Homecare: commissioning is the key to quality, fair work and better outcomes

Homecare Association has published a new report, Homecare: commissioning is the key to quality, fair work and better outcomes, setting out how commissioning reform can improve care quality, workforce sustainability and outcomes for people drawing on care and support.

Homecare enables hundreds of thousands of people to live independently in their own homes. However, publicly funded homecare is often commissioned through fragmented arrangements, with providers paid retrospectively by the contact minute and at rates that do not reflect the full cost of delivering safe, lawful and sustainable care.

The report argues that commissioning decisions shape not only the provider market, but also workforce conditions and the quality of care people receive. It identifies four interdependent elements that must align:

• Price: the fee must cover the lawful and efficient cost of the service required.
• Allocation: each provider location needs sufficient, reasonably predictable work within a compact geographical area.
• Payment mechanism: providers should be paid for assessed need, planned capacity or agreed outcomes, rather than retrospectively for isolated contact minutes.
• Assurance: contracts must secure safe, good-quality care and the lawful and fair treatment of workers.

The report proposes a practical pathway from fragmented, time-and-task commissioning towards neighbourhood-based and outcomes-focused models of care. In the longer term, it envisages a system where people have greater choice and control through portable funding linked to assessed need and delivered by quality-assured local providers.

It also explores the implications for workforce security, neighbourhood health, prevention, consumer choice, the Employment Rights Act, the proposed Fair Pay Agreement and the long-term sustainability of local authority and NHS-funded care.

The report concludes that commissioning reform is essential if the sector is to deliver better outcomes for people, support fair work and create a sustainable homecare market for the future.

Click here to read the full report.