Scottish Government

2. Supporting People - Activities and costs

INTRODUCTION

2.1 The Supporting People budget funds a large and varied programme of projects which provide support to diverse groups. This diversity presents a challenge to an overall Cost Benefit appraisal. An analysis of the programme which focused at the level of the SP budget as a whole would obviously be far too aggregated while it is impractical to conduct an analysis of every individual project. The approach adopted has focused on client groups - the rationale being that the members of these groups - e.g. people with disabilities, homeless persons -face essentially the same problems which initiatives seek to resolve or mitigate.

2.2 A first step in the analysis was, therefore, to establish a meaningful classification of client groups and to undertake the collection and analysis of data on the cost of providing supporting people services to those groups and the numbers of persons supported - the aim being to estimate the unit costs of support to those groups. This element of the analysis has been inescapably constrained by the nature of the available Scotland-wide data and the manner in which data are collected and held.

2.3 The main source of quantitative information on Supporting People expenditure and programmes is in Scottish Executive databases which are compiled from returns made by local authorities. These databases contain information on expenditure and beneficiary/client numbers. In addition, some information on the number and nature of SPprojects was obtained from a survey of local authority SP lead officers conducted during the study. The findings of this survey are considered after the analysis of the Scottish Executive data.

2.4 The Scottish Executive data are held in two separate datasets which are based on returns made to the Executive by local authorities. The first is a financial dataset which contains information on expenditure by local authorities under the SP programme. The second database is built up from local authority statistical returns which contain information on client numbers, client types and forms of provision under the SP programme. It is important to note that these two databases are based on separate data collection exercises.

2.5 The analysis of expenditure and of client numbers was carried out at both the Scotland level and for individual local authorities. In order to calculate unit costs ( i.e. expenditure per client) it was necessary to combine data from the two data sets.

EXPENDITURE AND CLIENT NUMBERS

2.6 In 2004/05, as shown in Table 2.1, an estimated 172,616 ¹² individuals in Scotland were assisted through Supporting People funding. This represents about 4% of the total population aged 16 and over, and an increase of some 32,000 individuals over the number recorded in 2003/04 ¹³. Total expenditure on Supporting People services was estimated at £405.8 million ¹⁴ in 2004/05, implying an average cost per client of £2,351 across Scotland. This was slightly lower than the average cost recorded in 2003/04.

Table 2.1 Supporting people, clients and expenditure 2003/04-2004/05

Source: Scottish Executive. NB: * Client numbers may differ from published data. This dataset incorporates revisions and corrections received directly from some local authorities.

2.7 These figures mask a wide variation in the average expenditure per client on Supporting People projects between local authorities. As Figure 2.1 shows, average expenditure per client in 2004/05 ranged from a low of £1,100 in Angus to £5,800 in Argyll and Bute. Overall, 6 authorities recorded an cost per client more than 50% above the national average, while 3 authorities record an average less than half that of Scotland as a whole.

Figure 2.1: Supporting People expenditure per client by local authority, 2004/05

Source: Scottish Executive data analysed by Tribal

2.8 The scope for disaggregated analysis was constrained by the definitions used in the returns from which the databases were constructed.

2.9 Overall, four client groups accounted for 84% of total expenditure on Supporting People services in Scotland and for almost three quarters of all clients supported - these groups were: people with a learning disability; older people; people who were homeless or sleeping rough; and people with mental health difficulties (see Table 2.2). However, this pattern was not entirely uniform across local authorities. Thus, while older people accounted for almost half of all Supporting People clients across Scotland as a whole, at a local authority level this proportion varied from as few as 13% of all clients in Renfrewshire to 89% of all clients in East Dunbartonshire. Similarly, the proportion of clients recorded as having learning disabilities ranged from a low of 2% in Angus to 14% of all clients in North Lanarkshire.

2.10 These variations in the "mix" of provision by client group appear to account for much of the observed variation in cost per client (unit cost) between local authorities which was illustrated in figure 2.1. As table 2.2 shows, the distribution of expenditure across client groups was strikingly different - in some cases - from the distribution of client numbers. This implies wide disparities in the average cost of providing services to client groups. For example, people with mental health problems and people with a learning disability account for a far higher proportion of expenditure than of clients supported, suggesting an above average unit cost of provision. At the same time, services to older people account for only a quarter of all expenditure but almost half of all clients receiving Supporting People services, indicating a relatively low unit cost.

Table 2.2 Expenditure and client numbers by client group, 2004/05

Source: Scottish Executive. NB: Client numbers may differ from published data. This dataset incorporates corrections received directly from some local authorities

2.11 However, the data in Table 2.2 cannot be used to generate reliable figures for unit costs as there are important differences in the manner in which the client data and expenditure data are collected.

2.12 The critical difference between the two data sets is that expenditure is allocated to client group according to the main focus of the programme which is funded while the data on clients is based on what is termed the " primary characteristic" of the client supported. Problems arise where the primary characteristic of a client differs from the focus of the programme under which that client is being supported. For example, a young person receiving support from a programme to help homeless people may be classified as a client in another group such as "vulnerable due to young age" - the spending will be recorded under the "vulnerable due to young age programme" while the client may have been recorded as homeless. Similarly, a client aged over 65 who has dementia may have been classified as an "Older person" in the client database while the funds used to provide support to that person have been provided from, and have been recorded as part of, a programme to support people with dementia. There is certainly evidence that more than 1,300 SP clients suffer dementia - three housing associations (Bield, Hanover and Trust) have provided evidence that they alone have about 770 SP clients suffering from dementia which suggests that the official data understate the prevalence of this client characteristic.

2.13 These differences in data collection procedures seriously limit the extent to which the unit cost analysis can be broken down to client groups or programmes.

2.14 This difference in the data collection procedures for client numbers and for spending accounts for some striking anomalies produced by a simple comparative analysis of costs and clients at the local authority level. Taking again the example of dementia, the records for one local authority for 2004/05 show no expenditure on programmes for people with dementia but also show that there were 351 clients classified as dementia sufferers - the implied unit cost being zero. Conversely, the same authority had expenditure of £250,000 on programmes for persons vulnerable due to young age but no clients in that group - an implied unit cost of infinity. Of course, in reality, the clients of the programmes for vulnerable young people had been counted elsewhere - most probably with other homeless people - while the people with dementia in that area were almost certainly assisted by projects (and spending) classified as being for older people or people with illness/disability.

2.15 Other anomalies created by the differences in the data sets include massive apparent variations in the unit cost of provision of specific services (in some cases authorities appear to be spending up to 20-30 times the Scottish average on individual services) as well as numerous instances, further to the example given above, where authorities have a record of clients supported in a category, but no record of any spending on that group.

2.16 A further difficulty is that while the financial dataset is based on a breakdown of 18 client groups, the client dataset provides a 19 ^th category of 'Other vulnerable groups' ¹⁵. As table 2.2 above shows, this category accounts for 16% of all clients even though almost no spending is allocated against it. In some local authorities this group accounts for an even higher proportion of clients - in West Lothian, for instance, almost half of all clients are recorded as 'Other vulnerable groups', with no data available relating to the type of service provided or the cost of provision.

2.17 This analysis indicates that while a comparison of the total number of clients supported and the total expenditure provides a meaningful figure for the total unit cost of the Supporting People programme, there are serious limitations on the scope for analysis by client group.

REVISED CLIENT GROUP ANALYSIS

2.18 Although the problems detailed above limit the scope for analysis by client group, they do not completely eliminate that scope. An approach which provides reasonably reliable estimates of unit cost of provision by broad client group is detailed below.

2.19 The core of the data problem is that the individuals in any particular client group may have received support from programmes which have been classified under a different client group heading. However, these inconsistencies or overlaps are not random but tend to involve particular groups. For example, consultations with local authorities and providers during the course of the study indicated that there was a strong overlap between the Physical Disability and Older People client groups in that older people with disabilities might be classified as clients in the Physical Disability group while the programme supporting them and the expenditure would counted under the Older Persons category. Similarly, it was noted that there was a strong overlap between clients receiving support from projects for homeless people and those people supported by programmes focussed on causes of homelessness ( e.g. programmes for people "vulnerable due to young age", "people using drugs/alcohol" and "people at risk of offending"). Conversely, some groups have nil or negligible overlap - an older person will not be a beneficiary of a programme aimed at young people and is very unlikely to be a beneficiary of a programme aimed at offenders.

2.20 In the light of these considerations and drawing on advice obtained during the consultations and case studies, an analysis of client numbers and expenditure was undertaken using five broad client groups (termed super groups). It is considered that overlap between the large groups is minimal - i.e. very few people in any of these groups will be receiving support from a programme which has been classified (along with its expenditure) in one of the other groups.

2.21 Data on client numbers, expenditure and unit costs for the five revised client groupings (super groups) are presented in table 2.3. The client groupings have been defined as follows:

• Older People and Physical Disabilities: this group includes Older People, People with sensory impairment, People with a physical disability, People with dementia, People with an acquired brain injury;
• Mental Health and Related: includes People having mental health problems and People experiencing psychological trauma;
• Learning Disabilities: includes People with a learning disability;
• Homeless and related: includes People who are homeless or sleeping rough, People who use drugs, People who use alcohol, People who have HIV/ AIDS, People who are vulnerable due to young age, People at risk of offending/re-offending, Women at risk of domestic violence and People with poor social skills/disruptive behaviour;
• Other groups: includes Gypsies/Travellers, Refugees and other vulnerable groups.

2.22 As the analysis in table 2.3 shows, there are significant variations in the unit costs between these groups. Services to clients in the older people and physical disabilities group are relatively inexpensive in comparison to the cost of providing services to clients with learning disabilities or with mental health problems.

2.23 Overall, services to older people and those with physical disabilities account for over 50% of all supporting people clients, but less than a third of all expenditure. By comparison, clients with learning disabilities account for only 4% of the total number supported but 31% of all expenditure.

Table 2.3 Revised client groupings, expenditure per client 2004/05

Source: Scottish Executive data analysed by Tribal. NB: Client numbers may differ from published data. This dataset incorporates revisions and corrections received directly from some local authorities

2.24 These differences in unit cost between client groups are useful in explaining a large part of the variation in average expenditure per client between local authorities (illustrated in figure 2.1). Of the nine local authorities who recorded a total average cost per client more than 30% above the Scottish average, eight had a higher than average level of provision of services to clients with learning disabilities. At the same time, of the five local authorities whose overall spend per client ratio is more than 30% below the Scottish average, most record very low levels of service to clients with learning disabilities

LEAD OFFICER SURVEY FINDINGS

2.25 Analysis of the number of Supporting People projects (as opposed to analysis of spending or client numbers) is not possible from the Scottish Executive statistics. To provide information on this aspect of the programme a survey of SP lead officers was undertaken. In total 26 out of the 32 local authorities in Scotland returned the survey forms.

2.26 The survey indicated there are presently around 2,100 projects/ services funded by SP in Scotland. As shown in figure 2.2, projects for older people and for people with learning disabilities account for more than half of these (38% and 29% respectively), while projects for people with mental health problems and projects for homeless people each account for around 10% of SP funded services/projects. This pattern of projects is very broadly in line with the expenditure pattern reported in Table 2.2 - especially when account is taken of the relatively high cost nature of support to people with learning disabilities (which accounts for a higher share of spend than it does of clients).

Figure 2.2 Breakdown of SP funded services/projects in Scotland by client group

Source: Supporting People Research - Lead Officer Survey

2.27 This breakdown is broadly similar across local authority areas, with the following notable differences:

• Projects for older people projects account for a significantly high proportion of SP funded projects in Perth and Kinross (62%), Dundee City (58%), East Lothian (58%) and West Lothian (51%);
• East Dunbartonshire (62%), Orkney Islands (57%), Aberdeenshire (54%) and Moray (52%) have high proportions of their services/projects devoted to people with learning disabilities compared to the Scottish average (29%);
• Comhairle nan Eilean Siar (25%), South Ayrshire (19%) and Argyll and Bute (19%) have a significantly high representation of services/projects for people with mental health problems;
• Almost a third of SP funded services/projects in the City of Edinburgh, are for homeless people compared to only 10% across Scotland as a whole; and

2.28 Comhairle nan Eilean Siar and Fife both have significantly above average proportions of services/projects for vulnerable people due to young age - 17% compared to 5% across Scotland as a whole.

2.29 There is no evident systematic explanation for these differences. Rather they appear to illustrate the degree to which SP provision has been driven by local priorities and local circumstances with authorities having sought funds to support projects which they had identified based on very specific circumstances at particular times in particular places. The degree of variation in provision which appears unrelated to any known pattern of variation in need does, however, raise the question of whether the existing pattern of distribution of resources and activity can be regarded as optimal. It has certainly not arisen as a result of any national level, "top-down" need analysis.

CONCLUSIONS

2.30 This section of the report has shown how the annual £400 million budget of Supporting People is distributed across client groups. At least half the people helped by the programme are older people (there may be more older people classified under other client headings) while homeless persons (or people at risk of homelessness) are the other main client group. The distribution of resources is different in pattern from the structure of the client base - though the data issues discussed above (see paragraph 2.14) mean that differences in expenditure by client group must be treated cautiously. What can be said is that a large part of the SP budget (the largest single item) is devoted to helping people with learning disabilities. Other large elements of the budget are applied to problems of homelessness, to mental health problems and to problems directly associated with ageing.

2.31 As has been emphasised, unit cost data must be treated cautiously but there is reasonably robust evidence that support to people with learning disabilities and to people with mental health problems is relatively expensive. Consultations conducted during the study support this interpretation - people in these groups often require relatively intensive support and thus a relatively high number of hours per week of contact.

2.32 The analysis of costs and benefits which is set out below is conducted in terms of the "super groups" used above - the data do not allow costs and benefits to be compared reliably for narrower client groups.

2.33 Finally, it may be noted that the geographical pattern of Supporting People activity in terms of both resources and the mix of activities has been shaped by a "bottom up" process and by local priorities and circumstances.. There is no clear evidence that the pattern of provision accords with any national pattern of need for the services provided through SP and this begs the question of whether Value for Money from SP spending could be increased by better targeting and greater consistency in the pattern of provision.