Papers by Jose-Luis Fernandez
Health & Social Care in the Community, 2021
he Care Act 2014 imposed new statutory duties on English local authorities in relation to family ... more he Care Act 2014 imposed new statutory duties on English local authorities in relation to family or informal carers and it broadened carers’ statutory entitlements to assessment, care and support, irrespective of eligibility for local authority funding of the person they care for. Despite this legislative framework, local authorities appear to be translating the new legal obligation into practice in different ways. This paper draws on evidence from in-depth interviews held during 2017–2018 with key stakeholders in three English local authorities to investigate whether and how local efforts meet the Act's intention of supporting carers. We explored local goals associated with supporting carers, local authorities’ approaches to needs assessment and service provision as well as barriers and facilitators to adoption of the new legal obligations towards carers. The paper draws on Twigg, J., & Atkin, K. (1995), typology to explore perceptions of local stakeholders of the interaction between formal care system and carers post-Care Act. The findings indicate that despite a clear Care Act emphasis on meeting carers’ needs, when faced with financial constraints the formal care system approaches carers mainly as a resource and often supports carers to keep cared-for people away from health and social care systems. Although replacement care is a vital element in the Care Act's ambitions to support carers, in sampled authorities, it was often newly being subject to needs thresholds and financial assessment of people they care for, leading to reported conflicts of interests between carers’ needs and those of cared-for-people. The Care Act is nonetheless seen as having made progress in legitimising carers’ needs as clients. Social care professionals increasingly emphasise the importance of meeting carers’ needs and well-being as valued and desirable outcomes.
BMJ, Mar 20, 2013
Objective To examine the costs and cost effectiveness of telehealth in addition to standard suppo... more Objective To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment. Design Economic evaluation nested in a pragmatic, cluster randomised controlled trial. Setting Community based telehealth intervention in three local authority areas in England. Participants 3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care. Interventions Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care. Main outcome measure Primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained. Results We undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). The adjusted mean difference in QALY gain between groups at 12 months was 0.012. Total health and social care costs (including direct costs of the intervention) for the three months before 12 month interview were £1390 (€1610; $2150) and £1596 for the usual care and telehealth groups, respectively. Cost effectiveness acceptability curves were generated to examine decision uncertainty in the analysis surrounding the value of
RePEc: Research Papers in Economics, 2012
Cuadernos aragoneses de economía, 2009
El articulo presenta las caracteristicas principales que definen el sistema de proteccion a perso... more El articulo presenta las caracteristicas principales que definen el sistema de proteccion a personas con dependencias fisicas y mentales en Inglaterra, y discute los cambios recientes en politica en el sector. En las ultimas tres decadas, el sistema de servicios sociales ingles ha sostenido sucesivas reformas, en respuesta a cambios en el patron demografico y a esfuerzos por mejorar la distribucion de servicios entre la poblacion dependiente. Entre otros cambios, dichas reformas han acrecentado las responsabilidades de las autoridades locales sobre la financiacion y coordinacion de la ayuda publica, que esta siendo concentrada cada vez mas en personas con los niveles de dependencia mas elevados. Recientemente, las reformas en politicas de servicios sociales han resaltado la necesidad de promover las formas de asistencia a domicilio, y el desarrollo de paquetes de ayuda disenados en funcion de las caracteristicas individuales de cada usuario de servicios. En la actualidad, aproximadamente 1.7 millones de personas en Inglaterra reciben ayuda publica para la dependencia, la mayoria de las cuales son personas mayores de 65 anos. El acceso a dichos servicios se rige a la vez por criterios de dependencia y de medios.
Journal of Aging & Social Policy, 2020
This perspective examines the challenge posed by COVID-19 for social care services in England and... more This perspective examines the challenge posed by COVID-19 for social care services in England and describes responses to this challenge. People with social care needs experience increased risks of death and deteriorating physical and mental health with COVID-19. Social isolation introduced to reduce COVID-19 transmission may adversely affect well-being. While the need for social care rises, the ability of families and social care staff to provide support is reduced by illness and quarantine, implying reductions in staffing levels. Consequently, COVID-19 could seriously threaten care availability and quality. The government has sought volunteers to work in health and social care to help address the threat posed by staff shortages at a time of rising need, and the call has achieved an excellent response. The government has also removed some barriers to effective coordination between health and social care, while introducing measures to promote the financial viability of care providers. The pandemic presents unprecedented challenges that require well-co-coordinated responses across central and local government, health services, and non-government sectors.
Health & Social Care in The Community, Oct 11, 2021
Author contribution statement The authors have made substantial contribution to conception and de... more Author contribution statement The authors have made substantial contribution to conception and design, or acquisition of data, or analysis and interpretation of data. The authors have been involved in drafting the manuscript and revising it critically for important intellectual content and given final approval of the version to be published. Each author takes public responsibility for appropriate portions of the content; and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Conflict of interest statement The authors declare that there is no conflict of interest.
A subset of models examining people with specific diseases and in particular age groups were not ... more A subset of models examining people with specific diseases and in particular age groups were not found to improve the results of the analysis. Replicating and predicting EQ-5D scores We tested three prediction methods for the 'full' and 'simple' models to determine how closely the predicted distributions of EQ-5D scores matched the actual scores. The results of the 'simple' regression model from group 0 were used to predict EQ-5D scores in Group 0 and in Group 1 (test sample). The 'full' models were more accurate in predicting individual level scores, but the 'simple' models produced a closer mean value to the actual observed means. In both cases, the mean errors suggested that individual EQ-5D score predictions were limited in their accuracy. Overall, the use of the dimension level regression models for predicting EQ-5D scores had limited success. Although the replication of the distribution of actual EQ-5D scores was reasonably good, the predicted individual and mean scores were not accurate. These findings are in line with previous work by Ara et al 1 whereby using regression models for case-mix adjustments can be problematic. Derivation of a weighted health-related quality of life index Given the limited success of the regression-based method, we sought an alternative approach to standardise the NRFs of people with long-term conditions in GPPS. We developed a needs-weighted health-related quality of life index using a set of weights which reflected the prevalence in GPPS of the key factors linked to variations in EQ-5D. Based on the population weights thus derived, subsequent waves of GPPS could be reweighted to give people with different characteristics the same relative importance as in the base year when estimating (weighted) average EQ-5D scores.
Age and ageing, 2014
to examine the costs and cost-effectiveness of 'second-generation' telecare, in addition ... more to examine the costs and cost-effectiveness of 'second-generation' telecare, in addition to standard support and care that could include 'first-generation' forms of telecare, compared with standard support and care that could include…
Journal of Child Psychology and Psychiatry, 2014
Background: Policy and practice guidelines emphasize that responses to children and young people ... more Background: Policy and practice guidelines emphasize that responses to children and young people with poor mental health should be tailored to needs, but little is known about the impact on costs. We investigated variations in service-related public sector costs for a nationally representative sample of children in Britain, focusing on the impact of mental health problems. Methods: Analysis of service uses data and associated costs for 2461 children aged 5-15 from the British Child and Adolescent Mental Health Surveys. Multivariate statistical analyses, including two-part models, examined factors potentially associated with interindividual differences in service use related to emotional or behavioural problems and cost. We categorized service use into primary care, specialist mental health services, frontline education, special education and social care. Results: Marked interindividual variations in utilization and costs were observed. Impairment, reading attainment, child age, gender and ethnicity, maternal age, parental anxiety and depression, social class, family size and functioning were significantly associated with utilization and/or costs. Conclusions: Unexplained variation in costs could indicate poor targeting, inequality and inefficiency in the way that mental health, education and social care systems respond to emotional and behavioural problems.
Journal of Social Welfare and Family Law, 2012
To what extent, if at all, is the current legal position on long-term care for older people in En... more To what extent, if at all, is the current legal position on long-term care for older people in England and Scotland potentially inconsistent with the UK's obligations in EU law? The implications of EU law for UK healthcare provision have been tracked by the literature, exploited by litigation (Case C–372/04 Watts [2006] ECR I–4325, BetterCare [2002] CAT 7), and covered
Journal of Social Policy, 2006
Direct payments have moved to the heart of the government's drive for increased user choice. ... more Direct payments have moved to the heart of the government's drive for increased user choice. At the same time, implementation has remained disappointing. This article explores the demand, supply and related factors associated with patterns of local variability in uptake and intensity of care package provision. Statistical analyses are conducted for key client groups – people with physical disabilities, older people, people with learning disabilities and people who use mental health services – using data for England from 2000–01 to 2002–03. The results suggest that direct payments variability reflects a complex array of factors, both within and beyond the control of local public actors. In particular, while local policy preferences appear to shape the extent of direct payments growth, the results also demonstrate that understanding levels of activity requires attention to local circumstances.I see direct payments, personal cash budgets, and other ways of extending choice and cont...
Journal of Child Psychology and Psychiatry, 2013
The economic impact of childhood psychiatric disorder on public sector services in Britain: estim... more The economic impact of childhood psychiatric disorder on public sector services in Britain: estimates based on national survey data
The King's Fund is an independent charitable foundation working for better health, especially in ... more The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.
Ageing and Society, 2006
The financial and social climate in which the residential-care sector operates in the United King... more The financial and social climate in which the residential-care sector operates in the United Kingdom has changed substantially over recent years. This paper examines the underlying motivations for providing residential-care services for older people. We focus on the motivations of a sample of managers and owners of care homes drawn from eight English local authorities, and explore the intrinsic aspects of their motivations, particularly professional achievement, recognition and job satisfaction. The majority of the respondents' primary motivations were to meet the needs of older people and to accomplish professional achievements. Their caring motivations had four principal components, which were labelled professional, financial, client-specific and client-generic, and as for their professional motivations, the interviewees reported high levels of job satisfaction. The respondents were satisfied with their career choice and felt that, through their work, they were contributing to...
Social Policy and Society, 2011
As in other countries, improving collaboration between health and social care services is a long-... more As in other countries, improving collaboration between health and social care services is a long-established objective of English social policy. A more recent priority has been the personalisation of social care for adults and older people through the introduction of individualised funding arrangements. Individual budgets (IBs) were piloted in 13 English local authorities from 2005 to 2007, but they explicitly excluded NHS resources and services. This article draws on interviews with lead officers responsible for implementing IBs. It shows how the contexts of local collaboration created problems for the implementation of the personalisation pilots, jeopardised inter-sectoral relationships and threatened some of the collaborative arrangements that had developed over the previous decade. Personal budgets for some health services have subsequently also been piloted. These will need to build upon the experiences of the social care IB pilots, so that policy objectives of personalisation ...
The LSE Companion to Health Policy
PharmacoEconomics, 2008
The selection of the Generalized Linear Model (GLM) with a log link and poisson (or gamma) distri... more The selection of the Generalized Linear Model (GLM) with a log link and poisson (or gamma) distribution to estimate the treatment effect on the total costs is based on the recommendations provided by Manning and Mullahy. [1] The selection process has two distinct steps. The log-scaled residuals to determine the decision between a GLM approach or a ordinary least square (OLS) based model with ln(cost) as the dependent variable. If the GLM approach is chosen, the next step is to select the variance distribution. If the log-OLS model is used, the next step is to develop a retransformation strategy. This later process applied on the modeling of total cost on the completers set is detailed below. Step 1: Choosing between GLM or log-OLS Log-scaled residuals were examined for the dependent variable of interest: total costs. The kurtosis for total costs on the log scale was <3 (0.473), which indicated that the GLM model was the preferable option. Step 2: Choosing a GLM distribution The modified Park test on the raw-scaled residuals enables the selection of the variance distribution associated with GLM models with log link: [1]
Applied Economic Perspectives and Policy, 2012
Abstract Using a stochastic frontier approach, this paper explores efficiency in the commissionin... more Abstract Using a stochastic frontier approach, this paper explores efficiency in the commissioning of publicly funded social services among 148 English Councils through a six-year panel database (2002-2007), covering institutional and community care. Our estimates provide key policy evidence in a context in which optimization is critical both for social and financial purposes. Results suggest a slight decrease in the average inefficiency score, moving from 1.080 in the first year to 1.076 in the last year. Cost-output elasticity of ...
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Papers by Jose-Luis Fernandez