Ministers bid to end home care contracting by the minute

Ministers want to end the practice of councils contracting for home care “by the minute” or in short-time slots but will do so by spreading good practice rather than banning it, revealed yesterday’s White Paper.

It said commissioning practices that “put such tight constraints on how care and support is provided are unacceptable”, compromised service user dignity and safety and should be brought to an end. The government has charged Think Local Act Personal (TLAP) – the sector coalition that supports the implementation of personalisation – with achieving this ambition by working with councils and providers to encourage commissioning by outcomes.

The news drew a qualified welcome from the United Kingdom Homecare Association (UKHCA), which last week produced evidence showing three-quarters of home care visits were commissioned for 30 minutes or less and that one-third of providers felt service users’ dignity was being compromised by the shortness of visits.

Warning

The proposal “should benefit people who use services”, said UKHCA chief executive Bridget Warr. “However, in practice we need to see that local authorities use this to commission genuinely dignified and effective care, not just to re-jig inadequate visit lengths into fewer visits each week.”

The measure was one of a number in the White Paper designed to improve the quality of social care provision. As of yesterday, all providers of registered domiciliary or residential care in England have a profile on the government’s NHS Choices website. Though this currently contains basic information and details of compliance with Care Quality Commission (CQC) essential standards, these will be supplemented by April 2013 to include:-

• Information on performance against quality standards being developed by the National Institute for Health and Clinical Excellence (Nice) as part of its new social care role;
• Details on complaint levels, drawn from the local government ombudsman;
• Feedback from families who use the service, pooled by government from the growing number of consumer ratings websites for care services;
• Reports from the local Healthwatch – the new body to represent health and social care consumers;
• Information published by providers on issues such as staff turnover and training and the number of falls in a care home as part of a recently launched transparency and quality compact.

However, this raises the prospect of variable levels of information being available on providers. Healthwatch reports will only apply to certain providers and it will be up to organisations to test themselves against Nice quality standards – through a nationally agreed audit procedure – and sign up to the transparency and quality compact.

Confusion

Concerns were also raised about the potential confusion arising from the number of bodies now involved in assessing or promoting social care quality, including the CQC, Nice, TLAP, the Social Care Institute for Excellence and the Healthcare Quality Improvement Partnership.

“The whole picture is getting quite confusing,” said John Adams, general secretary of Voluntary Organisations Disability Group, which represents voluntary care providers. “You’ve got all these agencies involved and provides investing in their own quality systems.”

On the provider profiles, he added: “Transparency is all important; it’s whether members of the public can find their way through the data and understand it.”

Other key measures for providers

• Councils will be under a duty to promote diversity and quality in the provision of services – all authorities will have to produce a “market position statement”, encompassing information on how they will improve diversity of provision and on their commissioning practices;
• The government will consult in autumn 2012 on whether there is a need for greater oversight of bigger care providers to guard against care being adversely affected by a collapse such as that of Southern Cross;
• Ministers aim to double the number of social care apprenticeships to 100,000 over the next five years, including by encouraging smaller providers to take them up;
• The long-promised code of conduct and minimum training standards for adult social care and healthcare support workers will be published in September 2012 and the CQC will be asked to take account of this in its judgements of providers’ compliance with staffing standards;
• The government will work with providers to develop a sector-specific compact on improving skills and training;
• It will explore how to improve support for registered managers, including through regular mentoring and supervision, through a new leadership forum for social care, which will be established by March 2013.

More White Paper coverage

Sector slams lack of funding solution in care White Paper

Care assessments to be outsourced under White Paper plans 

What people are saying about the care White Paper 

Social care White Paper: early responses