The challenges of commissioning home care for older people in England: commissioners’ perspectives
The challenges of commissioning home care for older people in England: commissioners’ perspectives
复制标题
在英格兰为老年人委托家庭护理所面临的挑战：专员的观点
作者：
K. Davies;E. Dalgarno;S. Davies;A. Roberts;J. Hughes;Helen Chester;Rowan Jasper;David. Wilson;D. Challis
在英格兰，老年人的家庭护理主要通过地方当局与独立的护理提供者合作进行。专员们以市场模式运作，为当地人口规划和采购家庭护理服务。他们的作用包括“管理”和“塑造"市场，以确保有足够的护理提供者。从个性化原则中产生的另一个必要条件是实现用户成果的驱动力，而不是“时间和任务”目标。很少有正式的研究调查专员如何协调这些不同的要求和组织委托。本研究采用定性电话访谈的委托方法与10名专员从不同的地方当局在英格兰。对调试的特点进行了专题分析。调查结果表明：（a）委托涉及复杂的系统和程序，这些系统和程序根据当地情况独特地形成，但经常变化，这表明不断需要重新制定委托安排;（B）与供应商的伙伴关系主要是交易性的，偶尔有合作模式的例子，这被认为有助于提供更适合于委托取得个性化成果的灵活服务;以及（c）只有少数专员试图调和严格规定的订约和与供应商合作这两个相互竞争和不相容的目标。需要更好地了解灵活的合同安排和信任合作的特点，以超越合同和委托的程序要素。
Abstract Home care for older people in England is commissioned through local authorities working predominantly with independent providers of care. Commissioners operate in a market model, planning and procuring home care services for local populations. Their role involves ‘managing’ and ‘shaping’ the market to ensure an adequate supply of care providers. Another imperative, emerging from the principles of personalisation, is the drive to achieve user outcomes rather than ‘time and task’ objectives. Little formal research has investigated the way commissioners reconcile these different requirements and organise commissioning. This study investigated commissioning approaches using qualitative telephone interviews with ten commissioners from different local authorities in England. The characteristics of commissioning were analysed thematically. Findings indicated (a) commissioning involved complex systems and processes, uniquely shaped for the local context, but frequently changed, suggesting a constant need for reframing commissioning arrangements; (b) partnerships with providers were mainly transactional, with occasional examples of collaborative models, that were considered to facilitate flexible services more appropriate for commissioning for personalised outcomes; and (c) only a small number of commissioners had attempted to reconcile the competing and incompatible goals of tightly prescribed contracting and working collaboratively with providers. A better understanding of flexible contracting arrangements and the hallmarks of a trusting collaboration is required to move beyond the procedural elements of contracting and commissioning.