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Domiciliary Support in Leicester
Vision (2019 – 2025)
 
Introduction
Leicester City Council and Leicester City Clinical Commissioning Group jointly purchase domiciliary support or home care for people who are eligible for health or adult social care funding.  With many changes occurring the health and social care system, as well as the way in which domiciliary support is purchased and delivered, it is important to hold a vision to set out the direction for commissioning and provision of this support.  From this vision, a range of delivery plans can be developed, new ways of working piloted and barriers identified and addressed. 
This joint vision sets the scene until the expiry of the current contract for provision and identifies where changes can be planned for in advance of the next round of procurement.
The Vision
Commissioned Domiciliary support in Leicester should offer support that:
Maintains people in their own homes for as long as they can be there.  It should support the maintenance of their independence and ability to undertake tasks for themselves for as long as possible and often contributes to the maintenance of a person’s own health and wellbeing.
Prevents unnecessary hospital admission through spotting the early signs of deterioration and supporting people to access appropriate services, ideally before a crisis arises but sometimes, unavoidably when a crisis does occur.  Prevention should address both physical and mental health and may include identifying ‘assets’ in people’s lives such as carers who could be signposted for support.
Is Sustainable in terms of the market and viability and the workforce that the system relies upon.
Is Flexible to address a person’s changing need, crisis events or times when care can be reduced e.g. when someone experiences a period of more positive health or has visitors who wish to provide some of the care. 
Is of high Quality, ensuring that a common agreement about what constitutes quality is held and that all parties work to ensure that this is achieved.
Works as part of a wider System of support that people access across the adult social care and health system as their needs change.

 
Drivers
It is important to recognise within this vision the range of drivers that exist for partners involved with and interacting with domiciliary support.  These drivers include:
Service users:
  • Continuity of carers to enable people to develop relationships
  • Timeliness of calls so people know when to expect a visit but flexibility to adapt this according to their need
  • Communication and caring skills from the staff that visit to deliver care
Commissioners:
  • Provision that meets the level of demand
  • Reliability of carers and providers (i.e. calls take place and providers remain in the market)
  • Quality of care
  • Affordability
Providers:
  • Reducing the administrative burden
  • Viable business
  • Recruitment and retention of a reliable, high quality workforce
Workforce:
  • The option of permanent contracts, shifts and guaranteed hours (rather than being forced into zero-hour contracts)
  • A rate of pay that enables them to meet their necessary costs
  • Guarantee of work for those that want it (if they are of high enough quality)
System:
  • Flow through the system e.g. a move out of hospital and into holding or mainstream provision
  • Preventing unnecessary hospital admission and reducing the pull on more acute services
  • Early ‘spotters’ of deterioration
 
Implementation
Implementation of the vision takes place through all parties working together to agree the direction, identify barriers and work together to find solutions.  These discussions will occur on a case by case basis, through discussions at provider forums, through consultation and quality visits and through commissioning decisions and contractual arrangements.
A development plan for the year ahead will guide the actions necessary and will support the identification of barriers to achieving the vision.