Contracting: Commissioning home care for older people
The buying of home care is a powerful tool for making sure that services meet the needs of people who use services and their unpaid carers and for engineering the kind of provision that allows for the personalised care that is so desirable.
Commissioners should:
- use interventions that are based on evidence
- a service should be funded only where there is clear evidence that it will deliver the desired outcomes or, where such evidence does not exist, the service should be tried out and then evaluated [4]
- make sure that there is a wide range of service providers
- commissioners should encourage a range of small to large service providers in the statutory, independent and voluntary sectors
- they should do this by working closely with service providers, users and their unpaid carers to develop services that respond to needs within the local community [4]
- encourage the role of voluntary organisations
- voluntary organisations can be particularly helpful to people with complex needs, providing niche services such as personal care for very complex cases and end-of-life care – see practice example 10
- to secure the future of useful but vulnerable voluntary organisations, the following would all help: longer-term contracts, the ability to raise funds for the development of capital and a standard form of contract between voluntary organisations and health and local authorities/HSC trusts [8]
- consider the value that can be created by working closely with service providers to create services that meet needs in the local area
- consult users and their unpaid carers on any major changes in the way support is delivered – sudden changes can result in anxiety, loss of a valued service or paid carer or increased expense [17]
- look closely at staff recruitment and retention
- paid carers are a major component of good home care and, particularly in rural areas, are in short supply
- commissioners can have a big influence on the pay, conditions, training and freedom of paid carers to perform their tasks well [6]
- they should consider how developing the social care workforce might attract new people to social care
- better terms and conditions could help staff retention
- consider how effective improvements can be achieved with existing staff and resources
- for example, staff can be trained to work at a higher level with users so that users can stay in their own homes
- identify the cost-effectiveness of different forms of intervention over a longer time period and across funding streams
- for example, intensive post-stroke recovery services that reduce dependency may initially appear expensive but be a cheaper option than long-term care and support [4]
- consider establishing a lead professional or case manager role, especially for complex cases
- this would include care planning, assessment, taking account of users’ personal goals, monitoring and reviewing care
- it is not currently available for most older and frail users, even though it potentially reduces unplanned medical admissions and makes a difference to those ‘on the margins of independent living’. [9, 14]
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