Domiciliary care agencies' responses to increased user choice: perceived threats, barriers and opportunities from a changing market

SPRU research team

• Caroline Glendinning
• Kate Baxter

External collaborators

• Ian Greener, Manchester Business School

Background

Traditionally, local authorities (LAs) have acted as proxy purchasers for service users through their care management and commissioning systems. These systems have been undergoing change as more responsibility for choosing care packages is devolved to individuals. This study looked at the impact on domiciliary care agencies of these changes.

One way of capturing these changes is through the use of principal agent theory. Principal-agent theory deals with problems associated with delegated choice. It examines the situation where the purchaser of a service (the principal) depends upon another person (the agent) for its delivery. We considered domiciliary care agencies’ dual roles as agents to local authorities and private purchasers of care, and as principals to the home care workers they employ.

Aim

The aim of this study was to examine, from the perspectives of domiciliary care agencies, the perceived threats, barriers and opportunities for responding to increases in user choice exercised through mechanisms such as direct payments and personal budgets. The study also examined also how any barriers could be overcome and opportunities realised.

Methods

The study included both quantitative and qualitative elements. An initial secondary analysis of survey data on home care providers was undertaken to refine the research questions and inform the study sample and the subsequent interviews. This was followed by semi-structured interviews with local authority commissioning managers and domiciliary care agency managers from four contrasting local authorities.

Findings

Changes in local authority contracting arrangements, to create smaller geographical zones for providers, risked restricting opportunities for users to choose between different providers. The closer relationships that smaller agencies had with clients offered better opportunities for negotiating personalised home care services; however, larger agencies were thought to be better protected against new financial risks arising from the personalised purchasing. Because personal budgets can be used in a wide variety of ways, they were expected to create opportunities for providers to offer new services, such as shopping, pet care and help with social activities.

However, home care provider agencies had to operate within very tight labour markets and were also aware of the risk of losing home care workers to private employment by personal budget holders. They tried to counter this by emphasising the advantages to staff of working for an agency rather than a private employer.

Additional information