
• Certain services are excluded: Health Impact Assessments (HIAs), community alarms, leasehold schemes, pipeline services.

Table 2 – Accommodation-based support

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Table 3 – Floating support

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Table 4 - Unit costs with comparable regional and national figures

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Notes:

• These figures are augmented total weekly unit costs. These are weighted averages (means), weighted using the number of units.
• All figures relate to the Platinum Cut submission.
• Certain services are excluded: HIAs, community alarms, leasehold schemes, pipeline services.

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