Commissioning needs to move with the times if home care is to meet user demand

Council commissioners are in the firing line of a report revealing home care services are inflexible and highly rationed, reports Josephine Hocking

Home care for older people in England is often inflexible, misses opportunities to promote independence and suffers chronic
staff shortages, a report published last week by the Commission for Social Care Inspection has found.

Despite government policy on early intervention, CSCI found services are concentrated on older people with severe needs and that many who would benefit from home care do not receive it.

Its hard-hitting report portrays services that often fail to meet older people’s needs and are delivered by a poorly skilled, low-paid workforce, whose turnover is estimated at up to one-third a year. Some employers were also found to “cut corners” on selection and recruitment and 39 per cent of inspected agencies failed national minimum standards in this area, which includes staff checks.

Despite the concerns, services have improved since the sector started being regulated three years ago, the report states.

Three-quarters of providers were found to comply with national minimum standards and CSCI inspectors had most praise for “particular aspects of personal care, associated with the usually respectful, caring and helpful attitudes of staff ”.

The commission predicts that demand for home care will continue to rise and says council commissioning must improve to support older people in line with government policy on independence and choice.

“Just doing more of the same will not deliver better personalised care services,” says CSCI chair Denise Platt in the report.

Action on Elder Abuse chief executive Gary FitzGerald, who was a local authority domiciliary care manager for 20 years, agrees that commissioning needs to improve. “Local authority commissioning practices have not kept pace with government expectations and the changing direction towards choice, control and independence,” he says.

The report cited major variations between areas in numbers supported by councils and service quality. Good practice (see Good practice cited by CSCI) highlighted in the report may not be more expensive than traditional services, although further evaluation is needed, according to CSCI.

Jenny Owen, director of adult care at Essex Council and co-chair of the Association of Directors of Social Services’ older people’s committee, says home care is “still developing”.

She says councils are working on outcome-based commissioning but Colin Angel, head of policy at the UK Home Care Association, says this practice is “not well developed”.

CSCI wants the government to bring forward its review of home care’s national minimum standards. Last week at the National Children and Adult Services conference health secretary Patricia Hewitt stressed the report’s importance – so change may
be on the cards.

● Essex Council: uses direct payments.
● Mushkil Aasaan: charity set up by Asian women in London borough of Wandsworth, provider of specialist domiciliary care
● Sunderland Home Care Associates: employee-owned social enterprise.
● Oldham Council: uses individual budgets.
● Shropshire and Leicestershire councils: in-house home care teams place emphasis on promoting independence.
● Thurrock and Hartlepool councils: use outcome-focused commissioning and involve service users in planning provision.

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