July 18, 2023

From the Unit Costs of Health and Social Care’s team of Research Advisors and Researchers 

Background 

Members of the Unit Cost programme met with our Patient and Public Involvement and Engagement (PPIE) Research Advisors for our first Unit Cost PPIE project discussion in November 2022. Unit costs of health and social care quantifies the resources required to produce these services in monetary terms. The purpose of the meeting was to jointly develop our understanding of how Research Advisors involvement will work in the programme and to think through how, together, we can make the most of the Unit Cost programme, over its 5 year time horizon. We were keen to identify creative, impactful, opportunistic ways to draw on a range of views on unit costs and create more value from the research through our public involvement activities.

We began by introducing ourselves and talking about our interest in the programme and how PPIE can be embedded within the research from start to finish. Our proposal for the Unit Cost programme committed us to this activity and, now, more importantly, it’s time to elicit

“meaningful involvement” by putting this into practice by consulting on “what would

actually work within the programme”, to understand how we can “do things differently” to

“make a difference”. 

The Programme team highlighted that the Department of Health and Social Care is very positive about the research and what we aim to achieve, with PPIE embedded throughout the research. Unit costs can be very academic and we can do more to make the outputs from the research “not only useful but used.” Engagement with our Research Advisors needs to be ongoing and iterative so that we can all learn from each other and support greater engagement with Unit Costs by the public and for the public.

Why are unit costs of interest to the public? 

A key question the researchers were asked is “Why will the public be interested in this, if at all?” Building on this “What’s in it for the public?” “How can Unit Costs be useful for the

public?” “If this is useful, how can it be used?” Three steps for involving PPIE were posited. First, we are doing PPIE because it’s essential for impactful and relevant research. Second, because we believe it’s worth involving PPIE, that it’s the right thing to do. And third, because we want to make a difference for the public. It was questioned whether the research can actually make a difference to the public directly. That is “how much of what we do is a

construct rather than reality”? Indirectly impacts might be felt if those serving the public interest, such as Commissioners of health and social care services and the charitable sector advocating for specific groups (e.g., Age UK) are better informed about what resources are used and how, when a service is delivered. The point was made that perhaps the public do not always need or want to know the nuts and bolts of unit costs and the technicalities, however the public may value the outputs such as what does ‘x’ service cost. Also, our Research Advisors highlighted their aim to support users of unit costs by ensuring that the research is transparent, using good governance and that it is quality assured. It was felt that the PPIE

voice should inform every layer of the research so that the public’s voice feeds into decisions made on their behalf. The Unit Cost programme was seen as “fundamentally real world… and this makes it… really meaningful … and the impact really tangible.” 

What do we want to achieve through doing this research on unit costs? 

Elder care nurse playing jigsaw puzzle with senior woman in nursing home

The Research Advisors pointed out that Unit Costs are “a means to an end” for most users and that this research therefore “has to be relevant”. Most NHS care and some social care is provided free at the point of delivery so the cost of care appears invisible but we need to be aware of those who purchase care such as commissioners, clients purchasing Personal Care, members of the public purchasing services privately out of their own pocket.

When there is a choice about which service or intervention to buy, the use of unit costs helps to inform that choice. It was suggested that there is considerable amount of cost variation across the country for many reasons, including the way in which people use resources. There will be benefits from making these costs more visible, as well as, potentially, some unintended consequences which need to be thought through. One example that was discussed and was flagged as being high on people’s interests was the variation in costs across providers and regions in England.

What is next? 

Throughout the meeting there was agreement by us all that it was essential to bring unit costs to a wider audience and that there’s great shared enthusiasm across the research team and Research Advisors to make progress on this. Feedback was invited from the Research Advisors to shape activities, training needs and resources to enhance participation, to ensure that the public has a voice and a real influence in the outputs of this research.

The PPIE group will inform the programme throughout the tenure of the project, for example advising on website design, and reviewing information for public dissemination. More formally, the PPIE group will meet with the research team and our Programme Advisory Group once yearly, and with the research team twice yearly. Two Research Advisors are co- applicants on the project and are invited to join the research team at their monthly meetings. There is plenty of opportunity to continue building on our keenness and combined energy to bring unit costs to a wider audience and make the invisible, visible!

If you would like to find out more about the Unit Costs Programme, please visit our Unit Cost for Health and Social Care Website! (https://www.pssru.ac.uk/unitcostsreport/) For any further comments, please feel free to email Sarah Birch.

This output is independent research funded by the National Institute for Health Research (NIHR 203457; Policy Research Programme). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.