Homecare: commissioning is the key to quality, fair work and better outcomes
The Homecare Association have produced a new paper to contribute to discussions on commissioning: Homecare: commissioning is the key to quality, fair work and better outcomes.
The report argues that four commissioning decisions must align:
Price: the fee must cover the lawful and efficient cost of the service required.
Allocation: each provider location needs sufficient, reasonably predictable work within a compact geographical area.
Payment mechanism: providers should be paid for assessed need, planned capacity or agreed outcomes, rather than retrospectively for isolated contact minutes.
Assurance: contracts must secure safe, good-quality care and the lawful and fair treatment of workers.
A serious failure in any one of these areas cannot be offset by strength in another, though they do interact.
The Homecare Association propose a practical pathway from fragmented, minute-based purchasing, through viable neighbourhood commissioning, towards consumer-directed, outcomes-based care.
In the longer-term model, assessed need would create a portable personal funding entitlement; the person would direct that funding to a chosen provider within a quality-assured local network; and the provider would receive prospective or regular payment mainly for assessed need and capacity, with flexibility over delivery and a modest adjustment for outcomes, experience and quality.
The report also considers the implications for workforce security, the Employment Rights Act, the proposed Fair Pay Agreement, neighbourhood health, prevention, consumer choice and the sustainability of local authority and NHS-funded care.
The Homecare Association have shared the report with ministers and officials responsible for social care, local government and employment rights. They hope it will also contribute to wider discussion across the sector about how commissioning can support better lives, fairer work and more effective use of public resources.