Outcome-based commissioning in Domiciliary Care

What is the challenge?

There are unprecedented, and well-documented, challenges facing Social Care commissioning. Commissioning teams need to look after more service users, who have increasingly complex needs, with less funding and internal resource. At the same time, the Care Act is requiring councils to also evidence that they’re achieving an outcome for their service users.

How have you responded?

In response to these challenges, many believe that using a fixed number of providers is the most efficient way to be able to commission with outcomes in mind.

The rationale is that using fixed supply is more manageable and equally better for providers.

Sadly, this isn’t the reality.


Commissioning teams still aren’t able to commission, measure or track outcomes delivered, even after locking capacity down.

This is despite consciously deciding to work with fewer providers. Ultimately this means that service user outcomes and needs are continuously put at risk.

What symptoms will you recognise?

Typically, three symptoms form from firefighting to fulfil care packages, which stop commissioning teams from:

  • engaging the provider market so they know what needs and outcomes require attention on each individual package of care
  • teams then can’t embed an internal outcomes process throughout the commissioning lifecycle
  • which means they’re unable to begin thinking about how they can transition to an outcomes payment structure to replace the traditional ‘Task & Time’ approach

Instead, commissioners often work how they always have done. Calling up providers they know and have a relationship with to see if they have capacity. Rarely will the commissioner have time to explain, in detail, the criteria for that individual. Which means the provider won’t be fully informed of what actually needs to be delivered to meet the outcomes of the individual.

This process is repeated over time and often means the inconsistencies of the process don’t allow commissioners to isolate the cause and fix it.

Which results in providers pulling out, an overspent budget and teams demoralised. This then leaves local authorities believing that the answer to the problem is simply more funding. The problem is, more funding will only temporarily ease these symptoms and not resolve the actual cause.

What is the actual cause?

There are typically two main causes preventing an outcome-based commissioning approach:

  1. Often it is the accumulation of legacy commissioning processes compounding over time that haven’t kept up with demand or changes to the available funding.
  2. Local Authorities also have very limited visibility and engagement of all the available providers who can deliver Domiciliary Care services.

These causes make the transition from task and time, to outcomes a difficult one. Teams simply don’t have the time to work an outcomes approach into their process.

There is also a third cause. Insight, from available data. With no capacity to make changes and existing commissioning models in place; there isn’t enough information available to teams to make decisions about:

  • Which provider is best able to meet the needs and outcomes of the individual
  • How to track outcomes throughout the internal commissioning process leading to a service agreement
  • How to pay and reward quality services provided

Ultimately, local authorities aren’t able to price packages based on their value or then pay providers based on the outcomes achieved for the individual.

These causes cannot remain unsolved as demand continues to grow and needs become more complex.

How can you solve them?

Despite the complexity of these challenges, a number of councils across the country are beginning to evidence an outcome-based approach to commissioning.

Councils such as the Isle of Wight, Brighton and Hove and Waltham Forest are opening up the market and commissioning the provider best suited to meet the outcome specifications set in the service requirement.

This is being achieved using Digital Commissioning Technology and ongoing Supplier Engagement and Management.

It’s an approach that is enabling commissioning teams the ability to use technology to set outcome criteria for individual care packages. The market then has visibility over all the relevant requirements that they are able to support. Through improved MI, the ongoing management of the provider market through one system, gives the commissioning team the ability to reward quality service delivery. Over time, the model instils a market where providers are able to organically set rates for personalised services. This is not only better for the provider and council, but the individual receiving the service.

The results:

Embedding outcomes into your commissioning process is a tough task, we've pulled together a number of questions to answer as you think about making the transition.

Why not understand how others have uncovered and solved the causes impacting market capacity too.