Domiciliary care agencies' responses to increased user choice: perceived threats, barriers and opportunities from a changing market
Researchers: Kate Baxter, Caroline Glendinning, Ian Greener (Manchester Business School)
Funder: Department of Health Policy Research Programme
Duration: January 2007 to March 2008
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.
Publications and presentations
2012
Efficiency, choice and control in social care commissioning, 2012
Wilberforce, M., Baxter, K. and Glendinning, C., Public Money & Management, 32, 4, 249-256.
2011
Personalisation - implications for the home care market. Invited.
Baxter, K., Personalisation and Personal Budgets: Lessons from Research, Challenges from Policy and Practice Conference, TechnoCentre, Coventry University, Coventry, 15 July 2011. PDF of presentation
The implications of personal budgets for the home care market, 2011
Baxter, K., Glendinning, C. and Greener, I., Public Money & Management, 31, 2, 91-98.
Personal budgets and the workforce implications for social care providers: expectations and early experiences, 2011
Baxter, K., Wilberforce, M. and Glendinning, C., Social Policy and Society, 10, 1, 55-65.
2009
Domiciliary care agencies and personal budgets - perceptions of opportunities and risks
Baxter, K., Making Research Count Seminar, University of York, York, 16 February 2009.
Service provider responses to personalisation: perceived opportunities and threats
Glendinning, C., Association of Chief Executives of Voluntary Organisations Annual Conference, London, 26 March 2009.
2008
Personal budgets - opportunities, risks and mixed perceptions, 2008
Baxter, K., Homecarer, November, 8-9.
Personalised budgets and care worker retention: experiences and expectations of domiciliary agencies in England
Baxter, K., Social Policy Association Annual Conference, University of Edinburgh, 23-25 June 2008.
Personalised budgets and care worker retention: experiences and expectations of domiciliary agencies in England
Baxter, K., 37th Annual Conference of the British Society of Gerontology: Sustainable Futures in an Ageing World, University of Bristol, 4-6 September 2008.
Personalised budgets and care worker retention: experiences and expectations of domiciliary care agencies in England
Baxter, K., Clarke, S., Glendinning, C. and Greener, I., Transforming Elderly Care Conference, Copenhagen, 26-28 June 2008.
Domiciliary care agency responses to increased user choice, 2008
Baxter, K., Glendinning, C., Clarke, S. and Greener, I., Research Works, 2008-3, Social Policy Research Unit.
Domiciliary Care Agency Responses to Increased User Choice: Perceived threats, barriers and opportunities from a changing market, 2008
Baxter, K., Glendinning, C., Clarke, S. and Greener, I., Social Policy Research Unit.
2007
Domiciliary care agency responses to increased user choice
Baxter, K., Department of Health Social Care Research Showcase - The Challenge of Modernisation, British Library, London, 22 July 2007.
Characteristics of domiciliary care providers with high and low percentages of privately paying clients
Baxter, K., Sandhu, S. and Glendinning, C., Social Policy Association Annual Conference: New Frontiers? Social Policy in the 21st Century, Birmingham University, 24 July 2007.
Professional press
The Homecarer, May 2010. National reports - Scotland: Ministers put self directed support at the heart of social care strategy.
If you require further information about the project, please contact Kate Baxter 
