Home care market ‘faces collapse without total overhaul’

The “fragmented” home care market risks collapse unless councils and providers work together to reshape it around the objectives of active ageing, reablement and maintaining independence.

That was the verdict of a report today from the Institute for Public Care (IPC) at Oxford Brookes University, which has separately been commissioned by government to help councils improve the way they shape local care markets.

The current home care market is characterised by a wide range of small and medium-sized providers, trying to meet very different needs and struggling to remain viable because of rising costs and static council fees.

Little evidence of what works

There is little evidence of what works and services are not integrated with other community-based provision, leading to significant inefficiencies at a time when demographic pressures were pushing up the overall demand and cost of home care. At the same time, there were large concerns among service users about quality, particularly due to rushed care visits driven by time-based council commissioning, and a workforce characterised by low pay and a lack of qualifications.

While there was a growing market of self-funders and increasing use of direct payments or personal budgets to purchase home care, the report said consumer pressure could not be relied upon to reshape the market. This was not just because councils would continue to fund a large proportion of services into the future but because home care needed to meet clear public policy objectives, such as reducing hospital or residential care admissions and dependency among older people.

Blueprint to reshape market

The IPC said that government, commissioners and providers needed to come together to “reconfigure” the home care market to meet three separate objectives:
• supporting people to live well in the community through low-level care and support to access community activities (lifestyle):
• preventing people with significant needs from going into hospital or residential care through short-term interventions (reablement);
• helping maintain people with care needs in the community over the long-term (maintenance).

Each sub-market would be characterised by different providers, commissioning arrangements and levels of staff skill and regulation, but in each case home care would be effectively integrated with other services with similar objectives.

Key challenges for commissioners – across all three areas – involved only funding provision that demonstrated benefits, including through payment by results arrangements, and ensuring services were targeted at clients for whom they would be most effective. Home care providers also needed to consider working together with services from other sectors – such as equipment – and reconfiguring their provision to promote independence and reduce dependency.

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