Monitoring: Commissioning home care for older people

Opportunities to improve services and make sure that they are sustainable – through consistently reviewing and monitoring them – may be missed. There is a mixed picture but there is evidence of a lack of attention to measuring the impact and outcomes of services in any systematic way. [18]

Commissioners should:

• make sure that services are continually assessed in terms of how effective they are in meeting the needs of the people they are supporting and whether they represent value for money [8]
• encourage service providers to show how they will increase users’ independence and measure the outcomes of the service/what has been achieved to determine success – rather than measure the number of people provided with a service or what activities are performed [4]
• work collaboratively with the Care Quality Commission (or in Northern Ireland the Regulation and Quality Improvement Authority) in sharing information and in ensuring the quality of service providers
• include the principles of human rights and the quality of outcomes (rather than just checking outputs and processes) to make sure that providers prioritise and deliver on these areas [1]
• take into account the particular needs of certain groups including:
  • people living in rural areas
  • people from black and minority ethnic groups
  • people from the lesbian, gay, bisexual and transgender (LGBT) community [15]
  • people who misuse substances
  • people with learning difficulties
  • refugees and asylum seekers
• set high standards for monitoring
  • high-quality monitoring involves face-to-face interviews with service users and their ‘unpaid’ carers
  • it places older people’s views at the heart of the assessment of the quality of care
  • examples include training older people from the local community as ‘citizen assessors’ to talk to other older people receiving care at home, or involving voluntary organisations that specialise in working with older people [1]
  • commissioners should act on the feedback they receive.