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Costing care in hospital and in the community

Beecham, Jennifer and Hallam, Angela and Knapp, Martin R J. and Baines, Barry and Fenyo, Andrew J. and Asbury, M.P.J. (1997) Costing care in hospital and in the community. In: Leff, Julian, ed. Care in the Community: Illusion or Reality. John Wiley & Sons, Chichester, pp. 93-108. ISBN hbk: 0 47196 981 8 / pbk: 0 47196 982 6. (The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided) (KAR id:26422)

The full text of this publication is not currently available from this repository. You may be able to access a copy if URLs are provided.


<p>Issues of relative cost-effectiveness have been central to government policy on closing long-stay psychiatric hospitals. Budget constraints, the introduction of quasi-market delivery modes and individual level care planning mechanisms have also meant service planners and commissioners must consider the resource implications of their decisions. In 1986, as the new cost-consciousness was beginning to take hold, the North East Thames Regional Health Authority commissioned PSSRU to undertake an economic evaluation of the reprovision of services form Friern and Claybury psychiatric hospitals.

<p><p><p>This chapter focuses on describing the service receipt patterns and the costs of community support one year after discharge (n=533), and the associations between costs and clients’ characteristics and needs (as measured in hospital) and their welfare outcomes.

<p><p><p>A range of accommodation facilities were used by former long-stay hospital residents, with 42 per cent of the study population living in highly supported facilities and only 12 per cent living in their own (domestic) flats. Almost half of the residents were living in accommodation managed by the NHS. In addition to accommodation, about fifty discrete service types were used, such as the general practitioner, hospital in-, out- and day-patient services or community nurses.

<p><p><p>The costs of community care varied considerably but show a general rising trend as each successive annual research cohort left hospital. With the inclusion of the final cohort of leavers, who posed the most serious challenges to services, community care costs were slightly higher than the global costs of hospital care. The statistical exploration of cost variation showed longer care histories and some clinical indicators as measured in hospital were associated with higher community costs. Higher costs were also found to be associated with final outcomes including improvements in some symptoms of mental illness but reduced social networks.

<p><p><p>The reprovision of long-stay services from Friern and Claybury hospitals was a well-planned and well-financed programme, and the research evidence suggests it has been a successful approach.

Item Type: Book section
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Personal Social Services Research Unit
Depositing User: R. Bass
Date Deposited: 21 May 2011 01:06 UTC
Last Modified: 16 Nov 2021 10:04 UTC
Resource URI: (The current URI for this page, for reference purposes)

University of Kent Author Information

Beecham, Jennifer.

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Fenyo, Andrew J..

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