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Home care in England

Views from commissioners and providers

Authors: Laura Jefferson, Laura Bennett, Patrick Hall, Julia Cream, Veronica Dale, Matthew Honeyman, Yvonne Birks, Karen Bloor and Richard Murray

This report aims to understand the key trends and challenges facing the home care sector, based on discussions with commissioners, providers and national social care organisations. It draws on work carried out between 2016 and 2018, when The King’s Fund produced three linked pieces of research into issues affecting the home care market in England, in collaboration with the University of York.

  • Adult social care: local authority commissioning behaviours, which examined the factors driving commissioning of adult social care (including care homes) in England (Jefferson et al 2017). It explored the factors that either constrain or support commissioners to use their purchasing powers to shape the market. In total, 23 participants from 20 organisations – local authorities and national stakeholders – were interviewed.
  • Understanding domiciliary care in England, which aimed to improve understanding of the mechanisms of purchasing and delivery of home care, including the current state of supply and demand and key drivers of market dynamics (Hall et al 2017). It drew on the report into local authority commissioning behaviours, but also used the following analysis:

◦◦ a literature review of reports, articles and reviews published in the previous five years

◦◦ national data analysis, drawing on samples of the labour force data supplied by Skills for Care from the National Minimum Data Set for Social Care (NMDS-SC) and data on registered providers of care from the CQC, along with data on expenditure and activity from NHS Digital. Other data sources included the Relative Needs Formula for adult social care, which estimates need to guide local funding; data on delayed transfer of care; and contextual data from the Indices of Deprivation and the Annual Survey of Hours and Earnings

◦◦ 20 qualitative interviews with providers and commissioners in six locations across England, as well as interviews with a number of national stakeholders, including the CQC.

  • New models of home care, which involved a literature review and 10 interviews with innovative providers and commissioners (Bennett et al 2018). It explored alternatives to traditional ‘time-and-task’ models of delivering care at home, highlighting a wide range of emerging models of care:

◦◦ technology and digital, including assistive technology and inhome monitoring

◦◦ co-ordinated care planning

◦◦ new approaches to recruitment in home care, including values-based recruitment

◦◦ autonomous team working, including the Buurtzorg model and wellbeing team

◦◦ alternative approaches to commissioning, including outcomes-based models

◦◦ personalisation, including personal budgets and integrated service funds

◦◦ integrated care approaches

◦◦ community asset or connections models, including Community Circles

◦◦ family-based support and community living models such as Shared Lives and Homeshare.

This report is based largely on these three pieces of work. It uses the original research, analysis and interviews from all three and combines them to further define and explore key trends and challenges, to form a narrative about the state of the home care market in England. It should be noted that the report, and the original material on which it draws, record the stated opinions of the participants, whether commissioners, providers or other stakeholders. These views give insight into why participants behave as they do in the home care market – why, for example, commissioners believe it is reasonable to focus on driving down the price they pay for home care – but do not necessarily explore the evidence for these beliefs or their consequences.

The report also includes references to other publications by The King’s Fund that touch on the subject of home care, in particular Reimagining community services: making the most of our assets (Charles et al 2018) and Understanding quality in district nursing services: learning from patients, carers and staff (Maybin et al 2016).