In Key to Care, we recommended that councils look at their commissioning practice and implement more user focused services using outcomes rather than time and task. Buckinghamshire County Council invited us in yesterday to talk about Commission on the Future of the Home Care Workforce and to facilitate a conversation between themselves and their potential providers as they prepare to re-commission home care services.
In the morning, I did a short presentation on our findings to council staff, councillors and staff from councils across the South East. Lauren Lucas our head of projects – mentioned in the intro that Key to Care generated a huge amount of publicity – including the front page of the Mirror (if you’re going to hit the tabloid headlines – this is the way to do it!).
I explained that part of the reason that it did, was that the report was based around stories. Stories of care workers, carers and those needing care – and that this is the same approach that has to underpin outcomes based commissioning. This isn’t the easiest way to gather performance information or evidence of effectiveness, but it’s the one that will generate change in how we do home care: convincing councillors and engaging the wider community.
Time and task and workforce
When council colleagues were asked what the could do to move away from time and task issues in commissioning and support a well-developed workforce. Trust was the key issue. Trusting providers, trusting the community, trusting the workforce and maybe most importantly trusting service users themselves.
Key to Care emphasised the importance of valuing the workforce. Care workers can’t feel valued if they don’t feel trusted and listened to – sharing their knowledge about the needs of service users and good ways to meet them.
Commissioners and social care staff acknowledged that this would have to be a big cultural shift, but one that was worth making.
On the other side of trust, was information. Councils thought that much more could be done to take advantage of new technologies and that care should be a data driven business. And while no one thinks that tech can replace humans in care, there’s a great deal of variability in how well information technology, smart phones and apps are used to support care services. The LGiU wants to work with councils to develop applications that support better information sharing between care workers and support both more consistent care and more flexible approaches.
Councils and providers
In the afternoon, we ran a workshop on bringing together county council staff and domiciliary care providers and asked them to look at challenges and priorities from each others’ perspectives. There weren’t many surprises, but once again trust was a key issue. Where the trust really mattered was in the assessment of home care clients’ needs. Home care providers have to make assessment of client need and this could be used to support the council’s assessment (councils have to make broader assessments of need which can’t solely rely on provider assessments) and in follow-up assessments where support needs are re-assessed after a certain period of time or when needs change for the better or worse. Currently, this can cause delay in addressing needs at home for the client or in getting payment for extra care for the provider.
By hosting this collaborative conversation between commissioners and providers, we’re taking the first step toward not only building trusting professional relationships, but the commissioning frameworks that can support them.