CASE STUDY

Using comparator data to understand why a budget is overspending

Authority X has a significant predicted overspend on older people's services and staff have been told by members that this will have to be managed down before the end of the financial year. Users and frontline staff say that neighbouring authorities provide more and better quality services for older people and are not talking about further reductions.

Stage 1 - Comparative Costs. Managers compare data on overall spend on older people, spend per capita and the costs of providing different sorts of services with other comparable/neighbouring authorities.

Stage 2 - Comparative Activity. Managers compare their activity with other authorities, looking at things like the numbers in residential/nursing care, the numbers receiving support to remain at home etc.

Stage 3 - Analysis. Managers use this data to make sense of why they appear to be able to provide less of a service. Is it about the level of overall expenditure, or expenditure on a particular bit of the service which may be particularly expensive? Is it about the numbers of people receiving a service as a whole, or the numbers receiving a more expensive service? Is it because they appear to be paying more than neighbouring authorities for similar services? Or is the information they are basing their analysis on so inadequate that they are unable at this point to reach any conclusion. Or is it a combination?

Getting through these three stages should not take too long, and taking a report back to members, staff and users at this point should enable a much more informed analysis of the problem and therefore a better informed solution. In this instance authority X identifies its major problems as being focused on the high use and cost of residential and nursing care

Stage 4 involves further more sophisticated analysis of the activity and costs data together with colleagues in health and in the provider units to confirm the accuracy of the data that is being used.

Stage 5 involves an audit of the decision making that led to residential and nursing home placements to see why these placements were chosen and what alternative services might have reduced the demand for residential and nursing care.

Stage 6 involves greater analysis of the costs of care and how these might be better managed through the commissioning process in partnership with local providers. At this point proposals should be taken to members on the strategy to reduce the costs/numbers of placements for older people.

Stage 7 will be the monitoring of the new strategy. This will also be an opportunity to test the effectiveness of analytical work that has been done and bring this back into wider learning about the use of data within the authority.

Stage 8 involves the development of more complex activity/cost monitoring systems, which enable the authority to monitor activity/expenditure on a day to day basis for instance tracking moves in and out of care to identify seasonal patterns, differential practice between teams, effectiveness of different community based services etc in order to improve the quality of care management and the responsiveness of the supply side

Developing a performance management culture

• Involve frontline staff in developing performance monitoring
• Develop a culture at all levels in the authority that recognises the value of good information
• Tell all staff about your performance, include your successes as well as your weaknesses
• Audit data quality regularly, not just when there appears to be a big problem
• Develop your own targets beyond Department of Health indicators to focus on areas where there are particular problems
• Don't assume new IT systems will solve everything
• Create systems that can link finance and activity data
• Work with partners on information systems to ensure your developments will be compatible
• Capitalise on new developments like the recent Improving Information Management Grant. E government and electronic records are high government priorities