Outcome-based commissioning in domiciliary care

Many councils are grappling with how to ensure their services promote better outcomes for their local communities, and nowhere is this more true than adult social care.

Although outcomes are generally acknowledged to be the future of commissioning (recent LGiU research showed that over 90% of councils regard outcome-based commissioning as ‘important’ or ‘very important’ in social care in future), the path towards a truly outcome-focused approach has been fraught with difficulty.

In partnership with leading social care provider Mears, the LGiU has undertaken research with over 200 officers and elected members working in social care to investigate current commissioning practice in domiciliary care. Some of the key findings include:

  • while most respondents reported the regular use of outcome-based commissioning, a sizeable minority of 35.9% said that it was only used ‘to a limited degree’ in their authority. More than 70% saw commissioning for outcomes as a ‘very important’ priority for social care in future.
  • 75.9% of respondents disagreed with the statement ‘our current systems and processes will be sufficient to manage our adult social care provision in future’, reflecting the present resourcing challenge facing social care. More than 90% agreed that pressure on resources was making them reconsider the way in which they provide social care.
  • 74.4% of respondents regarded ‘a culture of running services on a time-task basis’ as an important barrier to outcome-based commissioning in future. However, over 90% still pay providers according to the time they spend with a service user, rather than outcomes.
  • the types of organisations being commissioned as providers is expected to diversify. More authorities identified in-house provision as a method of delivery in future, while the number of councils commissioning social enterprise providers is expected to double.

The research culminated in our 2012 report Outcomes Matter: effective commissioning in domiciliary care, which was succeeded by a programme of six regional roundtables. In 2013, the LGiU will be holding a social care network with expert practitioners to develop further briefings on this subject.

This project is supported by Mears Group