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Home care in England: Summary

Views from commissioners and providers

Care is provided at home each year to more than 350,000 older people and 76,300 young people with disabilities. Commissioning and delivering the highest quality home care should be a significant objective of our health and social care system.

Between 2016 and 2018, The King’s Fund carried out three pieces of research exploring: the factors driving commissioning adult social care; the mechanisms of purchasing and delivery of home care; alternatives to traditional models of delivering care at home. This report draws together the findings of those research projects, which record the stated opinions of commissioners, providers and other stakeholders.

Recruiting and retaining home care staff remains a fundamental challenge for providers, but the extent of the challenge varies greatly depending on geographical location, with those in some rural and also in some prosperous areas particularly struggling.

Despite the challenges facing providers, most councils commissioning home care attempted to hold down the fees they pay. Commissioners and providers disagreed about whether quality of home care had declined in recent years and, if it had, the role of fees in that process.

Home care continues to be commissioned on a ‘time and task’ basis rather than with a view to health and care outcomes. Nor is there much evidence that health and care providers are joining up commissioning of home care.

Alternative approaches to home care provision have yet to demonstrate they can be scaled up effectively, while approaches using new technology have not yet had time to be properly evaluated.