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Delivering outcomes-based commissioning for home care

Many councils are seeking to deliver outcomes-based commissioning, but don’t know how to achieve this difficult goal. Ingrid Koehler, service innovation lead at the Local Government Information Unit (LGiU), explains how a new project could help facilitate improvements in the home care sector.

Although outcomes are generally acknowledged to be the future of commissioning in social care, the path towards a truly outcomes-based approach has been anything but straightforward. 

The LGiU has, however, embarked on a project to develop an app and information system which supports outcomes-based commissioning in home care. 

Ingrid Koehler, service innovation lead at the LGiU, who is working with technology and design partners Sebastian Nause-Blueml and Oscar Alexander of Cubicus to develop CoCare, said the project has the “potential to offer much more effective care”. 

Tackling hard to measure outcomes 

Although outcomes-based commissioning has been on the radar for quite some time there has been a frustrating lack of progress in this area, said Koehler, as it can be very hard to measure outcomes, especially as commissioners are quite distant from the person receiving care. 

“There are a lot of layers between the commissioner and the person who receives the care,” added Koehler. “Traditionally, for example, any information about a person is usually written down by a carer in a little book that sits in that person’s house. So if you aren’t with them, you can’t see how things are changing from day-to-day. You can’t see if the person is getting better or worse or if outcomes are being achieved.” 

CoCare has been designed to overcome this, said Koehler, as it gives the ability to everyone in the system – care workers, social workers, commissioners, agencies, and care receivers and their friends and families – to share information about social care needs, health conditions and personal goals. It also allows all the parties to communicate through the app. 

Koehler explained that, historically, people have been trying to integrate data systems and healthcare IT systems to bring information together: “We’ve actually said that might be a good idea, but is quite expensive and is quite high risk and is a big project. 

“We don’t actually need to do that. We can have an easy-to-use layer that is compatible with those other systems but sits aside from that, and enables a personal connection around everyone involved with the system.” 

Change in thinking around channel shift 

While the project is still in the development phase, with a number of councils showing an interest in CoCare’s potential, Koehler added that there needs to be a change in the public sector’s thinking around channel shift. 

“In the past, channel shift has been largely about shifting the way people engage with transactional services,” she said, adding: “There is definitely some benefit to that. 

“But we really need to think about the overall interaction and life story around individuals. We need to think about how people interact with local government and other public services. Digital obviously has a massive role to play, and has an even bigger role to play going forward.” 

Koehler added that citizens are demanding much more user-friendly digital services, following the rise of digital giants like Uber and Amazon, and this trend will only continue to increase. 

“But these companies have a lot of money to invest in that user experience and have invested the money in user-experience interaction and design,” she said. “Local government has not had the money or the experience of doing this, to the same degree. 

“I think what we would advocate is that maybe there isn’t the money for everyone to really think about interaction design on their own, but the problem of interaction isn’t majorly different from area to area. It might make sense for some councils to club together for service design. But I don’t think this is just limited to digital.” 

She added that while design-led digital services are not a new concept, new ways of thinking are starting to take hold. Reflecting on the potential of CoCare and digital design, Koehler said “you can change an experience online”, and while CoCare might not be a silver bullet for all outcomes-based commissioning it is “quite a radical departure for working in social care and home care” with the ability to deliver major benefits for people in receipt of care.

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