Home care for older people recommendations


This report presents the Commission’s assessment of what local authorities, Government, the Care Quality Commission and the Local Government Ombudsman have done in response to recommendations directed at them in our Close to home inquiry report.

Download the Close to Home recommendations review

Supplementary research report:

Local authority responses to the ‘Close to home’ inquiry research report


This report presents the Commission's assessment of what local authorities, Government, the Care Quality Commission and the Local Government Ombudsman have done in response to recommendations directed at them in our Close to home inquiry report.

Close to home was published in November 2011 following a formal inquiry into older people and human rights in home care. It revealed serious breaches of human rights including people not getting support to eat and drink, being put to bed at 2.45pm and being left unwashed for days.

Close to home called for:

  • effective monitoring to ensure that human rights are properly incorporated into the ways in which local authorities commission home care and that systems are put in place so that problems in care delivery come to light early;
  • protection to close gaps in the current legal system; and
  • better guidance for older people so that they have clear information about their human rights when making decisions about home care plus guidance for local authorities about their human rights obligations.


Local authorities

We are encouraged that around 66 per cent of local authorities responded to the survey and that, of these, around three-quarters have taken some action to review their commissioning policies and practices. However, we are disappointed that around one-third of authorities did not respond by our initial deadline despite our efforts to give them simple, and time-saving, ways to do so.

The review revealed that a small number of local authorities are implementing a systematic human rights based approach to the way in which they assess, commission and monitor care services.

It is these authorities that appear to have done the most to put the Close to home recommendations into practice and human rights at the heart of what they do. For example, these authorities promote human rights at every stage of the procurement process; train elected members about their care commissioning and human rights obligations; and use transparent costing models.

Close to home found that the low pay and status of care workers, coupled with high workforce turnover rates, was a significant factor exacerbating threats to the human rights of older people. Therefore it was reassuring that the recommendations review made a finding that 71 of the 77 local authorities had taken some action to review commissioning practices and assess whether their practices were conducive to ensuring a well skilled and supported care workforce. However, apart from a handful of notable exceptions, our findings did not convince us that authorities had been able to make significant improvements to the conditions of care workers.

It was disappointing that so few authorities provided human rights training for elected members and, while many local authorities reported having well established information, advocacy, brokerage and other systems in place, many do not appear to take account of the specific needs of older people. We remain concerned about this and the consequent impact on older people’s human rights.

Government and others

Close to home evidence suggested that the lack of independent oversight of adult social care commissioning practices could contribute to the risks of threats to human rights going undetected. We therefore welcome the government's indication that the Care Quality Commission will resume responsibility for monitoring adult social care commissioning. NB. the government has subsequently changed its position, during the passage of the Care Bill 2013 through Parliament the government removed clauses that would have provided the Care Quality Commission with powers to inspect local authority commissioning of adult social care.

The new strategic direction adopted by the Care Quality Commission over the past six months marks a positive step away from generic inspections to those that are tailored for each sector. This offers the Care Quality Commission the framework to develop a specialised inspection team for home care services. We also welcome steps taken by the Care Quality Commission to encourage views and feedback direct from service users and incorporate this into their provider profiles and general intelligence base.

It is an ongoing concern that the legislative framework still does not give adequate protection to people receiving publicly commissioned home care from private and third sector providers, given the Government's clear resistance to taking steps to close this loophole in the Human Rights Act.

We also take the view that, without government guidance on human rights which is relevant to the challenging legal and financial context in which local authorities now operate, they will continue to struggle to understand the practical implications of their human rights obligations generally and in relation to home care.

Norman Lamb MP, Minister of State for Care, has demonstrated a strong commitment to improving the current home care system for both service users and care workers. In taking personal leadership of the Homecare Innovation Challenge with key stakeholders (including the Commission, the United Kingdom Homecare Association and others), he aims to find solutions to the unsustainable home care system which he sees as being in crisis' and incentivising neglect'.

Next steps

In the light of the recommendations review findings, the Commission plans to take the following steps.

  1. We will write to all local authorities indicating our findings, promoting our published guidance on human rights for commissioners of home care, and drawing their attention to the sample clauses set out in Appendix B of the report about the National Minimum Wage and third party rights.
  2. We have written to the local authorities that did not respond to this review reminding them that failure to do so will result in their being publicly named as non-responders. We have also asked them to publish the steps they are taking to promote and protect older people's human rights in home care services. We will review their progress after publishing this report and will decide on appropriate action if they fail to engage with us.
  3. We recommend that all local authorities use costing models which incorporate essential elements for safe and legal care and that they demonstrate transparency about how their home care commissioning rates are calculated by putting costing models on their websites.
  4. We have started to discuss our findings with the Department of Health to assist the development measures to assess compliance with the ban on age discrimination in services in relation to health and social care.
  5. We will convene a round table with stakeholders to discuss ways of promoting commissioning practices that most effectively support payment of at least the National Minimum Wage to home care workers.
  6. We will explore with the Care Quality Commission new ways to address some local authorities apparent confusion and lack of knowledge about the significance of human rights obligations when commissioning home care.
  7. We intend to explore the impact of digital exclusion and potential indirect age discrimination.
  8. We will continue to provide briefings to Parliamentarians on the Care Bill about the need to close the human rights loophole and on advocacy. We will also support relevant test cases to clarify the scope of the Human Rights Act.
  9. Finally, we will monitor commissioning practices in the context of direct and indirect age discrimination and the public sector equality duty (PSED) and use relevant regulatory approaches, including legal action where this is necessary and proportionate.

Last updated: 14 Apr 2016