Assessment: Commissioning home care for older people

Well-targeted home care interventions can have a positive effect on overall demand for other services. They can also have a positive impact on cost and efficiency. [4] This suggests that if commissioners had a better appreciation of the needs and service provision in their local areas, this will help them to plan and commission more useful services.

Commissioners should:

• develop a clearer understanding of the complex needs of older people in their area, so that they can commission the right services for them [8]
  • they should consider the whole needs of the person – from practical and medical needs to social and emotional needs
  • read practice examples 5 and 6 to see how services can cater for the whole needs of a person
• identify which are the areas of poor performance in their locality that stoke up demand and develop a clear integrated plan for how they might commission services differently to improve the outcomes that can be achieved
  • particular areas to focus on are strokes, falls, incontinence, dementia and community dental services [4]
• involve people who use services and unpaid carers at this and every stage of the commissioning process
  • it is only through listening to what users and their unpaid carers want from services that commissioners can really know how to develop services [1, 13]
  • when service users and their unpaid carers take part in the process, services are more responsive to their needs, and policy and the quality of services improve. This leads to better outcomes in care, an increased sense of ownership over services and greater knowledge and confidence among users and their unpaid carers [16]
  • take care when asking the views of older people who may have difficulties in communicating, such as people with dementia. To find out useful information, staff should be trained and have experience with the people concerned [11]
  • be aware that older people may be reluctant to complain
• improve their knowledge of the services that are provided in their area and how they are performing
  • lack of knowledge of service providers and the options available can lead to some voluntary sector providers being excluded. Ultimately this prohibits the development of the best service. [8]