PSSRU Bulletin 16, November 2006 - School of Nursing, Midwifery ...

PSSRU
B U L L E T I N 1 6
NOVEMBER 2006

PSSRU Bulletin No. 16
The PSSRU
The Personal Social Services Research Unit was
established in 1974 and now has branches at three UK
universities: the University of Kent, the London School
of Economics and Political Science, and the University
of Manchester.
Its mission is to conduct high quality research on social
and health care to inform and influence policy, practice
and theory.
An overview of our research programmes can be found
on pages 30–36; contact details for the staff at the three
PSSRU branches are on the inside back cover.
About this Bulletin
© PSSRU 2006
This issue of the PSSRU Bulletin was edited by
Juliette Malley and Demetra Nicolaou-Frini and
sub-edited and typeset at the PSSRU by Nick Brawn.
Published by:
Personal Social Services Research Unit
Canterbury, London and Manchester
ISSN 1350-4703
The research reported in this Bulletin was
undertaken by the PSSRU, which receives support
from the Department of Health and other funders;
the views expressed are those of the authors and
not necessarily those of the Department of Health
or other PSSRU funders.
The three branches of the
PSSRU are recognised as
Investors in People.
2
The PSSRU Bulletin records recent developments in
the Unit, presents recent findings from each of our
main programmes of work, and gives a concise overview
of research projects and recent publications with
contact information.
The Bulletin is distributed free of charge to all local
authorities, health authorities, relevant voluntary
organisations, and to others on request. If you would
like further copies, please contact the librarian at the
PSSRU in Canterbury (phone 01227 827773; fax 01227
827038; email pssru_library@kent.ac.uk). If this copy
was wrongly addressed, please let us know, quoting the
mailing number from the label if you can.
We welcome comments on this Bulletin or other aspects
of our work.
Other PSSRU publications
A wide range of publications reports the PSSRU’s
work. Some are mentioned in the articles which follow
and listed in the section beginning on page 30.
The Unit website gives a complete listing, with many
downloadable publications (including this Bulletin and
previous issues), along with more information on
current and completed research.
PSSRUlist
To subscribe to this email list for announcements of
publications, events and developments at the PSSRU,
go to www.jiscmail.ac.uk/lists/pssrulist.html
PSSRU website
http://www.PSSRU.ac.uk/
rev. 000

Introduction
In the past year the three branches of the PSSRU
(at the Universities of Kent and Manchester, and at
the London School of Economics and Political
Science) have started work on their new core
programmes. These research programmes are
funded by the Department of Health as part of a
five-year contract that commenced January 2006.
We are delighted that the DH continues to value
our research.
The component activities of the new DHsupported
programme in the next couple of years
are set out in this Bulletin, with some of the work
described in more detail on pages 6–21.
Researchers in each of the three branches are also
active on other research projects, some funded by
the DH, most funded by other bodies. The full list
of programmes and projects can be seen on pages
30–36.
PSSRU’s spread of activities is clearly broad.
Around the core long-term theme of social care are
arranged a number of other projects that look at a
variety of health care topics (particularly mental
health), housing, criminal justice, social exclusion,
early years services and employment. But the core
business of PSSRU has always been social care,
with a majority of our projects concerned with
older people – their circumstances and needs, their
preferences and choices, the service and other
arrangements that support them, and the outcomes
they experience.
An increasingly important focus of our research is
the development of user-directed services,
particularly direct payments and individual budgets.
(The three PSSRU branches are working together,
and in collaboration with the Social Policy Research
Unit at York and the Social Care Workforce
Research Unit at King’s College London, on the
evaluation of the thirteen individual budget pilot
sites set up this year in England. See page 28.)
Among the highlights of the past year was PSSRU’s
work on the Wanless Social Care Review, led by
Julien Forder and José-Luis Fernández, and
supported by numerous other colleagues (see page
38).
Many people in PSSRU have contributed to this
Bulletin, but I would particularly like to thank my
LSE colleagues Juliette Malley and Demetra
Nicolaou-Frini for the work they have done in
pulling together the material from across all three
branches. Glenys Harrison, Anji Mehta and Angela
Worden – at their respective branches – supported
and encouraged their colleagues as they drafted the
articles and details that you will find on subsequent
pages. As in previous years, Nick Brawn (at the
Kent branch) took expert charge of the Bulletin
design and typesetting.
Martin Knapp, PSSRU,
London School of Economics and Political Science,
September 2006
PSSRU Bulletin No. 16
Contents
Introduction .....................................................................................3
The PSSRU 2005–2006. ............................................................................4
Staff News. ......................................................................................4
Current research programmes
Assessment, Performance Measurement and User Satisfaction in Older People’s Services. .......................6
Commissioning and Performance ....................................................................8
Mapping and Evaluation of Care Management Arrangements for People with Mental Health Problems in England. ...10
Costs, Quality and Outcomes ......................................................................12
Children’s Services: Active Cases, Case Longevity and Staff Time in Social Care. ..............................14
Financing Long-Term Care for Older People. ..........................................................16
Mental Health Economics and Policy .................................................................18
Housing and Care: Care Homes and their Alternatives ..................................................20
Research reports, new projects, publications and contact details
Quality of Dementia Care Services in North West England. ..............................................22
Services for Older People with Mental Health Problems: The Impact of the National Service Framework. .........23
Paying For Long-Term Care for Older People: the Costs and Incidence of a Range of Options ...................24
Consequences of Local Variations in Social Care on the Performance of the Acute Health Care Sector ...........25
Valuing Social Service Outcomes ....................................................................26
Analysis to Support the Development of the Relative Needs Formula for Older People ........................27
New Projects ...................................................................................28
Current Research Projects and Recent Publications. ....................................................30
Staff Contact Details. .............................................................................39
3

PSSRU Bulletin No. 16
The PSSRU 2005–2006
New Research Grants
PSSRU at Kent will be conducting and
leading four projects commissioned as
part of an important new initiative, the
Quality Measurement Framework
(QMF) programme, which is being
funded for three years by the Treasury
under Invest to Save and led by the
Office of National Statistics. The aim
of the QMF programme is to create
new mechanisms for more effective
and efficient measurement and
monitoring of third sector provision of
public services while reducing the
burden on the third sector.
The Long-Term Care Finance team at
LSE have been awarded a grant by
the ESRC under their New Dynamics
of Ageing research programme. This
is to conduct a study, Modelling Needs
and Resources of Older People to
2030, in collaboration with
researchers at the University of
Essex, University of Leicester,
London School of Hygiene and
Tropical Medicine, London School of
Economics and Pensions Policy
Institute. This will use simulation
models to project up to 2030 the
numbers, family circumstances,
income, pensions, savings, disability
and care needs (formal and informal)
of older people, the key
determinants of their resources and
needs. The three-year study, led by
Professor Mike Murphy (LSE), is
expected to start in January 2007.
PSSRU staff at LSE will be
contributing to a new study
commissioned by the King’s Fund.
The work will be led by the Centre
for the Economics of Mental Health,
Institute of Psychiatry and aims to
estimate mental health expenditure in
England over the next 20 years. This
study will conclude in autumn 2007.
In collaboration with Professor Paul
Williams, Raisa Deber, Janet Lum and
colleagues at the University of
Toronto, PSSRU at Manchester has
been awarded two grants of C$2.9
million and C$600,000 to develop
their joint work.
Wanless Social Care
Report
The publication of the Wanless
report on social care for older people
was a major event in this field in
2006. The review was commissioned
by the King’s Fund and was led by Sir
Derek Wanless. It was produced in
collaboration between the King’s
Fund and the PSSRU at LSE. Dr Julien
Forder and Dr José-Luis Fernández of
PSSRU managed the project and,
along with Professor Martin Knapp,
sat on the steering group. Several
PSSRU, LSE colleagues were
members of the research team. The
main recommendations of the review
(see page 38) were challenging, calling
for sharp increases in funding over
the next two decades and also a
major overhaul of the way that care
for older people is financed.
LSE Health & Social Care
Annual Lecture
We are pleased to announce that Sir
Derek Wanless will be giving the
2006 LSE Health & Social Care
Annual Lecture, to be held on 21
November 2006 at the LSE’s Hong
Kong Theatre. A reception will follow
the lecture.
4
Staff News
Barry Baines
Barry Baines, who was a researcher in
PSSRU during the 1980s and who
continued to contribute to projects
subsequently, sadly has died after
many years of living with Friedreich’s
Ataxia, a progressive neuromuscular
degenerative disorder.
Barry and his widow Chris
campaigned for many years against
the ‘medical’ model of disability. As
they say in their mission statement (at
www.albassocs.com):
‘We resist the emphasis on the
medical model of disability. Providers
must recognise the group who, although
they are severely physically disabled,
are not ill and have learned to live with
their condition over many years. They
must learn that – apart from changing
antediluvian attitudes – adaptation of
the physical environment and
provision of essential equipment are
all that the independent disabled
person asks for. There are huge
numbers of severely disabled people
who function independently,
professionally, economically, socially,
within partnerships or families. And
the number is going to increase
enormously in the near future, as
more young disabled people are
integrated into mainstream education
and employment.’
Barry worked on a number of
projects in the child social care area
and in relation to services for older
people. His background in labour
economics and his econometric
abilities made him a sought-after
colleague as the PSSRU developed
research interests in these areas.
After his retirement from the PSSRU,
Barry and Chris undertook freelance
research, both in their academic fields
and in the general area of health and
social service provision and wrote on
various issues in the field of disability
experience.
CASE studentship
A CASE studentship has been
awarded jointly to the Tizard Centre
and PSSRU at the University of Kent
with the Commission for Social Care
Inspection as the partner

The event is open to all. Please
contact pssru@lse.ac.uk for further
details or visit the PSSRU website.
Simon Institute in Public
Policy and Management
Across the developed and developing
worlds, governments are struggling
with issues of how to provide
efficient and effective public services
which earn the trust of the public and
increase social well-being and
cohesion. PSSRU Manchester is to
join a number of other research
groups as part of a new initiative –
the Simon Institute in Public Policy
and Management, established at the
University of Manchester to network
and promote those engaged in public
policy and management activity
across the University and engage
more fully with this global debate.
Housing and Care of Older
People Research Network
The research network, coordinated
by the PSSRU at the University of
Kent, was established in 2005 to bring
together researchers interested in the
role of housing in social care. To date,
the network has held five meetings,
and the next will be in November
2006, when Professor Julienne
Hanson will be talking about her
work on telecare.
The research network is intended
primarily to provide a forum for the
views of researchers, but a key role
of the network will be to enable
communication with commissioners,
policy makers and end users. A
number of ways of sharing
information are being developed,
including an electronic discussion list
and a website.
The network supports a range of
activities:
Information exchange
Collaboration on research
proposals
Developing messages for
commissioners and providers
Sharing methodological
experiences
Suggesting new programmes of
research
Ethical issues
For further information about the
network, please contact Robin
Darton (R.A.Darton@kent.ac.uk).
Health Economics, Policy
and Law
LSE Health and Social Care has been
instrumental in establishing this new
quarterly journal, published by
Cambridge University Press.
International trends highlight the
confluence of economics, politics and
legal considerations in the health
policy process. HEPL serves as a
forum for scholarship on health policy
issues from these perspectives, and is
of use to academics, policy makers
and health care managers and
professionals.
HEPL is international in scope, and
publishes both theoretical and applied
work. The definition of health policy
is broad, and includes factors that
affect health but that transcend health
care, and factors that only indirectly
affect health, such as legal and
economic considerations in medical
research. Articles on social care
issues are also considered.
Contributions and general
correspondence should be sent to:
Anna Maresso, Managing Editor, at
LSE Health and Social Care (email
hepl@lse.ac.uk).
PSSRU Bulletin No. 16
organisation. The recipient of the
studentship is Jan Smith.
Arrivals and departures …
We welcome a number of new staff
to PSSRU this year. At the Kent
branch: Theresia Bäumker, Lisa Nash
and Nick Smith. Lyn James is working
for PSSRU at Kent, but is based in
Somerset. Kent has also appointed
the first of a number of local
fieldworkers on the Extra Care
Housing project around England:
Joice Amos, Zoe Benedetti, Sue
Blackford, Angela Grimsdell, Christine
Hall, Hilary Poole and John Rushton.
At the LSE branch, new staff joining
include Research Assistants Jacqueline
Damant, Tom Snell and Ami Somani.
LSE students Sarah Deacon, Sue
Gauge, Alexandra Lewis and Vangelis
Tsirovasilis worked at the PSSRU as
Occasional Research Assistants
during the summer, contributing to a
number of projects.
At the LSE branch have been pleased
to welcome Dr Jeremy Kendall and
Dr Ann Richardson as Visiting
Fellows; Sujith Dhanasiri, Margaret
Ellis, Pat Gordon, Robert Hayward,
Dr Julian Pratt, Dr Diane Plamping
and Birgit Trukeschitz as Visiting
Research Associates; and Anna
Melke, a visiting PhD student from
Stockholm University
Since our previous Bulletin we
welcome back from maternity leave
Demetra Nicolaou-Frini and Adelina
Comas-Herrera (LSE) and Jacquetta
Williams (Kent).
PSSRU at Manchester is to have a
new honorary member of staff, Dr
David Jolley – an eminent old age
psychiatrist who is an Honorary
Reader at the Unit.
This year, Laura Dawson left PSSRU
Kent to work at the Department of
Primary Care and General Practice,
University of Birmingham. Sima
Sandhu is leaving PSSRU Kent to
undertake a PhD and teaching post at
the School of Psychology, University
of East London.
At LSE we said farewell to Claire
Curran, who has joined Eli Lilly and
Company, and Birgit Trukeschitz, who
returned to Austria.
Alison McQuade, Research Secretary
at Manchester has moved to work
elsewhere in the University.
Since the previous Bulletin the PSSRU
extended family has grown with the
arrivals of Adam Frini (to Demetra
Nicolaou-Frini), John Comas Kendall
(to Adelina Comas-Herrera and
Jeremy Kendall), Jacob Towers (to
Ann-Marie Towers) and Cerys
Venables (to Dan Venables).
Congratulations also to Vanessa
Davey on her wedding.
5

CURRENT RESEARCH PROGRAMMES
PSSRU Bulletin No. 16
6
Further
information
For further
information on the
SAP study see the
project outline at
www.pssru.ac.uk/pdf/
p060.pdf.
A Research and
Policy Update on
Stage I of the SAP
project is available.
Please contact PSSRU
Manchester for more
details.
For further
information about
the programme
please contact:
pssru@
manchester.ac.uk.
Assessment, Performance Measurement and
User Satisfaction in Older People’s Services
Paul Clarkson, David Challis, Jane Hughes, Michele Abendstern,
Caroline Sutcliffe and Sue Tucker
This programme, at PSSRU Manchester, continues to develop, viewing
assessment not only as a central component from which to design appropriate
services to meet the needs of older people at the professional level, but also as
vital to national policies aiming to promote more efficient and effective care.
Assessment:continued problems requiring ‘large solutions’?
Since the community care reforms of the late 1990s, assessment has been
viewed as an important tool for policy makers to achieve greater efficiency
and effectiveness in community care services. The assessment process
continues to provide examples of problems, both in the way information is
collected from older people and in the use of such information. Difficulties
around information sharing between different professionals and omissions of
important need domains in community care assessments have prompted
policy makers to consider major changes to the assessment process (Challis,
1999; Stewart et al., 1999). One recent policy has been the Single Assessment
Process (SAP), formally introduced in England from April 2004, which
PSSRU Manchester is evaluating.
The SAP represents what the late political scientist Aaron Wildavsky (1979)
termed a ‘large solution’ in public policy: the assessment process represents
the decision making of large numbers of staff from diverse professional groups
and represents a major consumption of human and financial resources. In
contrast to innovative experiments, which attempt to improve the assessment
process by, for example, providing ways for individual professionals to share
information more effectively (Challis et al., 2004; Clarkson et al., 2006), a
national policy seeks changes to assessment across the country. This demands
that governments develop approaches which seek to change professional
attitudes and behaviour. The problem with such large solutions is that
changing behaviour is inherently more complex and difficult than purely
shifting resources across settings. Findings from Stage II of our SAP project,
which is examining the policy’s impact, are beginning to show that
stakeholders have experienced challenges in implementing the policy locally.
To what extent implementation will feed through into impacts for older
people, in terms of the policy’s aims to make assessment more effective at
identifying needs and designing more appropriate service responses, is to be
explored in two sub-studies of the larger project. Data collection for these is
nearing completion. See ‘further information’ for details.
Monitoring assessment:performance and user satisfaction
At a local level, monitoring the conduct of assessment is an area ripe for
development, and here ways will need to be found to generate data to
comment on the effectiveness and efficiency of the assessment process. Work
on our SAP project has already developed a user satisfaction tool, in
consultation with groups of older people, which is being used to gauge the
impact of the SAP on older users. Such monitoring is crucial in ensuring that
policies are tested in terms of user satisfaction – a key outcome measure for
older people and their carers (Applebaum et al., 2000). Much routine
monitoring has, so far, focused only on levels of satisfaction with services and
the new tool provides an opportunity to consider satisfaction with the

assessment process itself (Scottish Executive Social Research, 2005). The user
satisfaction tool is currently being piloted in several statutory and voluntary
organisations, and as part of work within one social services authority
interviewing older users to assess the impact of the SAP locally.
Monitoring assessment in this way is crucial to developing performance
measurement further in terms of key outcomes. This is important, because
much of the data currently used for performance review are derived from the
interactions between older users and professionals in their assessment and
care planning activities. However, either local data concerning assessment,
care planning and review are lacking or there are challenges with design and
collection. In other countries, such as Australia, more extensive data relating
to assessments are available (Lincoln Gerontology Centre, 1997). In contrast,
the predominant approach to measuring performance in UK social and health
care is a national one, based on key indicators used to compare units of
organisation. We simply do not know the extent to which, across the country,
local councils are engaged in employing local performance measures and, if
they are, the benefits of doing so. The links between the national regulatory
performance regime and local approaches are also unclear. A three-year study
funded by the Economic and Social Research Council (ESRC) aims to throw
light on some of these issues through a national questionnaire survey in
England and Northern Ireland. The study will begin in late 2006 and is
designed to address some unanswered questions concerning the links between
national and local monitoring and the influences on how councils are rated in
terms of their performance. From this we hope to draw conclusions of relevance
to not only social care but also the wider public sector.
PSSRU Bulletin No. 16
Another, largely measurement, issue regarding the national performance
regime in social care has been explored in our recent work on this
programme. Despite the rationale for performance measurement, as stated in
Modernising Social Services (Cm4169, 1998), being the driving up of standards
‘to match those of the best’, recent techniques do not allow such comparisons
to take place. Instead, social services authorities are usually compared with
the averagely performing unit. Recent work has compared different methods,
including multivariate and mathematical techniques, for measuring efficiency
in national performance across groups of authorities. This work has found
that different methods for analysing performance result in very different
rankings of authorities from those endorsed by the recent system. This is a
point of great interest to managers and policy makers, where recent debate
has been critical about the extent to which the particular circumstances facing
‘poor performers’ are not included in current ratings across England
(Clarkson and Challis, 2006).
This programme at Manchester will continue to develop measurement
approaches aimed at investigating how changes to assessment can produce
gains in terms of efficiency and effectiveness. Data collections are planned, or
already underway, to explore the links between assessment and the
appropriateness, timeliness and efficiency of care to older people – important
dimensions by which to judge performance, both nationally and locally.
References
Applebaum, R., Straker, J. and Geron, S. M. (2000) Assessing Satisfaction in
Health and Long-term Care: Practical Approaches to Hearing the Voices
of Consumers, Springer Publishing Co., New York.
Challis, D. (1999) Assessment and care management: developments since
the community care reforms, in With Respect to Old Age: Long Term
Care Rights and Responsibilities, Royal Commission on Long Term
Care, Cm 4192-II/3, The Stationery Office, London.
Challis, D., Clarkson, P., Williamson, J., Hughes, J., Venables, D., Burns, A.
and Weinberg, A. (2004) The value of specialist clinical assessment of
older people prior to entry to care homes, Age and Ageing, 33, 25–34.
Clarkson, P. and Challis, D. (2006) Performance measurement in social
care: a comparison of efficiency measurement methods, Social Policy &
Society, 5, 4, 1–17.
Clarkson, P., Venables, D., Hughes, J., Burns, A. and Challis, D. (2006)
Integrated specialist assessment of older people and predictors of
care home admission. Psychological Medicine, 36, 1011–1021.
Cm 4169 (1998) Modernising Social Services, The Stationery Office,
London.
Lincoln Gerontology Centre (1997) Aged Care System Study: Twenty First
Progress Report, October 1997, Volume 1, Lincoln Gerontology Centre,
La Trobe University, Bundoora, Victoria.
Scottish Executive Social Research (2005) Development of Tools to
Measure Service User and Carer Satisfaction with Single Shared
Assessment, Scottish Executive/Infusion Co-operative Limited,
Edinburgh.
Stewart, K., Challis, D., Carpenter, I. and Dickinson, E. (1999) Assessment
approaches for older people receiving social care: content and
coverage, International Journal of Geriatric Psychiatry, 14, 147–156.
Wildavsky, A. (1979) The Art and Craft of Policy Analysis, Macmillan Press,
Basingstoke.
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CURRENT RESEARCH PROGRAMMES
PSSRU Bulletin No. 16
Commissioning and Performance
Martin Knapp, José-Luis Fernández, Julien Forder, Vanessa Davey, Catherine
Henderson, Tihana Matosevic, Francesco Moscone, Margaret Perkins, Jackie
Damant, Tom Snell, Vangelis Tsirovasilis and Gerald Wistow
The Commissioning and Performance Programme comprises research funded
by the Department of Health core grant to PSSRU as well as other projects.
The programme aims to improve understanding of how social care services
are commissioned (and hence our research on, for example, direct payments
and individual budgets), and with what implications for performance (and so
our work on variations, for instance). Two projects are outlined here.
Members of the C&P team are involved in the evaluation of national pilot
schemes (including POPP and IBSEN – see page 28) and local initiatives
(such as the Innovation Forum programme on older people – see page 29). A
recent major activity was the work on the Wanless Social Care Inquiry –
coordinated by Julien Forder and José-Luis Fernández (see page 38).
Direct payments
Since 2004, PSSRU has been evaluating the Direct Payments Development
Fund (DPDF). This was introduced in 2003 to assist English local authority
and voluntary sector partners in developing support for direct payment (DP)
users. It was expected to increase the numbers of direct payment users,
improve access to services and promote efficiency. The evaluation has
therefore sought to examine the effectiveness of DP implementation methods.
It has involved working closely with the National Centre for Independent
Living (NCIL) and with other researchers in gathering national data (see
box 1). The main elements of the research include:
Outcomes for older people using DPs We are investigating how outcomes
reflect individual circumstances, mediated by provision of support with DPs.
Analysis of the DP workforce We are examining how implementing DPs
involves a shift in employer responsibility to users, and a loss of the
administrative role of ‘traditional’ service-providing organisations.
Evaluation of the impact of the DPDF We are also evaluating the success of
8
Box1 TheDirectPaymentsSurvey
The Direct Payments Survey involved a UK-wide postal
questionnaire collection from local authorities and support
organisations covering direct payments policies and practices.
This collaborative project was led by the DPDF evaluation team
at PSSRU and combined the work of three multidisciplinary
research teams involved in national studies of direct payments
backed by the DH, the Economic and Social Research Council
and the Modernisation of Adult Social Care Initiative.
Three quarters of local authorities in England responded to
the survey. Of particular interest are new findings that
contribute to our understanding of the way resources are
delivered to DP users (Davey et al., 2006):
Despite wide variations in the typical prices of care for
different user groups, hourly DP rates are largely identical.
There are marked variations between local authorities in DP
rates.
DP rates are generally lower than average prices for home
care, raising concerns about purchasing power within local
care markets.
The majority of DP users receive intensive packages of care
according to DH classification (i.e. more than ten hours of
care per week). Higher levels of DP clients receive intensive
packages of care than clients using mainstream services.
Whereas the expenditure on DP care packages for learning
disability clients is lower than that of standard packages, the
reverse is true for physically disabled clients. Expenditure on
DP for older people is approximately the same as for
standard packages.
There has been a substantial decrease in local authority
funding for DP support services in the last two years. Also,
there are very wide disparities in per client funding. This is
despite the fact that the large majority of local authorities
perceive such services as critical to the development of DP.
For further details see: http://www.pssru.ac.uk/dps.htm.

Further
information
The projects within
the C&P programme
are organised in
clusters. See the
PSSRU website for
details and cluster
leads, or contact
Anji Mehta
(a.mehta3@lse.ac.uk)
who will direct your
inquiry appropriately.
the DPDF in increasing the numbers of DP users.
Costs of providing DPs and supporting DP service users Indicators of
costs, intensity of support and DP provision have been collected as part of the
UK-wide survey (Davey et al., 2006; see box 1). These data on value for
money will be interpreted alongside evidence on service outcomes.
DPs to mental health service users We are looking at developments in the
field of mental health services.
Developing roles and impacts of direct payments in the mixed economy
of care DPs could have profound, enduring effects on local social care
economies. The evaluation is looking at their impact on the roles and
responsibilities of local authorities in relation to service users, carers,
providers and workforce.
Local variations in DPs Based on quantitative evidence, the study has
explored the range of factors shaping variations in the take up and package
intensity of DPs across England (Fernández et al., 2007). Indicators of local
need, supply conditions and local service policy were all relevant. The results
show that whereas some factors outside the control of policy makers (such as
service prices) affect the development of DPs locally, much of the variation
relates to local policy attitudes, such as decisions about the degree of in-house
provision or balance of care between residential and community services. A
large proportion of the variation was not linked to the factors explored.
Motivations
Social care actors’ motivations and attitudes obviously play a central role in
service delivery. Through their work as managers or owners, providers’
motivations therefore directly affect the quality of care. We have been
examining providers’ motivations in a series of studies. Recently, work has
been looking at the underlying motivations for providing residential care
services for older people. The study has been focusing on the intrinsic aspects
of private, voluntary and local authority care home providers’ motivations –
including professional achievement, job satisfaction and recognition. We have
also examined the extent to which motivations are influenced by personal,
social and financial factors.
Most respondents were primarily intrinsically motivated by meeting older
people’s needs and by professional achievements. The motivational indicators
can be grouped into four components: professional, financial, client-specific and
client-generic caring motivations. With regards to professional motivations,
interviewees reported high levels of job satisfaction. Care providers were
satisfied with their career choice and felt that, through their work, they were
contributing to society. The study also identified personal and external factors
that could influence intrinsic motivations and professional aspirations.
Further work is now examining whether commissioners accurately interpret
the motivations of providers in their area. We are also looking at changes over
time: many of the sampled providers have been interviewed three times since
1993, offering an opportunity to study the influences of the rapidly changing
social care context.
PSSRU Bulletin No. 16
References
Davey, V., Fernández, J.L., Knapp, M., Vick, N., Jolly, D., Swift, P., Tobin,
R., Kendall, J. Ferrie, J. Pearson, C., Mercer, G. and Priestley, M. (2006)
Direct Payments Survey: A national survey of direct payments policy and
practice. Personal Social Services Research Unit, London School of
Economics and Political Science, forthcoming.
Davey, V. (2006) Direct Payment Rates in England, in L. Curtis and A.
Netten, Unit Costs of Health and Social Care 2006. Personal Social
Services Research Unit, University of Kent, forthcoming.
Fernández, J.L., Kendall, J., Davey, V. and Knapp, M. (2007) Direct
payments in England: Factors linked to variations in local provision,
Journal of Social Policy, 36, 1, forthcoming.
Matosevic, T., Knapp, M., Kendall, J., Henderson, C. and Fernández, J.L.
(2006) Care home providers as professionals: understanding the
motivations of care home providers in England, Ageing and Society, 26,
forthcoming.
9

CURRENT RESEARCH PROGRAMMES
PSSRU Bulletin No. 16
Further
information
For further
information on this
programme, please
contact
PSSRU@manchester.
ac.uk.
Mapping and Evaluation of Care Management
Arrangements for People with Mental Health
Problems in England
Dan Venables, Jane Hughes, Siobhan Reilly, Karen Stewart and David Challis
Care management was introduced in the UK in 1993 for all adult user groups
(SSI/SSWG, 1991a; 1991b) as a system of care coordination designed to
facilitate the organisation and delivery of services in local government social
services departments. Official guidance issued in the early 1990s was vague
however, and recent PSSRU research suggested that this had contributed to
wide national variation in the shape and form of care management
arrangements for older people (Challis et al., 2001; Weiner et al., 2002). In
addition to services for older people, care management remains fundamental
to the organisation and delivery of community mental health services
(Cm4169, 1998; Department of Health, 1999). However, it is still largely
unclear how these arrangements are organised across the UK.
As part of its ongoing programme of research into care management
arrangements the PSSRU at Manchester undertook a national postal survey
of all English social services departments, in order to identify and describe the
different forms of care management which have emerged for people with
mental health problems (response rate: 77%). The project has recently yielded
two publications, with a third in preparation (see box 1).
In the first of these, Venables et al. (2005) reported significant national
variation in care management arrangements for people with mental health
problems. This variation suggested that users with similar levels of need in
different geographical localities would have significantly different experiences
of the care management process. In addition, little evidence was found of
integration between health and social care services, or of the provision of
differentiated service responses according to need. Widespread disparity
between recent care management arrangements and government guidelines
was also described.
In the second paper, Venables et al. (2006) examined the survey data for
‘clustering’ of the central features of care management arrangements. Discrete
groups of features were not found however, suggesting that services were not
being arranged and developed locally according to specific combinations, or
‘models’ of services, which research has shown to be effective. This
highlighted the need for care management arrangements to reconnect with
10
Box 1 Key Results
Venables et al. (2005)
There is significant national variation in care management
arrangements for people with mental health problems.
Little evidence was found of integration between health
and social care, specialist mental health teams, or selective
arrangements targeted at those with the highest levels of
need.
There appeared to be widespread disparity between recent
care management arrangements and government
guidelines.
Venables et al. (2006)
Distinct, evidence-based ‘models’ of care management
arrangements do not appear to exist.
There is even more variation in care management
arrangements for people with mental health problems than
in those for older people.
Sets of care management arrangements can be categorised,
and discriminated between, using a limited number of key
indicators.
Venables et al. (in preparation)
Three organisational factors were associated with
integration at practice level:
NHS staff can work as care managers
Care managers have joint access to computerised
records and/or hospital records
Total agency budgets for mental health services are
pooled.

the validated, evidence-based models from which they originated. Secondary
analysis explored a system of classification of care management arrangements
through the development of a typology, using key indicators. Through this
method, it was possible to identify and discriminate between the sets of care
management arrangements most commonly found in England (table 1). The
number of types (eight) identified in this study suggested that the extent of
national variability in care management arrangements in mental health
services exceeded the levels reported in those for older people: in the earlier
study by Challis and colleagues (2001), only six types were identified, using
the same number of indicators.
Table 1 Most common sets of care management arrangements in England
(Venables et al., 2006)
Indicator
Type
Evidence of
targeting
Two or more
tiers of
assessment
Continuity
NHS staff as
care
managers
Number of
authorities
1 18
2 17
3 16
4 10
5 8
6 7
7 6
8 5
Total authorities (n=101) 49 73 73 34 87
PSSRU Bulletin No. 16
Finally, Venables et al. (in preparation) will focus on two of the underlying
themes of the National Service Framework for Mental Health (Department of
Health, 1999). This paper will draw attention to the requirement for services
to provide a differentiated response according to the needs of the individual;
and it will further investigate the extent of integration between health and
social care in mental health services. It will also identify organisational factors
which are associated with both integrative and differentiating procedures at
practice level. It will therefore hope to draw attention to some of the
organisational features of care management arrangements which may make
the most difference to the provision of effective, integrated, and appropriately
targeted services at practitioner level.
This research makes a number of important contributions to the
understanding of care management arrangements for people with mental
health problems in England. First, it paints a clear and unique cross-sectional
picture of recent care management arrangements across the country. Second,
these studies present a useful method by which care management
arrangements can be categorised and distinguished, through the identification
and description of a limited number of key indicators. Third, the research
draws attention to the areas in which the greatest levels of service
development are required for modern standards to be achieved.
References
Challis, D., Weiner, K., Darton, R., Hughes, J. and Stewart, K. (2001)
Emerging patterns of care management: arrangements for older
people in England, Social Policy and Administration, 35, 6, 672–687.
Cm 4169 (1998) Modernising Social Services, The Stationery Office, London.
Department of Health (DH) (1999) National Service Framework for Mental
Health: Modern Standards and Service Models, Department of Health,
London.
Social Services Inspectorate and Social Work Services Group (1991a)
Care Management and Assessment: Manager’s Guide, HMSO, London.
Social Services Inspectorate and Social Work Services Group (1991b)
Care Management and Assessment: Practitioner’s Guide, HMSO,
London.
Venables, D., Hughes, J., Reilly, S., Stewart, K. and Challis, D. (2006)
Patterns of care management arrangements for people with mental
health problems in England, Australian Journal of Case Management, 7,
2, 3–9.
Venables, D., Stewart, K., Hughes, J., Weiner, K., Darton, R. and Challis,
D. (2005) Variations in care management arrangements for people
with mental health problems in England, Care Management Journals, 6,
3, 131–138.
Weiner, K.,Stewart, K., Hughes, J., Challis, D. and Darton, R. (2002) Care
management arrangements for older people in England: key areas of
variation in a national study, Ageing and Society, 22, 419–439.
11

CURRENT RESEARCH PROGRAMMES
Further
information
Contact Professor
Ann Netten,
A.P.Netten@
kent.ac.uk
Costs, Quality and Outcomes
Ann Netten, Theresia Bäumker, Lesley Curtis, Karen Jones, Juliette Malley,
Sima Sandhu and Nick Smith
PSSRU Bulletin No. 16
The programme focus is the measurement and analysis of costs, quality and
outcomes. Over the past few years the programme has conducted a series of
studies investigating home care services, the measurement of unit costs and
the measurement of outcome and outputs of social care. Here we briefly
outline some results of a study of home care provider and workforce
influences on home care quality and describe work undertaken on the
measurement of outputs.
Home Care Provider Study
Good quality home care is a cornerstone of maintaining people in their own
homes. The PSSRU extension to the 2003 User Experience Survey (UES) for
older people using home care services suggested that those service users
receiving care from in-house providers were more satisfied with their services
than those receiving care from independent providers (Netten et al., 2004).
Given the trend towards using increasing levels of independent provision this
raises the following questions: what lies behind this finding and what are the
implications for commissioning of home care services in the future? The
provider study was designed to investigate provider-level influences on service
users’ perceptions of home care service quality.
The study was conducted in 27 local authorities in England. Twenty-four of
these were drawn from the 34 authorities that participated in the extension to
the 2003 UES (Netten et al., 2004). Information was available about service
quality for 121 home care providers. Telephone interviews were administered
by providers, of which 28 were in-house and 93 were independent.
Independent providers tended to be much smaller than local authority inhouse
organisations in terms of numbers of clients served, hours provided and
care workers employed (p

Measuring the outputs of social care
A series of studies is being undertaken to feed into work by the Office of
National Statistics on the measurement of government outputs for national
statistics (Atkinson, 2005), with the longer-term objective of improving
measurement and understanding of personal social services output and
productivity in social care (Netten et al., 2005, 2006). A core principle has
been that we should be able to use routine sources of data to reflect changes
in quality and productivity of social care expenditure over time. To do this we
need to weight activity measures to reflect outcomes. We have developed a
framework in which we define three types of outcome:
Increased individual/care network productivity
Increased individual knowledge and information
Needs met.
While much policy emphasis is currently on the first two of these, historically
the bulk of expenditure and activity has focused on meeting the needs of
individuals and this is where the work has focused to date.
To measure met needs we start with the number of people helped. We need to
weight this number to reflect:
Frequency of help
Amount people are helped
Quality of help.
PSSRU Bulletin No. 16
For frequency we use the number of weeks that people have been helped
drawing on routine statistical sources. For the amount people have been
helped we use an indicator of Capacity for Benefit (CfB). This is the level of
output per week that the intervention could deliver if it were perfect. In order
to reflect what is in fact delivered we incorporate an indicator of quality drawn
from the national UES and care home standards. Thus the outputs of an
intervention are reflected by:
Capacity
for Benefit
x
Quality
x
Weeks’
help
CfB reflects both what the intervention does and how much it does. What an
intervention does depends on the domains of outcome (see page 26) that are
addressed. How much it does depends on how much service users rely on that
intervention.
Figure 1 Predicted equal-weighted Capacity for Benefit
from care homes
CfB
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
Alone
With others
0 1 2 3 4 5 6 7 8 9
Number of ADL problems
The approach has been applied to home care of older
people and simulated for care homes for older people
(Netten et al., 2006). As far as possible we draw on the
service user perspective: identifying through a survey of
home care users (Darton et al., 2006) the needs that
home care was addressing (CfB). Figure 1 shows the
relationship between the number of problems with
activities of daily living (ADLs) and CfB used for care
homes.
The approach provides us with a promising way
forward for monitoring the benefits and productivity of
social care that could be useful to providers,
commissioners and policy makers as well as national
statisticians.
References
Atkinson, A. (2005) Atkinson Review: Final Report, Palgrave Macmillan,
Basingstoke. Available to download at www.statistics.gov.uk.
Darton, R., Forder, J., Bebbington, A., Netten, A., Towers, A-M. and
Williams, J. (2006) Analysis to support the Development of FSS
Formulae for Older People: Final Report. Discussion Paper No. 2265/
2, PSSRU, University of Kent, Canterbury.
Netten, A., Forder, J. and Shapiro, J. (2006) Measuring Personal Social
Services Outputs for National Accounts: Services for Older People.
Discussion Paper 2673, PSSRU, University of Kent, Canterbury.
Netten, A., Francis, J., Jones, K. and Bebbington, A. (2004) Performance
and Quality: User Experiences of Home Care Services, Discussion Paper
2104/3, PSSRU, University of Kent, Canterbury.
Netten,A.,McDaid,D.,Fernández,J.L.,Forder,J.,Knapp,M.,Matosevic,T.
and Shapiro, J. (2005) Measuring and understanding social services outputs,
Discussion Paper No. 2132/2, PSSRU, University of Kent, Canterbury.
13

CURRENT RESEARCH PROGRAMMES
PSSRU Bulletin No. 16
14
Further
information
Full versions of these
reports and those on
disabled children in
need, ethnicity and
service use, and child
asylum seekers are
available at
www.dfes.gov.uk/
qualityprotects/
work_pro/
analysis1.shtml. Each
starts with a brief
Departmental
commentary.
Information on this
and other CIN
Surveys (2000, 2003
and 2005) are
available at
www.dfes.gov.uk/
rsgateway/DB/VOL.
These reports do not
include the types of
detailed work shown
here.
Children’s Services: Active Cases, Case
Longevity and Staff Time in Social Care
Jennifer Beecham and Andrew Bebbington
As part of the drive to improve the level of knowledge about children
supported by social services a new statistical collection for children’s social
care services was developed: the Children in Need (CIN) Survey. This oneweek
survey, first collected in 2000, brings together information on children,
their needs for services, the social services’ responses, and costs. The 2001
CIN Survey provides data on 363,389 children who were ‘on the books’ of
144 English children’s departments that year (CIN2001). The characteristics
of children (age, gender, ethnic group membership, etc.) were recorded
alongside one of nine broad pre-set ‘needs’ categories such as abuse and
neglect, disability, and parental ill-health. Over the one-week period all social
services department services and staff recorded how much support they
provided for each child. Thus the ‘care package’ for any child in the dataset
included social services-funded days in the various placements, receipt of
grants or one-off payments, and group work or individual sessions with social
services staff.
The PSSRU was asked by the Department of Health to produce topic-specific
analyses from these data. The findings from three analyses are reported here:
active case rates, the length of time cases have been open, and the division
between child and non-child time for different groups of staff.
Active cases are defined as open cases that received any of the care package
components, including casework, during the survey week: 214,598 children
and young people in CIN2001. Active case rates were highest, around 90%,
for Children Looked After (CLA). Some groups of CLA were more likely to
be ‘inactive’ than others. About 11% of all CLA were receiving respite care
and a quarter of this group were ‘inactive’. Three-quarters of all children
receiving respite care were disabled. This means that disabled children were
about twice as likely as other children to receive no support during the survey
week.
Just over a half of all Children Supported in their Families or Independently
(CSFI) were active cases during the survey week. Children listed on the Child
Protection Register were particularly likely to have been seen. Otherwise there
were modest trends suggesting older children were generally less likely to have
been seen during the survey week, as were disabled children. Children whose
primary need for support was ‘low income’ were more likely to be active cases
than others, as were children of mixed race.
There were wide differences between councils in their active case rates:
between 60% and 100% for CLA, and from 19% to 94% for CSFI. Little of
this variation could be explained by the children’s personal circumstances.
Smaller authorities tended to have higher active case rates. Higher numbers of
operational staff working with children, particularly social workers, also meant
more CSFI were seen during the survey week.
Case longevity, or the length of time a case has been open, has two
important practice implications. First there are expectations of how quickly
social services should respond to needs after referral; an initial assessment, for
example, should be completed within seven days. It was encouraging to find
that within a week of being referred, much of the basic information had been
recorded on the CIN database and that there are relatively high levels of
service contact during this period. Second, it is likely that children who were
referred some years ago will be among those presenting the greatest number

Figure 1 Case longevity at survey date
Between 1 and 6 months – 75,370 (22.5%)
Between 2 and 4 weeks – 18,005 (5.4%)
Between 1 and 2 weeks – 7,330 (2.2%)
Less than 1 week – 20,550 (6.1%)
Between 6 and
24 months –
111,315 (33.3%)
More than 24 months – 102,185 (30.5%)
of challenges to services. The median number of weeks since referral for CLA
was 120, and for CSFI it was 39.
Around a third of all children were referred to social services for their current
episode between six and 24 months earlier. Another third have been known
for more than two years. The level of social services input dropped after the
first few weeks following referral and did not appear to change much after
that. For obvious reasons, older children tended to have been referred the
longest time ago. Apart from that, those who had been known for the longest
included disabled children, those receiving post-adoption support, and child
asylum seekers. As with active case rates, there were striking differences
between authorities’ case longevity data that were hard to explain in terms of
the child’s circumstances.
Child and non-child related activity information is important for
workforce planning. For the CIN2001 Survey, child time includes all visits,
interviews and other activities that could be directly related to particular
children. Non-child time includes leave, management, sickness, training, etc.
PSSRU Bulletin No. 16
Figure 2 Average proportion of non-child time worked, and part-time working a
Administration
Manager
Team leader
Occupational therapy
Youth justice
Residential care worker
Nurse
Child protection
Project worker
Support staff
Senior staff
Family workers
Care managers
Community social work
Social work
Average % non-child time
% working less than
30 hours per week
0 20 40 60 80 100
Per cent
a Grouped by frequently occurring elements in the job titles. Individuals may fall into more
than one job title in this table.
Over 26,000 social services employees recorded some child-related time over
the survey week, of which 17,000 could be linked to activities with children in
the survey. Sixty per cent were social workers or social work assistants, and a
further 6% were (family) support workers. On average, social workers spent
the least amount of time in non-child activities (34%). The proportion of
non-child time spent in management meetings was higher than average in
London. The proportion of time spent on sick leave was considerably above
the average in north-east metropolitan districts.
15

CURRENT RESEARCH PROGRAMMES
Further
information
PSSRU Bulletin No. 16
16
The most recent
projections are
summarised in
PSSRU Research
Summary 35, Thirty-
Five Years On: Future
Demand for Long-
Term Care in England
(www.pssru.ac.uk). For
further information
on this programme
of work, contact
r.wittenberg@lse.ac.
uk.
Financing Long-Term Care for Older People
Raphael Wittenberg, Linda Pickard, Adelina Comas-Herrera, Derek King and
Juliette Malley
Around one in two women and one in three men who turn 65 will require
intensive long-term care in their late old age (Glennerster, 1996). How this
care is to be funded is an important issue which continues to provoke lively
debate. It will affect many of us and our families.
The PSSRU long-term care financing model
The PSSRU long-term care financing programme, funded by the Department
of Health (DH), has developed a model to make projections of demand for
long-term care by older people and associated expenditure, under clearly
specified assumptions (Wittenberg et al., 2006). The aim is to inform debate
about long-term care finance.
The model has recently been updated, extended to make projections to 2041
and expanded to make projections in two new areas: disability benefits used to
fund care and social care workforce. The model now produces four types of
projections: numbers of disabled older people, demand for long-term care
health and social services, public and private expenditure on those services
and on disability benefits, and social care workforce.
Disability Benefits
Disability benefits are cash entitlements provided to compensate for
additional expenditure resulting from disability. The model makes projections
for both Attendance Allowance and Disability Living Allowance. Analysis of
data from the Department of Work and Pensions was used to derive
probabilities of receipt of disability benefits by age. The ratio of numbers of
recipients by age to numbers of older people by disability is held constant over
time. The approach takes account of the finding that receipt of disability
benefits rises with more severe disability.
Workforce
Staff shortages in some areas have raised concerns over the ability of the social
care workforce to expand to meet demand. The model makes projections of
the numbers of social care (but not National Health Service) staff required to
provide the projected volume of social services, for different groups of staff.
DH estimates on numbers by category of staff and service have been used for
2002. For future years, it has been assumed that for care staff in care homes,
the ratio of staff to clients remains constant to 2041, for care staff in the
community, the ratio of staff to volume of services provided remains constant
to 2041, and for administrative and managerial staff, the ratio of such staff to
care staff remains constant to 2041.
Key projections
The model does not forecast future policies or patterns of care, but makes
projections based on specific assumptions about future trends in key factors
influencing demand for care. The base case projections take account of
expected changes in factors external to long-term care policy, such as
demographic trends, but hold constant policy-related factors, such as patterns
of care and the funding system. They can be used as a point of comparison

when assumptions are subsequently varied in scenarios.
The model projects that under base case assumptions the number of disabled
older people will double between 2002 and 2041. The number of recipients of
informal care is projected to increase from 1.7 million in 2002 to 3.3 million
in 2041, assuming that receipt of informal care remains constant by age,
gender, and marital status. The numbers of disabled older people receiving
care from a spouse or partner are projected to increase faster than the
numbers receiving care from a child. Demand for formal services is also
projected to increase, which is reflected by a projected increase in total
expenditure on services from £13bn in 2002 to £55bn in 2041, in constant
2002 prices. This corresponds to a rise from 1.4% of Gross Domestic Product
(GDP) in 2002 to 2.6% in 2041, as illustrated in figure 1.
Sensitivity analysis
Several alternative scenarios have been developed to explore different
assumptions about key factors, such as trends in life expectancy, disability rates,
supply of informal care, patterns of care and unit costs of care. An important
finding from this strand of work is that changes to these assumptions have a
significant effect on the projections. This is illustrated in figure 1, which
compares projected expenditure as a percentage of GDP in 2041 under the
base case to three variant scenarios. In the disability scenario (Brookings
scenario), age-specific disability rates fall instead of remaining constant over
time. In the unit cost scenarios, the real rise in unit costs is varied by plus or
minus 0.5% around the base case assumption of 2% per year. The scenarios
shown are not intended to cover the most extreme assumptions possible: they
are plausible assumptions on two of the variables considered.
PSSRU Bulletin No. 16
Figure 1 Projected total expenditure on long-term care as a percentage
of GDP under different assumptions about trends in disability
3.5 rates and rises in unit costs, 2002 and 2041, England
3
Expenditure as % of GDP
2.5
2
1.5
1
0.5
0
Base case
2002
Base case
2041
Brookings
2041
1.5% rise
unit costs 2041
2.5% rise
unit costs 2041
An important message is that policy-makers need to plan for uncertainty in
future demand for long-term care for older people. Future disability rates and
rises in unit costs, which are inevitably uncertain, have substantial
implications for future demand for long-term care and associated expenditure.
The projections do not suggest that there is a looming crisis of sustainability
of long-term care expenditure. They do suggest, however, that the promotion
of efficiency will be important to limit to some extent real rises in unit costs,
although the scope for this may be limited, and that investment to reduce the
disabling effects of impairments will also be important.
References
Glennerster, H. (1996), Caring for the Very Old: Public and Private Solutions,
London: London School of Economics, Welfare State Discussion
Paper WSP/126.
Wittenberg, R., Comas-Herrera, A., King, D., Malley, J., Pickard, L. and
Darton, R. (2006) Future Demand for Long-Term Care, 2002 to
2041: Projections of Demand for Long-Term Care for Older People in
England, PSSRU Discussion Paper 2330.
17

CURRENT RESEARCH PROGRAMMES
PSSRU Bulletin No. 16
18
CEMH
The PSSRU has close
links and shares staff
with the Centre for
the Economics of
Mental Health,
Institute of
Psychiatry, London
Research undertaken
at the PSSRU
complements topic
areas studied at
CEMH, particularly
those in the
Economics of Child
Social Care and
Mental Health
Economics and Policy
programmes.
See the CEMH
website
www.iop.kcl.ac.uk/
CEMH/ for more
information.
Mental Health Economics and Policy
Martin Knapp, David McDaid, Claire Curran, Andrew Healey, Derek King,
Roshni Mangalore, Helena Medeiros, Francesco Moscone and Ami Somani
The impacts of poor mental health range far and wide: stigma, discrimination,
social exclusion, unemployment, poverty, high levels of service use and high
costs. Investment in mental health services can be substantial, for instance
£189 per head of the population was invested in adult mental health services
in England in 2005/06. Thus it is crucial to improve our understanding of
what works and for whom, in what context or system structure, and at what
cost.
The PSSRU’s Mental Health Economics and Policy programme address
some of these issues. Here we offer some examples.
UK Mental Health
Research on equity and mental health Reducing health inequalities is a
major policy goal. While there is a general recognition of the disadvantaged
position of people with mental health problems, the extent of inequality,
particularly the association with socio-economic characteristics, has not been
widely studied. There is a need to examine the distribution of psychiatric
morbidity and use of services by income, socio-economic group, ethnicity,
gender and residence, and, of course, to examine how equity can be promoted
(Mangalore and Knapp, 2006).
This has been the objective of ongoing work, led by Roshni Mangalore and
Martin Knapp. Initial findings, recently presented at the 7th European Health
Economics Conference in Budapest, indicate marked inequalities
unfavourable to lower-income groups with respect to all mental health
disorders and symptoms. Income-related inequality for each of the major
psychiatric disorders is higher than that for general health in the UK.
Inequalities between income groups also appear to have increased between
1993 and 2000.
Long term consequences of anti-social behaviour in childhood The
Cambridge Study of Delinquent Development has followed a cohort of
approximately 400 boys from the age of eight. They were most recently
interviewed at age 48. We are looking at the impact of antisocial behaviour in
childhood and adolescence on a number of ‘economic’ outcomes in
adulthood: health and social care service use, employment, and costs
associated with these outcomes. Initial findings were recently presented by
Derek King at the 7th European Conference on Health Economics in
Budapest. Antisocial behaviour in childhood and adolescence may not have a
significant impact on health and social care costs at age 48, though there does
appear to be a trend towards greater use of accident and emergency services.
This work continues.
Spatial patterns Recent years have witnessed growing interest in the
geography of mental health, with particular emphasis on the spatial
concentration of needs. The object of some of our research is the study of
spatial variations in mental health expenditure: to provide theoretical
foundations and empirical evidence of underlying spatial patterns of mental
health spending in England. This work by Francesco Moscone will contribute
to discussions of the factors that influence local spending levels.
Analysing antipsychotic prescribing patterns Derek King and Martin
Knapp looked at how antipsychotic medications are prescribed to people with

schizophrenia and schizoaffective disorders. The study sought to determine
what factors impact on the prescribing of the newer class of antipsychotics
(‘atypicals’) relative to the older class of drugs (‘typicals’), drawing on General
Practice Research Database data from 1993–99. Factors other than need may
impact on whether or not an individual receives an atypical antipsychotic. One
important factor is age: on average, a 35 year old individual is 15% less likely
to be prescribed an atypical compared to someone aged 30, and likewise, a 40
year old is 15% less likely to be prescribed an atypical as a 35 year old (and so
on). Careful evaluation is required of how different factors influence choice of
medication; this is particularly relevant in light of guidance from the National
Institute for Clinical Excellence recommending that atypicals be more widely
prescribed. Findings from the study were recently published (King and
Knapp, 2006).
International Mental Health Programme
Comparative analysis of mental health systems in Europe The Mental
Health Economics European Network (MHEEN), supported by the European
Commission, was established in 2002. Now coordinated at the LSE by Martin
Knapp, David McDaid and Helena Medeiros, working with the Brusselsbased
NGO Mental Health Europe, its objectives include collating data on the
organisation and funding of mental health services, the impact of poor mental
health on employment, the capacity to conduct economic evaluation and
economic influences on patterns of provision (particularly the move to close
institutions). A forthcoming issue of the Journal of Mental Health includes six
papers that report detailed findings of the first phase of work.
PSSRU Bulletin No. 16
MHEEN has now been extended to cover 32 countries, including all the new
EU member states. The second phase of analysis will be completed in 2007
(McDaid et al., 2005, 2006).
EQOLISE: Enhancing the quality of life and independence of persons
disabled by severe mental illness through supported employment
Individual Placement and Support (IPS) has proved successful in the US in
helping people with severe mental health problems to find paid employment.
Individuals are placed in ‘open’ (competitive) jobs, and they and their
employers are supported by skilled staff for as long as is needed to get
themselves established. But it is not known whether the IPS model could be
successful in the very different contexts of European countries – where health
systems, benefit entitlements, labour market dynamics and economic
circumstances are very different. Led by a team from St George’s Medical
School, London, and with funding from the European Commission over three
years, a major randomised controlled trial has been completed. The results
from the EQOLISE study will be available soon. PSSRU staff from LSE
carried out the cost-effectiveness evaluation of the IPS approach compared to
standard vocational services in six European sites, and also looked into the
economic and policy contexts that might shape some of the findings. The
PSSRU team comprises Martin Knapp, Adelina Comas-Herrera and Claire
Curran, with Anita Patel (CEMH) contributing considerably to the costeffectiveness
analysis.
References
King, D. and Knapp, M. (2006) Patterns of, and factors associated with,
atypical and typical antipsychotic prescribing by general practitioners
in the UK during the 1990s, Journal of Mental Health, 15, 3, 269–278.
Knapp, M., Kanavos, P., King, D. and Yesudian, H. (2005) Economic
issues in access to medications: schizophrenia treatment in England,
International Journal of Law and Psychiatry, 28, 514–531.
Mangalore, R. and Knapp, M. (2006) Equity in Mental Health,
Epidemiologia E Psichiatria Sociale, forthcoming.
McDaid, D., Curran, C. and Knapp, M. (2005) Promoting mental wellbeing
in the workplace: a European Policy Perspective, International
Review of Psychiatry, 17, 365–373.
McDaid, D., Knapp, M., Curran, C. and the MHEEN Group (2006)
Meeting the challenge of funding and allocating resources to mental
health across Europe: developing the Mental Health Economics
European Network, Epidemiologia e Psichiatria Sociale, 15, 117–122.
Moscone, F. and Knapp, M. (2005) Exploring the spatial pattern of
mental health expenditure, Journal of Mental Health Policy and
Economics, 8, 205–217.
19

CURRENT RESEARCH PROGRAMMES
Further
information
PSSRU Bulletin No. 16
20
Contact Professor
Ann Netten,
A.P.Netten@
kent.ac.uk
Housing and Care: Care Homes and their
Alternatives
Ann Netten, Robin Darton, Theresia Bäumker, Lisa Nash, Ann-Marie Towers
and Jacquetta Williams
This programme is investigating housing and care arrangements with a
particular focus on extra care housing (ECH) and care homes. The
programme has undertaken a study investigating levels of provision and
factors affecting development of ECH in a cross section of local authorities,
and a comparative study of residents living in care homes and extra care
schemes and is undertaking a longitudinal evaluation of schemes funded
under the Department of Health’s Extra Care Housing Funding Initiative.
Development of extra care housing
The key objectives of this study (Dawson et al., 2006) were:
To improve our understanding of current levels of provision
To establish the main hindrances and the most supportive factors in
developing schemes.
A stratified sample of 13 authorities with social services responsibilities agreed
to participate in a telephone interview in England. For each authority, the
social service’s lead and the housing department’s lead completed a telephone
interview and a brief form on current levels of provision. For the purposes of
this study, we used Laing and Buisson’s (2003) set of characteristics. To be
counted as extra care each scheme had to:
be for older people
have self-contained accommodation
have care and support available 24 hours a day
have communal facilities
have security of tenure.
All authorities in this sample agreed with this definition, but there was a move
towards a requirement for 24-hour care to be available on site.
There were 68 schemes with 2455 dwellings in our 13 authorities, using this
definition, compared with 103 schemes and 3855 dwellings according to the
Elderly Accommodation Counsel (EAC) Guide (2005). This suggested that
in 2005, the national level of provision was in the range of 400 to 500 schemes
with 19,000–20,000 places. The authorities in the benchmarking sample were
planning to build 15% more schemes in the next two years.
Respondents were asked how a number of different factors affected the
development of ECH: whether these were problematic or supportive in their
authority. The most problematic factors were the lack of appropriate sites and
the lack of availability of capital and revenue funding. The most supportive
factor was a good working partnership between social services and housing
departments. In practice the majority of authorities reported good working
relationships.
The study suggested that the level of provision of ECH, although developing
rapidly, was starting from a very low base once we use a consistent definition.
Sense of control in extra care housing and care homes
Interviews were conducted with 183 older people living in care homes (n=89)
and ECH (n=94). Information was collected about:
Background (e.g. age, time lived in the scheme or home, etc.)
Dependency (ability to perform Activities of Daily Living (ADLs))

Self-perceived health
Desire for control
Objective control
Subjective control
Well-being
The meaning of home
Despite no overall difference in the level of dependency of the residents in
each type of setting, the ECH residents rated their health as significantly
worse than the care home residents. This difference held even after we
controlled for the fact the ECH tenants were significantly younger than the
care home residents and being unable to perform two ADLs. This was
important as self-perceived health was the most significant predictor of wellbeing.
The next most important predictor, as we might expect, was residents’
subjective sense of control. However, objective control was not associated with
well-being and, surprisingly, nor was it related to subjective well-being except
among the most dependent residents (Towers, 2006).
The study raised some important questions about our understanding of
people’s sense of control in supported environments, which warrant further
research.
PSSRU Bulletin No. 16
Evaluation of extra care housing
Twenty-two new build ECH schemes were selected to receive funding from
the DH’s ECH programme in 2004–06 (Department of Health, 2004). The
schemes include 18 medium-sized developments, containing 27–62 units of
accommodation, and four care villages, each containing over 200 units of
accommodation. All of the schemes have been designed to include singlebedroom
and two-bedroom units, and one of the villages will include some
three-bedroom units. The schemes will offer a mixture of housing tenures,
including rented accommodation, leasehold and shared ownership
arrangements. Seven of the 22 schemes are expected to open during 2006,
and the research team has been developing the fieldwork arrangements in
collaboration with these schemes since the beginning of the year. In order to
develop a close relationship with each scheme, we are recruiting local
interviewers to liaise with the scheme, and to assist in data collection,
including helping residents to complete questionnaires when required.
The evaluation has been designed to collect information about the residents
in a way that will allow us to compare them with care home residents, both in
terms of characteristics on admission and how they change over time. We will
also be asking residents about their experience and expectations on moving
into the schemes and subsequently. In addition to the core evaluation we are
seeking funding for additional studies to complement and enhance the value
of the results. To date, the Joseph Rowntree Foundation has funded a study to
investigate the social well-being of residents and what affects the development
of a supportive social environment.
The study will provide a long-term perspective on new and innovative
approaches to providing housing and care, which should provide valuable
information for future developments of new types of supported
accommodation.
References
Dawson, L., Williams, and Netten, A. (2006) Extra Care Housing: is it
really an option for older people? PSSRU Discussion Paper 2365,
Personal Social Services Research Unit, University of Kent,
Canterbury.
Department of Health (2004) Developing and Implementing Local Extra
Care Housing Strategies, Department of Health, London.
Elderly Accommodation Counsel (2005) Guide to Extra Care Housing in
England, Elderly Accommodation Counsel, London.
Laing and Buisson (2003) Extra-Care Housing Markets 2003/2004, Laing
& Buisson, London.
Towers, A-M. (2006) Control, well-being and the meaning of home in
care homes and Extra Care Housing, PSSRU Discussion Paper 2342,
Personal Social Services Research Unit, University of Kent,
Canterbury.
21

RESEARCH REPORTS
PSSRU Bulletin No. 16
Box 1 Key Results
Day Care (Reilly et al., 2006b)
Quality of Dementia Care Services in North
West England
Dan Venables, Jane Hughes, Siobhan Reilly, Michele Abendstern and
David Challis
Dementia is one of the greatest challenges to health and social services,
affecting about one in ten people over the age of 65 and about one in four
over the age of 85, costing about £6 billion per annum (Audit Commission,
2000). Dementia care requires a wide range of specialist services: along with
residential care, nursing care and hospital-based services, a range of
community-based mental health service provision is required, including day
care, domiciliary care and out-patient services (Department of Health, 2001).
The PSSRU at Manchester undertook an evaluation of the scope and quality
of dementia care services in North West England. Questionnaires were
developed to cover four key areas of service provision: day care, home care,
residential care, and professional community teams. Quality indicators were
developed from government guidelines, charity recommendations and
independent research into single documents. They were designed to capture
variations in service provision in terms of both client characteristics, structural
features of the service, and also on
various ‘quality standards’. Specialist
dementia services were identified
Substantial differences found between day centres and day hospitals.
More staff in day centres had received specific dementia care training.
Day centres were more likely to have effective transport arrangements.
Day hospitals performed better than day centres on measures of: systematic
assessment and care planning, promotion of rehabilitation, carer involvement
and use of building design features to encourage independence and choice.
Home Care (Venables et al., 2006)
Few differences were found between specialist and generic services.
Generic services provided greater flexibility.
Specialist services provided greater person-centred care.
Professional Community Teams (Abendstern et al., 2006)
Multidisciplinary teams were more likely to offer integrated, specialist and
accessible services.
Single discipline teams provided greater cultural sensitivity.
Assessment, care planning and carer support practices showed
improvement compared to earlier studies.
Residential Care (Reilly et al., 2006a)
Few differences found between elderly mentally infirm and non-EMI homes.
EMI homes performed better than non-EMI homes on measures of: building
design features to encourage independence and choice, person-centred care
and promotion of rehabilitation.
through a screening questionnaire sent
to key personnel in service-providing
organisations. An overall response rate
of 64% was achieved.
Four articles have been published to
date, the key results of which can be
found in box 1. The results of these
surveys provide key material for shaping
the provision of dementia care services,
and help to inform the understanding of
service mix and provision. In the case of
home and residential care services, they
provide an insight into the uptake of
national minimum standards and, where
these are not yet specifically available
(day care services and professional
community teams), they are particularly
important in providing objective
information on the breadth and quality
of currently available care.
22
References
Abendstern, M., Reilly, S.; Hughes, J., Venables, D. and Challis, D. (2006)
Levels of integration and specialisation within professional
community teams for people with dementia, International Journal of
Geriatric Psychiatry, 21, 77–85
Audit Commission (2000) Forget Me Not: Mental Health Services for
Older People, Holbrooks, Portsmouth.
Department of Health (2001) National Service Framework for Older
People, Department of Health, London.
Reilly, S., Abendstern, M., Hughes, J., Challis, D., Venables, D. and
Pedersen, I. (2006a) Quality in long term care homes for people with
dementia: an assessment of specialist provision, Ageing and Society,
26, 649–668.
Reilly, S., Venables, D., Hughes, J., Challis, D. and Abendstern, M.
(2006b) Standards of care in day hospitals and day centres: A
comparison of services for older people with dementia. International
Journal of Geriatric Psychiatry, 21, 460–468.
Venables, D., Reilly, S., Hughes, J., Challis, D. and Abendstern, M. (2006)
Standards of care in home care services: A comparison of generic
and specialist services for older people with dementia. Aging and
Mental Health, 10, 2, 187–194.

RESEARCH REPORTS
* This work is being
undertaken with four old
age psychiatry colleagues:
Bob Baldwin, Andrew
Barker, Susan Benbow and
Alistair Burns
Box 1 Psychiatrists’ particular concerns
The lack of availability of certain professional
groups seen as core to the provision of
multidisciplinary services
The inability of community services to meet
client needs
Increasing referral rates and workloads
The nature of the relationship between health
and social services
The lack of effective information systems
The difficulties of providing adequate support
to generic services caring for older people with
mental health problems
Services for Older People with Mental Health
Problems: The Impact of the National Service
Framework
Sue Tucker, Jane Hughes and David Challis*
The enhancement of community-based care and the provision of mental
health services that are comprehensive, accessible, responsive, individualised,
multidisciplinary, accountable and systemic are broadly universal aims
(WHO/WPA, 1997). Not all areas can live up to such aspirations however,
and past reports have highlighted considerable differences in the provision of
health and social care for older people with mental health problems in
England (Alzheimer’s Disease Society, 1997; Audit Commission 2000, 2002).
The publication of the National Service Framework for Older People
(NSFOP) (DH, 2001) was thus widely welcomed as an attempt to address
these inconsistencies and drive up the quality of care.
An essential component of the NHS Plan (DH, 2000), the NSFOP sets out a
ten-year programme of action and reform based around the achievement of
eight standards. While standard seven specifically addresses the provision of
integrated mental health services, other aspects of the programme, including the
elimination of age discrimination and the delivery of ‘person-centred’ care,
would also be expected to make a significant impact on the experience of older
people with mental health problems. However, subsequent progress reviews
have made little mention of the development of mental health services.
In 2004, the PSSRU at Manchester, working in conjunction with the Royal
College of Psychiatrists Faculty of Old Age Psychiatry, undertook a study to
provide a more detailed picture of the extent to which, some three years after
its publication, old age mental health services were delivering the
Framework’s goals. The study took the form of a cross-sectional survey of
consultant psychiatrists, working in England and specialising in the care of
older people. A self-administered structured postal questionnaire, with items
firmly grounded in the guidance of the NSFOP, explored four key domains:
The range of specialist mental health services provided for older people
The nature of the interface between specialist mental health
services and generic services caring for older people
The degree of interdisciplinary/interagency working
The extent to which services for older people with mental
health problems were person-centred.
More than 300 consultants responded, representing nearly 90%
of trusts providing mental health services. Considerable
differences were reported in each domain, with variation both
within and between trusts. While a handful of respondents
described well-resourced, comprehensive services, and many felt
that their services were developing, provision in most areas
appeared to be patchy and inconsistent. There were particular
concerns about the issues detailed in box 1.
PSSRU Bulletin No. 16
References
Alzheimer’s Disease Society (1997) No Accounting for Health: Health
commissioning for dementia, Alzheimer’s Disease Society, London.
Audit Commission (2000) Forget Me Not: Mental health services for older
people, Audit Commission, London.
Audit Commission (2002) Forget Me Not 2002: Developing mental health
services for older people in England, Audit Commission, London.
Department of Health (2000) The NHS Plan: A plan for investment. A plan
for reform,The Stationery Office, London.
Department of Health (2001) National Service Framework for Older People,
Department of Health, London.
World Health Organization, World Psychiatric Association (1997).
Organisation of Care in Psychiatry of the Elderly: A technical consensus
statement, WHO and WPA, Geneva.
23

RESEARCH REPORTS
Further
information
PSSRU Bulletin No. 16
24
Paying for Long-Term Care for Older People:
the Costs and Distributional Effects of a Range
of Options
Raphael Wittenberg, Linda Pickard, Adelina Comas-Herrera, Derek King and
Juliette Malley*
The PSSRU has recently completed a new study on paying for long-term care
for older people in the UK, funded by the Nuffield Foundation. The study
makes projections of expenditure on long-term care services under a range of
options for reforming the funding system. The projections include a
breakdown of expenditure between public and private funding and an analysis
of the projected differential impact on older people in different parts of the
income distribution.
An innovative linkage was developed between two simulation models: the
PSSRU macrosimulation model described in the article on pages 16–17 and
the CARESIM microsimulation model developed at the University of Essex.
A base case set of projections was made on the basis of official population
projections, constant disability rates, real unit costs rising by 2% per year,
current patterns of care and the current English funding system. Public
expenditure on long-term care is projected to rise, under these assumptions,
from around 0.95% of Gross Domestic Product (GDP) in 2002 to around
1.95% of GDP in 2051. The projections are sensitive to assumptions about
future mortality rates, disability rates and rises in real unit costs.
Options for reforming the means test would lead to higher projected public
expenditure in 2051 (figure 1). The projections for 2051 range from 2.0% of
GDP for a complete disregard of disability benefits, through 2.05% of GDP
for a maximum lifetime limit of
Figure 1 Estimated public expenditure as a proportion of GDP, in 2002 and
2051, under different charging systems
£100,000 for private funding of
2.5
residential care, 2.1% of GDP
for a personal expenses
allowance of £73 per week,
2
around 2.2% of GDP for
abolishing the upper capital limit
1.5
and halving the tariff rate, to
2.25% for a complete disregard
of housing assets in residential
1
care. Such options mostly favour
home owners and higher-income
groups.
%GDP
The full report of the
study is available for
download from the
PSSRU website:
Hancock R., Pickard
L.,Wittenberg R.,
Comas-Herrera A.,
Juarez-Garcia A., King
D., Malley J. (2006)
Paying For Long-Term
Care for Older People
in the UK: Modelling
the Costs and
Distributional Effects of
a Range of Options.
Report to the Nuffield
Foundation, PSSRU
Discussion Paper
2336.
* This work has been
undertaken in
collaboration with
colleagues from the
Universities of Essex and
Birmingham: Ruth
Hancock and Ariadna
Juarez-Garcia,
respectively.
0.5
0
Base
case
Lifetime
maximum
payment
Higher
PEA
Raise
capital
limits
No upper
capital
limit
Disregard
housing
assets
Free
personal
care (1)
Free
personal
care (2)
Options for introducing free
personal care would take
projected public expenditure to
between 2.15% and 2.55% of
GDP in 2051, rather than
around 1.95% under the current
funding system. They would benefit home owners and the higher quintiles of
the income distribution of older people.
The costs of free personal care could be funded by an increase in the higher
rate of income tax from 40% to 41.5%. The net gain from the combination of
free personal care and a higher tax rate would be greatest for the middle
quintile of the income distribution of the whole population, while the highest
quintile would lose.

RESEARCH REPORTS
Further
information
See Fernández, J.L.
and Forder, J. (2007)
Consequences of
local variations in
social care on the
performance of the
acute health care
sector, Applied
Economics,
forthcoming.
Consequences of Local Variations in Social
Care on the Performance of the Acute Health
Care Sector
José-Luis Fernández, Julien Forder and Martin Knapp
There is growing concern over the efficiency implications for the acute health
care sector of shortages in social care resources. In 2000, for instance, the
NHS plan announced a very significant expansion of intermediate care
services with the aim to reduce demand levels on the acute sector.
Using local and health authority quantitative data, the Commissioning and
Performance team have explored the relationship between local variations in
social care services and three key indicators of acute health system
performance, the rates of hospital delayed discharges for patients over 75
years old, of emergency readmissions following an acute episode and of
hospital throughput (finished consultant episodes).
Although the analysis was primarily concerned with estimating the strength
and significance of the relationship between provision of social care services
and health care performance, it also presented estimates of the relationships
between rates of delayed discharges, emergency readmissions, average lengths
of stay and hospital throughputs with the particular aim to test whether
improvements with respect to delayed discharges are at the expense of
deteriorations in other dimensions of performance.
The results of the study corroborate the widely held but seldom quantified
hypothesis that social care resources affect, to a very significant degree, the
efficiency of the acute health care sector. The results suggested ‘richer’ social
care departments enjoyed lower levels of delays, other things being equal. In
turn, the levels of social care services purchased were found to depend, among
other things, on the input prices faced by the providers of the services. As a
result, increases in input prices (as indicated by property prices and average
gross weekly earnings) were found to worsen delay rates. Holding hospital
capacity constant, increases in the revenue of the health care sector were also
found to reduce observed delay rates. However, when expressed in monetary
terms, this effect was found to be several times weaker than that of social care
budgets.
Overall, the analysis identified a positive impact of social care services on
hospital throughput, reducing delayed discharges and freeing up beds for
further treatment. Between types of services, the results suggested
institutional modes of care might be more effective at improving rates of
delayed discharge and emergency readmissions.
The results of this study raise questions about the current separate
organisational systems of health and social care in England and whether realignment
is needed. The results also confirm the major impact that input
prices (wages and house prices) have on local authority levels of demand for
services, and therefore on the performance of the acute health care system.
Given the extreme geographical variability in prices in England, further
attention needs to be paid to understanding the extent to which local cost
adjustment factors incorporated into local allocation formulae do or do not
fully compensate for local variations in prices.
PSSRU Bulletin No. 16
25

RESEARCH REPORTS
* RAND Europe
Valuing Social Service Outcomes
Peter Burge*, Federico Gallo* and Ann Netten
PSSRU Bulletin No. 16
Background
The Gershon review of efficiency recommended that target improvements in
efficiency should be met in part through improvements in quality. In order to
explore the potential for financial valuations of quality and outcomes, this
pilot study built on ongoing work on the measurement of personal social
services outputs (see pages 12–13). The aim was to attach financial valuations
to data that had already been collected on the capacity for benefit (CfB) of
home care (Burge et al., 2006).
Method
Box 1 Outcome
domains
Nine outcome domains
were used, intended to
cover all interventions
and client groups
including carers:
Personal cleanliness
and comfort (PC)
Social participation
and involvement
(Soc)
Control over daily life
(Cont)
Meals and nutrition
Safety
Accommodation
cleanliness, order and
accessibility
Employment and
occupation (Occ)
Role support (as a
carer or parent)
The study used discrete choice experiments in which respondents were asked
which they would prefer of two situations, described in terms of the domains
(see box 1) and a level of financial benefits. This allows us to estimate
‘willingness to accept’ valuations that reflect the importance of the domains
but should not be interpreted as the amount they would have to pay in the
existing market or the amount that currently compensates them in the form of
benefits. Half the sample of 500 respondents selected from the general
population was over 65, to allow for a comparison between preferences of
older and younger adults.
Results
The results provided a broadly consistent picture and gave valid estimates for
each domain and level.
Figure 1 shows the ranking of the domains when we take the difference
between high-level need and no need for help. Respondents rated personal
cleanliness and comfort, living in their own home, meals and sense of control
very highly. Accommodation
Figure 1 Ranking of domains
(excluded from figure 1)
800
rated even more highly,
possibly because two aspects
700
of accommodation –
598
‘cleanliness and comfort’ and
600
536 ‘acccessibility’ – could have
503
500
483
been taken as two separate
domains. The only area
394
400
360
where older people showed
significantly different
300
283 preferences was care of
others: unlike younger age
200
groups who valued this in all
circumstances, a value was
100
only put on caring for others
0
when they were living in
their own home.
PC Home Meals Cont
Soc Safety Occ
£ per week
26
Reference
Burge, P., Gallo, F. and Netten, A. (2006) Valuing PSS outputs and quality changes, PSSRU Discussion Paper 2356.

RESEARCH REPORTS
Further
information
The full report of this
work is available on
the PSSRU website:
Darton, R., Forder, J.,
Bebbington, A.,
Netten, A., Towers,
A.-M. and Williams, J.
(2006) Analysis to
Support the
Development of the
Relative Needs
Formula for Older
People: Final Report.
PSSRU Discussion
Paper No. 2265/3.
Table 1 Variables included in formulae
Individual-level analysis:
cost of services
Age (80–84 and 85+)
Single person households
Tenure (renting)
Receipt of benefits
Limiting longstanding illness
Analysis to Support the Development of the
Relative Needs Formula for Older People
Robin Darton, Julien Forder, Andrew Bebbington, Ann Netten,
Ann-Marie Towers and Jacquetta Williams
In 2004, the Department of Health commissioned research on the allocation
of central government funding to councils with social service responsibilities
(CSSRs). The first stage in determining the level of grant to local authorities
involves calculating Relative Needs Formulae (RNFs) for each of the main
services. For social services, there are separate RNFs for children, younger
adults and older people. The Kent and LSE branches undertook a study of
needs for older people’s services.
Previous PSSRU studies combined primary data from surveys of individual
service recipients with secondary data about the general population, using the
General Household Survey (GHS), for example. An alternative approach,
used for children’s services and, particularly, for allocating resources across
the NHS, is small area analysis. This uses data collected at the ward level, for
example, for routine, administrative purposes. The present study was unique
in examining both approaches.
The individual-level analysis used data on 826 care home admissions (32%)
in 16 local authorities and 384 domiciliary care recipients (28%) in 13 local
authorities, combined with 2001–02 GHS data. This was the most recent
GHS with the relevant data on older people, but took place prior to the
introduction of Pension Credit. Various approaches to estimating Pension
Credit receipt were examined, and the main analysis used an income-based
estimate. Table 1 shows the variables included in the formula.
Small area analysis:
expenditure per head
Age (90+)
Single person households
Tenure (renting)
Receipt of benefits
The small area analysis drew on data for older people in 17
local authorities as part of the study on the younger adults’
RNF by Secta Consulting. It was based on 76,325 older
service users in 775 wards. Two models for expenditure per
ward were estimated, based on rates per head of population
aged 65 plus and on total spend and numbers of individuals,
respectively. See table 1 for the variables included in the
formula for rates per head of population.
Given the small sample sizes in the two surveys, and the problems of
estimating Pension Credit receipt, it was not possible to produce final RNF
options using the individual-level data. Instead, the calculations were based on
the small area analysis.
Despite the differences in approach, both methods produced equations based
on similar variables. The totals model in the small area analysis also included
limiting longstanding illness. The population aged over 90 was preferred for
the rates model, and the survey of admissions also indicated the increasing
importance of this age group. However, there was no corresponding variable
in the GHS data to enable this to be included in the analysis.
The calculation of RNFs requires the routine availability of data at the
national level. The surveys of admissions and home care recipients and, to a
lesser extent the GHS, included a much wider range of information about the
characteristics of older people. The inclusion of such variables in the analyses
could increase the explanatory power of the equations. However, this would
require a corresponding increase in the range of national data available, as
well as a return to the response rates obtained in previous surveys.
PSSRU Bulletin No. 16
27

NEW PROJECTS
New Projects
These two pages highlight some of our current and planned work. For a more comprehensive outline of the PSSRU
programme of research with details of publications, see the section starting on page 30.
PSSRU Bulletin No. 16
28
Individual Budgets: IBSEN
The PSSRU, across all three branches, is working in
collaboration with the Social Policy Research Unit (University
of York) and the Social Care Workforce Research Unit
(King’s College London) on a two-year project, funded by the
Department of Health (DH), to evaluate the national
programme of individual budget pilots.
The 2005 Cabinet Office Strategy Unit report, Improving the
Life Chances of Disabled People, first proposed the piloting of
individual budgets, a theme taken up in last year’s Green
Paper on Adult Social Care and in the UK Government
strategy for an ageing population. Individual budgets bring
together a number of different funding streams supporting
individual people: social care budgets of local authorities,
integrated community equipment services, disabled facilities
grants, the Supporting People programme, Access to Work
resources and the Independent Living Fund. The total funding
available is made transparent to the individual who can then
decide how best to allocate these resources to meet their
needs. In the wider policy context, individual budgets are a
key element in policies to modernise public services.
Individual budgets therefore have considerable potential.
Compared to current local authority social services
arrangements (including direct payments), individual budgets
could considerably expand the opportunities for people
entitled to social care and/or other services to have a better
understanding of their entitlements, greater choice and
control over how their needs are met, and better access to a
range of formal and informal support. They do not require
the employment and other responsibilities associated with
direct payments, although some individuals may choose to
receive their individual budget in the form of direct payments.
Thirteen English local authorities with social services
responsibilities have been funded by the DH to pilot
individual budgets (Barking and Dagenham, Barnsley, Bath and
North East Somerset, Coventry, Essex, Gateshead,
Kensington and Chelsea, Leicester City, Lincolnshire,
Manchester, Norfolk, Oldham, and West Sussex). The Care
Services Improvement Partnership (CSIP) is providing
developmental support.
The three PSSRU branches, working very closely with the
other two DH-funded social care units at York and King’s
College London, are evaluating many aspects of the individual
budget pilots. This is the IBSEN project.
The core aim of the IBSEN project is to identify whether
individual budgets offer a better way of supporting older
people, disabled adults, people with learning disabilities and
people with mental health problems than conventional
methods of resource allocation and service delivery and, if
so, which models work best for which groups of users.
The research has five main themes:
Experiences and outcomes for users and carers
The effectiveness and cost-effectiveness of individual
budget arrangements in comparison with standard
approaches
Implications for social care and other agencies (such as the
NHS and the Department of Work and Pensions) and for
service providers
How services purchased by individual budgets are
identified, managed and coordinated
Workforce implications, in terms of financial management
of budgets and the impact on the professional and legal
roles of social workers and care managers.
Innovative research designs are being employed within a
mixed methods approach to ensure that the most robust
evidence is obtained on individual budgets. The evaluation
commenced in spring 2006. Updates on progress and further
information are provided in the regular IBSEN newsletters
(available on the PSSRU website).
APOLLO
The Apollo project, coordinated by University of Athens and
funded by the European Commission, is a three year multicountry
multi-partner project looking at strategies and best
practice to reduce the health and social-economic costs and
consequences of injuries both accidental and self inflicted.
David McDaid (LSE) is working on this project.
Partnership for Older People Pilot (POPPs)
evaluation
The PSSRU is to play a dual role in the evaluation of the
POPPs initiative. At a national level the LSE branch is leading
on the cost effectiveness element of the evaluation. At a local
level the Kent branch is evaluating the Somerset initiative,
which is introducing 50 Active Living Centres (ALCs)
throughout the county. The ALCs are intended to serve their
immediate local communities hosting a variety of activities
and acting as a source of information and referral. They will
use peer group volunteers to support self-assessment in
maintaining independence and are intended to serve as a
vehicle for community empowerment.
SDO governance
The Department of Health (NHS Service Delivery
Organisation) has awarded PSSRU at the LSE (in
collaboration with the Universities of Hertfordshire,
Plymouth and Keele University) £300,000 to look at the
impact of governance and incentives on unplanned hospital
admissions of older people (75+).
The project aims to compare and critically analyse the impact
of different governance models as local authorities and NHS
bodies work together to reduce unplanned inpatient bed days
for older people aged 75 and over. Phase 1 will explore
models of governance, partnerships, local initiatives and
incentives within nine IF sites. Phase 2 will focus on case

NEW PROJECTS
studies in three IF sites, and a governance and incentives
model will be created in phase 3.
The study builds on a one-year research collaboration with
nine local authorities and their NHS partners under the
auspices of the Innovation Forum: Improving the Future for
Older People (IF). The PSSRU staff involved are Martin
Knapp, Catherine Henderson and Gerald Wistow.
Implementing Mental Health Promotion Action
IMHPA is a network of partners across 20 European
countries and led from the Ministry of Health in Catalonia
with funding from the European Commission. The network
aims to develop and disseminate evidence-based mental
health promotion and mental disorder prevention strategies
across Europe and to facilitate their integration into countries’
policies, programmes and health care professionals’ daily
clinical work. The PSSRU component is led by David McDaid.
The design and use of local metrics to evaluate
performance: a comparative analysis of social
care organisations
Performance measures, now available in the UK public sector,
are employed primarily on a national basis, often to assist
government regulation. However, knowledge of their use
locally, particularly in local authority social care is limited.
PSSRU at Manchester has been funded by the ESRC to
examine local approaches to performance measurement in
social care. This two stage study is to examine the use of
performance measures and monitoring techniques in local
social care services for older people, so as to draw
conclusions regarding the future conduct of the performance
regime in social care, health and other public services. The
first stage will explore the use of measures and their
relationship with how organisations are rated on their
performance through a questionnaire survey across England
and Northern Ireland. The second stage will explore, through
management interviews and written material in the UK, and
comparatively the design and use of performance measures
in Japan, where measures at a more local level are more
generally available in this setting. The results of the study will
be generalised to other public services in addition to
reporting their significance for social care. For further
information contact Paul Clarkson.
Enhancing the efficiency and effectiveness of
community care assessments
Ever since the late 1980s, improving the quality and
consistency of assessment has concerned not just the realm
of practice but also that of policy. There is a lengthy tradition
of research relating to assessment in the Manchester branch.
Studies have examined the quality of assessment tools
employed in community-based care and in residential and
nursing home care. Specialist assessment tools for use in care
homes have been developed, representing a technology
transfer of work originating from the US. A study of the
impact of comprehensive multi-disciplinary assessment in the
community indicated the gains from home assessments of
vulnerable older people by specialist clinicians such as
geriatricians and old age psychiatrists. Current work is
evaluating the implementation of the Single Assessment
Process in England.
Building on this stream of work relating to assessment,
PSSRU at Manchester has been awarded further funding to
evaluate new developments in assessment. The focus of the
new work will address developments designed to streamline
the assessment process and also the development of selfassessment
approaches in different local authorities.
Social well-being in Extra Care Housing
The Joseph Rowntree Trust has funded a three year project
as part of our evaluation of 22 schemes funded under the
Extra Care Housing Funding Initiative. The aim is to identify
for newly opened innovative schemes:
Residents’ expectations and experiences of a variety of
approaches to developing social activities
The relative effectiveness of these in fostering individual
social well being and a supportive and encouraging social
climate
Quality, outcomes and costs of equipment
As part of our DH funded programme of work we are
investigating quality, outcomes and costs of equipment. The
initial focus of the work is on the measurement of the benefit
and quality of equipment and equipment services for adults,
including older people, from the user perspective.
The work builds on the approach developed to measuring
the benefit of social care outputs described on page 26. The
aim is both to generate measures that can be used in future
research relating quality and outcomes to costs and to feed
into thinking about future user experience surveys of this
group.
Journal of Care Services Management
This recently launched journal publishes detailed,
authoritative briefings, analysis, case studies, research and
reviews by leading experts and practitioners in the field.
The key areas covered include, among others:
new and emerging policy
cost-effective and efficient delivery of services
commissioning of care services
business development for care service providers
funding and finance
care regulation and care standards compliance
data sets for social care
service user assessment and risk assessment
staff recruitment, retention, training and supervision
PSSRU professors David Challis (Manchester), Martin
Knapp (LSE) and Ann Netten (Kent) are members of the
editorial board.
Further details can be found at www.henrystewart.com/
care_services_management/index.html
PSSRU Bulletin No. 16
29

PROJECTS AND PUBLICATIONS
Current Research Projects and Recent Publications
These pages give a brief listing of most work current at September 2006, categorised by programme (groups of
related studies) and individual projects or clusters of projects, which are shown as boxed titles.
Also listed under each programme of work are relevant publications by PSSRU authors (often in collaboration with
colleagues at other institutions) since the previous Bulletin in October 2005. Articles are arranged in alphabetical
order of title.
PSSRU Bulletin No. 16
30
Assessment and Performance Measurement
Programme leader: Professor David Challis
See pages 6–7 for more information on work in this programme.
The Unit has a tradition of work in relation to assessment of
older people’s needs both in research and development. Current
and planned work will examine changes in the roles of staff as
assessment processes develop and changes in performance
management processes. With regard to both the assessment of
older people and developments in care coordination, the planned
work is designed to identify and explore the impact of the new
arrangements through examination of new patterns of working,
the contribution of different professional groups and
organisations, and the experiences of service users and their
carers. Work is underway in two areas:
Assessment processes: staff involvement, care pathways
and service outcomes
This work is planned to investigate developments in assessment
processes in terms of the variation in staff involvement and their
possible effects in terms of service outcomes and user
experience. It will also evaluate major policy changes in
assessment from the perspective of its links to relevant
performance criteria with which to judge the impact of the policy.
The intention is to assess the impact of the policy against one of
its major aims, which is to ensure assessments are more inclusive
of relevant staff and more integrated in their content and in their
mode of operation.
Performance Measurement
A new book has been published (see below) and a new project
examining local variations in performance measurement in older
people's services has just commenced.
Recent publications from this programme
Assessing care home quality using routine regulatory information
Worden, A. and Challis, D. (2006)
Quality in Ageing, 7, 3, 33–44
Performance Indicators in Social Care for Older People
Challis, D., Clarkson, P. and Warburton, R. (2006)
Ashgate, Aldershot
Performance measurement in social care: a comparison of
efficiency measurement methods
Clarkson, P. and Challis, D. (2006)
Social Policy and Society, 5, 4, 461–477
‘Single’ assessment for older people: comparison of the MDS-HC
with current auditable methods in the home care setting
Carpenter, I., Challis, D. and Swift, C. (2005)
Journal of Integrated Care, 13, 5, 35–41
The assessment of older people’s needs in care homes
Worden, A., Challis, D. and Pedersen, I. (2006)
Aging and Mental Health, 10, 5, 549–557
The needs of older people with dementia in residential care
Hancock, G., Woods, B., Challis, D. and Orrell, M. (2006)
International Journal of Geriatric Psychiatry, 21, 43–49
Services for Children and Young People
Programme leader: Dr Jennifer Beecham
See pages 14–15 for more information on work in this
programme.
Focusing on children and young people who have additional
needs and who use specialist services alongside universal
supports, this programme brings an economic perspective to
studies of cross-agency service provision and use of services. It
has its roots in the earlier Economics of Social Care programme
but reflects the broader vision found in the Change for Children
policy agenda. Current research includes exploring support for
disabled children, mental health services, adoption services,
specialist foster care, and the interfaces between health,
education and social care. Strong links are maintained with the
Mental Health Economics and Policy programme and the Centre
for the Economics of Mental Health at the Institute of Psychiatry,
London.
Access to child and adolescent mental health services
In this project we will build on work already undertaken with
adult mental health services to explore two issues; the potential
for access through availability of services, and the actual access
made as indicated by utilisation rates of child and adolescent
mental health services (CAMHS).
Education services for young people living away from
home
This study, in collaboration with researchers at the Department
of Applied Social Studies, University of Bedfordshire, is funded
under the Department of Health Quality Protects research
initiative. The main research questions are
What is the quality of care provided for different group of
‘difficult to manage’ adolescents living in foster care, children’s
homes and residential schools for children with emotional and
behavioural problems (EBD)?
What are the educational and wider outcomes for children in
these groups?
What are the costs of the care and education services used
and how do these relate to outcomes?
How do the public and independent sectors compare?
Multi-agency support for disabled young people
The aim is to identify and collate recent research findings and
data on the way disabled children and their families use services,
allowing the following activities:
exploration of the ways in which disabled children and their
families are supported by multi-agency packages of care
estimation of the costs of supporting children who have
different types of disability, needs or levels of severity
exploration of the associations between the costs of support
and needs
Health, social care and education interface
Provision of integrated services is a central component of the
policy to improve access to a range of supports for children and
families. This project will identify these ‘interface’ services and
explore the ways in which they are provided, to whom and at

PROJECTS AND PUBLICATIONS
what cost. The focus will be on the way that health services are
supporting particular groups of children in a range of non-health
settings.
Costs and outcomes in children’s social care
Thirteen studies were funded under the Department of Health
research initiative, The Costs and Effectiveness of Services to
Children in Need. They covered diverse subjects using a range of
designs; from an extended health visiting service for babies to
support for young people as they leave care, and from small
comparative experimental studies to large cohort studies. Each
study included an economic component. Some described the
costs of services and others aimed to look at why the costs of
services or the costs of supporting children might vary. A few
brought costs and outcomes information together within a costeffectiveness
framework.
See Beecham and Sinclair (2006) and
www.everychildmatters.gov.uk
An investigation of linking and matching in adoption
Little is known about what makes a good match in adoption or
how much it might cost. A national survey will provide a broad
picture of linking and matching practices. Innovative as well as
more routine approaches will be examined in more detail
through a catch-up prospective study of 150 children from 5–10
adoption agencies in the public and voluntary sectors.
In collaboration with researchers at the School for Policy Studies,
University of Bristol.
An exploration of different models of key worker
services for disabled children and their families:
effectiveness and costs
Research has shown that families of disabled children who have a
key worker benefit from this service and recent policy initiatives
emphasis the importance of such provision. Alongside the recent
expansion of these services (30 were found in a recent national
survey) has come a proliferation of models of service delivery.
This study, undertaken with researchers at the Social Policy
Research Unit, University of York aimed to identify which
characteristics of key worker services were associated with
better outcomes for disabled children and their families, and at
what cost.
Recent publications from this programme
Adoption by foster carers: a profile of interest and outcomes
Kirton, D., Beecham, J. and Ogilvie, K. (2006)
Child and Family Social Work, 11, 2, 139–146
An Exploration of Different Models of Multi-Agency Partnerships
in Key Worker Services and Disabled Children: Effectiveness
and Costs
Greco, V., Sloper, P., Webb, R. and Beecham, J. (2005)
Published as DfES Research Report 656. Department for
Education and Skills, London.
Assessing services, supports and costs for young families under
stress
Sleed, M., Beecham, J., Knapp, M., McAuley, C. and McCurry,
N. (2006)
Child: Care, Health and Development, 32, 1, January, 101–110
A randomised controlled trial of family therapy and cognitive
behavioural guided self-care for adolescents with bulimia
nervosa or related disorders
Schmidt, U., Lee, S., Beecham, J., Perkins, S., Treasure, J. et al.
(2006)
American Journal of Psychiatry, forthcoming
Costs and Outcomes in Children’s Social Care: Messages from
Research
Beecham, J. and Sinclair, I. (2006)
Jessica Kingsley Publishing, forthcoming
Developing Social Care: The Current Position
Knapp, M., Fernández, J.L., Kendall, J., Beecham, J., Northey, S.
and Richardson, A. (2005)
Report commissioned by the Social Care Institute for
Excellence (SCIE), London.
Economic cost of severe antisocial behaviour in children – and
who pays it
Romeo, R., Knapp, M. and Scott, A. (2006)
British Journal of Psychiatry, 188, 547–553
Foster carer training: resources, payments and support
Kirton, D. and Beecham, J. (2006)
Adoption and Fostering, forthcoming
Gaining satisfaction? An exploration of foster carers’ attitudes to
payment
Kirton, D., Ogilvie, K. and Beecham, J. (2006)
British Journal of Social Work.
Key worker services for disabled children: the views of parents
Sloper, P., Greco, V., Beecham, J. and Webb, R. (2006)
Children and Society, forthcoming
Key worker services for disabled children: the views of staff
Greco, V., Sloper, T., Webb, R. and Beecham, J. (2006)
Health and Social Care in the Community, forthcoming
Key worker services for disabled children: what characteristics of
service lead to better outcomes for children and families
Sloper, P., Greco, V., Beecham, J. and Webb, R. (2006)
Child: Care, Health and Development, 32, 2, March, 147–157
Resource use and cost of caring for ventilator-dependent
children in the United Kingdom
Noyes, J., Godfrey, C. and Beecham, J. (2006)
Health and Social Care in the Community, forthcoming
Social services support and expenditure for children with autism
Bebbington, A. and Beecham, J. (2006)
Austism, forthcoming
The economic impact of chronic pain in adolescence:
Methodological consideration and a preliminary costs-of-illness
study
Sleed, M., Eccleston, C., Beecham, J., Knapp, M. and Jordan, A.
(2005)
Pain – International Association for the Study of Pain, 119, 1–3,
December, 183–190
The Report of the Older People’s Inquiry into ‘That Bit of Help’
Raynes, N., Clark, H. and Beecham, J. (eds) (2006)
Joseph Rowntree Foundation, York, forthcoming
Transition Pathways for Young People with Complex Disabilities:
Exploring The Economic Consequences
Knapp, M., Perkins, M., Beecham, J. and Dhananiri, S. (2006)
Report to Disability and Rehabilitation Education (DARE)
Young families under stress: assessing maternal and child wellbeing
using a mixed methods approach
McAuley, C., McCurry, N., Knapp, M., Beecham, J. and Sleed,
M. (2006)
Child and Family Social Work, 11, 1, 43–54
Commissioning and Performance
PSSRU Bulletin No. 16
Programme leader: Professor Martin Knapp
See pages 8–9 for information on previous work in this
programme.
The Commissioning and Performance programme endeavours to
describe and evaluate the mixed economy of care in England,
particularly focused on commissioning, providing, market
development and choice. This work builds on earlier work on the
‘mixed economy of care’ which sought to describe and evaluate
the development, structure and performance of social care
markets. There is a particular focus on:
the approaches and perspectives of purchasers
the characteristics, motivations and behaviour of providers
the key features of commissioning and their consequences for
market structure and outcomes
micro-commissioning by care managers and the participative
roles of service users
commissioning of services by users, through direct payments
and individual budgets
Current research is organised into five clusters. 31

PROJECTS AND PUBLICATIONS
PSSRU Bulletin No. 16
32
Balance of care
A number of projects are examining the range and balance of
services needed to provide the most cost-effective and equitable
outcomes for people. Some of the work builds on the Wanless
Review of Social Care, considering the criteria and application of
cost-effectiveness principles, the services that satisfy these
principles, how commissioning can be developed using planning
tools derived from them, and examining the projected future
costs. Three national evaluations are looking at aspects of the
balance of care for older people. The team is contributing to the
national evaluation of the Partnership for Older People Projects
(POPPs). The SDO is funding a study of the impact of different
local governance arrangements on efforts to reduce the use of
inappropriate hospital stays. And work continues on the
evaluation of the Innovation Forum programme for older people.
Care service evaluations
Work underway on the motivations of care home owners and
managers is coming to an end, with reports and papers
produced. The PSSRU contributed to a major national evaluation
of Healthy Living Centres. Work carried out for the Wanless
Review, and subsequently prompted by it, continues to explore
the patterns of need, demand and supply in relation to older
people’s social care.
Consumer-directed care
A major policy emphasis in recent years has been to shift more
power and responsibility over to service users. Our evaluation of
direct payments for older people will soon end, including
coordination of UK-wide surveys of local authorities and support
organisations (see page 8). PSSRU inputs to the evaluation of the
Individual Budget pilots take forward this interest in consumerdirected
care. Further research in this area is planned. Another
project is looking at the Invest to Save programme in Kent,
promoting ‘brighter futures’ for older people, especially through
the involvement of volunteers.
Local variations
All aspects of social care provision in England are characterised
by significant local variability, whether in funding patterns,
eligibility criteria, service mix, costs or outcomes. Within the core
programme are studies examining whether such variability results
from influences beyond the control of local policy makers or
from local policy decisions, and the resultant impacts on equity
and efficiency.
European social care
Research within this cluster is comparative across a number of
European countries. It includes an evaluation of assistive
technology for older people and people with disabilities (the
MonAMI project); a study exploring the impact on social care
system performance of recent changes in the role of the state as
service provider/regulator; and a study of the comparative costs
and effectiveness of community and institution-based services
across 28 European countries.
Recent publications from this programme
An Evaluation of Intermediate Care for Older People
Godfrey, M., Keen, J., Townsend, J., Moore, J., Ware, P., Hardy,
B., West, R., Weatherly, H. and Henderson, K. (2005)
Health and Social Care Group Institute of Health Sciences and
Public Health Research, University of Leeds
Analysis to support the development of FSS formulae for older
people. Interim report
Darton, R., Forder, J., Bebbington, A., Netten, A. and Muncer,
A-M. (2005)
Personal Social Services Research Unit, University of Kent
Care home providers as professionals, understanding the
motivations of care home providers in England
Matosevic, T., Knapp, M., Kendall, J., Henderson, K., Fernández,
J.L.. (2006)
Ageing and Society, forthcoming
Delivering effective social/long-term care to older people
Davies, B. (2006)
in M. Johnson, V. Bengtson, P. Coleman and T. Kirkwood (eds)
The Cambridge Handbook on Ageing, Cambridge University
Press, Cambridge
Le livre vert de l’Angleterre sur les services sociaux pour les
adultes, indépendance, bien-être et choix
Davies, B. (2006)
Retraite et Société, 47, 194–200
Social care and the nonprofit sector in the western developed
world
Kendall, J., Knapp, M. and Forder, J. (2006)
in W. Powell and R. Steinberg (eds) The Nonprofit Sector. A
Research Handbook, Second Edition, Yale University Press, New
Haven.
Social Care Review: Securing Good Care for Older People.
Taking a Long-Term View
Wanless, D., Forder, J., Fernández, J.L., Poole, T., Beesley, L.,
Henwood, M. and Moscone, F. (2006)
Wanless Report to King’s Fund, King’s Fund London
The determinants of private medical insurance prevalence in
England, 1997–2000
King, D. and Mossialos, E. (2005)
Health Services Research, 40, 1, 195–212
The Evaluation of the Big Lottery Fund Healthy Living Centres,
Third Annual Report of the Bridge Consortium
Stern, E., Petticrew, M., Popay, J., Boydell, L., Platt, S., McDaid,
D., Williams, A. and the BRIDGE Consortium (2005)
The Big Lottery Fund, London
Coordinated Care and Care Management
Arrangements for Older People
Programme leader: Professor David Challis
See pages 10–11 for information on previous work in this
programme.
A distinct theme of the work at PSSRU Manchester has been
field-level experimentation and evaluation to address policy
questions such as the impact of assessment prior to care home
placement. Current work is designed to identify and explore the
impact of the new care management arrangements through
examination of new patterns of working, the contribution of
different professional groups and organisations, and the impact
upon service outcomes. Work is underway in two areas:
Towards the new care coordination for older people:
exploration of emergent arrangements for the provision
of care at home
The project aims to explore the different emerging arrangements
for coordinated care provision and to discern changes in them
since the late 1990s. A number of specific questions are being
addressed to determine the extent to which services are
differentiated and integrated, to address the needs and wishes of
older people against the criteria of flexibility, choice and
responsiveness. A national survey of care management and care
coordination arrangements for older people in England is
currently underway.
Links between care management provided through the
social care system and NHS case management
This work is exploring the different linkages and interfaces
between care management as provided through the social care
system and NHS case management, as developed for people
with complex, long-term conditions. Work has begun in North
West England, working with PCTs in the Greater Manchester
area to examine the nature of case management arrangements,
and variations in outcomes of different approaches. It is hoped to

PROJECTS AND PUBLICATIONS
extend this work at a later date.
Recent publications from this programme
Are different forms of care management associated with
variations in case-mix, service use and care managers’ time use
in mental health services?
Challis, D., Jacobs, S., Hughes, J., Stewart, K., Venables, D. and
Weiner, K. (2005)
Research, Policy and Planning, 23, 2, 71–85
Are different forms of care management for older people in
England associated with variations in case-mix, service use and
care managers’ time use?
Challis, D., Hughes, J., Jacobs, S., Stewart, K. and Weiner, K.
(2006)
Ageing and Society, forthcoming
Better prevention
Bhaduri, R. (2004)
Care and Health Magazine, 4–20 September, 26–27
Care management for older people: does integration make a
difference?
Challis, D., Stewart, K., Donnelly, M., Hughes, J. and Weiner, K.
(2006)
Journal of Interprofessional Care, forthcoming
Care management: is it all assessment and paperwork? A diary
study of care managers’ working practices in three service
settings
Jacobs, S., Hughes, J., Challis, D., Stewart, K. and Weiner, K.
(2006)
Journal of Integrated Care, 14, 3, 22–31
Community care: service delivery, development and evaluation
Challis, D. and Hughes, J. (2005)
in B. Roe and R. Beech (eds) Intermediate and Continuing Care,
Blackwell, Oxford
Continuing care: policy and context
Challis, D. and Netten, A. (2005)
in B. Roe and R. Beech (eds) Intermediate and Continuing Care,
Blackwell, Oxford
Exploring the factors influencing care management arrangements
in adult mental health services in england
Hughes, J., Stewart, K., Challis, D., Jacobs, S., Venables, D. and
Weiner, K. (2005)
Research Policy and Planning, 23, 1, 31–42
Integrated specialist assessment of older people and predictors
of care home admission
Clarkson, P., Venables, D., Hughes, J., Burns, A. and Challis, D.
(2006)
Psychological Medicine, 36, 1011–1021
Levels of integration and specialisation within professional
community teams for people with dementia
Abendstern, M., Reilly, S., Hughes, J., Venables, D. and Challis,
D. (2006)
International Journal of Geriatric Psychiatry, 21, 77–85
Patterns of care management arrangements for people with
mental health problems in England
Venables, D., Hughes, J., Reilly, S., Stewart, K. and Challis, D.
(2006)
Australian Journal of Case Management, 7,2,3–9
Quality in long term care homes for people with dementia: an
assessment of specialist provision
Reilly, S., Abendstern, M., Hughes, J., Challis, D., Venables, D.
and Pedersen, I. (2006)
Ageing and Society, 26, 4, 649–668
Standards of care in day hospitals and day centres: a comparison
of services for older people with dementia
Reilly, S., Venables, D., Hughes, J., Challis, D. and Abendstern,
M. (2006)
International Journal of Geriatric Psychiatry, 21, 460–468
Standards of care in home care services: a comparison of
specialist and generic services for older people with dementia
Venables, D., Reilly, S., Challis, D., Hughes, J. and Abendstern,
M. (2006)
Aging and Mental Health, 10, 2, 187–194
Social work and care management
Challis, D., Sutcliffe, C. and Hughes, J. (2004)
in J. O’Brien, D. Ames and A. Burns (eds) Dementia (3rd Edition)
Hodder Arnold, London
The impact of specialist clinical assessment on the carers of
vulnerable older people: a randomised controlled trial
Venables, D., Clarkson, P., Challis, D., Hughes, J. and Burns, A.
(2006)
Ageing and Society, forthcoming
Variations in care management arrangements for people with
mental health problems in England
Venables, D., Hughes, J., Stewart, K. and Challis, D. (2005)
Care Management Journals, 6, 3, 131–138
Costs, quality and outcomes
Programme leader: Professor Ann Netten
See pages 12–13 for information on previous work in this
programme.
The programme has three aims:
to develop and improve the measurement of costs, quality and
outcomes
to investigate factors associated with variations in costs, quality
and outcomes of services and contribute to our understanding
of how it is possible to improve efficiency while maintaining or
improving key aspects of quality and outcome
to enhance the value of both research and routine statistical
information for monitoring, evaluative and ongoing policy
purposes.
Initially four projects areas are planned:
Unit costs of health and social care
This continues a long running stream of work which aims to
identify, improve and disseminate information about unit costs of
health and social care.
The project enables findings from research studies to be updated
and remain easily accessible in the public domain. The project’s
annual volumes (see page 38) are widely used.
Costs, quality and outcomes of equipment services
Our objectives are:
to identify methods of measuring equipment service outputs,
quality and outcomes for younger and older disabled adults
to identify the use of equipment and adaptations over time
to provide an understanding of the relationship between cost
quality and outcomes
to investigate factors underlying variations in efficiency
An extension to the younger adults user experience
survey (UES)
The principal aims of this research are:
to explore the problem of non-response in the UES
to consider how performance indicators might be developed
using such data given the problem of non-response
to add value to a sample of participating local authorities by
collecting data on the quality of services delivered to younger
adults with physical and sensory impairments (PSI)
to facilitate the further development of a measure of the
quality of services for adults with PSI
to investigate variations in younger adult service users’
experience
Development of PSS output index
PSSRU Bulletin No. 16
This project will continue to develop the approach to the
measurement of personal social services outputs developed for
the Atkinson Review of National Statistics and to explore the
wider potential for the measurement of productivity and
efficiency. A number of projects are involved, particularly the
Quality Management Framework studies announced on page 4.
This will comprise four projects at PSSRU over a three year
period starting October 2006: 33

PROJECTS AND PUBLICATIONS
PSSRU Bulletin No. 16
34
Measuring and monitoring quality of outputs of care homes
Estimating value and monitoring the quality of outputs of lowlevel
interventions
The value of information and advice services
A population preference study of social care outcomes
The care homes project is being conducted in conjunction with
the Commission for Social Care Inspection and will aim to both
feed into the review of care standards and build on these for
monitoring quality.
Recent publications from this programme
Incorporating user experiences in performance monitoring of
home care
Jones, K., Netten, A. and Francis, J. (2006)
Health and Social Care in the Community, under review
Provider and care workforce influences in quality of home care
services in England
Netten, A., Jones, K. and Sandhu, S. (2006)
Journal of Aging and Social Policy, inpress
The influence of individual characteristics in the reporting of
home care service quality by service users
Sandhu, S., Bebbington, A. and Netten, A. (2006)
Research Policy and Practice, 24, 2, in press
Unit Costs of Health and Social Care 2006
Curtis, L. and Netten, A. (eds) (2006)
Personal Social Services Research Unit, University of Kent
Using discrete choice experiments to estimate a preferencebased
measure of outcome – An application to social care for
older people
Ryan, M., Netten, A., Skatun, D. and Smith, P. (2006)
Journal of Health Economics. Available online at
www.sciencedirect.com
Long-Term Care Finance
Programme leader: Raphael Wittenberg
See pages 16–17 for information on previous work in this
programme.
The overall aims of the LTCF programme are to make
projections of likely demand for long-term care for older people
and associated expenditure to 2041 under different scenarios.
The scenarios relate to changes in external drivers of demand,
such as demographic pressures, and to potential changes in
patterns of care or policies. A specific objective is to assess the
likely impact of different policies and approaches to funding longterm
care for older people on the balance of expenditure
between sectors.
Work to date has been widely used by national and local policymakers.
Cognitive impairment study
This project is concerned with the exploration of scenarios about
the future prevalence of cognitive impairment in older people
and their impact on long-term care expenditure and has been
funded by the Alzheimer’s Research Trust. The aim of the study
is to explore scenarios about the future prevalence of cognitive
impairment in older people through the views of experts working
on the development of treatments for dementia. The cost
implications of these scenarios is being investigated using an
updated version of the PSSRU Cognitive Impairment Model,
which makes projections of future demand for long-term care
services and of associated expenditure, based on alternative
scenarios about trends in the drivers of demand.
Long-term care projections project
This DH-funded project is concerned with projections of
demand for long-term care for older people in England to 2041
and associated public and private expenditure under different
assumptions about key factors affecting demand. The project has
involved the construction of a cell-based computer model to
make projections, the development of scenarios on trends in the
key drivers of demand for long-term care and the production of
projections under variant assumptions and scenarios. A wide
range of formal health and social services and disability benefits is
covered and informal care is considered. Projections have been
produced under different assumptions about trends in life
expectancy, disability rates, real unit costs, availability of informal
care and patterns of formal care. Projections have also been
made of future expenditure under different funding systems. The
project has generated projections and analyses for the
Department of Health, the Royal Commission on Long-Term
Care, HM Treasury and the Wanless Health Trends and Social
Care Reviews.
Paying for long-term care
The aim of the study, funded by the Nuffield Foundation, is to
make projections of expenditure on long-term care services
under a wide range of options for reforming the system for
funding long term care for older people. The projections under
each option include a projected breakdown of expenditure
between public sources of funding (NHS, social services and
DWP disability benefits) and private sources (service users) and
an analysis of the projected differential impact on older people in
different parts of the income distribution. The study involves
linkage between a variant model of the PSSRU long-term care
finance model and the CARESIM model. It is being conducted in
collaboration with researchers at the Universities of Essex and
Birmingham. The study will be completed by the end of 2006.
Projected financial implications of the Wanless Report
The aim of this project was to prepare projections of the
financial implications of the Wanless Review of Social Care. A
variant version of the PSSRU long-term care finance model was
developed to produce analyses commissioned by the Wanless
Review team. The structure and basis of the Wanless Review
version of the model draws upon existing work carried out by
the PSSRU long-term care team and established links with the
CARESIM model at the University of Essex. The study was
completed in March 2006 with the publication of projections to
2026 of the financial implications of the service models
recommended by the Wanless Review.
Recent publications from this programme
Care by spouses, care by children: projections for informal care
for older people in England to 2031
Pickard, L., Wittenberg, R., Comas-Herrera, A., King, D and
Malley, J. (2007)
Social Policy and Society, forthcoming
Cognitive impairment in older people: the implications for future
demand for long-term care services and their costs
Comas-Herrera, A., Wittenberg, R., Pickard, L., Knapp, M. and
MRC CFAS (2006)
International Journal of Geriatric Psychiatry, forthcoming.
Expenditure on social care for older people to 2026: projected
financial implications of the Wanless Report
Malley, J., Comas-Herrera, A., Hancock, R., Juarez-Garcia, A.,
Pickard, L. and King, D. (2006)
Appendix to the Wanless Report, Securing Good Care for Older
People, King’s Fund, London, available at www.kingsfund.org
Future long-term care expenditure in Germany, Spain, Italy and
the United Kingdom
Comas-Herrera, A., Wittenberg, R., Costa-Font, J., Gori, C., di
Maio, A., Patxot, C., Pickard, L., Pozzi, A. and Rothgang, H.
(2006)
Ageing and Society, 6, 2, 285–302
Long-term care for older people in the United Kingdom:
structure and challenges
Comas-Herrera, A., Wittenberg, R. and Pickard, L.. (2005)
in M. Knapp, J.L. Fernández, D. Challis and A. Netten (eds)
Long-Term Care: Matching Resources and Needs, Ashgate,
Aldershot

PROJECTS AND PUBLICATIONS
What are the most effective and cost-effective services for
informal carers of older people?
Pickard, L. (2006)
Research in Practice for Adults, 4, June
Housing and Care
Programme leader: Professor Ann Netten
See pages 20–21 for more information this programme.
This work investigates the implications and potential of current
developments in housing and care for the welfare of older
people and the efficient use of resources. In particular, the
planned projects will look at the feasibility, affordability,
desirability and implications of moves away from care homes
towards alternative housing and care options. To what extent do
developments such as extra care housing deliver improved
outcomes and at what cost? What are the implications for care
homes?
The work outlined below is current in this programme, together
with the support of a research network (see the news page 4).
An evaluation of extra care housing for older people
The longer-term aims are to monitor how the schemes funded
under the Department of Health’s Extra Care Housing Funding
Initiative develop over time, to track long-term outcomes for
schemes and residents and to compare the costs and outcomes
with people moving into care homes. See page 21.
Analysis of evidence about the contribution of care
homes and extra care to the support of older people
This work will draw on previous and recent data collections to
examine the implications of changing patterns of use of care
homes and extra care housing for older people. See also page 29.
Recent publications from this programme
Alternative Housing and Care Arrangements: The Evidence
Darton, R. and Muncer, A-M. (2005)
in B. Roe and R. Beech (eds) Intermediate and Continuing Care:
Policy and Practice, Blackwell Publishing, Oxford
Care Homes and Continuing Care
Netten, A., Darton, R. and Williams, J. (2005)
in B. Roe and R. Beech (eds) Intermediate and Continuing Care:
Policy and Practice, Blackwell Publishing, Oxford
Mental Health Economics and Policy
Programme leader: Professor Martin Knapp
See pages 18–19 for information on work in this programme.
The programme comprises research on mental health policy and
practice, drawing particularly but not exclusively on economic
approaches and associated empirical methods. Work covers the
full age range and all mental disorders, and includes research on
intellectual disabilities. Much of the work is conducted outside
the UK.
UK studies
The core DH-funded programme includes work exploring the
links between childhood mental health problems and adulthood
economic implications, and what can be done to address the
problem; links between employment and mental health; and
evaluations of a number of policy initiatives.
Recent or current work has included an evaluation of the
Choose Life suicide prevention programme in Scotland. An
examination of income-related inequalities in prevalence and
service use is underway. A long-term theme has been the link
between mental health problems and social exclusion, working
collaboratively with the Centre for the Analysis of Social
Exclusion at LSE. Mental Health problems in old age have been
studied in three projects: the impacts of unrecognised
depression, the prevalence and costs of dementia, and the
impact of needs assessments on care patterns and performance.
A major study of medium secure units is coming to an end.
International mental health
The flagship project here is the Mental Health Economic
European Network, covering 32 European countries and some
non-European countries, now in its second phase. A further eight
EU-funded projects are also underway, including work on
supported employment for people with serious mental health
problems, strategies to integrate people with disabilities into the
labour market, child and adolescent mental health service
development, genetic testing and depression treatment, and
mental health prevention and promotion.
Outside Europe, PSSRU team members are contributing to
mental health policy and practice development initiatives in
southern Africa and a major programme to raise the profile of
depression and its socio-economic consequences in Asia.
Recent publications from this programme
PSSRU Bulletin No. 16
Access to mental health supports in England: crisis resolution
teams and day servcies
Beecham, J. (2005)
International Journal of Law and Psychiatry, 28, 574–587
An economic, financial and health systems analysis of systems to
support mental health in the Sverdlovsk Oblast, Russian
Federation Report prepared as part of DFID Adult Mental
Health Reform Project 2002–2006
Samyshkin, Y. and McDaid, D. (2005)
Sverdlovsk, Oblast, Russian Federation
A methodological approach for assessing the cost-effectiveness
of treatments using longitudinal observational data, the SOHO
study
Windmeijer, F., Kontodimas, S., Knapp, M., Brown, J. and Haro,
J.M. (2006)
International Journal of Technology Assessment in Health Care,
forthcoming
Annotation, Economic evaluations of child and adolescent mental
health interventions, a systematic review
Romeo, R., Byford, S. and Knapp, M. (2005)
Journal of Child Psychology and Psychiatry, 46, 9, 919–930
Balancing Institutional and Community based care. European
Observatory on Health Systems and Policies. Policy Brief
McDaid, D. and Thornicroft G. (2005)
World Health Organization, Copenhagen
Challenges in multi-disciplinary systematic reviewing, improving
the evidence base for social exclusion and mental health policy
Curran, C., Burchardt, T., Knapp, M., McDaid, D. and Li, B.
(2006)
Social Policy and Administration, forthcoming
Children in foster care, mental health, service use and costs
Minnis, H., Everett, K., Pelosi, A., Dunn, J. and Knapp, M. (2006)
European Child and Adolescent Psychiatry, 2, 63–70
Children with antisocial behaviour, what do they cost and who pays?
Romeo, R., Knapp, M. and Scott, S. (2006)
British Journal of Psychiatry, 188, 547–553
Cognitive stimulation therapy for people with dementia, costeffectiveness
analysis
Knapp, M., Thorgrimsen, L., Patel, A., Spector, A., Hallam, A.,
Woods, B. and Orrell, M. (2006)
British Journal of Psychiatry, 188, 574–580
Cost analysis of treating schizophrenia with amisulpride,
naturalistic mirror image study
Surguladze, S., Patel, A., Kerwin, R., Knapp, M. and Travis, M.
(2005)
Progress in Neuro-Psychopharmacology and Biological Psychiatry,
29, 517-522
Cost-effectiveness of individual versus group psychotherapy for
sexually abused girls
McCrone, P., Weeramanthri, T., Knapp, M., Rushton, A.,
Trowell, J., Miles, G. and Kolvin, I. (2005)
Child and Adolescent Mental Health, 10, 26–31 35

PROJECTS AND PUBLICATIONS
PSSRU Bulletin No. 16
36
Cost factors in group care
Knapp, M. (2006)
in F. Ainsworth and L. Fulcher (eds) Issues in Group Care, Second
Edition, Tavistock, London
Cost impact of young adults with high-functioning autistic
spectrum disorder
Jarbrink, K., McCrone, P., Fombonne, E., Zanden, H. and
Knapp, M. (2006)
Research in Developmental Disabilities, forthcoming
Costs of Schizophrenia
Knapp, M. (2005)
Psychiatry, 4, 10, 3335
Effectiveness and costs of acute day hospital treatment as
compared with conventional in-patient care: a randomised
controlled trial
Priebe, S., Briscoe, J., Jones, G., McCabe, R., Wright, D., Sleed,
M. and Beecham, J. (2006)
British Journal of Psychiatry, forthcoming
Evaluation of the cost-effectiveness of Escitalopram versus
Venlafaxine XR in Major Depressive Disorder
Fernández, J., Montgomery, S. and François, C. (2005)
PharmacoEconomics, 23, 2, 155–167
Evaluation of the First Phase of Choose Life. Final Report
Platt, S., Halliday, E., Maxwell, M., McCollam, A., McLean, J.,
Woodhouse, A., Blamey, A., Mackenzie, M. and McDaid, D.
(2006)
Scottish Executive, Edinburgh, forthcoming
Financing mental health care in Spain. Context and critical issues
Salvador-Carulla, L., Garrido, M., McDaid, D. and Haro, J.M.
(2006)
European Journal of Psychiatry, 20, 1, 29–44
Financing mental health, equity and efficiency concerns for low
and middle income countries
Dixon, A., McDaid, D., Knapp, M. and Curran, C. (2006)
Health Policy and Planning, 21, 171–182
Funding mental health in Europe. European Observatory on
Health Systems and Policies. Policy Brief.
McDaid, D., Knapp, M. and Curran, C. (2005)
World Health Organization, Copenhagen
Health system factors impacting on delivery of mental health
services in Russia, multi-methods study
McDaid, D., Samyshkin, Y., Jenkins, R., Potasheva, A.P.,
Nikiforov, A.L. and Atun, R.A. (2006)
Health Policy, Feb 9.
Income, health and health care utilisation in the UK
Mangalore, R. (2006)
Applied Economics, 38, 6, 605–617
Income-related inequality in mental health in Britain: the
concentration index approach
Mangalore, R. and Knapp, M. (2006)
Psychological Medicine, forthcoming
Inequalities in health, international patterns and trends
McDaid, D. and Oliver, A. (2005)
in A. Scriven and S. Garman (eds) Promoting Health, Global
Issues and Perspectives, Palgrave Macmillan, Basingstoke
Intellectual disability, challenging behaviour and cost in care
accommodation: what are the links?
Knapp, M., Comas-Herrera, A., Astin, J., Beecham, J. and
Pendaries, C. (2005)
Health and Social Care in the Community, 13, 4, 297–306
Key issues in mental health policy and practice development
across Europe. European Observatory on Health Systems and
Policies. Policy Brief
McDaid, D. (2005)
World Health Organization, Copenhagen
Measurement of health-related quality of life for people with
dementia, development of a new instrument (DEMQOL) and
an evaluation of current methodology
Smith, S., Lamping, D., Banerjee, S., Harwood, R., Foley, B.,
Smith, P., Cook, J., Murray, J., Prince, M., Leven, E., Mann, A.
and Knapp, M. (2005)
Health Technology Assessment, 9, 10, 1–93
Mental health expenditure in England, A spatial panel approach
Moscone, F., Knapp, M. and Tosetti, E. (2006)
Journal of Health Economics, forthcoming
Mental health in low- and middle-income countries, economic
barriers to better practice and policy
Knapp, M., Funk, M., Curran, C., Prince, M., Gibbs, M. and
McDaid, D. (2006)
Health Policy and Planning, 21, 157–170
Mental Health Policy and Practice across Europe
Knapp, M., McDaid, D., Mossialos, E. and Thornicroft, G. (eds)
(2006)
Open University Press, Buckingham
Primary prevention of child mental health problems using primary
health care professionals, cost comparisons
Knapp, M., Barrett, B., Byford, S., Hallam, A., Davis, L., Tsiantis,
J., Puura, K., Ispanovic-Radojkovic, V. and Paradisiotou, A.
(2005)
International Journal of Mental Health Promotion, 7, 95–102.
Quality and costs of community-based residential supports for
people with mental retardation and challenging behaviour
Robertson, R., Emerson, E., Pinkney, L., Caesar, E., Felce, D.,
Meek, A., Carr, D., Lowe, K., Knapp, M. and Hallam, A. (2006)
American Journal on Mental Retardation, forthcoming
Schizophrenia patients with cognitive deficits, factors associated
with costs
Patel, A., Everitt, B., Knapp, M., Reeder, C., Grant, G. and
Wykes, T. (2006)
Schizophrenia Bulletin, forthcoming
Service use and costs of support for people with learning
disabilities twelve years after leaving hospital
Hallam, A., Beecham, J., Knapp, M., Carpenter, J., Cambridge,
P., Forrester-Jones, R., Tate, A., Coolen-Schrijner, P. and Wooff,
F (2006)
Journal of Applied Research in Intellectual Disabilities,
forthcoming, available online 25 November 2005
Service use and costs of supporting the most socially disabled
patients in a hospital reprovision programme, a two-hospital
comparison
McCrone, P., Hallam, A., Knapp, M., Swaray, F., Lowin, A., Leff,
J. and Szmidla, A . (2006)
Social Psychiatry and Psychiatric Epidemiology, forthcoming
The case for suicide prevention, an economic perspective
McDaid, D. and Kennelly, B. (2006)
iIn D. Wasserman and C. Wasserman (eds) The Oxford Textbook
of Suicidology – The Five Continents Perspective, Oxford
University Press, Oxford, forthcoming
The costs and effectiveness of two psychosocial treatment
programmes for personality disorder, a controlled study
Beecham, J., Sleed, M., Knapp, M., Chiesa, M. and Drahorad, C.
(2006)
European Psychiatry, 21, 102-109
The Evaluation of the Big Lottery Fund Healthy Living Centres,
Third Annual Report of the Bridge Consortium
Stern, E., Petticrew, M., Popay, J., Boydell, L., Platt, S., McDaid,
D., Williams, A. and the BRIDGE Consortium (2005)
The Big Lottery Fund, London
The development of a local index of need (LIN) and its use to
explain variations in social services expenditure on mental
health care in England
McCrone, P., Thornicroft, G., Boyle, S., Knapp, M. and Aziz, F.
(2006)
Health and Social Care in the Community, 14, 254-263
The social networks of people with intellectual disability living in
the community twelve years after resettlement from long-stay
hospitals
Forrester-Jones, R., Carpenter, J., Coolen-Schrijner, P.,
Cambridge, P., Tate, A., Beecham, J., Hallam, A. and Knapp, M.
(2006)
Journal of Applied Research in Intellectual Disabilities,
forthcoming, available online 26 September 2005
Twelve years on: service use and costs for people with mental
health problems who left psychiatric hospitals
Beecham, L., Hallam, A., Knapp, M., Carpenter, I, Cambridge,
P., Forrester-Jones, R., Tate, A., Wooff, D. and Coolen-
Schrijner, P. (2004)
Journal of Mental Health, 13, 4, 363–377

RECENT BOOKS, REPORTS AND MONOGRAPHS
Costs and Outcomes in Children’s Social Care:
Messages from Research
Jennifer Beecham and Ian Sinclair (Consultant editor:
Carolyn Davies), Jessica Kingsley Press, London
Thirteen studies were funded under the Costs and
Effectiveness of Services to Children in Need research
initiative. They covered diverse subjects and used a range
of designs: from an extended health visiting service for
babies to support for young people as they leave care, and
from small comparative experimental studies to large
cohort studies. Each study included an economic
component. Some described the costs of services and
others aimed to look at why costs vary. A few brought
costs and outcomes information together within a costeffectiveness
framework.
Care services for children depend on a limited supply of
resources; it is vital that these are used to best effect. This
book pulls together broad findings from the research
initiative to examine the way services are delivered and
how resources are distributed. It considers the efficiency
and cost-effectiveness of these services and their
contribution to children’s well-being. Particular attention is
paid to the possible contributions of early intervention
and better coordination.
International Outcome Measures in Mental
Health: Quality of Life, Needs, Service
Satisfaction, Costs and Impacts on Carers
Graham Thornicroft, Thomas Becker, Martin Knapp, Helle
Charlotte Knudsen, Aart Schene, Michele Tansella and
José Luis Vásquez-Barquero, ISBN 1-904671-00-4, Gaskell,
The Royal College of Psychiatrists, January 2006, 172
pages, paperback, £45.00
How do we know if mental health services work? What
are the best ways to measure the outcomes of care for
people with mental health problems?
This book contains five practical scales for assessing the
outcomes of mental healthcare. They are the European
versions of:
Camberwell Assessment of Need (for unmet and met
needs)
Client Socio-demographic and Service Receipt
Inventory (for service costs)
Involvement Evaluation Questionnaire (for impact of
care on family members)
Lancashire Quality of Life Profile (for quality of life)
Verona Service Satisfaction Scale (for service
satisfaction).
Each scale has been standardised (in Danish, Dutch,
English, Italian and Spanish), and has been shown to be
reliable and valid in all these European languages.
The book contains full details of the development of these
scales, manuals for their use, the scales themselves and
instructions on how to use the results.
Long-Term Care Finance Reports
Three new reports from the Long-Term Care Finance
(LTCF) team have recently been completed. The first,
Future Demand for Long-Term Care, 2002 to 2041:
Projections of Demand for Long-Term Care for Older
People in England, reports on recent developments and
updates to the projections model, describing the
addition of new modules on disability benefits and
workforce. It also sets out projections from the model.
The second, Expenditure on Social Care for Older People
to 2026: Projected Financial Implications of the Wanless
Report, arises from the study undertaken by the LTCF
team for the Wanless Review on Social Care funded by
the King’s Fund. The team was asked by the Wanless
Review to produce projections of demand for and
expenditure on social care for older people under
different patterns of care. This report presents those
projections with further analyses and provides technical
details of the modelling.
The third follows from a project undertaken for the
Nuffield Foundation with colleagues from the
Universities of Essex and Birmingham. A summary of
the report, Paying for Long-Term Care for Older People in
the UK: Modelling the Costs and Incidence of a Range of
Options, can be found on page 24.
All these reports and their research summaries are
available for download from the PSSRU website.
Mental Health Policy and Practice Across Europe
Edited by Martin Knapp, David McDaid, Elias Mossialos
and Graham Thornicroft, Open University Press,
November 2006
PSSRU Bulletin No. 16
Recent years have witnessed a growing interest in
mental health policy and practice in Europe, culminating
in the recent Helsinki Declaration and Action Plan for
mental health signed by all 52 countries of Europe. This
new book, produced as part of a series developed by
the European Observatory on Health Systems and
Policies, and featuring contributions by leading experts,
maps the current state of service provision and funding
for mental health across Europe, taking account of the
differing historical contexts influencing the development
of services and the ways in which they are delivered. A
holistic approach is adopted, looking not only at mental
health care services, but also at the influence of
environmental factors such as housing, poverty,
employment, social justice, and displacement on mental
health. The legal rights of people with mental health
problems take on special significance; the right to liberty
of individuals must be balanced against the need to
protect individuals from self-harm. Stigma, social
exclusion and discrimination need to be addressed. The
role of service users and families in the development of
mental health services and policy are also considered.
Facilitating evidence informed policy and economic
analysis, reflections on approaches to reform, and the
future development of services for the promotion of
good mental well-being and treatment/rehabilitation of
people with mental health problems are also provided.
37

RECENT BOOKS, REPORTS AND MONOGRAPHS
PSSRU Bulletin No. 16
38
Securing Good Social Care for Older People:
taking a long-term view
Available to download at www.kingsfund.org.uk
Social care for older people in England will require sharp
increases in funding over the next two decades and also a
major overhaul of the way that care is financed. These are
the main recommendations of this major review
commissioned by the King’s Fund, led by former NatWest
group chief executive, Sir Derek Wanless, and produced
in collaboration between the King’s Fund and the PSSRU at
LSE. Julien Forder and José Luis Fernández of PSSRU
managed the project and, along with Martin Knapp, sat on
the project steering group. PSSRU staff Raphael
Wittenberg, Adelina Comas-Herrera, Juliette Malley and
Francesco Moscone were members of the research team.
The review found that simply keeping pace with
population changes and not seeking to improve care
services or the way they are funded, total public and
private spending on social care for older people would
need to increase from £10.1 billion in 2002 to £24 billion
by 2026. In view of serious shortcomings in funding
arrangements, the review recommended that the current
means-tested funding system should be scrapped and
replaced with a partnership model. Everyone in need
would be entitled to an agreed level of free care, after
which individuals' contributions would be matched by the
state up to a defined limit. People on low incomes would
be eligible for benefits to fund their contributions.
Performance Indicators in Social Care
for Older People
David Challis, Paul Clarkson and Raymond Warburton,
Ashgate, Aldershot, 2006, 362 pages, ISBN 0754647447,
hardback, £55.00.
A number of central government initiatives in the 1980s
forged a climate of opinion around the idea of efficiency in
managing public resources. This is evident in a growing
focus upon performance review and monitoring which has
increased the awareness and use of performance
indicators throughout a range of public services. For social
care organisations, it is increasingly a requirement that
data be available to make performance review possible.
This work involved the development, implementation and
monitoring of a set of performance indicators for services
to older people. The book sets this work within a national
context by reviewing the historical development and
measurement issues around the use of indicators, within
the public sector more generally and social care in
particular. The White Paper Modernising Social Services
established a national Performance Assessment
Framework which requires supplementation by local
indicators. This book provides the rationale for and
contents of a suite of PIs for the social care of older
people to meet these requirements. It also considers the
process of engaging staff at various levels of the
organisation in using the evidence from local indicators to
address issues of local equity and quality improvement.
Further information is at www.ashgate.com where you can
also order the book.
The Older People’s Inquiry into
‘That Bit of Help’
Edited by Norma Raynes, Heather Clark and Jennifer
Beecham, Joseph Rowntree Foundation, York
Volume 1 of this report focuses on how to involve
older people alongside professionals in identifying what
services they may want and value. A model is provided
to ensure older people’s central involvement in
prioritising valued services; the methods used would be
easily transferred to local level. This volume provides an
overview of the Inquiry’s findings and presents the
chosen ‘baker’s dozen’ of small ways in which life can
be made better for older people, giving ideas about
what services might be developed.
The second volume draws together the evidence
submitted to the Inquiry, going beyond the boundaries
of health and social care. The starting point is seven key
areas older people identify as central to their lives:
comfortable and secure homes, an adequate income,
safe neighbourhoods, getting out and about, friendships
and opportunities for learning and leisure, keeping
active and healthy, and access to good relevant
information. Each is mapped onto the research
evidence, the development of policy since 1989, and
the funding streams available.
Unit Costs of Health and Social Care 2006
Edited by Lesley Curtis and Ann Netten
PSSRU, November 2006, 229 pages, ISSN 1368-230X,
paperback, £33.00.
This is the latest updated volume in a well-established
series bringing together information from a variety of
sources to estimate national unit costs for a wide range
of health and social care services.
This report consists of tables for more than 130 types
of service which as well as providing the most detailed
and comprehensive information possible, also quote
sources and assumptions so users can adapt the
information for their own purposes. Also included is a
preface in which current and new developments are
discussed, a guest editorial and brief articles providing
background to user services and descriptions of cost
methodology or use of cost estimates, price indices, a
reference list of key studies a glossary and indexes.
This year’s volume includes an editorial on conducting
and interpreting multi-national economic evaluations
and four new articles: on the costs of a home visiting
programme for vulnerable families; direct payments;
person centred planning; and unit costs and funding.
The 2006 edition is available in full at the PSSRU
website. Printed copies are available from the librarian
at the PSSRU in Canterbury, price £33 including
postage. Volumes for previous years to 1995 (with
articles on different aspects of costing research and
methodology) are available, and are priced at £15 for
the 2005 volume and £2 each for previous years (when
ordered with the 2006 volume). All prices include post
and packaging.

STAFF CONTACT DETAILS
PSSRU branch addresses and contact numbers for general enquiries are on the back cover. In the list below,
K indicates a member of PSSRU staff at the University of Kent at Canterbury, L at the London School of
Economics and Political Science and M at the University of Manchester.
David Challis
Director, Chair of PSSRU Executive Group
and Professor of Community Care Research (M) 0161 275 5222 D.J.Challis@manchester.ac.uk
Martin Knapp Director and Professor of Social Policy (L) 020 7955 6225 m.knapp@lse.ac.uk
Ann Netten Director and Professor of Social Welfare (K) 01227 823644 A.P.Netten@kent.ac.uk
Abendstern, Dr Michele Research Associate (M) ...........................0161 275 6851 Michele.Abendstern@manchester.ac.uk
Bass, Rosalyn Librarian (K) ....................................01227 827773 R.Bass@kent.ac.uk
Bäumker, Theresia Research Officer (K) .............................01227 824022 T.L.Baumker@kent.ac.uk
Beecham, Dr Jennifer Reader in Social Policy (K) .........................01227 823792 J.K.Beecham@kent.ac.uk
Boyle, Sean
Senior Research Fellow(L) .........................0207955 6251 s.boyle@lse.ac.uk
Brawn, Nick Senior Information Officer (K) .....................01227 823863 N.C.S.Brawn@kent.ac.uk
Clarkson, Paul
Research Fellow (M) .............................0161 275 5674 Paul.C.Clarkson@manchester.ac.uk
Comas-Herrera, Adelina Research Fellow (L) ..............................0207955 7306 a.comas@lse.ac.uk
Cornwell, Dr Jocelyn Visiting Research Associate (L). .....................0207955 7352 j.s.cornwell@lse.ac.uk
Cox, Lesley Research Secretary (K) ...........................01227 823963 L.A.Cox@kent.ac.uk
Curtis, Lesley Research Officer (K) .............................01227 827193 L.A.Curtis@kent.ac.uk
Damant, Jacqueline Research Assistant (L) ............................0207955 6087 j.damant@lse.ac.uk
Darton, Robin Research Fellow (K) .............................01227 827643 R.A.Darton@kent.ac.uk
Davey, Vanessa Research Officer (L) .............................0207955 6376 v.davey@lse.ac.uk
Davies, Bleddyn Emeritus Professor of Social Policy (K)
Emeritus Professor of Social Policy (L) ...............0207955 6212 b.davies@lse.ac.uk
Dennett, Jane Branch Administrator (K) .........................01227 827672 J.Dennett@kent.ac.uk
Dennis, Judith
Information and Library Officer (M) .................0161 275 5682 Judith.Dennis@manchester.ac.uk
Fenyo, Andrew Senior Computing Officer (K) ......................01227 827610 A.J.Fenyo@kent.ac.uk
Fernández, Dr José Luis Research Fellow (L) ..............................0207955 6160 j.fernandez@lse.ac.uk
Forder, Dr Julien Senior Research Fellow and Deputy Director at LSE (L) . 020 7955 6173 j.forder@lse.ac.uk
Harrison, Glenys Secretary and Information Officer (K) ...............01227 823862 G.Harrison@kent.ac.uk
Robert Hayward Visiting Research Associate (L). .....................01227 824852 R.Hayward@kent.ac.uk
Healey, Dr Andrew Research Fellow (L) ..............................0207955 6134 a.t.healey@lse.ac.uk
Henderson, Catherine Research Officer (L) .............................0207955 7247 s.henderson@lse.ac.uk
Hughes, Jane
Lecturer in Community Care Research (M) ...........0161 275 5229 Jane.Hughes@manchester.ac.uk
Jacobs, Dr Sally Research Associate (M) ...........................0161 275 1721 Sally.R.Jacobs@manchester.ac.uk
James, Dr Lyn Research Officer (K) .............................01225 830514 lyn.james2004@tiscali.co.uk
Jolley, Dr David Honorary Reader (M) ............................0161 275 5652 David.Jolley@manchester.ac.uk
Jones, Dr Karen Research Officer (K) .............................01227 827953 K.C.Jones@kent.ac.uk
King, Derek
Research Fellow (L) ..............................0207 955 7863 d.king@lse.ac.uk
Malley, Juliette Research Officer (K and L). ........................01227 823877 J.N.Malley@kent.ac.uk
020 7955 6134 j.n.malley@lse.ac.uk
Mangalore, Roshni Research Fellow (L) ..............................0207955 7594 r.k.mangalore@lse.ac.uk
Martin, Sue
Research Secretary (M) ...........................0161 275 5391 Sue.Martin@manchester.ac.uk
Matosevic, Tihana Research Officer (L) .............................0207955 6315 t.matosevic@lse.ac.uk
McDaid, David
Research Fellow (L) ..............................0207955 6381 d.mcdaid@lse.ac.uk
Medeiros, Helena Research Officer (L). .............................0207955 6147 h.medeiros@lse.ac.uk
Mehta, Angela
Branch Administrator (L) .........................0207955 6238 a.mehta3@lse.ac.uk
Melke, Anna Visiting PhD Student (L) ........................... a.melke@lse.ac.uk
Moscone, Francesco Research Officer (L). .............................0207955 6087 f.moscone@lse.ac.uk
Nash, Lisa Research Officer (K) .............................01227 827891 L.A.Nash@kent.ac.uk
Nicolaou-Frini, Demetra Development and Communications Manager (L) .......0207955 7540 d.nicolaou@lse.ac.uk
Northey, Sara
Research Officer (L). .............................0207955 7306 s.k.northey@lse.ac.uk
Pedersen, Irene Research Assistant (M). ...........................0161 275 5250 pssru@manchester.ac.uk
Perkins, Margaret Research Officer (L). .............................0207955 6132 m.a.perkins@lse.ac.uk
Pickard, Linda
Research Fellow (L) ..............................0207955 6214 l.m.pickard@lse.ac.uk
Rees, Tony Data Management Clerk (K) .......................01227 827569 T.Rees@kent.ac.uk
Reilly, Dr Siobhan Research Fellow (M). .............................0161 275 5680 Siobhan.Reilly@manchester.ac.uk
Sandhu, Sima Research Officer (K) .............................01227 827194 S.Sandhu@kent.ac.uk
Scott, Judy
Research Fellow (M) .............................0161 275 1723 Judith.Scott@manchester.ac.uk
Smith, Jan CASE student (K) ................................01227 827954 jes31@kent.ac.uk
Smith, Nick Research Officer (K) .............................01227 827552 N.J.Smith@kent.ac.uk
Snell, Tom
Research Assistant (L) ............................0207955 7692 t.r.snell@lse.ac.uk
Somani, Ami Research Assistant (L) ............................ a.somani@lse.ac.uk
Sutcliffe, Caroline Research Associate (M) ...........................0161 275 5227 Caroline.Sutcliffe@manchester ac.uk
Towers, Ann-Marie Research Officer (K) .............................01227 827954 A.Towers@kent.ac.uk
Tucker, Sue
Research Fellow (M) .............................0161 275 5938 Sue.Tucker@manchester.ac.uk
Venables, Dan
Research Asssociate (M) ..........................0161 275 5678 Daniel.Venables@manchester.ac.uk
Williams, Jacquetta Research Officer (K) .............................01227 827587 J.M.Williams@kent.ac.uk
Wistow, Gerald Visiting Professor (L) .............................0207955 6238 gerald.wistow@btinternet.com
Wittenberg, Raphael Senior Research Fellow (L) ........................0207955 6186 r.wittenberg@lse.ac.uk
Worden, Angela Research Coordinator (M) ........................0161 275 5250 Angela.Worden@manchester.ac.uk
Xie, Dr Cheng-qiu Research Associate (M) ...........................0161 275 5960 Chengqiu.Xie@manchester.ac.uk
PSSRU Bulletin No. 16
39

PERSONAL SOCIAL SERVICES RESEARCH UNIT
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PSSRU
Cornwallis Building
University of Kent
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Tel: 01227 823963/823862
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Email: PSSRU@kent.ac.uk
PSSRU
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Tel: 020 7955 6238
Fax: 020 7955 6131
Email: PSSRU@lse.ac.uk
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Tel: 0161 275 5250
Fax: 0161 275 5790
Email: PSSRU@manchester.ac.uk
www.PSSRU.ac.uk ISSN 1350-4703