What cost care?

Modus Care asks what the future holds for service users who need complex care and treatment.

The Comprehensive Spending Review is requiring every local authority and PCT to look long and hard at its budgets. As they do this, their attention will inevitably fall on the area of complex healthcare services. These are services provided for individuals who have confounded and exhausted all attempts to find placement solutions in mainstream, less supported and less costly settings. They are services provided for some of the most challenging and vulnerable people in our society.


For some, the word 'complex' translates simply as 'expensive.' But this attitude demands an equally direct response: expensive compared to what? Of course, most complex services do consume significantly larger chunk of the budget compared to mainstream services. This is compounded by the fact that these services are highly specialised, and likely to be provided outside of the Council or PCT area. Complex services by their very nature will demand most (if not all) of the following:
• higher staff levels
• higher levels of training and qualified staff
• bespoke environments
• greater levels of attrition on the environment
• higher maintenance
• greater risks to staff, public and service users
• higher insurance costs
• provision of modified vehicles
• specialist clinical input
• greater risk of service breakdown.
• Detailed assessment by professionals who have the necessary qualifications and experience.
So one would expect scrutiny. It is surely prudent to examine whether these services provide value for money compared to recognised and measurable criteria. To do any less is to harm the public purse, to betray the taxpayer. However, it should be recognised that the need for complex service has often arisen due to lack of suitable services or not enough resources initially to meet needs. The result is multiple failures of service, each bringing an incremental increase in behaviours or condition. So the next package of care treatment has to be even more intensive. This is a downward spiral for the individual, an upward spiral in terms of cost. Ending this cycle is not simple or cheap, however is possible. The right services can reverse the trend and put the individual back on a journey towards more independence and less intensive services, which are ultimately less expensive. To scrutinise these services based purely on a cost model that makes no reference to value for money, good and best practice or realistic and achievable care pathways means there is potential for the needs of vulnerable people to go unmet and the cycle of service failure to recommence.
Modus have proven ability to work with commissioners in a positive way to find solutions which are successful and cost effective. Our expertise in moving individuals on from higher cost intensive support services to more long term sustainable solutions for individuals is, we believe, one of our greatest assets. This "invest to save" approach is one which we are keen to explore with new commissioners in order to help them to achieve the outcomes which their governing bodies are looking for. These are difficult times for all of us, so let's work together to achieve positive, sustainable change for some of the most vulnerable members of our communities.