Abstract
The cost implications of moving from a system of services for people with mental handicaps centred on large institutions to a network of community-based services are not precisely known. The provision of the NIMROD service in a part of Cardiff, with its aim not only to meet the residential needs of adults comprehensively by providing a number of houses in the community but also to develop a support service to people living in their family home, gave an opportunity to investigate and report the revenue costs of a number of service elements with respect to a defined total population. The residential costs of intensively staffed houses in 1986–87, varying in size from two to six places, were found to range between £16,473 and £23,319 per person per year. With the addition of community support costs, such as the provision of day services, the total costs of care per resident averaged £21,708; range, £18,883-£26,009. These compared to the total costs in a minimally staffed house of £9,678 per resident. The costs of community support services for people living in their family homes averaged £5,614 inclusive of DSS benefits, of which £1,743 was accounted for by the NIMROD domiciliary support service, office base and administrative overheads. The residential costs reported were compared to other cost data in the literature. The study supports previous conclusions that there is little evidence of diseconomy attached to small scale per se but that the way staffing levels and therefore staff costs are determined is critical. No evidence was found in this study to link greater cost to better quality.
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