Abstract
In England, care to support people living at home is largely commissioned by local authorities (statutory organisations with responsibility for social care in specific localities) from non-statutory home-care providers (for-profit, not-for-profit, voluntary). This paper explores how managers of these services perceive commissioning arrangements and their impact on home-care providers, the care workforce and service users. Little formal research of providers' experiences of working with local authorities in a commissioning model is available. A qualitative study employed semi-structured telephone interviews with 20 managers of for-profit home-care providers from 10 selected local authority areas in England. Data were analysed using thematic analysis to identify main and subsidiary themes. Home-care providers reported operating in a complex and changeable partnership with commissioners, characterised by: (a) relationships ranging from transactional to collaborative, (b) providers expressing a strong sense of public service motivation, (c) commissioning practices that were complex to negotiate, time-consuming and overly prescriptive, (d) frequent changes in commissioning practices and a perceived lack of strategic planning, which were reported as contributing to uncertainty and tension for providers and confusion for service users. Attempting to operate a market model with tightly prescribed contracts is likely to be unsustainable. An alternative approach based on a collaborative model of joint responsibility for providing home care is recommended drawing on a conceptual framework of principal-steward relationships in contracting.
Highlights
This paper examines home-care providers’ perception of commissioning arrangements with local authorities in England, considering how they experience contracting and the potential impact on home-care providers and service users
Adopting a market model was based on the assumption that contracting home care from non-statutory providers would assure gains in efficiency, cost and quality (Hardy & Wistow, 1997; Knapp et al, 2001)
This study found that home-care providers navigate complicated and time-consuming contracting arrangements with local authorities
Summary
This paper examines home-care providers’ perception of commissioning arrangements with local authorities in England, considering how they experience contracting and the potential impact on home-care providers and service users. Adopting a market model was based on the assumption that contracting home care from non-statutory providers (hereafter referred to as ‘home-care providers’) would assure gains in efficiency, cost and quality (Hardy & Wistow, 1997; Knapp et al, 2001). This was conceived as a purchaser–provider process, followed by reforms that introduced a commissioner–provider model (Clarke, 2006). With the introduction of the Care Act (2014), a greater emphasis on their role of ‘shaping’ and ‘managing’ the market within localities was introduced
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