A mixed-methods evaluation of a Strategic Optimisation Service of the domiciliary care workforce

Context

With Skills for Care reporting an average vacancy rate of 9.9% and a turnover rate of 28.3% for the adult health and social care workforce, significant pressures are impacting workers, service users, and local authorities (LA) (Skills for Care, 2023). Such pressures may be attributed to the standards in which the workforce operates in, with workers reporting issues of low pay, 22% of filled posts having zero-hour contracts, and providers struggling with low workforce utilisation (Skills for Care, 2023). Due to scarce public funding and inefficient working practices, innovation has the potential to improve utilisation of the current workforce to offer relatively low-cost solutions to build workforce capacity (Toner, 2011).

The innovation specialises in workforce optimisation and logistical planning. Their strategic optimisation service aims to improve workforce utilisation and operational efficiency by offering alternative planning solutions, to support policy makers, commissioners, and other key-decision makers, providing the basis for the Domiciliary Care Workforce Programme.

This is powered by the companies AI-based technology, which analyses operational processes, producing detailed models which are used to provide alternative planning solutions. The service can be applied to analyse work patterns, including geographical work patches, planning practices, team sizes, roles and responsibilities and can help manage and improve outsourcing practices.

What we did

Unity Insights were commissioned by Health Innovation West of England, formerly West of England Academic Health Science Network, to independently evaluate a Domiciliary Care Workforce Programme, assessing the effectiveness of a Strategic Optimisation Service in supporting the social care workforce. The evaluation used data gathered from two care providers in the Southwest. The scope of the evaluation aimed to answer questions on the acceptability and implementation of the innovation, effectiveness against desired outcomes, a value-based health economic review and the potential environmental sustainability. This included perspectives from the local council, providers, domiciliary care staff and the wider healthcare system.

A mixed-methods approach was used to answer these questions, with methods including a care worker survey, interviews of provider staff and council leads, quantitative analysis of care worker appointment schedules, and a cost benefit analysis.

Survey results

Quantitative analysis

Cost-benefit analysis

Results from the cost-benefit analysis were overall positive, with the following summary of outcomes from the analysis:

Further investigation, however, is required before definitive conclusions can be drawn. This is due to variability in results between sites, changing landscape influences and limitations of the data.

Conclusion

In summary, the qualitative feedback suggested improved scheduling and worker satisfaction from implementation of a Strategic Optimisation Service; however, interviews highlighted a range of implementation barriers. Quantitative analysis suggested a Strategic Optimisation Service can be effective, but challenges remain in measuring impact. Cost-benefit analysis indicates a positive return on investment, contingent on sustained positive impact and the low costing structure applied after Year 1. Overall, the evaluation results suggest that if barriers and challenges in the market are overcome or mitigated, there is potential for strategic optimisation to achieve impactful change and desired outcomes.

What did this evaluation add?

The report is to be used alongside supporting papers created by the project team, as an initial step to provide evidence of the potential impact of these types of solutions and the barriers in place, with long-term transformation of domiciliary care being the aim.

In terms of the spread and adoption of the solution, a small sample of qualitative data collected suggested that council members felt the solution had the potential to create benefits in the domiciliary care space, with notable interest from other parties. In contrast, providers suggest that cultural barriers and a more holistic approach may be needed to support the success of further rollout.

“I believe that for the first time, large amounts of homecare data has been shared, analysed and presented to the public and this has highlighted some interesting and challenging findings. I would like to personally thank all of those involved in this programme.“
– Roger McDermott, Programme Manager for the Domiciliary Care Workforce Programme at Health Innovation West of England

“I hope that the programme and evaluation report provide a useful contribution to the debate on how to improve social care. We have shown that councils and providers have the opportunity to deliver a better experience for the service users and care workers, whilst reducing waiting lists to receive home care and contributing to Net Zero plans. If anyone would like to meet to discuss the findings from the programme further and how we might be able to work together I’d love to hear from you.”

“We are delighted to have been part of the trial to evaluate the use of optimisation technology in domiciliary care through the Domiciliary Care Workforce Programme. We are really grateful for the contributions of local providers in the South West.“
Nikki Taylor, Programme Manager for the Domiciliary Care Workforce Programme at Health Innovation South West

“The outcomes from the report show the potential of AI to support local authorities in delivering benefits to home care providers, carers and families through reduced travel and waiting times and improved quality of care, whilst helping with staff retention. By harnessing this technology to translate data into predictive insights, local authorities will be able to drive transformative approaches to demand forecasting, route optimisation, and supply planning as examples of future models of care.”