Information provided by the Department suggests that 32 organisations are presently funded to provide Community Access Services across Tasmania. An analysis of the potential cost drivers impacting organisations delivering this service, which was informed by the online survey and initial data cleansing activities, suggested that:
The key driver of unit cost continues to be labour (70 per cent direct labour). The mean hourly rate is impacted by the individual organisation’s allocation of staff resources, which is related to the average level of client need and captured in the average staff to client ratio.
Non-labour costs accounted for approximately 20 per cent of direct costs. There was insufficient data provided by survey participants to help identify a distinct pattern of spend in relation to these indirect costs.
Insufficient data was available relating to capital expenditure for this service type. No premium appears warranted for organisation size or regionality.
The high quality and easily comparable financial data provided by organisations could not be aligned with a consistent unit of activity for Community Access Services, however. Variations in the reporting of service activity were attributable to broad disparities in the manner in which services are reported. Observed differences in the method of service delivery, driven by client needs and preferences, are characterised by differences in the location of service delivery (i.e. centre-based or community-based) and the level of staffing required to deliver the service (staff to client ratios). Accordingly, subsequent project activities were designed to:
explicitly defining the units of service (episodes / clients)
standardise the way services are delivered at the outlet level (i.e. the ratio of staff to clients at each level of client need)
explain how differences in the services themselves (including the nature of the activities undertaken) will impact key cost drivers
construct a price based on the standardised labour requirements and incorporate amounts for non-labour and indirect costs in accordance with the survey data.
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on a one-to-one basis as part of a group in a centre-based setting in the community.
In addition, whilst service requirements will vary from client to client, programs are generally delivered six hours per day, five days per week and 47 weeks per year.
Resource requirements
Implicit in the way Community Access Services are delivered (and presently funded) is a broad correlation between the level of client need and the associated amount of staff time required to service that need. A client’s disability or level of ‘complexity’ does not necessarily correlate with the level of support need, however, as clients deemed to be of lower complexity may participate in more complicated activities. Based on an analysis of the client to staff ratios across a number of organisations funded to deliver Community Access Services, who are known to provide vastly different models of care, there were observed to be consistent group sizes of roughly 2.6 clients to every staff member across the state.
Units of service
Based on an understanding of the consistency with respect to the way services are delivered to individual clients, a unit of service will effectively be a unit of capacity (e.g. a place) that accounts for all or part of the 30 hours per week, 47 weeks per year available for service participation. For example, one Community Access placement may be equal to 30 hours per week of one-on-one staff to client time. Partial units of service will also be funded, which reflect reductions in either the amount of time or the level of supervision required to deliver a service appropriate to an individual client’s needs or preferences.
Recommendations
On the basis of the observed labour costs and a standard definition of what constitutes a ‘unit of service’, the Department must now make a
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Access Services. A price can then be negotiated with a suitable provider where there is known capacity and the organisation is able to provide services suitable to the needs of the client.
As an example, where a new client is considered to have highly complex needs requiring one-on-one services delivered six hours per day, three days per week, then the unit price will effectively be set at 60 per cent of the one-to-one price. The one-to-one price will be the annualised labour cost (per full time equivalent employee), which is uplifted to incorporate standard allowances for non-labour costs and overheads, in line with survey findings. Utilising this method will help the Department to identify and assess where capacity may exist in the sector, inform pricing negotiations and permit organisations to better manage capacity and plan for future service delivery.
Where funding arrangements are presently in place, the Department can set prices in future service agreements on the basis of whether clients receive services on a one-on-one basis or as part of a group. In the absence of detailed census data pertaining to the individual requirements of all clients across the system, the pricing structure may be based on two broad categories:
One-to-one service delivery Group services.