Shorter visits can have a place within a wider care package
'Service users often wish to know what time people are going to turn up and for how long they will stay.' Photograph: Aardvark/Alamy
Local authority commissioners often face criticism for the regimented way they purchase care and particularly for the hourly rates they offer. Interested observers will talk about the need to purchase care around outcomes, rather than the seemingly outdated method of paying by the hour, half hour or 15 minutes. In reality this is a bit of a holy grail as very few local authorities have mastered the art of outcome-based commissioning. This is made more difficult by the fact that service users often wish to know what time people are going to turn up and for how long they will stay. There is also the small matter of deciding how to pay for such arrangements.
Amid the concern about how local authorities deal with homecare issues the subject of 15-minute care visits has led to an outpouring of criticism. Last year's report from Leonard Cheshire led to substantial publicity and the almost universal view that 15-minute visits were an evil invented by local authorities to short change both service users and providers.
How can a local authority possibly defend such a practice? In North Yorkshire we were aware that 15-minute visits were a routine part of care packages. One issue that stood out was their inconsistent use, with some parts of the county having a much higher percentage of these visits. We therefore decided to look at the practice and try and come to some conclusions about its use.
The review didn't take the form of a desktop exercise. As an assistant director I accompanied independent sector care workers on visits. These encompassed all timeframes and gave an opportunity for both users of services and care workers to talk to a senior manager about the care they received.
In addition, a working group was set up that included council staff and the organisations who provide care. An important part of this group's work was to take into account service user views. A surprising early finding was that most parties agreed there is a role for 15-minute visits.
The key to people's views and to the final guidance that was produced centred on what could be undertaken in 15 minutes; the main principle being that such a visit in isolation was not good. However, a 15-minute visit within a wider care package did allow some simple single tasks to be undertaken. The guidance outlines some key tasks that need to be provided within any visit, such as ensuring all necessary hygiene requirements are met, plus one personal care task. The latter includes a wide range of activities from emptying a catheter bag, safety or security checks, to preparing meals or drinks.
The key element is that this is taking place within a wider care package and the care worker will be known to the person. The visit builds on the other support provided.
In a follow up survey it was found that over 90% of people were satisfied with the guidance and issues. A further interesting aspect of our feedback was that because some service users have to pay for care, they were concerned when visits ran over the allocated time.
We are now looking to build both the guidance and the approach. A key element of our commissioning as we attempt to attain the goal of being outcome-based is to ensure the providers and service users talk about how their care will be provided. If within the overall constraints of the care package they wish to make changes, then this will be allowed.
So should 15-minute visits ever occur? The answer in North Yorkshire is clearly yes.
Should 15-minute visits exist outside of a larger care package? The answer is probably not.
However, our approach is to talk directly to service users about how their care should be provided. If they do feel that one off 15 minutes meet their needs the answer becomes – why not?