Care home commissioning overhaul improved council’s relationship with providers, finds study

A change in commissioning practices and a leadership programme for care home managers were among changes that have helped improve the relationship between Essex council and local care providers, a report has found.

The evaluation of the My Home Life Essex scheme, carried out by National Development Team for Inclusion (NDTi) and funded by the Joseph Rowntree Foundation (JRF), said the changes resulted in better commissioning, a focus on quality improvement rather than monitoring compliance, investment in care, better leadership and support networks for care home managers.

The study found signs of improvements in care for older people as a result of the programme and warm interactions between staff and residents, but said the “changes brought about in Essex have yet to show clear impacts” for care home residents.

The My Home Life programme, sponsored by Age UK, City University, JRF, participating local authorities and the City Bridge Trust, aims to improve the quality of life for everyone involved with care homes and develop care focused on relationships between staff, older people and their families. It has eight themes – managing transitions; maintaining identity; creating community; sharing decision making; improving health and healthcare; supporting a good end of life; keeping a workforce fit for purpose; and promoting a positive culture – and a central part of it is a leadership development programme for care home managers.

Essex council introduced the scheme to try to improve the quality of care in residential care homes in the county, which are all owned by external providers.

Quality improvement team set up

It set up a new quality improvement team, including someone who took the role of quality innovation lead. The team aimed to support providers to improve and to deal with problems rather than take a “punitive” approach to monitoring.

The council also established a leadership development programme and a network for care home managers, which helped to reduce their isolation and enabled them to problem solve with their peers. The report said the leadership programme and the support of the quality improvement team had improved the confidence of care home managers. This helped them develop stronger relationships with other health and social care organisations, such as a clinical commissioning groups, leading to joint solutions to problems.

The council also invested £8m to incentivise providers to adopt an approach which built relationships between older people, staff and commissioners, and meant staff could understand and respond to older people as individuals.

The investment included payments built into the care homes’ contracts linked to progress on the themes of My Home Life Essex. Contractual decisions were also based on performance against the themes. The council also produced a self-assessment process for care homes in the programme.

However the report said not all care home proprietors in the county were “fully committed to the Essex approach” – some did not take part in the voluntary programme – and incentives or regulation may be needed to involve them. The report mooted the idea of making involvement in My Home Life Essex mandatory for care homes in the county.

The study also said the voices of older people had “not been strong to date” in the programme but it added that discussions are underway between commissioners and providers about a broader range of models of care with the voices of older people “central to these developments”.