Provision of homecare in England

Citation

(2001), "Provision of homecare in England", International Journal of Health Care Quality Assurance, Vol. 14 No. 2. https://doi.org/10.1108/ijhcqa.2001.06214bab.003

Provision of homecare in England

Provision of homecare in England

According to a new market report on domiciliary social care and community health services from analysts Laing & Buisson (Domiciliary Care Markets 2000, Laing & Buisson, published October 2000), for the first time ever the volume of homecare that English local authorities purchase has exceeded the volume that they directly provide.

Local authorities' social services departments fund homecare for older and disabled people who meet the authority's eligibility criteria and pay a charge which depends on a means test. Homecare was known as the home help service when it provided practical or domestic care rather than the personal care it does now.

During a sample week in September 1999 social services departments purchased 1.35 million hours of homecare or home help services from independent sector providers, compared with the 1.32 million hours that they provided through their own in-house teams.

The report's author, Philip Mickleborough, said:

This is a continuation of the pattern of increasing commissioning and less direct provision that we have been observing since the community care reforms of April 1993.Eight years ago, before the reforms, social services delivered 98 percent of the homecare they funded. Now it is down to 49 percent, and I expect the proportion to drop further. Social services recognise that directly providing in-house homecare is more expensive than purchasing it from the independent sector. By commissioning homecare, social services can provide more care hours for older people than if they delivered it themselves.

As intended by the NHS and Community Care Act 1990, homecare is being focused on the most dependent clients who might otherwise have had to leave their homes to enter residential care. The number of homecare hours funded by local authorities rose in 1999 by 3 per cent, but the number of households receiving it dropped by 5 per cent to 424,000. In 1999 each household received on average 6.3 hours of care per week, compared with 5.8 hours the previous year. The nature of the care continues to develop, with a greater emphasis in England on personal care such as getting people up and washed in the mornings, and less on domestic care such as house cleaning.

Table I is an extract from the above report and gives the relevant figures for the year before the community care reforms and for the most recent two years.

Scotland still has more of an emphasis on domestic care, and here there was a reduction of 7 per cent in the number of homecare hours provided, while local authorities in Wales increased the number of hours they funded by 7 per cent during 1998/99.

A shortage of carers remains a major problem for in-house and independent sector homecare providers. According to the author, the greatest demand for care is early in the morning, when older people have to rise, be washed and helped to dress, and in the evenings when they have to be prepared for bed. However, these are the times when the carer shortage is most acute, and providers face the greatest challenges in maintaining the quality of their services. Homecare providers compete with the retail and hospitality industries for staff, and this is proving increasingly difficult for them as the economy does well and retail opening hours grow longer.

Further information on Domiciliary Care Markets 2000, published October 2000 is available from Laing & Buisson, 29 Angel Gate, City Road London EC1V 2PT. Tel: +44 (0)20 7833 9123; Web site: www.laingbuisson.co.uk. For further information, contact Philip Mickleborough Tel: +44 (0)20 7833 9123