Home‐care providers as collaborators in commissioning arrangements for older people

Karen Davies, Elizabeth Dalgarno, Colin Angel, Susan Davies, Jane Hughes, Helen Chester, Rowan Jasper, Amy Roberts, David Challis

Research output: Contribution to journalArticlepeer-review


In England, care to support people living at home is largely commissioned by local authorities (statutory organisations with responsibility for social care in specific localities) from non-statutory home-care providers (for-profit, not-for-profit, voluntary). This paper explores how managers of these services perceive commissioning arrangements and their impact on home-care providers, the care workforce and service users. Little formal research of providers’ experiences of working with local authorities in a commissioning model is available. A qualitative study employed semi-structured telephone interviews with 20 managers of for-profit home-care providers from 10 selected local authority areas in England. Data were analysed using thematic analysis to identify main and subsidiary themes. Home-care providers reported operating in a complex and changeable partnership with commissioners, characterised by: (a) relationships ranging from transactional to collaborative, (b) providers expressing a strong sense of public service motivation, (c) commissioning practices that were complex to negotiate, time-consuming and overly prescriptive, (d) frequent changes in commissioning practices and a perceived lack of strategic planning, which were reported as contributing to uncertainty and tension for providers and confusion for service users. Attempting to operate a market model with tightly prescribed contracts is likely to be unsustainable. An alternative approach based on a collaborative model of joint responsibility for providing home care is recommended drawing on a conceptual framework of principal–steward relationships in contracting.

Original languageEnglish
JournalHealth and Social Care in the Community
Early online date1 Oct 2020
Publication statusPublished - Oct 2020


  • care providers
  • commissioning practice
  • home-care
  • market model
  • qualitative study
  • relational contracting


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