Scottish Government

CHAPTER 4: COST EFFECTIVENESS OF THE PILOT SCHEMES

4.1 This chapter considers the cost effectiveness of the Mandatory Drug Testing of Arrestees across the three pilot schemes, as well as a comparison against The Scottish Government's Arrest Referral scheme. The chapter outlines what the pilot schemes have achieved, in terms of the number of people referred for assessment, the number of people who turned up for assessment and the number who engaged with drug treatment services in the three pilot schemes. It then considers the financial cost of these impacts to determine the relative effectiveness of the various schemes.

4.2 The Scottish Government's study brief explained that the indicators of effectiveness were to include:

A description of the spending on the pilots in each area, broken down into specific costs relating to the pilot;

An indication of the numbers of arrestees entering treatment services for the first time as a result of the pilot;

An assessment of the cost effectiveness of the pilot; and

A comparison of the cost effectiveness of MDTA with the cost effectiveness of Arrest Referral.

4.3 Each of these areas will be considered in turn. In considering the cost effectiveness of the various schemes, the analysis aims to focus on what the process has achieved per pound of grant. This section will therefore compare the level of grant per individual referred for assessment and the level of grant per individual who turned up for assessment in the MDTA pilot schemes. More importantly, given the aims of the pilot schemes, comparisons will also be made of the level of grant per individual who engaged with drug treatment as a direct consequence of the MDTA pilots. This will also be compared with the same figure for the Arrest Referral scheme to provide an indication of the relative cost effectiveness of the two schemes.

4.4 It should be emphasised that the cost effectiveness analysis does not compare the impact of the MDTA and Arrest Referral schemes as it is too early to conclude on this issue. The aim is to focus on the relative cost effectiveness of the process and concentrate on how the schemes fare in getting arrestees, who would not otherwise do so, to engage with drug treatment.

Funding

4.5 Scottish Government funding for the three MDTA pilots is split into funding for assessments and funding of treatment. Each of these is discussed in turn below.

Assessment

4.6 Grant funding from The Scottish Government to cover assessment for those meeting the eligibility criteria is £600,000 per annum. This is split equally across the three councils. Because the pilots are scheduled to run from June 2007 to May 2009, the £200,000 is split proportionately across the three financial years that the two years of the pilot cover i.e. June 2007 to March 2008, April 2008 to March 2009 and April 2009 to May 2009. The funding for the three periods is set out in Table 4.1 below.

Table 4.1 Grant for Assessment in the Three Pilot Areas, June 2007 to May 2009

Treatment

4.7 A total of £1,000,000 per annum is allocated in grant funding treatment and this is split as follows:

£400,000 for Aberdeen;
£300,000 for Edinburgh; and
£300,000 for Glasgow.

4.8 The grant is ring-fenced and paid through the respective city councils on a monthly basis. Similarly to the funding for assessments, the grant is split proportionately across the three financial years of the pilots, as outlined in Table 4.2 below.

Table 4.2 Grant for Treatment in the Three Pilot Areas, June 2007 to May 2009

4.9 The total grant funding from the Scottish Government available for assessment and treatment of arrestees for the three pilot schemes is set out in Table 4.3.

Table 4.3 Total Grant for Assessment and Treatment in the Three Pilot Areas, June 2007 to May 2009

4.10 In carrying out the cost effectiveness exercise it is important to use the amount of financial resources actually used rather than the total funding available to the three pilot schemes over the period. While the tables above outline the level of grant available from the Scottish Government for the three pilot schemes, it should be noted that not all of the allocation given to the respective pilot schemes was spent. For example, of the total £416,000 allocated to Glasgow for 2007-08, the total spend, including overheads, was only £230,152. A total of £186,000 was overpaid and therefore reallocated to other CJA non-core items or returned to the Scottish Government.

4.11 Similarly for Edinburgh, the audited spend, including overheads, totalled £311,600, resulting in an overpayment of around £104,000.

4.12 For Aberdeen, of the total payment of £486,000 only £84,641 was spent, resulting in an overpayment of around £401,000.

4.13 The following table shows the total spend out of that paid by the Scottish Government in 2007-08.

Table 4.4 Actual Spend in the Pilot Areas, June 2007 to March 2008

4.14 The cost effectiveness exercise covers the period from June 2007 to November 2008. It is therefore necessary to calculate the grant awarded over the evaluation period. While the amount paid from June 2007 to March 2008 is set out above, the grant awarded for the eight months from April 2008 to November 2008 is equivalent to eight times one twelfth (one month) of the total sum available for 2008 as a whole ⁶. The total amount for assessment and treatment which was actually spent in the period June 2007 to November 2008 is set out in Table 4.5.

Table 4.5 Grant Spend on MDTA in the Three Pilot Areas, June 2007 to November 2008⁷.

4.15 In addition to the funding for treatment and assessment under MDTA, each of the three pilot areas has been allocated additional ring-fenced funding to cover police activities supporting the pilots ⁸. The amounts are set out in Table 4.6.

Table 4.6 Police Funding for MDTA Pilots⁹

4.16 In addition to the funding for police resources, funding was also provided for the production, use and storage of medical equipment. The total sum was approximately £60,000 and this is assumed to have been split equally across the three pilot areas.

4.17 Including the funding for police and medical resources gives the total expenditure figures set out in Table 4.7 for the three areas between June 2007 to November 2008. The table shows that the Edinburgh pilot received £809,000, while the Glasgow and Aberdeen pilots received 732,000 and 658,000 respectively. The figures set out in Table 4.7 are the figures for the three pilot areas used in the cost effectiveness exercise.

Table 4.7 Total Grant Spend on MDTA in the Three Pilot Areas, June 2007 to November 2008.

Arrest Referral

4.18 To allow a sensible comparison of MDTA with the cost effectiveness of the Arrest Referral scheme it is first necessary to select comparable areas. The areas chosen are Northern (which includes Aberdeen), Lothian & Borders and Glasgow areas. The following table shows the funding allocated to the three areas for 2007-08 and 2008-09.

Table 4.8 Arrest Referral Funding Allocations for 2007-08 and 2008-09

4.19 The actual spend for each of the areas in 2007-08 is set out in Table 4.9. This ranges from £40,438 (18% of the amount paid) in the Northern region to almost the total allocation in Lothian & Borders. Subtracting the audited spend from the amount paid reveals the amount overpaid in each pilot scheme.

Table 4.9 Actual Spend and Overpayments for Arrest Referral 2007-08

4.20 For comparison with MDTA a funding figure for Arrest Referral for June 2007 to November 2008 for Northern and Lothian & Borders has been calculated using a similar methodology to that used to calculate the funding for the MDTA scheme. The figure for Glasgow has been supplied by the Arrest Referral Finance Department. The total spend for the period for the three areas is set out in Table 4.10 below ¹². These are the figures to be used in the cost effectiveness comparisons with the MDTA pilot schemes.

Table 4.10 Spend on Arrest Referral, June 2007 to November 2008

Comparison of Referrals for Assessment

4.21 This section compares the cost effectiveness of the three MDTA pilots against the Arrest Referral scheme. While a key focus of the evaluation, as indicated in the study brief, is to look at numbers of arrestees entering treatment services for the first time as a result of the pilot, this has not been possible due to the figure for the number of people in Arrest Referral who were already receiving treatment not being available. In place of this, the cost effectiveness analysis compares the number of people entering drug treatment. Overall, the cost effectiveness analysis compares:

The number of arrestees referred for assessment;

The number of people who turned up for the assessment; and

The total number of people who engaged with drug treatment through the schemes (including those who were already in treatment).

4.22 In Aberdeen, the figures from the pilot schemes show a total of 310 ¹⁴ people were referred for assessment between June 2007 and November 2008. Out of the figure of 310 however, only 263 turned up for assessment. Out of this figure only 67 arrestees engaged with drug treatment, 42 of whom were not already involved in treatment. These figures are set out in Table 4.11 below.

4.23 Table 4.11 also shows that in Edinburgh, under the MDTA scheme between June 2007 and November 2008, a total of 381 people were referred for assessment, while a figure of only 247 actually turned up for the assessment. Out of the 247 who turned up for the assessment, only 46 of them went on to engage with drug treatment. The figure for those that were already engaged in treatment is not known for the Edinburgh pilot scheme.

4.24 In Glasgow, a total of 301 arrestees were referred for assessment under the MDTA pilot scheme. Of these, just over half (152) turned up for assessment. Of the 152 who turned up for assessment, 110 went on to engage in drug treatment, with 42 of these arrestees already involved in some form of drug treatment. A total of 68 people, who had not already done so, ended up engaging in drug treatment.

4.25 Table 4.11, in summarising these results, shows that while Edinburgh had the highest number of arrestees referred for assessment between June 2007 and November 2008, it had the lowest number of arrestees who actually ended up in treatment. Also from the table it is clear that while the Glasgow scheme had the lowest number of arrestees referred for assessment during the period, it had the highest number of people who engaged in treatment. It also had the highest number of people who were not already in treatment.

Table 4.11 Comparison of MDTA Pilots, June 2007 to November 2008

4.26 While Table 4.11 shows, in absolute terms, the number of people in each category per MDTA pilot scheme, it takes no account of the level of grant or expenditure. A more reliable indicator of relative cost effectiveness is the financial cost per person under each category, particularly the cost per arrestee entering treatment services for the first time as a result of the pilot. Table 4.12 therefore sets out the level of grant spent per head for each of the pilot scheme under each category.

Table 4.12 Scottish Government Grant Spend per MDTA Arrestee by Category, June 2007 to November 2008

4.27 The figures in Table 4.12 reveal that the level of grant spend by each individual referred for assessment is the same in Aberdeen (£2,123) and Edinburgh (£2,123), with both of these lower than the figure for Glasgow (£2,432). The level of grant spend, divided by the number of arrestees who turned up for assessment, is lower in Aberdeen, at £2,502, than both Edinburgh and Glasgow, with figures of £3,275 and £4,815 respectively. However, it is clear from the figures that the amount of grant spend per arrestee who engaged with drug treatment through MDTA is lower in Glasgow (£6,655) than in Aberdeen (£9,821) and Edinburgh (£17,586). The figure for grant spend per individual engaging in treatment who is not already doing so is also much lower in Glasgow compared to Aberdeen. This suggests that while the Glasgow pilot may not result in a large number of people, per grant spend, being referred for assessment, it is relatively more cost effective in achieving the objective of getting people into treatment. This is particularly so for those arrestees who were not already engaged in treatment.

4.28 Table 4.12 also shows that overall the Glasgow pilot scheme performs best in terms of the number of arrestees entering treatment services for the first time as a result of the pilot per pound of Scottish Government grant expenditure ¹⁵.

4.29 The study brief included a request to compare the cost effectiveness of the MDTA scheme against the cost effectiveness of the Arrest Referral scheme. Table 4.13 below shows that the number of people attending assessment under the Arrest Referral scheme between June 2007 and November 2008 was 162 in Northern, 616 in Glasgow and 1077 ¹⁶ in Lothian & Borders. In terms of the number of people engaging with drug treatment through Arrest Referral, there were 32 ¹⁷ in Northern and 208 ¹⁸ in Lothian & Borders. The figure for Glasgow for the period is not available. However, a figure of 251 is included for the period April 2008 to November 2008.

Table 4.13 Comparison of Arrestee Referral by area, June 2007 to November 2008

4.30 Similarly to the figures for the MDTA scheme, the following table sets out the level of grant under Arrest Referral per individual attending assessment and also per number engaged with drug treatment ²⁰. The table shows that the level of grant per individual attending assessment is lowest in the Lothian & Borders at £540. This is followed by Glasgow at £815. The highest sum in this category is Northern with a grant spend of £1,811 for each individual attending assessment. In terms of the level of grant per arrestee who engaged with drug treatment, Glasgow is by far the lowest at £865, followed by Lothian & Borders at £2,797. The comparable figure for the Northern area is the highest by a significant margin at £9,169. This figure would increase if only taking into account those engaged with drug treatment and not include those engaged with alcohol treatment.

Table 4.14 Scottish Government Grant per Arrest Referral Arrestee by Category, June 2007 to November 2008

4.31 Table 4.15 below provides a comparison of the MDTA and Arrest Referral figures where these are available: for the number of individuals attending assessment and, perhaps more importantly, the number of arrestees who engage with drug treatment. The figures cover the period June 2007 to November 2008, excluding the latter figure for Glasgow which covers April 2008 to November 2008. The figures show that in Aberdeen /Northern area, MDTA was higher than Arrest Referral for both the number of arrestees attending assessment and the number engaged with drug treatment. In Edinburgh/Lothian & Borders the opposite is true, with the numbers under the Arrest Referral scheme at least four times higher for both categories. The outcome in Glasgow was similar to Edinburgh, with the Arrest Referral figures also significantly higher than the figures for MDTA.

Table 4.15 Comparison of MDTA and Arrest Referral, June 2007 to November 2008

4.32 The figures in Table 4.15 are simply the absolute numbers under each category. Figure 4.16, on the other hand, compares the level of grant divided by the numbers of arrestees under each category. Comparing the level of grant per individual attending assessment for the various schemes shows that the cost per person under MDTA is higher than Arrest Referral in all areas. In the Northern/Aberdeen areas the level of grant per individual attending assessment under MDTA is £2,502, compared to a figure of £1,811 for Arrest Referral.

4.33 The comparisons in Lothian & Borders/Edinburgh and Glasgow are much more marked. For the former, the grant by individual attending assessment under MDTA is £3,275, compared to a figure of only £540 under Arrest Referral. In Glasgow, the figure under MDTA is £4,816 compared to £815 under Arrest Referral.

4.34 Focussing on the level of grant by individual engaged with drug treatment under the two schemes tells a very similar story, with the figures for grant per arrestee higher under MDTA than Arrest Referral. This is particularly so in Glasgow and Edinburgh/Lothian and Borders where the level of grant per individual is higher under MDTA by at least five times. The Glasgow figure of £865 under Arrest referral is the lowest grant spend per head for those engaged with drug treatment, while the MDTA figure for Edinburgh of £17,586 is by far the highest figure under all categories.

Table 4.16 Comparisons of MDTA and Arrest Referral grant spend per head

Conclusion

4.35 Comparing the impacts of the three MDTA pilot schemes reveals that, over the evaluation period, both Edinburgh and Aberdeen have performed better than Glasgow in terms of the number of arrestees referred for assessment and the number of arrestees attending assessment. However, the Glasgow scheme has clearly performed better in terms of the number of people engaging with drug treatment. This is particularly so for those arrestees who were not already engaging in treatment.

4.36 In cost effectiveness terms, the level of grant by individual attending assessment under MDTA is lowest in Aberdeen (£2,502), followed by Edinburgh (£3,275) and Glasgow (£4,816). However, when one focuses on the level of grant per person entering treatment, which is the key factor in the process, then it is clear that the figure for the Glasgow pilot (£6,655) is the most cost effective and performs significantly better than Aberdeen (£9,821) and Edinburgh (£17,586).

4.37 Comparing the cost effectiveness of the MDTA pilots against the Arrest Referral schemes shows that, in terms of individuals attending assessment and engaging with drug treatment, the Arrest Referral schemes appear to be more cost effective than the MDTA pilot schemes. This is particularly so in Glasgow where the Arrest Referral figures are the lowest of all the schemes, with a significantly lower level of grant spend per head. On the basis of the figures provided, the level of grant spend per individual engaging with drug treatment in the Edinburgh MDTA pilot scheme is the least cost effective of all.