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...t provided by the organisation responsible for accommodation and associated care, unit cost estimates were taken from the widely used annual compilation by the Personal Social Services Research Unit (=-=Netten et al. 1998-=-). Where costs for specific professionals were not available from this source, unit costs calculated by colleagues and employed in current or recent evaluations of services for people with intellectua...

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... distributed, OLS estimates may not be appropriate. We therefore also employed bootstrap methods using bias-corrected methods and 2000 replications to calculate an alternative set of standard errors (=-=Thompson & Barber 2000-=-). RESULTS Sample characteristics We obtained data about the characteristics and service receipt of 1120 people, and data on the costs of the services for 930 of them. As Table 1 shows, there were few...

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...e sample of people with intellectual disabilities. In the second phase, service use data were gathered for a sub-set of clients using a tailored version of the Client Service Receipt Inventory (CSRI; =-=Beecham & Knapp 1992-=-). The CSRI was sent to the 14 providers willing to continue in the research. Together they supported 1300 people with intellectual disabilities. Questionnaires were returned for 1128 service users, o...

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...in weekly cost could be explained by these factors. A small sample study in Wales looked at the accommodation costs of people with intellectual disabilities and the most severe challenging behaviour (=-=Felce et al. 2000-=-). It found that accommodation cost was higher for residents with lower ability. There was also a scale effect: costs were lower in larger facilities. At a different level of analysis - looking at res...

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...ata were collected. To inflate to current prices would in principle need a separate inflator for each service, although in fact all services have seen low and quite similar cost inflation since 1997 (=-=Netten & Curtis 2003-=-). Multiplying all costs reported in this paper by 1.29 would take them (approximately) to 2002/03 price levels. Statistical methods We hypothesised that service use patterns would vary between indivi...

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... to differ in certain respects although not as simply or as stereotypically as might be thought, as recent work on care homes and domiciliary care services for older people makes plain (Kendall 2001, =-=Kendall et al. 2003-=-). Service use and cost Table 3 shows the percentage of people using some of the services asked about in the study and the average costs for each user. (The services not listed in the table were used ...

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...ifferential access to scarce services. More generally, our results support previous evidence on the poor access to mainstream health care faced by many people with learning disabilities (Cooper 1997, =-=Morgan et al. 2000-=-, Secretary of State for Health 2001, Cope 2003). The regression analysis showed that costs were significantly linked to the intellectual disability and behavioural characteristics, as well as to scal...

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...f the scale (Comas-Herrera et al. 2001). In both sub-scales, higher scores indicate higher levels of severity. The validity of the LDCS has been tested in relation to the Adaptive Behaviour Schedule (=-=Nihira et al. 1993-=-), a well-established research instrument, and been found to measure similar things. The LDCS has also been found to have good inter-observer reliability and good test-retest reliability (Pendaries 19...

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...rtment of each participating organisation provided these data. Costing methodology The estimation of costs followed established methodologies and principles of economic evaluation in this field (e.g. =-=Beecham 1995-=-). After collecting service utilisation data using the CSRI we estimated the long-run marginal opportunity cost for each service in a unit of time (per day or per hour) that reflects the way people us...

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...ors. METHODS Sampling and data collection Data were collected as part of a study designed to develop ‘resource groups’ and ‘benefit groups’ for people with intellectual disabilities (Pendaries 1997a, =-=Comas-Herrera et al. 2001-=-). There were three phases of data collection, covering: (i) characteristics of sample members, (ii) their use of services and (iii) the unit costs of services. The first phase, in 1996, assessed the ...

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...available from this source, unit costs calculated by colleagues and employed in current or recent evaluations of services for people with intellectual disabilities or challenging behaviour were used (=-=Emerson et al. 2001-=-). Some sample members attended work-orientated day activity services. The provision of work for people with intellectual disabilities represents both a cost and a benefit to the employer: the benefit...

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...ext of other factors. METHODS Sampling and data collection Data were collected as part of a study designed to develop ‘resource groups’ and ‘benefit groups’ for people with intellectual disabilities (=-=Pendaries 1997-=-a, Comas-Herrera et al. 2001). There were three phases of data collection, covering: (i) characteristics of sample members, (ii) their use of services and (iii) the unit costs of services. The first p...

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...n costs and service user needs, particularly skills and behavioural characteristics, and some evidence of economies of scale within accommodation facilities (Knapp et al. 1992, Cambridge et al. 1994, =-=Beecham et al. 1997-=-). The latter study found that public sector community accommodation was more costly than private or voluntary sector accommodation, and indeed more expensive than hospital, after adjusting for differ...

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...elp, and/or differential access to scarce services. More generally, our results support previous evidence on the poor access to mainstream health care faced by many people with learning disabilities (=-=Cooper 1997-=-, Morgan et al. 2000, Secretary of State for Health 2001, Cope 2003). The regression analysis showed that costs were significantly linked to the intellectual disability and behavioural characteristics...

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...cial club, and also less likely to see a GP (again the influence of hospital residence is pertinent here). These sectoral patterns mirror some previous findings for residential care for older people (=-=Kavanagh & Knapp 1997-=-) and for people with long-term needs associated with mental health problems (Hallam et al. 1995). Such patterns might reflect unmeasured needs, and/or the preferences of residential setting staff whe...

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...may be responding poorly for a number of reasons, including lack of information on individual needs, managerial capacity, skilled staff shortages, inflexible working patterns, or financial pressures (=-=Cope 2003-=-, Department of Health 2004, Learning Disability Task Force 2004). In other words, the unexplained variance is probably part methodological and part situational, although we cannot separate or quantif...

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... here). These sectoral patterns mirror some previous findings for residential care for older people (Kavanagh & Knapp 1997) and for people with long-term needs associated with mental health problems (=-=Hallam et al. 1995-=-). Such patterns might reflect unmeasured needs, and/or the preferences of residential setting staff when seeking outside help, and/or differential access to scarce services. More generally, our resul...

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...e compared with the distribution of places in staffed residential homes in England in 1996-97: 9% in the NHS, 39% in the private sector, 34% in the voluntary sector, and 18% in local authority homes (=-=Kavanagh & Opit 1998-=-). Our sample therefore over-represented the NHS sector and underrepresented the other sectors, and so it would be inadvisable to generalise from the results that follow. Nevertheless, this quite larg...

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...ers are likely to differ in certain respects although not as simply or as stereotypically as might be thought, as recent work on care homes and domiciliary care services for older people makes plain (=-=Kendall 2001-=-, Kendall et al. 2003). Service use and cost Table 3 shows the percentage of people using some of the services asked about in the study and the average costs for each user. (The services not listed in...

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...ext of other factors. METHODS Sampling and data collection Data were collected as part of a study designed to develop ‘resource groups’ and ‘benefit groups’ for people with intellectual disabilities (=-=Pendaries 1997-=-a, Comas-Herrera et al. 2001). There were three phases of data collection, covering: (i) characteristics of sample members, (ii) their use of services and (iii) the unit costs of services. The first p...