Table 3 Per-person cost estimates for a six-session course of CR under four staff skill-mix scenarios
Parameters | Basis for calculations | |||||||
|---|---|---|---|---|---|---|---|---|
(a) Scenarios and assumptions | ||||||||
Skill-mix scenarios | 1, A qualified OT provides all 6 sessions 2. A qualified OT provides the first and last sessions and an OT support worker provides the intervening 4 sessions 3. A qualified OT and an OT support worker jointly provide the first and last sessions and the OT support worker provides the intervening 4 sessions 4. A qualified OT and OT support worker jointly provide the first session and the OT support worker provides the remaining 5 sessions | |||||||
Staff grades | Qualified OTs are on NHS Agenda for Change Band 6 (‘Occupational therapist specialist’) [41] Unqualified OT support workers^ are either OT Assistants on Band 3 (‘Clinical support worker, higher level, OT’) or OT Technicians on Band 4 (‘OT technician’) [42] | |||||||
Training | 20 h of staff time were allocated for training. Training was assumed to be accessed free of charge | |||||||
Supervision | Supervision was assumed to be provided in-house as part of routine staff supervision | |||||||
Session duration and preparation time | Sessions last 60 min. Preparation is estimated at 12 min per session, based on 12.5 min recorded in the GREAT trial | |||||||
Travel time | We could not identify any national statistics on average distance travelled for home visits; we therefore based our estimates on a published evaluation from an English NHS mental health Trust which reported that travel to home visits involved an average distance of 14 miles and took 25 min [43] | |||||||
Total time | Practitioner time per session was estimated at 72 min excluding travel time and 97 min including travel time, rounded up to 100 min | |||||||
(b) Calculation of unit costs | ||||||||
Cost category | Unit | Cost per unit (£, 2019/20) | Source; notes on calculations | |||||
OT Band 6—time | Year Hour | 77 199 48.32 | PSSRU UC, Table 9[44] | |||||
OT Technician Band 4—time | Year Hour | 50 659 31.27 | PSSRU UC, Table 9[44] | |||||
OT Assistant Band 3—time | Year Hour | 38 720 25.02 | PSSRU UC, calculated from healthcare assistants and other support staff annual earnings, Table 16.1, including salary on-costs (superannuation, employer’s NI), management costs (38.2% of salary costs), non-staff costs (24.5% of salary costs), capital costs (assumed same as for Band 4 in Table 9) | |||||
OT Band 6—CR training | Annual equivalent | 214.06 | Based on 20 h staff time at the hourly cost of the practitioner. Annuitized over 5 years at 3.5%, assuming a refresher course would be needed after 5 years | |||||
OT Tech Band 4—CR training | 138.52 | |||||||
OT Assistant Band 3—CR training | 110.84 | |||||||
OT Band 6 inc. training | Hour | 48.46 | Cost per hour of OT Band 6 * 1.0028 | |||||
OT Tech Band 4 inc. training | 31.36 | Cost per hour of OT Band 4 * 1.0027 | ||||||
OT Assistant Band 3 inc. training | 25.09 | Cost per hour of OT Band 3 * 1.0029 | ||||||
Mileage | Mile | 0.36 | NHS mileage allowances [45] | |||||
(c) Cost estimates including and excluding staff travel to conduct home visits | ||||||||
Scenario | 1 | 2 | 3 | 4 | 1 | 2 | 3 | 4 |
Travel costs | Included | Excluded | ||||||
OT costs | 500 | 167 | 83 | 167 | 349 | 116 | 58 | 116 |
OT Assistant costs | 0 | 182 | 274 | 274 | 0 | 120 | 181 | 181 |
OT Technician costs | 0 | 223 | 334 | 334 | 0 | 151 | 226 | 226 |
Total costs | ||||||||
OT only | 500 | - | - | - | 349 | - | - | - |
OT & OT Assistant | - | 349 | 357 | 440 | - | 237 | 239 | 297 |
OT & OT Technician | - | 390 | 418 | 501 | - | 267 | 284 | 342 |