Costs of alternative forms of NHS care for mentally handicapped persons

The main purpose of this paper is to measure the costs of small (i.e. less than 50 beds) NHS units for the care of mentally handicapped persons in the community and to compare these costs with those of hospital care standardising wherever possible for resident characteristics such as age and dependency. Other factors apart from size which are associated with variations in costs are also examined. Accordingly, this paper sets out the results of three main costing exercises: 1. The ward costs of the Royal Albert Hospital, Lancaster 2. The costs of small NHS units i n the South Western, Trent and West Midlands RHAs 3. An estimate of the cost consequences of transferring residents from hospital to community care in NHS units. Although capital costs are deliberately excluded from the analysis, the hospital and the small unit costs include the costs of Education and Social Services as well as NHS costs. The major factors associated with the variations in costs between wards in the hospital and between NHS units in the community were, so far as above average costs were concerned, the age of residents (usually care of the youngest or oldest patients,) dependency characteristics (proportion of residents physically handicapped and/or behaviourally disordered), low capacity usage and uncertainty about the future use. The main factor associated with lower than average costs was resource deployment which appeared to be low compared with the apparent demands for care. The resource consequences of shifting care from hospital to NHS based community units were divided between short-term and long-term effects. The short-term effects were based on resources which would be released if one ward closed and the long term effects were based on the closure of all wards. With several reservations the short term cost increases of this shift in the balance of care within the NHS was estimated at around 98% of existing hospital ward costs for the care of children and 75% for the care of adults. The longer term cost differences estimated at 28% for childrens' units and 22% for adult units.