This section focuses on how care and support can be commissioned in a way that best supports the retention of your workforce. When commissioning is done well, it can facilitate much of the good practice recommended throughout this guide.
The influence a council’s commissioning actions and decisions can have on how the provider’s workforce is employed and deployed can be underestimated and misunderstood. This is because the nature and level of impact may not always be clear and can differ according to the type of service (typically, home care is more impacted than care homes), the commissioning approach (the level of certainty and flexibility providers have) and local circumstances (typically, the fewer the self-funders the greater the impact of council commissioning).
This section is not advocating any specific commissioning actions or approach, but it aims to highlight key connections between commissioning approaches and the workforce, with examples used to illustrate the impact such approaches can have on workforce retention.
Terms, conditions and contracts
Where a council offers providers certainty of what they will commission, how and when, the provider will be better able to adopt positive terms and conditions for their staff. For example, block contracts with care homes for x number of beds over y period will provide greater clarity and certainty than commissioning all beds from multiple care homes on an ad-hoc basis. This is likely to impact the type of contracts and levels of commitment given to staff.
With community provision, multi-year contracts that give a small number of providers a guaranteed set number of hours can support providers to think longer-term. This can lead to greater use of permanent contracts and investment in career pathways, supporting staff retention.
Similarly, payment methods can also affect retention. Councils will typically pay providers in arrears but the length of this will vary. Councils may pay providers weekly or monthly and will differ in exactly how they pay for care (payment might be on what is commissioned, what is actually delivered or something similar). Councils will also have specific terms concerning cancelled home care visits or periods when the person needing care may be in hospital. The systems and processes councils use will also affect the accuracy and promptness of payment. Thinking about how payment agreements affect the workforce is important when considering retention issues.
Staff capacity, capability and wellbeing
Providers’ approaches will be influenced by how they are commissioned and how they deliver support to individuals. Across the country, home care is still typically commissioned in a way that means most care is delivered between 8.00 and 10.00 and 17.00 and 20.00 by staff who need to be able to travel quickly between visits. This has wider implications for who can work and how. Many councils are moving towards area-based commissioning where individual providers work in a specific geographic area, reducing the travel distance, time and creating opportunities to travel in different ways for staff.
Similarly, in community-based care, some councils commission ‘care rounds’, which are groups of care packages where the location and timing of each visit allows for an efficient and manageable care delivery routine for staff.
Councils can also agree processes to support care providers to understand and address situations where the delivery of care is creating additional pressures for staff. This can be due to the way packages are set up or the specific situation with people receiving care. However, the details will vary from care rounds no longer being deliverable, through to practical difficulties such as parking permits/availability/restrictions and/or personal issues like the relationship between the care worker, person receiving care and their family.
Top tips:
- Build relationships between commissioners, providers and people with lived experience regarding different commissioning methods and options, ensure it works most effectively in the local care system and supports staff retention.
- Consider whether moving towards or adopting some aspects of block commissioning, area-based commissioning or ‘care rounds’ could increase the potential workforce and support the retention of the current workforce.
- Reflect on the terms, conditions, payments and contracts to consider whether changes could provide greater certainty to providers and better enable medium and long-term support to the workforce.