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 quotes sources and assumptions so users can adapt the information for their own purposes. This year we have included a guest editorial on ‘Big Data’: increasing productivity while reducing costs in health and social care and three short articles on The cost of integrated care; Shared lives – improving understanding of the costs of family-based support and the costs of providing a group intervention to people with dementia and their family carers:SHIELD: RYCT & CSP intervention costs (Remembering Yesterday Caring Today and Carer Support Programme). There are also several new schema providing the costs of: advocacy for people with learning disabilities; a hospice rapid response service; the early years classroom management programme; residential parenting assessments; independent review officers; time banks; dentists and care home costs for people with dementia. The 2014 edition is also available in full, free of charge, at the PSSRU website www.pssru.ac.uk/unit-costs/2014/ as an Acrobat file.

Unit Costs of Health and Social Care 2014

This is the twelfth volume of a series designed to improve unit cost estimates over time, drawing on material as it becomes available, including ongoing and specially commissioned research. It brings together information from a variety of sources to estimate national unit costs for a wide range of health and social care services.

The costs reported always reflect, to a greater or lesser degree, work in progress, as the intention is to refine and improve estimates wherever possible, drawing on a wide variety of sources. The report consists of sets of ‘schemata’ or tables, 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 are: an editorial discussing current and new developments; brief articles providing background to user services, descriptions of cost methodology or use of cost estimates; price indices; a reference list of key studies; a glossary; and indexes.

New in this edition: This volume includes a considerable expansion of information about the costs of child social care services, based largely on the results of a series of studies commissioned under the Department of Health's Costs and Effectiveness of Services for Children in Need research initiative. Also included is information on the cost-effectiveness of screening and referral to an alcohol health worker in alcohol-misusing patients attending an NHS accident and emergency department. Information about the costs of a nurse practitioner in primary care is also included for the first time.

There are five brief articles: description of the methodology used and resulting unit costs of the adoption process and of supporting families; a brief article identifying the processes involved and the costs to social services of carrying out core assessments for children and their families; a description of the processes undertaken by social services and the factors associated with the variation in costs of child care; description of the evaluation of the costs and outcomes of Home-Start — a well-established national and international organisation offering support to families with young children experiencing difficulties; and information about a detailed study of family interventions and the costs of services used by families requiring support.

/pdf/unit-costs-of-health-and-social-care-2004-4g2t0zmosb.pdf

Unit Costs of Health and Social Care 2004

The concept of 'employability' plays a crucial role in informing labour market policy in the UK, the EU and beyond. This paper analyses current and previous applications of the term and discusses its value as an exploratory concept and a framework for policy analysis. It then traces the development of the concept, discusses its role in current labour market and training strategies (with particular reference to the UK) and seeks to identify an approach to defining employability that can better inform labour market policy, by transcending explanations of employment and unemployment that focus solely on either supply-side or demand-side factors. Although the literature offers a range of definitions of 'employability', many policy-makers have recently used the term as shorthand for 'the individual's employability skills and attributes'. It is argued that this 'narrow' usage can lead to a 'hollowing out' of the concept of employability. The paper concludes by presenting a broad framework for analysing employability built around individual factors, personal circumstances and external factors, which acknowledges the importance of both supply- and demand-side factors.

/pdf/the-concept-of-employability-2xpc822nfd.pdf

The Concept of Employability

To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients’ experiences of being engaged. Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign—discrete products largely derived from low-level engagement (consultative unidirectional feedback)—whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients’ experiences of the engagement process (n = 12; 25%). While most experiences were positive—increased self-esteem, feeling empowered, or independent—some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made. Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients’ experiences of the engagement process and whether these outcomes translate into improved quality of care. N/A (data extraction completed prior to registration on PROSPERO).

/pdf/engaging-patients-to-improve-quality-of-care-a-systematic-3q91ifvqem.pdf

Engaging patients to improve quality of care: a systematic review

Unit Costs of Health and Social Care 2018

The sequence of events in a behaviour change trial involves interactions between research participants and the trial process. Taking part in such a study has the potential to influence the behaviour of the participant, and if it does, this can engender bias in trial outcomes. Since participants’ experience has received scant attention, the aim of this study is thus to generate hypotheses about which aspects of the conduct of behaviour change trials might matter most to participants, and thus have potential to alter subsequent behaviours and bias trial outcomes

/pdf/shedding-light-on-research-participation-effects-in-xcojmkf738.pdf

Shedding light on research participation effects in behaviour change trials: a qualitative study examining research participant experiences

Objectives: To compare the motives and experiences of different ethnic groups participating in a randomised double blind placebo-controlled trial of montelukast in preschool wheeze, and to assess parents’ or guardians’ understanding of trial procedures and their implications, including the collection of genetic material. Design: Qualitative interviews with parents or guardians. Setting: Interviews occurred in the homes of London children recruited to a national multicentre clinical trial following primary and secondary care attendance with wheeze. Participants: 42 parents (20 of Bangladeshi origin, 10 white UK, 12 other ethnicities) of preschool children enrolled in a clinical trial. Results: Bangladeshi families were relatively reluctant to participate in the qualitative study, despite strong engagement with the parent study. Anxiety related to wheezing was a common primary motive for trial enrolment. Parents viewed the trial as a route to improved treatment. Verbal delivery of trial information appeared more effective than study literature, especially for Bangladeshi families, with low parental literacy and high levels of trust in medical professionals potential contributors to this effect. All ethnic groups expressed a low understanding and/or retention of essential study concepts such as randomisation and genetic testing. Conclusions: Bangladeshi families are particularly motivated to participate in clinical trials despite variable comprehension of study concepts. This motivation is more strongly contingent on strong researcher-subject rapport than on the quality of study literature. Trial teams seeking to recruit from South Asian populations should emphasise face-to-face verbal explanation of trial concepts and procedures and consider modified trial literature.

https://bmjopen.bmj.com/content/bmjopen/3/4/e002750.full.pdf

Recruiting ethnic minority participants to a clinical trial: a qualitative study

The focus of current government policy on maximising labour market participation among those of working age is known to have particular implications for people with multiple problems and needs. This article reports preliminary findings from a study based on in-depth interviews with 50 people with experience of not only unemployment, but several additional problems, such as homelessness, ill-health or disability, substance abuse, the criminal justice system, and disruptive family relationships. It points particularly to the traumatic nature of the lives experienced by many of those participating in the study and to the corrosive culture of self-blame to which they were subject. It concludes by arguing for more holistic ways of supporting people in such situations and for a different approach to assessing 'job readiness'.

Ready to work?: understanding the experiences of people with multiple problems and needs

Costs and consequences of services for troubled adolescents: an exploratory, analytic study

Results Statistically significant improvements were found in the proportion of people indicating satisfaction with information on what the medicine does and on possible impact on sex life. Furthermore a significant improvement was found on the “potential problems of medication” summary score on the SIMS. During the period of the study self reported physical function improved on the PDQ-39. No changes were found on the MARS.

A pilot evaluation of specialist community pharmacy services for patients with Parkinson's disease

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