A new report from local democracy think-tank the LGiU and social care provider Mears, endorsed by the Secretary of State for Health, argues that a culture of delivering care in 15 minute time slots is affecting the quality of life of older people and other recipients of social care services.
A survey of 113 local authority adult social care departments, reveals that the majority regard a shift to ‘outcome-based commissioning’, in which care providers are paid according the results they deliver for the individual, is a crucial element of care provision in future.
Despite this, three quarters of councils don’t believe that their current systems and processes will be sufficient to manage adult social care provision in future, and that a ‘time-task culture’, where service users are allocated social care in short slots of time, is the biggest barrier to a better quality of life for recipients of care.
Outcomes Matters argues that instead of paying care providers on their ability to get care workers in and out of a person’s property in 15 minutes, we should be paying them according to whether they have reduced hospital admissions, prevented falls and enabled independence for the individual.
A summary of the report can be downloaded here.
Secretary of State for Health Jeremy Hunt commented:
‘Commissioning for outcomes is an important issue that we need to get right, to deliver the kind of service and the quality of service that people need. We made a strong commitment in the Caring for our Future White Paper to work with the sector to bring an end to time and task commissioning practices that undermine people’s dignity and choice. This report provides further evidence to support this drive and a useful checklist for local authorities to help them to change their behaviours,’
Minister for Social Care Norman Lamb commented:
‘As we set out earlier this year, we want to put an end to undignified care by the minute. We want care that is judged by the outcomes that matter to people receiving the care.’
‘We know that some councils and care providers are leading the way, but there is still a long way to go. We will continue to work with care providers and people who use the services to bring an end to providing care that undermines people’s dignity and choice.
I am determined that collectively we develop commissioning skills so that providers are rewarded for improving health and well-being, promoting independence and increasing mobility.’
Director of Policy at LGiU Jonathan Carr-West commented:
“Councils are keen to find the best way to incentivise providers to deliver outcomes to individuals instead of focusing on narrow financial and time-based targets. Our survey shows that local government is shifting its approach which is very welcome – despite cuts in funding we are seeing a smarter approach to commissioning.”
Nevertheless, councils are still concerned about how this will be achieved. Outcomes Matter: effective commissioning in domiciliary care,identifies a five point checklist for better outcome-based commissioning.
1) Are you contracting for outcomes?
2) Have you considered the local drivers for need?
3) How well aligned is your commissioning for housing, health and social care?
4) Do you empower providers?
5) How engaged are elected members?
Mears Executive Director Alan Long said;
‘It shouldn’t matter if a care provider delivers services in ten minutes or ten hours, what matters is achieving a personalized service for individuals and improving their wellbeing. We would like to see care providers paid on the outcomes they achieve whether this be reducing the numbers of hospital admissions or increasing freedom for family members and carers.
While most Local Authorities support outcomes based commissioning, in most cases current tendering processes make delivering outcomes impossible.’
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About the LGiU
The LGiU is an award winning think tank and membership organisation. Our mission is to strengthen local democracy by putting citizens in control of their own lives, communities and local services. We work with local councils and other public service providers, along with a wider network of public, private and civil society organisations.
Mears is the leading social housing repairs and maintenance provider in the UK and a major presence in the domiciliary care market – bringing the highest standards of care to people and their homes. Partnering with clients, 13,000 Mears Group employees maintain, repair and upgrade people’s homes, care for individuals and work in communities across the country – from inner city estates to remote rural villages.
The report contains a number of case studies from councils around the country:
Case study 1: Wiltshire County Council’s ‘Help to Live at Home’ scheme
Wiltshire County Council’s ‘Help to Live at Home’ scheme rewards and penalises providers on the basis of their performance against outcomes. They have replaced traditional community care services for older people with an integrated system of care and support. “Help to Live at Home” reconciles three competing aims of social care reform: personalisation, recovery and prevention.
Assessments are person-centred and focus on outcomes, especially outcomes that leave customers better able to live well with less care. They aim first to help people recover their independence and then to stop their need for care growing. Reablement is not a special kind of service; it is the aim of all services.
Help to Live at Home pays for outcomes that improve or preserve independence. The Council applies financial penalties when customers’ outcomes are not achieved and rewards care providers when customers recover faster than planned. Wiltshire Council believes that buying outcomes instead of hours is a commercial incentive to improve the pay and skills of the care workforce.
Case study 2: Wirral Rapid Access Contract
Wirral’s Rapid Access Contract has broken down organisational boundaries to minimise discharge times for hospital patients around shared outcomes. Wirral PCT was experiencing problems with discharge times for people leaving hospital. The referral system was resulting in people remaining in hospital for longer than required. This had an impact on the patient’s health and recovery time, and was costing the service money and creating a bottle-neck for bed allocation. To address this problem, the PCT formed a partnership with the local authority, Mears, and three other social care providers to deliver a ‘rapid access’ contract that aimed to get people discharged within 24 hours.
Previously when a ward manager discharged a patient their case was referred to a broker, who tried to find a home care provider who could take on their case. Under the new arrangement, when an individual is deemed medically fit for discharge but does not have a package of home care in place, care plan and risk assessments are completed by a multi-disciplinary team at the hospital to cut down on waiting times for discharge. So far 280 clients have been allowed home from hospital on the rapid access contract all within 24 hours.
Case study 3: Payment by results in reablement – Essex County Council
Essex County Council is currently engaged in a long-term programme to shift their care and support provision away from a time task approach. They have already moved towards a best value ranking framework which emphasises both cost and quality. Their next challenge is to work with providers to develop a performance-based system, which pays for outcomes, rather than activities, and which promotes independence for service users wherever possible.
With this in mind, they have embarked on further consultation with providers and re-tendered their reablement service. Formerly, providers were paid for six-week packages at a set price. Under the new model, they will be paid in two ways. They will still receive a set price for the package, but will also receive a bonus payment if, at the end of the reablement plan, the service user does not require any further support.
The council intends to move away from setting an arbitrary number of weeks for the package, which will be shorter or longer than six weeks depending on the needs of the individual service user. Ultimately they aim to move all their home care provision onto a performance-based model. For service users with learning disabilities, they are working specifically on developing whole life budgets with an emphasis on pathways to independence.