https://orcid.org/0000-0002-9333-1962
Figures
Abstract
Context
Family and Group Conferencing (FGC) is a strengths-based approach to social work, originating from New Zealand and now used internationally. Previous research on FGC has focused largely on the context of children’s services but, FGC also aligns with the principle of the Care Act in England to prevent, reduce or delay the need for long-term (and potentially costly) adult care services. Limited previous research has tended to explore potential cost savings associated with FGC, without accounting for the cost of the intervention itself, risking biased results.
Objective
This paper aims to identify resource use and associated monetary costs associated with FGC services in English adult social care and mental health settings.
Methods
Framework development was informed by previously published work establishing programme theory for FGC, extended by expert opinion and published sources of monetary costs. The framework used scenario-based analysis and a bottom-up costing approach, with sensitivity analysis.
Results
Estimated costs of conducting a standard full FGC (excluding referral) range from £1,455 to £2,043 (adjusted from 2022–2023–2025 prices) from a local authority and National Health Service (NHS) perspective. Costs can vary depending on the involvement of an advocate or interpreter, network size and the complexity of issues being addressed. We report overall costs with and without resource use specifically related to referral.
Discussion
Higher staff costs account for slightly higher intervention costs in an NHS mental health setting, compared to adult social care settings.
Conclusion
Reallocating scarce public resources with the intention of preventing, reducing or delaying use of costly future care must be evidence-based as pressures build to meet acute needs. Accurate per-case costing of FGC is a necessary preliminary step towards exploring the cost-effectiveness of FGC. A full economic evaluation will account for costs, outcomes, and alternative options (uses of limited resources).
Citation: Liu L, Tew J, Mahesh S, Kinghorn P (2025) An exploration of the costs of family and group conferencing pathways in adult social care and mental health: A scenario-based cost analysis. PLoS One 20(12): e0326829. https://doi.org/10.1371/journal.pone.0326829
Editor: Ping Xiang, Central South University, CHINA
Received: June 12, 2025; Accepted: November 11, 2025; Published: December 3, 2025
Copyright: © 2025 Liu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All data are in the manuscript and/or Supporting information files.
Funding: This project is funded by the National institute for Heath and Care Research (NIHR), grant reference number NIHR135127. The views expressed are those of the authors and not necessarily those of NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
1. Introduction
Originating in New Zealand in the 1980s, Family and Group Conferencing (FGC) is a family-led decision-making model that is widely used internationally within children and family social services [1]. More recently, the approach has been offered within adult and mental health service contexts and fits within the broader family of strengths-based and preventative approaches [2].
The fundamental philosophy of a strengths-based approach is that strengths exist within all individuals, families and communities, and they are the ‘experts’ on their own challenges and issues [3,4]. FGC offers a voluntary and inclusive approach in which people can plan for their care and support on their terms – and which can mobilise the strengths and resources that may potentially exist within their family and social networks. It offers an opportunity for family, friends and neighbours to come together with a person to devise their own plan for how best to arrange their care, support and safety. Plans made in this way can be more acceptable both to the person and those involved in their support. They can also reduce the likelihood that responsibility for care and support will fall solely onto one network member. It is widely acknowledged that this approach can reduce the reliance on external resources and helps in the early identification and prevention of potential problems [5,6].
The Care Act (2014) [7], which applies to local authorities (councils) in England, emphasizes the importance of prevention to minimize the need for formal, long-term care and support for both adults and their carers. The goal is to prevent, reduce, or delay care needs while maximizing individuals’ independence and wellbeing for as long as possible [7]. Since the introduction of the Care Act, there has been growing awareness and interest in Adult Family and Group Conferencing (FGC), as the FGC “way of working” aligns closely to the principles of the Care Act [4,8].
Use of FGC is not restricted to the contexts of adult social care and children’s services, and it is also used within health services. The UK Secretary of State for Health and Social Care recently announced an aspiration to make “Three Shifts” within the National Health Service (NHS), as part of a 10-year health plan [9], designed to meet the changing needs of a changing population. Two such shifts, which FGC could potentially help facilitate, are: (i) from merely treating sickness to preventing it; and (ii) moving care from hospitals to communities. FGC has been explored in the Netherlands as an approach which aligns to the policy agenda around reducing coercion and involving social networks in the care of those with ongoing mental health conditions [10,11].
Potential cost saving through delaying or preventing intense forms of care services is likely to be a key motivator for public sector organisations funding FGC services, especially in the context of current budget pressures facing local authorities and the NHS in England and challenges meeting demand for long-term care internationally. Quantifying such potential cost savings could help to inform decisions about the allocation of scarce resources. However, there may also be an expectation that FGC will improve outcomes for individuals and families and economic evaluation offers a formal framework within which to compare both the costs and outcomes associated with alternative approaches (such as FGC and standard practice without FGC).
A cost-benefit analysis of an FGC service versus business as usual (BAU), in the context of children’s services and domestic abuse, was conducted in Leeds [12]. The analysis indicated that providing an FGC service is marginally more expensive than existing services, but on average, BAU families spent longer in the social care system, meaning that FGC was associated with savings estimated at £755 per family. In contrast, a cost-effectiveness analysis of FGC in the context of child welfare, conducted in the Netherlands, found no short- or long-term effect associated with FGC, in terms of child maltreatment, empowerment and social support as outcomes, and a low chance that FGC would be deemed cost-effective [13].
There is no such full economic analysis of FGC in the context of adult social care or NHS mental health services. In a 2021 scoping review of the use of FGC in adults’ mental health work, Ramon [14] identifies evidence of high satisfaction with the FGC process itself, but notes the absence of cost-effectiveness analysis. Research has been limited to quantifying the cost saving associated with reduced residential care, domiciliary care, and care management time, and this has been estimated at between £1,579 per FGC over 12 months [8] in the context of adult safeguarding and £7,000 per FGC over a two-year period [15] in the broader context of adult social care. However, these studies focus on cost savings from the perspective of statutory services and do not account for the cost of delivering FGC as an intervention, changes in the provision of unpaid care nor changes in well-being. There cannot be confident claims of cost saving if the costs of providing FGC services are not accounted for, particularly as cost savings identified in the literature so far can be of relatively modest magnitude.
This is therefore an important gap in the current literature, which we address by presenting detailed, systematic and transparent bottom-up costing of plausible and common FGC pathways. By pathways, we mean the structured processes and procedures followed in implementing FGC models within adult social care and mental health settings. Our use of expert opinion, and the foundation of our pathways in previously identified programme theory, represent novel aspects of our work and are effective ways of circumventing the challenge and complexity of data collection in social care contexts specifically. We account for variations in practice through sensitivity analysis, and account for the fact that not all referrals will lead to a full FGC conference [8].
2. Methods
Work reported in this paper draws upon published work by Tew et al. and Mahesh et al. [11,12]. Tew and Mahesh used survey, interview and deliberative forum methods to gain a contextual understanding of the operation of FGC services [11,12]. The involvement of people with lived experience was central to the development of the programme theory by Tew and Mahesh et al. [11,12].
Our methods here follow three steps: mapping out pathways which detail each stage of the FGC process (Step 1); the identification and quantification of resources used at each stage of the FGC pathway (step 2); and attributing monetary costs to resources used (step 3). Sensitivity analysis explores the impact of changing key assumptions and parameters.
Our work starts from the published programme theory by Tew and Mahesh et al. and also draws on expert practitioner opinion. Practitioners are members of the extended research team. Feedback has also been received from a Lived Experience Advisory Panel (LEAP), who also form part of the extended research team.
2.1. Ethics statement
There was no involvement by human research participants in the research reported in this paper; nor is there any retrospective study of medical records or archived samples.
2.2. Step 1: Pathway development
Plausible FGC pathways were directly informed by the existing literature [11,12]. All pathways cover three characterising stages of FGC: Preparation, Conference, and Review. Furthermore, all pathways were developed from three perspectives: the central person (or service user) around whose needs the FGC is to be convened, network members and the public sector (local authority (LA) and NHS). Our analysis principally adopts the ‘public sector perspective’, which might alternatively be referred to as a National Health Service (NHS) and Personal Social Services (PSS) perspective. A base case pathway (Scenario A) reflects all core elements of an FGC process (elements which would need to be included in order to categorise the intervention as being an FGC and align with best practice). Elements which might be added in some cases, dependent on needs and specific circumstances (such as the use of an advocate or an interpreter), are added in additional scenarios to generate a range of values, reflecting plausible variation in practice.
2.3. Step 2: Identifying and quantifying resource use
Parameters relating to resource use (step 2) were informed both by previously published research and by expert opinion obtained from FGC leads/managers and practitioners, working across two local authority FGC services and one NHS mental health FGC service; these were established FGC services with geographical spread across England. Because practitioners were part of the research team, it was not appropriate or necessary to obtain consent.
Informed by this expert opinion and previous research findings, we made several base case assumptions to decide which resources will plausibly be used, and in which quantities, in a typical adult social care setting. The same assumptions apply to mental health settings unless stated otherwise.
We allocate LA/NHS resource use to one of two categories, staff and non-staff, and summarise the quantity of resource use ‘consumed’ at each stage of the FGC process. Staff resources are measured in hours worked. Non-staff resources include travel, food, and venue hire. We also list time commitment for service user and network members at each stage of the FGC so we can estimate the opportunity cost of their time in Step 3.
2.4. Step 3: Attributing monetary values
In step 3, we conducted bottom-up costing for each of the different FGC pathways (using Scenario A consistently as the base case). To calculate the monetary costs, we assign a value (price) to the resources identified and quantified in step 2, based on several assumptions developed through discussions with the wider project team and FGC practitioners (principally regarding the seniority and salary band of professional staff). We categorized monetary costs from the public sector (LA/NHS) perspective into staff costs and non-staff costs, according to the type of resource utilized.
For staff costs, we used unit costs (prices) from the Personal Social Services Research Unit (PSSRU) 2022/23 [13]. Mapping to costs from PSSRU has the advantage that non-salary costs associated with employment are accounted for (such as pension and national insurance contributions). Whenever possible, unit costs from PSSRU are used which include qualifications; this approach ensures that training and education costs are accounted for, thus reflecting the full societal cost of skilled labour. To maintain consistency, we use the 2022/23 price levels for other resources wherever possible. To categorize the monetary costs from the perspectives of central persons and network members, we valued their time based on a shadow wage rate, a common approach used to estimate the opportunity cost of persons’ time when engaging in health or social care services [16]. We assume the opportunity cost for both the person and network members is equivalent to the 2023 UK National Living Wage. This rate is currently the same as the National Minimum Wage for those aged 23 and over [17].
The estimated staff and non-staff costs were then cumulatively summed for each stage of the full FGC service, providing a comprehensive breakdown of the financial implications of an FGC service, primarily from the LA/NHS perspective, but also reporting costs incurred by the person and their network. In sensitivity analysis, we explore the impact of assumptions (such as network size and conference duration) on the overall cost estimates.
Final cost amounts for each pathway (reflecting 2022/2023 prices) are adjusted to March 2025 prices using the Bank of England Inflation Calculator [16].
3. Results
3.1. FGC pathways
Fig 1 outlines the three common stages of a basic FGC (the broad pathway), which follow, or are triggered by a referral. Below Fig 1, we begin to characterise and specify greater detail for each stage.
Referral: The referral stage is a prerequisite step for FGC [1], which involves the referrer and the FGC manager (the FGC coordinator and FGC manager are distinct and separate roles). This referral is typically made by professionals such as a social worker in adult social care or a care coordinator in mental health, who identifies a situation where FGC could be beneficial. The case is then reviewed by the FGC manager (or team lead) to determine if the referral criteria are met. If so, an FGC coordinator is appointed to facilitate the process.
Preparation (Stage 1): The FGC coordinator engages with the central person and invites each network member to participate, establishing what they each hope to achieve from the process. At this stage, the coordinator would help the person to create an invitation list for the FGC, including supporters like family, friends, and any service providers they wish to involve, along with the referrer. Parallel conversations are held with the referrer and other professionals involved to ascertain any issues, such as safeguarding, or other non-negotiables.
Conference (Stage 2): The conference usually takes place at a community venue or the person’s home. At the beginning of the Conference, the coordinator sets (reads out) the pre-decided agenda as well as the ground rules for the Conference. The Conference begins with information sharing, where the coordinator facilitates a conversation between the person, network members and invited professionals. Following this, the person and network members have ‘private time’ to devise a plan independently. Finally, they share the plan (either directly or via the coordinator) and consult with relevant professionals and agencies to ensure the necessary services can be provided and that any professional concerns, such as safeguarding, are addressed.
Review (Stage 3): The coordinator helps assess how the plan is working and adapt it as necessary. A minimum of one review is usually offered, with the option for additional reviews or a further FGC to be offered as appropriate, particularly if circumstances change. Once the review is completed, the FGC referral is closed.
The referral stage is characterised by significant potential variation, with respect to the role title and seniority of professionals making referrals. Because the role and seniority of the referrer will differ across different contexts, inclusion of referral costs will limit generalisability of the findings. We therefore report total costs with and without referral.
Among the FGC cases observed by our advising FGC practitioners, approximately 14% of referrals who are accepted into FGC services do not progress to the (full) Conference stage. This is therefore a source of variation in the FGC process and is represented in a separate scenario in the following section (Section 3.2).
3.2. Identifying and measuring resource use
Five plausible scenarios emerge from this step, with Scenario A reflecting, wherever possible, the most typical FGC case, and alternative scenarios reflecting variation from that typical base case. Assumptions (A1-A9), underpinning all five scenarios, are as follows:
A1 Duration of stages: We assume that the FGC manager and referrer both spend one hour making the initial referral. We assume the FGC coordinator spends significant time on preparation, estimated at 10 hours. FGC practitioners reported that this preparation depends on the size of network and can take up to 20-hours in some cases, although our assumption of 10 hours reflects a typical network size; 20 hours would be an extreme outlier. Schout et al. found, in a mental health setting, that some patients were “too disturbed” for the organisation of a full conference to be feasible, but do not report the proportion of patients for whom this was the case.
The Conference itself is assumed to last for four hours, and the review meeting for two hours. For simplicity, we assume the review meeting will take place online.
A2 Professional Staff Making and Processing Referrals: In adult social care, the referrer is assumed to be a social worker. The FGC manager is also assumed to be a social worker. In the mental health context, the referrer is assumed to be a care coordinator (the equivalent of a Band 6 nurse). The FGC manager is also assumed to be the equivalent of a band 6 nurse. We explore the impact of referrals being made by a consultant psychiatrist in sensitivity analysis.
A3 Involvement of professional staff at the Preparation and Conference Stages: In addition to the FGC Coordinator, other service providers (for example, a representative of the service which made the referral or housing services) may be invited to join the conference by the network (or coordinator) [1]. We assume that two professional staff members attend (in addition to the FGC coordinator), based on the average number of professional staff reported to attend an FGC Conference by our advising FGC practitioners. In addition, we assume that each additional professional spends time (30 minutes) communicating with the coordinator at the preparation stage.
A4 Involvement of an advocate at the Conference: For our base case analysis (Scenario A), we assume no professional advocate attends the conference, but we include an advocate in our analysis of an alternative scenario (Scenario B). Advocacy is typically provided when the central person (or a network member) may have a learning disability or cognitive impairment, or may otherwise need support to express their views as part of the Conference process [1]. Advocacy may be provided by an advocacy service or, in some instances, by another FGC coordinator [11, p.22].
A5 Involvement of an interpreter at the Conference: In our base case scenario we exclude an interpreter, but an interpreter is included in analysis of an alternative scenario (Scenario C). Given the network-led decision-making process inherent in FGC services, it is essential that the FGC is conducted in the network’s preferred language wherever possible.
A6 Transport: We assume transportation is required for the FGC coordinator in order to visit the person and their network members in-person during the preparation stage and to attend the Conference. Our advising FGC practitioners emphasized the importance of in-person visits, as they are crucial for effectively promoting the idea of FGC. We assume that the LA/NHS covers travel costs for all professional participants, but not routinely for the central person and their network members. Exceptions are made for low-income families, where the social worker has discretion to provide a travel card or taxi pass.
A7 Food: Food and refreshments are assumed to be provided to all Conference attendees, at a cost to the LA/NHS; our preliminary work emphasised the importance of this, although we do present a scenario excluding food (Scenario D).
A8 Venue: The Conference is assumed to take place in a neutral venue chosen or agreed upon by the network (such as a community centre); alternatively, it may occur in the home of the person or a network member. Where the conference takes place at a venue other than a private residence (which is assumed to be the most common case), costs will be borne by the LA/NHS.
A9 Number of Network Members involved: We assume that three network members (e.g., family and friends) attend the Conference, based on the average number of participants reported by our advising FGC practitioners, reflecting practice in their organisations.
A9 Time involvement of service user and network members: We assume the central person spends two hours in one-to-one conversation with the FGC coordinator at the Preparation stage. We were advised that the FGC coordinator spends approximately one hour with each network member to share key information. We assume both the central person and network members attend the full Conference (the duration of which is four hours) and meetings occurring at the Review stage (two hours).
Resource use at each stage of the FGC process, and by each perspective, is reported in Table 1. Core elements (which would be expected in every typical good practice case) are presented with plain text formatting. Elements which may or may not be observed (such as inclusion of an advocate) are included in italics.
In total, we identified five scenarios that represent various possible and plausible FGC pathways in adult social care and mental health settings. The five scenarios are also summarised in Table 2.
- Scenario A: A full FGC pathway, incorporating all elements denoted in Table 1 with plain text formatting.
- Scenario B: A full FGC pathway, similar to Scenario A, but with the addition of an advocate at the Preparation, Conference and Review stages.
- Scenario C: A full FGC pathway, similar to Scenario A, but with the addition of an interpreter at the Preparation, Conference and Review stages.
- Scenario D: A full FGC pathway, similar to Scenario A, but excluding food provision at the Conference stage.
- Scenario E: A non-Conference (incomplete) FGC pathway, where the Conference does not take place. This may be because the central person and network members find that, as a result of the conversations initiated during the preparation phase, they can resolve their difficulties informally. Alternatively, a Conference may not proceed due to reasons such as the lack of a viable network or a significant change in circumstances.
There should be no systematic differences in resource use across scenarios A to D from a central person or network member perspective (i.e., resources they directly fund). Scenario E involves less time involvement for central persons, network members and professionals alike.
3.3. Monetary costs
Unit prices associated with all possible occurrences of resource use (documented in Table 1) are presented in Table 3 (for staffing and personal time) and Table 4 (for non-staff/non-time costs), along with the source of that unit price.
Next, we explore how costs vary across different scenarios (Table 6). The base case cost of a full FGC process in adult social care is £1,462 (see Panel A). The cost increases by 21% with the addition of an advocate and 17% with the addition of an interpreter. The increase is mainly driven by the added staff costs for these roles. Excluding food reduces the cost by 3%. As a result, the total cost ranges from £1,413 to £1,773. If the FGC does not proceed to the Conference stage, the cost drops to £599, which is 41% of the baseline. In the mental health setting (see Panel B), a full FGC pathway is more expensive, ranging from £1,589 to £1,985. If the Conference stage is not reached, the cost is reduced to £709.
Adjusting to March 2025 prices, using the Bank of England inflation calculator [16], gives an adult social care base case (Scenario A) cost of £1,505 (excluding referral, or £1,614 including referral), and an NHS Mental Health base case cost of £1,686 (excluding referral, or £1,818 including referral). Scenario B costs increase to £1,825 (£1,934 inclusive of referral costs) and £2,043 (£2,175 inclusive of referral costs) respectively. Scenario C costs at March 2025 prices are £1,763 (£1,873) and £1,945 (£2,076) respectively. Scenario D £1,455 (£1,564) and £1,636 (£1,768). Scenario E £617 (£726) and £730 (£862).
3.4 Sensitivity results
In this section we adjust the assumptions made earlier to explore how changes in the number of network members, professional staff attending, and the duration of the Conference affect the total base case cost (Scenario A in Table 6). The first column of Table 7 presents the base case costs from Table 6 for reference. The results for adult social care and mental health care settings are presented separately in Panels A and B (Table 7), respectively.
From a LA perspective, adding an extra network member increases the total cost from £1,462 to £1,579 an increase of £110. This relatively minor increase is due to additional time spent by the FGC coordinator at the preparation stage (two additional hours), additional travel costs incurred by the FGC Coordinator during the preparation stage and additional food costs at the conference. Adding an additional professional member, however, increases the total cost from £1,462 to £1,712, an increase of £250. This 17% increase from base case cost is primarily due to the additional staff expense, along with the added costs for food and transportation for the extra attendee. Reducing the duration of the Conference can lead to substantial cost saving. From a LA perspective, shortening the Conference to 3 hours decreases the total cost from £1,462 to £1,288. This reduction of £174, or 12% of the baseline cost is primarily due to the reduced hours worked of the coordinator, and practitioners invited or required. These effects are similar in a mental health care setting as presented in Panel B.
Finally, we acknowledge the voluntary nature of FGC services, recognizing that some families might choose not to proceed to the Conference stage. We have made assumptions about the probability that an FGC referral will advance to the Conference stage and present our estimates accordingly. Scenario E is presented as the non-Conference pathway (see S1 Table). If 85% of FGC referrals result in a full FGC pathway (Scenario A) and 15% result in a non-Conference pathway (Scenario E), the expected cost per case accepted into the FGC service for adult social care would be approximately £1,333, and £1,499 in NHS mental health services. In S1 Table, we also calculate the impact of 25% or 35% of cases not progressing to full Conference; 15% most closely aligns with observation in current practice, as specified by our expert practitioners.
Costs associated with referral may rise further in the mental health care setting if the referrer is assumed to be a consultant psychiatrist (a more senior clinical role). Feedback from our advising FGC practitioner in mental health care suggests that whilst referrals have historically come from care coordinators, there has been a growing number of referrals directly from psychiatrists. To account for this, costs were also calculated assuming the referrer to be a hospital-based psychiatric consultant, with an hourly cost of £143 (2022/23 rate with qualifications). The corresponding total costs for an FGC pathway including referral is £1,845 for scenario A (at 2022/23 prices, or £1,899 adjusted to 2025 prices). If the Conference stage is not reached, the cost is reduced to £916 (at 2022/23 prices, or £943 adjusted to 2025 prices). Referral costs are reported with full transparency in S2A Table and S2B Table.
3.5. Cost from other stakeholder perspectives
We present the costs for the central person and each network member across the two potential FGC pathways that are distinct from their perspective (see Table 8). During the preparation stage, we assumed the central person spent more time with the FGC coordinator, so the associated cost from the central person perspective is higher.
3. Discussion
In this study, we aimed to explore the costs associated with Family and Group Conferencing (FGC) pathways in adult social care and mental health settings from multiple stakeholder perspectives, drawing on data from the literature, programme theory developed in advance of our costing work, and expert opinion. Our findings indicate that the costs of conducting a full FGC (in 2022/23 prices) range from £1,413 to £1,985 depending on factors such as the provision of food and a venue, the involvement of an advocate or interpreter, and the setting (adult social care or mental health), but excluding the Referral stage. Adjusted to March 2025 prices, the range is £1,455 to £2,043. The increase in costs in mental health versus adult social care settings is mainly driven by higher salary costs in the health system, versus local authorities. Referral costs are more unpredictable and likely to vary more by setting and case by case within settings, but we estimated a typical referral cost in the adult social care setting to be £106, and £128 in mental health settings.
We conducted sensitivity analyses to examine the impact of having additional network members, professional staff and varying the duration of the Conference on the overall cost. The inclusion of an additional network member results in only a marginal increase (8–9%) in the overall cost, but the involvement of an additional professional can increase cost by 15–17%. Reducing the Conference duration (from four hours to three hours) could decrease the total cost by 11–12%.
Recognizing that some families may opt not to proceed to the Conference stage, we also estimated the expected cost per case accepted into the FGC service, adjusting for an 85% probability of proceeding to the Conference (full FGC). The expected cost per case accepted into an FGC service for adult social care would be approximately £1,333, and £1,499 in NHS mental health services in 2022/23 prices (£1,372 and £1,543, respectively, when adjusted to March 2025 prices). We also estimated the cost of engaging in FGC for the central person and each network member.
This is the first bottom-up costing of FGC in the contexts of adult social care and NHS Mental Health Services. The strength of the bottom-up costing is its foundation in the programme theory, developed in earlier phases of the project, the use of expert practitioner opinion to ensure that each assumption reflects practice in reality, use of credible cost sources (such as PSSRU Unit Costs of Health & Social Care), and the scenario-based analysis, including sensitivity analysis. However, the study has some limitations. We utilized data from three experts, representing three established FGC services, but there may be variation in FGC implementation across different services that were not fully captured. Some FGC services are shifting from in-person to online formats, a trend that has accelerated during the pandemic [20]. This transition could reduce overall costs by saving on travel, food and venue hire. However, this cost reduction might come at the expense of the trust built between the network and professionals, which may be harder to establish in a virtual setting. Furthermore, we have assumed the professional staff engage fully at the Conference for simplicity. However, in practice, their level of involvement may vary.
We acknowledge that drawing on the expert opinion of practitioners directly involved in the research could be perceived as a potential source of bias. Cost analysis was undertaken by two independent health economists (LL and PK). Practitioners primarily advised on parameters relating to resource use (the frequency and duration of tasks, the qualifications and seniority of staff), with costs being identified by trusted national sources. There were few cases where practitioners advised on direct costs, and these were typically linked to institutional policy, such as a budget for food. The impact of assumptions have been tested transparently through sensitivity and scenario-based analysis, and the parameters we report can be changed to reflect local/contextual variation.
These cost estimates highlight the financial investment required by LA/NHS to provide an FGC in adult social care and mental health settings. The inclusion of additional support personnel, such as advocates/interpreters and professionals, as well as the provision of food and venue, increases the overall cost. Furthermore, extended durations at the Conference stage can escalate costs, although, in principle, families are allowed unlimited time to formulate and agree upon a plan [1]. Whilst FGC services are a valuable tool that local authorities can use to meet their requirements under the Care Act, the investment in FGC must be justified in terms of improved outcomes, and full evidence on economic effectiveness.
Although current evaluations of FGC studies primarily draw from the child welfare context, our cost estimates align with broader literature on FGC costs across various settings. For instance, a rapid evidence review conducted in Camden noted that a standard FGC in early help settings for children typically costs the LA between £1,200 and £1,500, excluding the referral process [21]. Additionally, a 2015–2016 evaluation in Leeds reported the cost of providing FGC services as part of a broader initiative to implement restorative practices in children’s services at £2,418 per family [12]. These variations in cost estimates can be attributed to different methodological approaches, study sites, the specific needs of the central person and the professionals involved.
Policymakers and future research should consider the financial cost of FGC alongside the potential for future cost-saving; with cost savings associated with FGC having been estimated in the literature at between £1,579 (over 1-year) and £7,000 (over 2-years), it is not clear whether cost saving through lower use of care services will exceed intervention costs. However, policy-makers and service providers should not focus solely cost-saving measures without accounting for outcomes. The cost estimates presented in this paper are a preliminary step towards a comprehensive economic evaluation of FGC services in adult social care and mental health, which will evolve as more outcome data becomes available. Even if intervention costs are found to exceed cost saving in some cases, any increase in wellbeing outcomes is likely to mean that FGC could be considered to be cost-effective as an intervention. Indeed, Schout et al. indicated that benefits may accrue even in cases that have not progressed to a full conference [11].
A critical challenge in conducting full economic evaluation is selecting an appropriate counterfactual scenario – typically, “services-as-usual”. If the counterfactual is not accurately chosen, analysis may misrepresent the costs and benefits of FGC services, potentially leading to incorrect conclusions about its value.
There is a clear gap in the literature for a full economic evaluation of FGC in adult social care and mental health contexts and the intervention costs estimated in this paper can be used in future research aimed at addressing that gap.
Supporting information
S1 Table. Sensitivity results: Probability of advancing to the full FGC pathway (LA/NHS perspective).
https://doi.org/10.1371/journal.pone.0326829.s001
(DOCX)
S2 Tables. S2: Costing for the Referral Stage.
https://doi.org/10.1371/journal.pone.0326829.s002
(DOCX)
Acknowledgments
We would like to thank staff across our three case study sites for sharing their knowledge and experience and hence informing key assumptions and parameters underpinning our costings.
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