Home care outsourcing strategy

This paper aims to help public sector managers that are formulating strategies for outsourcing home care from the independent sector.

A review was performed of relevant literature on the outsourcing of home care and its political drivers in the U.K. This indicates that the future of home care services, taking into consideration outsourcing and how Best Value will be achieved, has not been researched widely. Therefore, an exploratory approach to research was adopted here using in-depth analysis of a small number of particularly informative local authorities and private providers selected by purposive/judgemental (extreme and critical case) sampling. Personal contact was deemed necessary in order to perform an intensive investigation to pursue in-depth information.

The British Government's Best Value regime is driving local authorities towards increasing levels of outsourcing in the provision of home care. A local authority may choose to outsource all of its home care or maintain some in-house provision based on capacity or capabilities that are complementary to those provided by the independent sector. The 100 per cent outsourcing strategy places enabling demands on the local authority, whereas the alternative strategy requires decisions to be made on what should be outsourced. Across the authorities surveyed, six strategies for creating a mixed economy of care have been identified, with the mix being based on complementary capacity and/or capabilities. With Best Value driving authorities to consider lower-cost options, the outcome may be a reduction in the amount of complementary capacity provided in-house, in favour of strategies involving complementary capabilities that deliver the Best Value possible. Re-enablement is emerging as a common, complementary or core capability that is remaining in-house. Outsourcing also requires decisions to be made on the number of independent providers to be used and the type of contracts to be employed. This paper considers the decisions that have been made in the local authorities surveyed and critiques the alternative home care outsourcing strategies so derived.

To date, the research has focused on Wales in general plus a few local authorities in England. The next stage will be to survey England in more detail along with other countries that are implementing substantial outsourcing of home care, such as Canada.

This paper provides timely guidance to public sector and health care managers seeking Best Value in home care through outsourcing.

Little has been found in the literature on strategies for outsourcing home care, yet such strategies are needed urgently in the U.K. to achieve Best Value. The World Health Organization stresses that strategies should be drawn up for providing support to patients and carers at community level in order to avoid costly institutional care.