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:

• have a genuine commitment to partnership working and collaboration – working together
• have the ability to work across different budgets to create seamless services that range from practical and social through to more rehabilitative/reablement [8]
• involve people who use services at the planning stage alongside their unpaid carers
  • people with complex needs may struggle to express their preferences
  • unpaid carers can provide invaluable information to help with the organisation of services [16]
• think about the benefit of designing services around a single point of entry
  • a big complaint of users and their unpaid carers is that they are not aware of the full range of services available and do not know how to access that information
  • many of those involved in the care process are also unaware of what is on offer and are unable to provide advice [6]
• think about the role that ‘assistive technology’ can play in the provision of services to older people with complex needs
  • this is a device or system that helps people to do things they would otherwise not be able to do or increases the ease or safety with which they do things
  • evidence suggests that ‘telecare’ – care provided remotely – can create efficiency savings by reducing the number of bed days and the level of home care needed, but success depends on the attitudes of older people towards it [14]
  • the use of a lifeline system (an emergency button connecting users to a 24-hour helpline) should be encouraged, particularly for users with complex needs who live alone, and those with mobility problems
  • technology has also been shown to be an effective way of providing support to unpaid carers [11]
  • See practice example 9 to learn how the London Borough of Hammersmith and Fulham is working to promote the use of assistive technology in home care.