Personal budgets managed by providers could help end the delivery of home care in short, task-focused slots so long as “significant challenges” in implementation are overcome, a study has concluded.
Using individual service funds (ISFs) in home care: a case study
Mary is 86, widowed, has suffered several falls in the past year and has become more confused in recent months. She needs support to shower safely and to make sure she eats and drinks and takes her medication, but doesn’t want to manage a direct payment. Her neighbour knows a good care agency, and Mary and her son agree on an ISF.
Mary’s has £4387.50 to spend a year on support and the agency charges £12.50 an hour. She and her son agree the provider will come in for an hour, three days a week, for half an hour on other days, and for 15 minutes each evening, with the timings negotiated.
Mary prefers to be supported by women and wants to know who will be coming to support her. As well as personal care, she needs support to maintain her social contacts, such as encouragement to go to church.
All of this is agreed with the provider and council. Financial arrangements are put in place to manage Mary’s contribution to her care and a six-weekly review agreed. As a contingency, Mary’s daughter asks neighbours to pop in to see how things are going and promises to contact the adult care department if more support is required.
Source: Individual service funds for home care by In Control and Helen Sanderson Associates
Individual service funds (ISFs) would enable people who did want the responsibility of a direct payment to choose how and when they receive care from their provider, rather than having this determined by commissioners, said the paper from In Control and personalisation consultancy Helen Sanderson Associates.
It said home care was “one of the most challenging areas of adult social care to truly personalise” but ISFs could help engineer a shift away from the much-criticised “time and task” approach to commissioning, in which services are delivered in short time slots and focused on completing personal care tasks. However, the paper warned that it was still early days in the use of ISFs in home care and the process for implementing them was complex for both councils and providers.
Choice and control
Ideally, ISFs should enable people to choose their support workers, when they receive support, whether this is at home or out and about, the type of support they receive and how it is delivered. They should also be able to choose the provider who both manages the budget and provides their care, and whether any part of the budget is spent with another provider.
To bring this about, providers needed to clear with service users about the costs of their services and what they can and cannot deliver, and ensure that the person knows how their budget is being spent, ideally in real time, with the details included in an accessible agreement with the service user.
Councils would also have to set up agreements with providers detailing issues such as how they will be paid, for instance whether this is gross or net of the clients’ contribution, how they will be audited for the use of the budget and how disputes and service failures would be managed.
“There is likely to be a significant increase in the use of ISFs for home care over the next few years,” said the report. “While we welcome the increased adoption of this model care needs to be taken that ISFs are being used in the right way.”
Strong provider backing
The study has the strong backing of providers, who have long bemoaned the time and task model; the report was sponsored by home care provider Mears and the United Kingdom Homecare Association. However, it was also supported by Lancashire and Wirral councils.
It comes with the government having pledged to end the “crude contracting by the minute” in home care, and tasked the Think Local Act Personal coalition with bringing this about in partnership with providers, commissioners and service users.
UKHCA policy director Colin Angel said ISFs “offered an exciting opportunity for delivering really person-centred outcomes for people supported by home care services”, and were “a positive move away from time and task commissioning”.
Alongside the paper, Individual service funds for home care, a benchmarking tool has been produced for providers to test their progress in developing ISFs, as part of Helen Sanderson Associates’ Progress for Providers series.