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The challenges of commissioning home care for older people in England: commissioners’ perspectives

Published online by Cambridge University Press:  21 February 2020

Karen Davies Open the ORCID record for Karen Davies [Opens in a new window] ,
Elizabeth Dalgarno ,
Susan Davies ,
Amy Roberts ,
Jane Hughes ,
Helen Chester ,
Rowan Jasper ,
David Wilson  and
David Challis
Karen Davies*
Affiliation:
Centre for Primary Care, University of Manchester, Manchester, UK
Elizabeth Dalgarno
Affiliation:
Centre for Primary Care, University of Manchester, Manchester, UK
Susan Davies
Affiliation:
Centre for Primary Care, University of Manchester, Manchester, UK
Amy Roberts
Affiliation:
Centre for Primary Care, University of Manchester, Manchester, UK
Jane Hughes
Affiliation:
Institute of Mental Health, University of Nottingham, Nottingham, UK
Helen Chester
Affiliation:
Institute of Mental Health, University of Nottingham, Nottingham, UK
Rowan Jasper
Affiliation:
Centre for Primary Care, University of Manchester, Manchester, UK
David Wilson
Affiliation:
Tameside Metropolitan Borough Council, Ashton-under-Lyne, UK
David Challis
Affiliation:
Institute of Mental Health, University of Nottingham, Nottingham, UK
*
*Corresponding author. Email: karen.davies-3@manchester.ac.uk
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Abstract

Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves ‘managing’ and ‘shaping’ the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than ‘time and task’ objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning.

Keywords

home care providerscommissioningcontractingcollaborationolder people
Type
Article
Information
Ageing & Society , Volume 41 , Issue 8 , August 2021 , pp. 1858 - 1877
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press.

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References

Bamford, T (2013) Commissioning and Purchasing. Abingdon, UK: Routledge.10.4324/9780203193952CrossRefGoogle Scholar
Bertelli, AM and Smith, CR (2009) Relational contracting and network management. Journal of Public Administration Research and Theory 20, 21–40.10.1093/jopart/mup033CrossRefGoogle Scholar
Bottery, S (2018) Home Care in England: Views from Commissioners and Providers. London: King's Fund.Google Scholar
Bovaird, T (2006) Developing new forms of partnership with the ‘market’ in the procurement of public services. Public Administration 84, 81–102.10.1111/j.0033-3298.2006.00494.xCrossRefGoogle Scholar
Bovaird, T (2016) The ins and outs of outsourcing and insourcing: what have we learnt from the past 30 years? Public Money & Management 36, 67–74.10.1080/09540962.2015.1093298CrossRefGoogle Scholar
Braun, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.CrossRefGoogle Scholar
Breakwell, GM (2006) Interviewing methods. Breakwell GM, Hammond S, Fife-Shaw C and Smith, JA (Eds.)(2006). Research Methods in Psychology. London: Sage, pp. 232–253Google Scholar
Chester, H, Hughes, J and Challis, D (2010) Patterns of commissioning, contracting and care management in social care services for older people in England. British Journal of Social Work 40, 2523–2537.10.1093/bjsw/bcq044CrossRefGoogle Scholar
Coleman, A, Checkland, K and Harrison, S (2009) Still puzzling: patient and public involvement in commissioning. Journal of Integrated Care 17, 23–30.10.1108/14769018200900043CrossRefGoogle Scholar
Davies, H, Nutley, S and Smith, P (2000) Introducing Evidence-based Policy and Practice in Public Services. What Works?: Evidence-based Policy and Practice in Public Services Bristol, UK: The Policy Press.Google Scholar
Davies, K and Davies, P (2012) Tensions in commissioning: services for children's speech, language and communication needs in one English region. Journal of Health Services Research & Policy 17, 37–44.10.1258/jhsrp.2012.011121CrossRefGoogle ScholarPubMed
Davies, S, Hughes, J, Chester, H, Davies, K, Jasper, R, Roberts, A and Challis, D (2019) Changes in commissioning home care: an English survey. Quality in Ageing and Older Adults 176–193.Google Scholar
Department of Health and Social Care (2012) Caring for Our Future: Reforming Care and Support (Cm 8378). London: Department of Health and Social Care.Google Scholar
Department of Health and Social Care (2014) Adult Social Care Outcomes Framework. London: Department of Health and Social Care.Google Scholar
Department of Health and Social Care (2018) Care and Support Statutory Guidance. Available at https://www.gov.uk/government/publications/care-act-statutory-guidance/care-and-support-statutory-guidance#chapter-4.Google Scholar
Glendinning, C, Clarke, S, Hare, P, Kotchetkova, I, Maddison, J and Newbronner, L (2006) Outcomes-focused Services for Older People – Progress and Possibilities. York, UK: Social Policy Research Unit.Google Scholar
Glendinning, C, Clarke, S, Harre, P and Maddison, J (2008) Progress and problems in developing outcome-focused social care services for older people in England. Health & Social Care in the Community 16, 54–63.10.1111/j.1365-2524.2007.00724.xCrossRefGoogle Scholar
Henwood, M (2019) Self-funders and Social Care: From Bystanders to Core Participants? Available at https://www.birmingham.ac.uk/schools/social-policy/departments/health-services-management-centre/news/viewpoint/2019/01/self-funders-and-social-care.aspx.Google Scholar
Högberg, L, Sköld, B and Tillmar, M (2018) Contextualising the coevolution of (dis)trust and control – a longitudinal case study of a public market. Journal of Trust Research 8, 192–219.10.1080/21515581.2018.1504299CrossRefGoogle Scholar
Holmes, J (2016) An Overview of Domiciliary Care Market in UK. Wallington, UK: UK Home Care Association.Google Scholar
Hudson, B (2004) Trust: towards conceptual clarification. Australian Journal of Political Science 39, 75–87.10.1080/1036114042000205650CrossRefGoogle Scholar
Hudson, B (2013) Competition and Collaboration in the New NHS. London: Centre for Health and the Public Interest.Google Scholar
Hudson, B (2015) Dealing with market failure: a new dilemma in UK health and social care policy? Critical Social Policy 35, 281–292.10.1177/0261018314563037CrossRefGoogle Scholar
Hudson, B (2018) Adult Social Care: Is Privatisation Irreversible? London School of Economics. Available at https://blogs.lse.ac.uk/politicsandpolicy/adult-social-care-is-privatisation-irreversible/.Google Scholar
Iacobucci, G (2019) NHS England sets out plan to revoke Lansley's competition rules. BMJ 364, 1990.Google ScholarPubMed
Isaksson, D, Blomqvist, P and Winblad, U (2018) Privatization of social care delivery – how can contracts be specified? Public Management Review 20, 1643–1662.10.1080/14719037.2017.1417465CrossRefGoogle Scholar
Jasper, R, Hughes, J, Roberts, A, Chester, H, Davies, S and Challis, D (2019) Commissioning home care for older people: scoping the evidence. Journal of Long Term Care, 176–193.CrossRefGoogle Scholar
King's Fund (2017) What is Commissioning and How is it Changing. Available at https://www.kingsfund.org.uk/publications/what-commissioning-and-how-it-changing.Google Scholar
Knapp, M, Hardy, B and Forder, J (2001) Commissioning for quality: ten years of social care markets in England. Journal of Social Policy 30, 283–306.10.1017/S0047279401006225CrossRefGoogle Scholar
Local Government Association (2018) National Procurement Strategy. Available at https://www.local.gov.uk/sites/default/files/documents/national-social-care-cate-468.pdf.Google Scholar
Mackintosh, M (2000) Flexible contracting? Economic cultures and implicit contracts in social care. Journal of Social Policy 29, 1–19.10.1017/S0047279400005845CrossRefGoogle Scholar
Moran, N, Glendinning, C, Wilberforce, M, Stevens, M, Netten, A, Jones, K, Manthorpe, J, Knapp, M, Fernández, JL, Challis, D and Jacobs, S (2013) Older people's experiences of cash-for-care schemes: evidence from the English Individual Budget pilot projects. Ageing & Society 33, 826–851.CrossRefGoogle Scholar
Newman, M, Bangpan, M, Kalra, N, Mays, N, Kwan, I and Roberts, T (2012) Commissioning in Health, Education and Social Care: Models, Research Bibliography and In-depth Review of Joint Commissioning Between Health and Social Care Agencies (Technical Report). London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.Google Scholar
Novick, G (2008) Is there a bias against telephone interviews in qualitative research? Research in Nursing & Health 31, 391–398.10.1002/nur.20259CrossRefGoogle Scholar
Porter, A, Mays, N, Shaw, SE, Rosen, R and Smith, J (2013) Commissioning healthcare for people with long term conditions: the persistence of relational contracting in England's NHS quasi-market. BMC Health Services Research 13, S2.10.1186/1472-6963-13-S1-S2CrossRefGoogle ScholarPubMed
Raynes, N, Temple, B, Glenister, C and Coulthard, L (2001) Quality at Home for Older People: Involving Service Users in Designing Home Care Specifications. Bristol, UK: Policy Press.Google Scholar
Robinson, S, Dickinson, H and Durrington, L (2016) Something old, something new, something borrowed, something blue? Reviewing the evidence on commissioning and health services. Australian Journal of Primary Health 22, 9–14.CrossRefGoogle ScholarPubMed
Rodrigues, R and Glendinning, C (2015) Choice, competition and care – developments in English social care and the impacts on providers and older users of home care services. Social Policy & Administration 49, 649–664.CrossRefGoogle Scholar
Rubery, J, Grimshaw, D and Hebson, G (2013) Exploring the limits to local authority social care commissioning: competing pressures, variable practices, and unresponsive providers. Public Administration 91, 419–437.CrossRefGoogle Scholar
Smith, R, Darton, R, Cameron, A, Johnson, EK, Lloyd, L, Evans, S and Porteus, J (2017) Outcomes-based commissioning for social care in extra care housing: is there a future? Housing, Care and Support 20, 60–70.CrossRefGoogle Scholar
Uenk, N and Telgen, J (2019) Managing challenges in social care service triads – exploring public procurement practices of Dutch municipalities. Journal of Purchasing and Supply Management 25, 5–17.CrossRefGoogle Scholar
Van Slyke, DM (2006) Agents or stewards: using theory to understand the government–nonprofit social service contracting relationship. Journal of Public Administration Research and Theory 17, 157–187.CrossRefGoogle Scholar
Ware, T, Matosevic, T, Hardy, B, Knapp, M, Kendall, J and Forder, J (2003) Commissioning care services for older people in England: the view from care managers, users and carers. Ageing & Society 23, 411–428.CrossRefGoogle Scholar
Wilberforce, M, Baxter, K and Glendinning, C (2012) Efficiency, choice and control in social care commissioning. Public Money & Management 32, 249–256.CrossRefGoogle Scholar