**3.2.4 Monitoring care for people with special needs**

One of the challenges for a service providing care for people with impairment or disability is the time that is required to plan, organise and deliver care for patients. In a health care system where there is increasing emphasis on 'value for money' and understanding the cost of care, if is necessary to be able to explain the time and costs involved in patient management to commissioners of care. Therefore, a case mix toolkit has been developed and piloted by Sheffield working with a number of other dental services in England and Wales (British Dental Association, 2008). It provides a tool for measuring the level of impairment and disability, of patients in conjunction with the volume of service activity. This should provide meaningful activity data for commissioners about the patient base and reflect the additional time, and resources, required to provide care for many patients with special needs. The toolkit measures:


Together with recommended 'weightings' these provide an overall patient 'complexity score'. This does not include any score for the complexity of the dental care, but rather time and patient management which should therefore explain the time involve and thus the cost of their management.
