Paying providers by the hour stifles quality, say council heads

Commissioning services by time is hampering a shift to outcomes-based commissioining, say council members and officers.

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Commissioning care by the hour is stifling councils’ ability to focus on the quality of care and improve outcomes for users, a survey of council officers and members has found.

Despite widespread support for outcomes-based commissioning – under which providers are paid for helping service users achieve agreed goals – an approach that costed services according to time and the delivery of certain tasks remained prevalent, found the research by the Local Government Information Unit (LGIU) and care provider Mears.

Three-quarters of the 210 respondents said ‘a culture of running services on a time-task basis’ was a key barrier to outcomes-based commissioning. Ninety three percent of respondents said home care providers were paid on the basis of time, with 37% saying they were paid by the minute or the quarter of an hour.

While 62% said they used outcomes-based commissioning in most or all cases, 38% said it was used to a limited degree or not at all. 

This was despite the fact that a move to commissioning residential and domiciliary care based on outcomes was seen as ‘very important’ for social care by seven out of ten respondents, while over 60% saw it as an opportunity to cut costs.

Among other barriers to outcomes-based commissioning, 38% of respondents cited a lack of up-front investment, 37% a lack of council contract management skills and 29% a lack of trust between commissioners and providers.

The LGIU and Mears have launched a campaign to gather and share good practice on outcomes-based commissioning. To contribute, email Lauren Lucas, policy manager at the LGIU.

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