Planning: Commissioning home care for older people

At the planning stage, commissioners should be looking at how services can be designed to improve outcomes for people who use services and their unpaid carers, and creating the structure and processes that allow this to happen.

This may involve a change of approach within the local authority or health and social care trust: a move away from the idea of home care as a series of domestic and health tasks done for the user, towards the concept of home care as a preventative service with a focus on impact, a service that can improve the lives of users and their unpaid carers with the ultimate aim, where possible, of reducing dependence on that service. [4]

Southwark (practice example 6), Bristol (practice example 7) and Wiltshire (practice example 8) have all set about changing the values and definitions of home care to transform the way services are commissioned.

Local authorities/HSC trusts should consider adopting an outcome-led approach to contracting for preventative services and have the confidence to pay by outcomes – what is achieved – rather than by the number of hours or length of the service.

The values that drive a local authority/HSC trust are crucial to outcomes: caring values are known to be the motivating force behind good home care and are vital throughout the system. [6] Elected members play a part here and may benefit from a better understanding of their important role in protecting the human rights of users. [1]

Skills and understanding are also necessary. Commissioning should be led by people who have a detailed knowledge of home care and what is provided in the local area. [1]

Good home care needs a teamwork approach. Commissioners should involve providers of health and social care services in planning and delivery. [4]

See practice example 7 for an example of health and social care staff in Bristol working together.

To support the wide range of needs of older people with complex needs, it is important that staff work together and that health and social care services are integrated. No single structure works across the country – integrated care approaches are dynamic and complicated and are difficult to replicate. [18]

Commissioners should:

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