Needs based planning for community care

Abstract

This is the report of a project which has been concerned: to develop principles for needs based planning for social services departments following the requirements and subsequence guidance of the NHS & Community Care Act;to review progress in the application of needs based planning in local authorities, and tools for population needs assessment;to undertake a demonstration project which would illustrate an application of these ideas, by the development of a population needs assessment model in one local authority and its application to several policy issues. The report is in two parts. Part ISection 1 is introductory. It describes the main purpose of this report is to introduce the reader to needs based planningmethods; to outline the desirable features that such systems might be expected to incorporate, to acquaint him/her with thesteps involved and the sources of information, and to illustrate various applications., Section 2 presents the background. It is argued that the new emphasis on consumerism and the purchaser-provider splitfollowing implementation of the NHS and Community Care Act, 1991, have radically changed the planning task for socialservices departments. Concerns with capital planning and labour management have reduced. Instead, planning concernsbalancing resources with the emerging pattern of client contracts that are negotiated by care managers, and managing themarket by providing incentives to providers. This planning requires information about needs. Population needs assessmentconcerns estimating levels of need in the community; individual needs assessment concerns the practice of care management with clients. Needs based planning is the process of using information from both these sources as part of strategic planning. It involves the integration of information about the states of welfare of people in the community, prices of services, resources, availability of substitutes, priorities and preferences about appropriate interventions. Section 3 contains a survey of needs based planning in eight local authorities during 1995. All have applied population needs assessment methods, often for geographical distribution of STG. However the methods used are ad-hoc. Most areinterested in the development of better methods, but the principal obstacles are the difficulty of population needs assessment and the insufficient development of IT systems for client needs assessment data. Scepticism remains and good demonstrations are needed. Section 4 reviews six methods of population needs assessment that are being developed in conjunction with a number ofsocial services departments, and lays out the desirable features that such methods should incorporate. These include the range of policy issues covered, the definition of target groups, the method of predicting them in the population, the treatment of supply including informal care, the treatment of resource use assumptions. Part IISection 1 is introductory. This part deals with the demonstration project for elderly care groups, which was undertaken inconjunction with Surrey SSD. Section 2 introduces the PSSRU population needs assessment approach. Features of this approach are the tailoring oftarget group definitions to local assumptions and evidence from assessments, refinement in the use of sources of evidence and synthetic estimation methods for prediction, evidence based treatment of takeup, use of local evidence about serviceallocations, and a full treatment of supply including health and social services, service substitution, prices. The context inSurrey is described. Section 3 describes the method of deriving target groups. This involved a survey of 319 recently assessed clients, for whom dependency and other information about state of welfare was available. These were divided into 14 target groups, defined by these welfare domains. This subdivision was partly guided by similarity in actual resource allocation, and partly on the basis of discussion with Surrey staff to reflect future priorities. Typical cases in each group are described. Section 4 describes the method of population needs assessment. Because the local survey was rather small for acurateestimation, all individuals in the UK Disability Survey were classified according to target group. This allows estimates of theprevalence of each group at a national level, among both people living in private households and those in communalestablishments. From this analysis synthetic estimators were prepared to enable local estimates to be prepared reflecting Census variations among elderly people. These were used to estimate numbers among the population of Surrey, both now and in future, and between Surrey's 24 localities. The Disability Survey also provides information about take-up, and this is used similarly to estimate local demand levels. Section 5 describes the translation of numbers to their cost implications. The basis for this is the average service allocations in the assessment survey, though with some modifications to exemplify a slightly more targeted approach. Prices are taken from average cost estimates. Price variations were explored and could have been incorporated, but this is not currently an issue. Section 6 applies the approach. There are four applications. Balance of care. Estimates of the predicted demand for services of different types, which can be compared with the actual service distribution. Geographic equity within Surrey. The method produces estimates of expenditure need for each locality. Unmet need. The model predicts a resource level considerably higher than actual spending, which implies unmet need.However, it does so for all shire authorities, and Surrey is not exceptional. The reasons why the model may produce high estimates are explained. Future projections. The model predicts increases in resource needs by 2001. The Appendix contains a short literature review describing the main welfare characteristics that are relevant to resource allocation decisions.</li