Innovation: Help to Live at Home project

United Kingdom

AAI Domains:

• Independent, healthy and secure living (independent living, care to older adults)

• Participation in society (social connectedness)

Ageing populations are likely to have increasing levels of need for social care that is provided in the domestic home environment but domiciliary care can often be cost-driven and inadequate both for the recipients and providers of the service. In the UK, the provision of such services is the responsibility of local municipalities who commission services from a mixed economy including private, voluntary sector and public sector providers.

The dominant model of commissioning is based on ‘time and tasks’ that assigns a fixed amount of time (usually in 15 minute blocks) for the completion of specified tasks. Local municipalities have experienced significant cuts to their budgets for social care in recent years and the inadequacies of this system such as low pay, poor training and zero hour contracts have become increasingly evident.

Care workers are often low paid, there is a high level of staff turnover and the care provided is often performed at high speed in order to meet time and task targets rather than the needs of people receiving care and support. This is increasingly recognised as a recipe for low quality care that is not satisfactory for people in need or for the workforce.

An innovative alternative approach has been pioneered in Wiltshire, a largely rural county in south west England with a population of over 600,000 people of whom more than one in six are aged over 65 years. The wider policy context for social care has placed great emphasis on personalisation, personal budgets and recovery-based interventions to enhance quality of life and to delay or reduce the need for care and support.

Wiltshire County Council chose to develop the Help to Live at Home project to provide support for adults in need that was based, in part, on sets of outcomes that were agreed by care commissioners (usually social workers) and clients. A care package was then commissioned with a service provider who was paid on the basis of delivering these outcomes for the individual and paid in part on the basis of achieving these results. After a prolonged period of consultation and service specification, eight contracts with four care providers from the private and voluntary sector with public sector workers transferred to a new arms-length from the municipality provider.

A positive and innovative feature of this system is that provider organisations have been able to pay their staff significantly more than the national minimum wage. They have moved away from the ‘time and task’ model of provision towards meeting the needs of their clients which was decided (or at least strongly influenced) in the commissioning process.

There is developing evidence that this system of outcome based commissioning is better for older people and for care workers who are able to build a relationship over a short period of time rather than being rushed by time and task requirements. The system has been in full operation since 2011–12 and the dynamics of the system are still developing but it has attracted considerable interest from other local authorities and beyond.

In relation to active ageing indicators, the Help to Live at Home project is designed to enhance the ability of people in need of social care support to live independently for longer through having support that they have partially defined as most appropriate to meeting their needs. It is an innovative approach to providing care to older adults that looks to empower the people in need of a service to decide what that support is and how it should be delivered.

The essence of the innovation is to build a stronger sense of social connectedness between the recipient and the provider of domiciliary care. It still operates in an environment of constrained resources but by paying higher wages to care workers it can contribute to their health and well-being rather than work being at the behest of a time and task manual.

Community Care website