The challenges of commissioning home care for older people in England: commissioners’ perspectives

Abstract

Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves ‘managing’ and ‘shaping’ the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than ‘time and task’ objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning.

Home care in dementia: The views of informal carers from a co-designed consultation

“…Firstly, carers who showed personal qualities and skills related to kindness, empathy, warmth and so on were as highly prized by informal carers and families as those with plentiful qualifications, as they were perceived as knowing the true familial value of providing care to their loved ones. This reiterates the importance of value-based care or care that is grounded around person centeredness (Davies et al, 2020; Veselinova, 2013). It demonstrates the importance of developing trust in formal carers to look after the person with dementia.…”

“…Informal carers have also previously reported a lack of adequate hours and flexibility in care delivery (McCabe et al, 2016). Moreover, commissioners of home care have themselves expressed the rushed nature of care visits due to budgetary constraints, the time and task model and the lack of status related to the care role, as devaluing the care role and as a barrier to recruitment and retention (Davies et al, 2020). Carers are also often coordinated via changeable rota systems and so continuity of care is not facilitated, which creates difficulties for carers in developing relationships with service users.…”

ESSS Outline: New models of care at home

“…This should include voluntary and community organisations providing social support (Jasper, 2019;Sutcliffe 2021). Davies (2021) found:…”

Delivering Personalised Home Care for People with Dementia: An Investigation of Care Providers’ Roles and Responsibilities

“…Many disliked its rigid format and restricted focus that could hinder person-centred care, a viewpoint reported elsewhere by home care agencies, clients, and care workers (Equality and Human Rights Commission, 2011;Jefferson et al, 2018). The imperative to commission for better outcomes (Local Government Association, 2015;Bolton, 2016) could be achieved more efficiently through a partnership model between home care agencies and commissioners (Davies et al, 2020), enabling agencies to be the mediators of commissioning for outcomes.…”