High cost placements

1. High cost placements Peter McGill and Jo Poynter

2. Background • Discussions within NSG steering group about cost issues • High cost of some placements a potential driver for the development of different models • Mansell report commented on the need to redirect resources from expensive out of area placements

3. Previous work • Little previous work • Hassiotis et al (2008) • Survey of high cost placements (over 70k) in 5 London boroughs for people with LD/CB • 205 placements identified, 65% of them out of area • Majority male and with moderate/severe LD • Health/sensory/mobility problems common • Nearly a third with autism • Over 10% with mental health diagnosis

4. Previous work (contd) • Hassiotis et al (2005) (contd) • Service users out of area • Had more severe cb • Were younger • hospital (private/nhs) most expensive • Overall, out of area placements slightly more expensive (106k vs 98k) and had higher CSCI scores

5. Questions/suspicions • Most high cost placements out of area? • Most for people who present challenging behaviour? • Most in traditionally organised care? • Significance of offending/mental health issues? • Significance of other individual characteristics? • Variation across areas?

6. What we did • JP emailed all (19) local authority commissioners in SE Region • Asked for information about their 5 highest cost placements: • Cost • Gender, age • Nature of disability • Nature of placement • Plan, discharge date • In/out area

7. What we did (contd) • After a reminder from PM 14 areas provided information about 70 placements • Some information missing or very limited despite follow-up seeking more detail

8. Findings - cost • Mean £172k, Range £83-£333k • Substantial variation in mean cost across authorities from £98k to £250k • Some evidence of clustering of costs within authorities

11. Findings – gender, age • Gender – 51 male, 19 female (130:75 in Hassiotis) • Age – mean of 33 years, range 18-60 (36 years in Hassiotis)

13. Findings – nature of disability • Note well, limited data • Autism – 23% • Physical/health needs – 13% • Challenging behaviour – 46% • Mental health needs – 11% • Severe ld – 16% • Mild/moderate ld – 27% • Offending behaviour – 7% • Specific syndrome – 7%

14. Findings – nature of placements

15. Findings – plan, discharge date, in/out area • Plans for individuals were reported in 54% of cases • Discharge dates were reported in 3% of cases • 71% of placements were out of area

16. Differences between in and out of area placements • People placed out of area significantly more likely • To be male (80% vs 55%) • To be in residential care (72% vs 35%) • Not to be in supported living (2% vs 45%) • No significant differences in cost, age, other individual characteristics, other placement characteristics

17. Predictors of higher costs • Hospital or similar placements (£219k vs £161k) • Challenging behaviour (£190k vs £157k) • Syndrome (£223k vs £168k) (SMS mentioned twice)

18. Summary • Problem of inadequate/missing data • Average cost of £172k, wide variation • Individuals are mainly male, young with high prevalence of challenging behaviour and autism • Mixture of people with mild vs severe ld • 3/5ths of placements residential care, 1/5th hospital or similar

19. Summary contd • Most placements out of area with limited evidence of planned changes • Out of area placements more likely to be residential care for males • High cost associated with hospital placements, challenging behaviour and individual having identified genetic syndrome

20. Implications/issues for discussion • Possibly some evidence of innovative local developments • Still lots of high cost, out of area placements with very limited evidence of plans to change this • Area differences may reflect many things including natural variation in low incidence characteristics • Pattern of individual characteristics perhaps draws attention to service deficits