Outcomes matter: effective commissioning in domiciliary care

SCIE Social Care Online
Local Government Information Unit
Publication date:
01 January 2012


The Mears Group worked with LGIU to explore current practices in commissioning for outcomes in domiciliary care in England. The researchers looked for barriers to change, opportunities, and examples of good and innovative practice in the face declining resources and ever greater focus on support in the home. A survey of local government officers and elected members working in social care received 210 responses from 113 councils. While most respondents reported regular use of outcome-based commissioning, more than a third only use it to a limited degree. Despite this, 70% believed it is an important priority for adult social care. Councils recognise that a time-task culture in domiciliary care is a major barrier to true outcome based commissioning, but breaking down this culture may be difficult. Reliance on a time-task approach leaves little alternative for cost saving other than cutting hourly rates paid to providers and increasing monitoring; both of which risk affecting the quality of the service and damaging the relationship with providers. The report concludes that care systems need to encourage independence and rehabilitation and paying for outcomes shifts the freedom and responsibility for finding better solutions to the provider. A number of case studies illustrate what can be achieved and the report ends with a series of recommendations for success in outcome based commissioning.