Local councils warned that "paying for failure cannot continue"

Three quarters of council social care departments doubt their capability to achieve fully personalised care-in-the-home services based on the current systems they have in place, according to research undertaken by the Local Government Information Unit (LGiU).

The LGiU has collaborated with home care company Mears Care Ltd in order to investigate the pressures that providers face in delivering outcome-focused services as demand for provision increases, collated in its report ‘Outcomes Matter: effective commissioning in domiciliary care’.

The purpose of the investigation was to investigate whether outcome-based commissioning and personalisation agendas have been successfully expanding despite declining public resources, with ‘patchy’ results reported.

Ninety per cent of social service departments that contributed to the findings found pressure on resources to be a constant concern, while three quarters felt their output was too attached to a ‘services on a time-task basis’.

Head of external relations for Mears, Abigail Lock, is keen to see this factor addressed, commenting: “Having grown up as a child carer for my father who had Multiple Sclerosis and received twice daily visits from care workers it often felt like we were part of a ‘conveyor belt of care’ just another family on the assembly line. Sadly fifteen years on and despite all the talk of personalisation too little has changed and little will so long as we continue to pay those delivering care on a task and time basis.”

Ms Lock continues, “Paying providers on this basis does nothing to promote the dignity of the individual requiring support, restricts a personalised approach (after all what one provider can deliver in fifteen minutes is often the same as what another provider can deliver in the same time) piles the pressure onto care workers and does nothing to incentivise prevention. In fact, in many cases the system is paying for failure. If someone in receipt of care deteriorates the care provider is rewarded with more hours. This cannot continue.”

Outlining the challenge faced by social service departments, the report states: “Increased levels of demand and complexity are coupled with a reduction in resources. The government’s commitment to eliminate the budget deficit within a single parliament has major implications for council budgets: the October 2010 Spending Review reduced central government’s grant to local government by 28 per cent over four years. Although this was offset to some extent by additional funding for health and social care, there are still major savings to be found from this service.”

This disparity between rising demand and declining resources leads the LGiU to call for a ‘shift in our understanding’ of how to approach caring for vulnerable adults, with ‘broader change’ required that includes: greater investment in preventative support; more support for independent-style living; a more versatile approach to informal care; and more extensive advice and information services.

Further issues highlighted include the tendency to purchase services in block contracts, which the LGiU wants to see become a thing of the past, advocating framework – or ‘umbrella’ – agreements as an alternative that are more suited to tailored care packages.

Utilising direct payments is also recommended, as well as access to a wider range of providers in order to maximise choice, although the LGiU does not believe there is a ‘one-size-fits-all model’ that offers all the answers.

Sarah Pickup, president of the Association of Directors of Adult Social Services (ADASS), has also called on local authorities to realise the urgency of the situation, describing services as “on the edge” to delegates at the National Children and Adult Services conference in Eastbourne:

“We will not emerge from these tough times anytime soon… The light at the end of the tunnel remains distant and flickering.

“Providers have a responsibility to ensure they can deliver against a service specification for the price they tender – including ensuring that they can recruit, train and retain sufficient suitable staff; cover travel costs and time, and pay at least the minimum wage.”

Ms Pickup believes that pressures on personal budgets means “a squeeze on providers as they try to compensate for frozen or lower prices and sometimes to deliver care in visits that are too short. The loser, of course, is the person who we all say should be at the centre of what we do.

“From the point of view of the person using services the objective is coordinated care. We must hold onto this as a common purpose – the ‘why’, when looking at what to integrate, and how.”

Ms Pickup concluded, “National government is relying on local government and its partners to take good decisions to drive forward its vision. For their part local government and its partners are relying on national government to take good decisions about how to fund it.”

The LGiU recognises that innovative and effective approaches are possible, finding schemes in Wiltshire, Essex and Wirral to be fine examples of how personalisation goals can be achieved despite a tough climate for funding.

Wiltshire County Council’s ‘Help to Live at Home’ scheme, for example, offers rewards to care providers that achieve quality outcomes and integrates personalisation methods with prevention as a way of driving down long-term costs.

Independent chair of transformation Angie Carmichael says of the Wiltshire scheme: “Cultural change and customer/service user involvement are inherently linked. Engagement is the key to changing the way things are done and ensuring services are designed around the needs of the customer.”

Health Secretary Jeremy Hunt comments on the report: “Commissioning for outcomes is an important issue that we need to get right, to deliver the kind of service and the quality of service that people need. We made a strong commitment in the Caring for our Future White Paper to work with the sector to bring an end to time and task commissioning practices that undermine people’s dignity and choice. This report provides further evidence to support this drive and a useful checklist for local authorities to help them to change their behaviours.”

Care Services Minister Norman Lamb also comments: “As we set out earlier this year, we want to put an end to undignified care by the minute. We want care that is judged by the outcomes that matter to people receiving the care.

“We know that some councils and care providers are leading the way, but there is still a long way to go. We will continue to work with care providers and people who use the services to bring an end to providing care that undermines people’s dignity and choice.

“I am determined that collectively we develop commissioning skills so that providers are rewarded for improving health and well-being, promoting independence and increasing mobility.”

To vote in our debate on the ‘time-task culture’ please visit: www.homecare.co.uk/news/article.cfm/id/12/should-there-be-a-minimum-time-of-30-minutes-for-home-care-visits