Sustainable Homecare – How North Devon Reduced Unfilled Care Packages by More than 90%

sustainable care commissioning

Back in 2015 the domiciliary care marketplace in North Devon reflected a typical national picture. The contracting framework was producing a race to the bottom in terms of pricing. The numbers of refusals and unfilled care packages were increasing. The lack of sustainable pricing caused issues with staff retention and, in turn, quality.

This picture is causing local authorities (particularly in rural areas) major concerns. Some are already facing fines and potential funding cuts if they fail to meet challenging delayed transfer of care targets that have been imposed on them. Many are finding it hard to find suitable care providers.

The commissioning and brokerage solution that emerged in North Devon could form a blueprint for sustainable provision in other areas – as well as offering a transition pathway toward ACOs and outcome based care.

Under the new arrangements Devon Cares acts as a single broker for home care packages across North Devon. It is operated by North Devon NHS Trust in collaboration with tier 1 care providers who sit on the management board.

The principle behind establishing the brokerage service was sustainability. There had to be a fair hourly rate that took account of the Living Wage, paid travel and reasonable breaks for care staff. Under the brokerage model the care provider gets the full hourly rate agreed with the LA commissioners.

Clearer communications

Rather than having around 300 care providers to deal with the LA now has a single interface through Devon Cares. There is also one organisation that can speak with a single voice on behalf of care providers.

As well as the credibility of the NHS brand, the trust also brings support for logistics, skills and specialist training. Having the trust in a pivotal role could also, over time, achieve better integration with health services and more effective early warning of service users who may need a health rather than social care intervention. There is also an opportunity to better coordinate home visits from health and social care professionals.

One year into the new structure, unfilled care packages are running at less than two per week instead of 15+ and rising. The care provider network is much more stable and issues such as continuity and quality of care are improving.

From it’s inception, Devon Cares put sustainability at the forefront

Sustainability in this model requires low overheads and administration costs. The maximum amount of funding can then support sustainable frontline care. To streamline administration and data gathering Devon Cares adopted the CareForIT eBrokerage platform.

A sustainable future for social care that is fair to care workers, care providers and commissioners is possible. It takes imaginative thinking of the type shown in North Devon – although other areas may develop their own structures.

Central to any solution must be a streamlined brokerage system such as CareForIT that uses modern technology to minimise admin costs and maximise accountability. That element of the solution is completely transferable to whatever new structures are adopted, including where LA commissioners retain brokerage responsibilities.

Webformed is offering local authorities 3 months’ free use of CareForIT eBrokerage. This allows care packages to be broadcast to care providers and will allow authorities to evaluate for themselves how much time can be released for activities that more directly support excellent front line care delivery.

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