Paying providers by the hour stifles quality, say council heads

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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