Local authority commissioning should be abandoned, UKHCA boss tells Jeremy Hunt

Jane-Townson 2

The chief executive of United Kingdom Homecare Association (UKHCA) said she would scrap the commissioning of social care services by local authorities if she were in charge of the country.

Giving evidence to the Health and Social Care Select Committee yesterday, Dr Jane Townson said the UK needs to do away with a commissioning system that treats care workers – and the people they care for – as “commodities”.

She also emphasised the value of putting people at the centre of commissioning arrangements with person-centred planning.

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“I often observe that the self-funded part of the home care market points the way to how we could do things because, in that part of the market, the people are the commissioners,” she told the committee’s chairman and former Health Secretary, Jeremy Hunt.

“In my world, I would abandon local authority commissioning and I would stop the micromanaging that goes on and allow [care staff] to work with the people that they are supporting to agree and decide on what can be offered within the budget.”

Dr Townson also stressed the importance of stopping the payment of home care workers by the minute.

“Councils buy care by the minute, which means that providers have to employ by the minute. Nobody wants to do that, but it’s the system that’s wrong and it’s that feeling of not being able to meet people’s needs,” she said.

“Imagine a clinical commissioning group saying to an NHS Trust ‘we’re only going to pay nurses for every minute that they are by a patient’s bedside and we’re going to electronically tag them to find out when they are there, but we’re not going to pay them when they’re moving from one patient’s bed to the next and we’re not going to pay them when they are training’. Can you imagine the outcry?”

“On top of that, the NHS Trust would have to pay for all of those additional things, by some miracle, in some way. That is what home care providers have to do and are expected to do every day.”

Raina Summerson, the chief executive of Agincare, also criticised the practice of paying home care workers by the minute, which she said was a result of restricted public funds for home care services.

“Who would have thought that this critical role of compassion and care could be broken down to paying people by the minute and having people … not be paid for when they are walking up someone’s garden path,” she said.

In response, Hunt said he would urge ministers to rethink the practice.

He said: “I think it is something we need to talk to ministers about. When I was health secretary, I was told 15-minute visits had been abolished, but it feels like they haven’t. It is definitely something we need to look into.”

Tags : commissioningDr Jane TownsonJane Townsonlocal authoritiesUKHCA
Sarah Clarke

The author Sarah Clarke


  1. Unfortunately with the system we work currently there is a general under appreciation of the carers and what they actually do, even throughout the pandemic there has been a focus on the NHS and don’t get me wrong they do a fantastic job, but so do the and I quote the prime minister ‘Unskilled’ Carers. most local authorities make you agree to pay travel time to the carers if you wish to be accepted on their framework and if you don’t then you can’t get any work from them. I agree that carers should be paid for travel time however the local authority then say ‘oh no we only pay you for the time in the call and if you ask for a longer call to cover the travel time we won’t pay that’
    I’m a registered manager of a Home care company that has many rural areas meaning that travel between clients can be up to 45 minutes but it would cripple the company if i even considered paying them the travel time. I do my best to pay a fair wage for what the carers do but once I’ve paid all the insurances and taxes there’s nothing left to increase the wages much above minimum.
    Carers in general are far from ‘Unskilled’ they have skills that can’t be taught,on top of their annual training. I wish I could have a few minutes face to face with Jeremy hunt and the prime minister to show them just how under appreciated the entire sector is.
    the reality of it is that you wouldn’t let an unqualified professional run a school, or hospital yet we allow the government with absolutely no understanding of the industry to dictate and comment.
    I ask the questions that I think are on every carer’s lips ‘Have any of the ministers in charge ever done a day in home care?, have they worked closely with an individual who has nobody else in the world around them and been the only face they will see all day? have they been the one that somebody has asked for on their deathbed? have they grieved numerous times for the individuals they have met?’ they will never know the pain of fighting for the permission to grant someones final wish when the local authority won’t help.

    I’m sorry for the rant but now is the time for us all to stand up and make the difference so that those who follow will have the care they deserve.

  2. Mr Hunt’s reply shows that he still hasn’t grasped the point that was being made.
    In some cases it maybe better to have 8 x 15min visits a day than 2×1 hour visits a day for certain clients.
    The point is let care providers and clients decide what is best for them within their budget.

  3. Perhaps, we had it right 20 years ago, with local authority homecarers paid to do what was needed living locally, nipping back to light fires. Perhaps the savings from privatising homecare brought unsustainable models of care. What is needed is a flexible rapid response, supported by friends, neighbours, family, community, District nurses and Gp. Give power back locally, allow people to draw on support daily based on how well a day they are having and who is is connecting with them.

    1. Would you like to be at a neighbours beck and call 24 hours a day to pop in to do the odd things they need doing as well as helping them wash and dress? How about getting a call at 8am saying they are staying in bed but could you pop in at 9.30 to help them get up instead or you’ve just settled down to eat your tea with your family and someone rings to ask you to just pop around to help them to the toilet. I have been in home care over 20 years and what you are describing has rarely been the case. In communities now people are working more, families are scattered and there is no time to set aside for helping out a neighbour or friend. In lockdown communities have come together to help each other and this is very commendable but when people go back to work they will be wrapped up in their own lives again and community will go back to mostly how it was before. District nurses are few and far between and are pushed for time and only have time for essential nursing tasks. The truth is there are not enough home carers to go round and its not seen as an important job. Carers need more recognition for the valuable resource they are and not to be seen as some kindly soul who will pop around to light the fire. .

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