Commissioning Care for Older People – Can we get it Right?


There were a few big themes that dominated the recent Health & Care Expo in London. Two that were echoed by many domiciliary care managers who visited our stand were the continuing controversy over 15 minute care visits (more of that in a later article), and the whole process for commissioning home care services.

There is a feeling among many domiciliary care providers that the processes used by commissioners are not always adequate; with too much focus just on cost. What they would like to see, as budgets get tighter and the number of older people with more complex care needs grows, is a commissioning process that focuses more on quality. In particular, the ability of providers to deliver high quality care that supports service users to lead as active and fulfilling a life as possible.

This is the type of care that most providers want to deliver but it’s a long way from the reality of the commissioning processes that many experience.

Commissioning Care

Against this backdrop, the Social Care Institute for Excellence SCIE, launched a new guide at the Expo titled: Commissioning home care for older people.

The theme that runs through the document is that service users want more than a care system that just looks after their immediate practical care needs. The guide lists four basic needs that older people typically express:

  • They want to live in their own homes for as long as possible
  • They want a good quality of life
  • They want to enjoy good relationships with their carers
  • They want high-quality, personalised care

A couple of immediate questions arise from this. First, how many of these factors currently feature in most commissioning and QA processes? And second, to what extent do domiciliary care providers currently use these criteria in their care planning and internal quality control?

It’s worth expanding on the last point. The SCIE guide goes on to describe what service users mean by high-quality, personalised care:

  • People want care that is tailored to their needs.
  • They want to be able to get in touch easily with those who organise their care.
  • They want support from one person who can help them prioritise the competing demands of their multiple conditions.
  • They want a care plan that is explained to them clearly and is easy to understand.
  • They want information about all the different services that are available to them in their local area.


  • People who use services want to be seen as individuals.
  • They want a care package that takes into account what they want and need, and that can be changed if their needs change. But many feel that carers are not encouraged to make changes to care packages.
  • They want to be listened to, but many feel that their paid carers have no time to listen.

None of these issues would be a surprise to a good home care provider. They are mostly things that they strive to do, even though the commissioning framework is not always supportive.

Management systems

Where management systems can help is with streamlining the processes that support these objectives.

An appropriate scheduling system will make it much easier to achieve the continuity of care that is the foundation of good relationships between care workers and service users; so much else flows from achieving this one objective.

It’s also easier to adapt care plans to meet changing needs if the administrative process is as straightforward as possible. This applies to monitoring and reporting how care needs are evolving and to updating the care plans accordingly. It’s not surprising that care plans can seem inflexible if providers are working on outdated or manual systems where any changes entail significant effort.

The process of communication between service users, unpaid carers and care providers is also critical. It should simple and clear. The care management software should support multiple channels of communication that are open 24/7. For providers there is a huge opportunity here to configure their service offer to match the real needs of their local community by doing a better job of listening.

We all hope that SCIE is successful in influencing commissioners to have more sophisticated and effective ways to purchase the care that people really need. Providers who are more responsive to local needs and who have the systems in place to deliver the high-quality care described above should then have a significant advantage – and deservedly so.

domiciliary care management


Dan Farrell-Wright, Director, CareForIT

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