Nationwide Children's Research Centre University of Huddersfield North East Region Sure Start Seminar Sure Start Bramley : An approach to analysing cost- effectiveness including home visiting / client contact services Programme Manager: Judy Bakes Evaluators: Brid Featherstone Martin Manby

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley - Cost Effectiveness difficult for non-economists to get started ! three phases (i) 2003 focus on VFM (ii) 2004 focus on benefits side of equation (iii) 2004 focus on costs side of equation small element in total evaluation activity

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley An essay in Cost Benefit Analysis Stage 1 Value for Money 2003 ɡ a tentative start! 갘 Reservations about applying cost effectiveness measures to Sure Start 辸 Local parents occupy multiple roles as clients, members of groups, being involved in community organisation, and as contributors partnership arrangements, e.g., seconded health visitor one day per week, provides direct service benefits to clients, and indirect benefits (closer working links with Sure Start, promoting joint work on supporting mothers’ experiencing post natal depression and on smoking cessation) - valuable but not easily costed.

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley Value for Money 2003 Context SSB budgets fixed in 2001 for 8 years with little scope for variation Principles transparent approach to funding issues (£) - including SLAs staff, parents and partner agencies expected to be well informed about £ delegating financial responsibility - SS Outreach Team produce costed proposals for all initiatives - training for parents on accounting procedures and using bank accounts - Parents’ Development Fund (£10k p.a.) partner agencies expected to contribute to new service development e.g. PCT contribution to PND groups

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley: VFM Summary

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley Stage 2 Focus on benefits, to service users, involving outreach staff Case studies, analysing - presenting problems - resources within the family - inputs from Sure Start - outcomes - levels of work (Hardiker Grid) Issues / problems arising in translating benefits to services users into £ Cost of Sure Start input (salary and on-costs)

Nationwide Children's Research Centre University of Huddersfield Hardiker Grid - Level of Problem

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley Case Example A - Outreach Worker 6 (OR6) (Male Worker) Length of Contact: 7 months Presenting Issues In this family, a mother and her one-year old child moved to Bramley from another part of country, experiencing isolation, post-natal depression and housing problems. Resources within the Family Although separated, mother had access to a supportive former partner who remained involved with his son. M had good parenting and child care skills. Inputs from Sure Start Intensive weekly then fortnightly visits by OR6, plus supportive telephone calls. OR6 had an advocacy role, regarding housing, utilities, benefits. Health Visitor, GP and Home Start involved. Outcomes Effective help with housing and financial problems. M became less isolated and overcame post-natal depression. M developed a network of friends and her son was introduced to Mother and Toddler groups. M more aware of local facilities and planning to obtain a job. Hardiker Grid: Level 2

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley Problems in costing benefits attribution difficult to cost benefits of M’s developing social network M resilient, may have “recovered” without support £ able benefits debt reduction housing obtained M ready to work, becoming contributor to local economy Costs (crude) of OR6’ help for this family (Case A) £833 based on salary £20k; 1/2 time allocated to one to one support; 7 months input; one seventh of caseload. £1499 based on same proportion of salary x 1.8 to include total on-costs.

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley Case Example B - Outreach Worker 2 (OR2) Length of Contact: 14 months Presenting Issues Mother and five children aged 8 months - 12 years with multiple problems; mother had experienced DV, alcohol problems and possibly learning difficulties. Daughters aged 2 years and 8 months overweight. Serious non-school attendance for older children. Son 5 had speech delay. Daughter 8 seemed withdrawn at school. Daughter aged 12 much involved in supporting mother. Gaps in ante-natal care, health checks and immunisation. Children neglected. Resources within the Family M loved her children and bonded with them. M had eventually accepted that she needed support. 12 year old daughter very helpful. Inputs from Sure Start OR2 visited twice weekly for a year. Had regularly taken daughter aged 2 to nursery. OR2 had successfully involved a range of agencies to support the family. Liaison with Education welfare; School Nurse; Learning Mentor; Social Services (Family Aid); Speech and Language Therapist; Health Visitor; Children’s Centre and Police. SSB Play Workers visiting the family fortnightly. Outcomes Mother persuaded to attend Health Clinic for ante-natal care. Immunisation for five children obtained. OR retained focus on child safety issues in the home. Problems with benefit forms resolved. Daughter aged two attending nursery regularly. Ongoing school attendance issues. (Hardiker Grid: Level 3)

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley Problems in Costing benefits difficult to cost benefits of liaison work / improving home safety, preventing accidents major problems of attribution of benefits to multiple agencies £able benefits include benefits of ante-natal care benefits to F2 of attending nursery benefits of play for younger children long term benefits of immunisation for five children Costs of OR2’s help for this family (Case B) £2717: based on salary £23k; 1/2 time allocated to casework; 14 months input; one seventh of caseload (£1917) plus 2 playworkers - salaries £32000, one session (out of possible 10) x 6 months fortnightly visits (£800). £4891 based on same proportion of salaries x 1.8 to include total on-costs

Nationwide Children's Research Centre University of Huddersfield File Review

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley

Nationwide Children's Research Centre University of Huddersfield

Identifying the Unit of Service

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley Costs per Contact Year 2002 / 03 No. of children seen: 1588 No. of parents seen: 1519 Total 3107 Actual Costs Outreach / home-visiting £153,600 Management costs - 20% £ 30,720 Total £184,320 Cost per contact £ 59.32

Nationwide Children's Research Centre University of Huddersfield

Sure Start Bramley: costs of other services Bramley Family Support Year 2002 / 03 No. of children seen: 1480 No. of parents seen: 1268 Total 2748 Bramley Home Start Year 2002 / 03 No. of children seen 173 No. of parents seen 142 Total 315 Actual Costs: £131,000 Cost per contact: £ Actual costs: £22,282 Cost per contact £70.73

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley Notes on costs of other services Bramley Family Support Voluntary sector project, run by Spurgeon’s Children’s Charity Provides variety of group care / parents and toddler groups and creche facilities Bramley Home Start Weekly intensive visits by volunteers for families with children under 5 Include (fairly high) training costs for volunteers

Nationwide Children's Research Centre University of Huddersfield Sure Start Bramley - Cost Effectiveness Position reached / next steps links to other work on VFM / budgets involve professional staff and focus on benefits SS Team more financially aware - new focus on importance of ending involvement next stage: refine calculations - compare costs of group work and one to one support; CB analysis of S S Bramley drop-in and advice service intensive support services vulnerable to crude CBA calculations

Nationwide Children's Research Centre University of Huddersfield File Review