A three-year programme to trial the use of optimisation technology in domiciliary care has identified a number of opportunities for local authorities and care providers to improve the planning of homecare, offering potentially significant benefits for care workers, service users and the social care sector as a whole.

Domiciliary care (or homecare) is provided at a local level by local authorities commissioning a range of contracts delivered by multiple providers. Significant pressures are impacting care workers, service users and local authorities, and providers are reportedly struggling with low workforce utilisation.

According to the King’s Fund, 818,000 people were using homecare in England in 2020/21, including some of the most vulnerable people in society, while the Care Quality Commission (CQC) has reported a further half a million people are on the waiting list, many with critical needs. In the first three months of 2022, 2.2 million hours of homecare could not be delivered because of insufficient workforce capacity, leading to unmet and under-met needs.

Exploring how the use of technology could help tackle some of these challenges, the Domiciliary Care Workforce Programme was led and co-funded by Health Innovation West of England, Health Innovation South West, and NHS England Workforce, Training and Education South West (formerly Health Education England South West).

A nationwide call was launched in 2021 to identify potential innovations. A panel of representatives from across the health and social care system assessed more than 30 applications, selecting Procomp’s Strategic Optimisation service as the appropriate solution to trial.

Procomp is a Finnish company with a background in logistics planning and optimisation. The company works with a third of the Finnish domiciliary care workforce. They use an AI-based solution to optimise planning, reduce mileage and improve carer utilisation, as well as to support key decision-makers identify and implement systemic changes.

Two local authorities successfully applied to take part in the trial, as part of a call to all local authorities in the South West.

Based on data modelling provided by Procomp’s Strategic Optimisation service, two rounds of changes to how homecare was planned and delivered were introduced in each locality between September 2022 and September 2023. These changes included:

  • reviewing care assessment practices
  • introducing flexible start times
  • balancing demand by organising non-critical activity at off-peak times
  • discussions around care worker gender.

Unity Insights were commissioned to independently evaluate the Domiciliary Care Workforce Programme. The evaluation focused on the acceptability and implementation of Procomp’s Strategic Optimisation service, its effectiveness against desired outcomes, and a value-based health economic review. The scope of the evaluation was set out at the beginning of the programme and was based on a set of objectives around the assumed areas of impacts of the solution and subsequent data gathered from those specific changes introduced.

Unity Insights’ evaluation evidenced specific benefits in using optimisation software to improve the working conditions, job satisfaction and retention of care workers and to increase provider revenue.

Care workers who experienced the changes in working practices were surveyed. Their feedback was positive and demonstrated increased satisfaction with their workload and the time available between home visits, as well as an increase in overall job satisfaction.

The evaluation also evidenced a reduction in miles travelled by care workers during the first month after implementation, and several staff reported less need to cut appointments short due to reduced travel requirements. However, the findings suggest that this impact is diluted over time if frequent changes do not occur. Rota reviews and changes should therefore take place regularly, ideally on a weekly basis.

Unity Insights’ cost-benefit analysis modelled the benefit of efficiency gains to homecare providers during the pilot. Results estimate the net present value and benefit-cost ratio between 2023/24 and 2027/28. The benefits were based on a reduction in travel distances, an increase in care packages delivered, and an improvement in staff retention. This demonstrated that the two pilot providers involved in the programme could potentially save a combined £3.58 for every £1 invested in the solution.

It is important to note that the real-world nature of the evaluation presented a number of limiting factors and uncontrolled variables impacted the data. Notably, the landscape of care delivery changed during the data collection period, which may have influenced the observed results. This includes changes to supply and demand through sponsored workers being onboarded, decreasing care package sizes (value and resource requirement of the average client care package), fluctuations in the number of both workers and clients, and reduced waiting lists being described.

The accuracy of some of the data supplied was another limiting factor. It is likely that reported visit lengths were subject to rounding up, which may skew both the quantitative and health economic results. Due to information governance requirements, data provided for travel distances by homecare staff did not include travel to and from home.

Several metrics forming the benefit streams calculations for the cost benefit analysis are expected to be impacted by external factors, such as assumptions about travel distances not changing significantly whilst servicing a larger region and retention rate fluctuations due to the introduction of sponsored workers.

Read Unity Insights’ full evaluation report here and view the summary infographic.

The evaluation findings coupled with broader insights, observations and learnings from implementation of the Domiciliary Care Workforce Programme as a whole offer a range of important areas for further consideration, discussion and research.

Procomp’s modelling of data from both local authorities indicated potentially wider opportunities to improve care worker utilisation by 35%; reduce mileage by 65%, along with associated travel costs for providers and care workers; and improve the overall experience of service users.

In summary, the Domiciliary Care Workforce Programme has demonstrated use of optimisation software offers promising opportunities to find solutions to systemic problems and better plan homecare provision that could result in potential benefits for the following key groups:

Service users would be more likely to receive their full allocation of commissioned visit time from care workers and have continuity of care worker.  There is also the opportunity to reduce the waiting list for receiving home care.

Domiciliary care workers: providers would be able to schedule their care workers’ time more effectively, allowing them to spend more time with service users rather than travelling or waiting in their car for the next appointment due to inefficient scheduling. This could potentially lead to better take-home pay and increased job satisfaction. Reduced mileage would also result in lower fuel costs and less wear-and-tear on care workers’ personal vehicles.

Domiciliary care providers would be more likely to utilise their workforce more effectively, leading to both improved staff retention (as a result of improved job satisfaction) and the ability to increase revenue through their workers being able to spend more time with clients (billable time).

Local authorities: by using an optimisation tool to implement strategic changes and improve the planning of domiciliary care, it might be possible for councils to reduce their waiting lists by offering the ‘right-sized care’ to service users through an improved understanding of their current data.

However, the homecare sector would need to address a number of barriers before it can take full advantage of these opportunities. These barriers are around sharing data, resistance from providers to change the status quo, and concerns around not being able to offer a personalised service tailored to service user needs.

Roger McDermott, Programme Manager for the Domiciliary Care Workforce Programme at Health Innovation West of England, said: “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.

“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.”

Nikki Taylor, Programme Manager for the Domiciliary Care Workforce Programme at Health Innovation South West, said: “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.

“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.”

Councillor Andy Virr, Portfolio Holder for Adults Social Care and Health, Cornwall Council, said: “Procomp’s strategic optimisation service delivered a depth of insight and evidence that exceeded our expectations, empowering us to make evidence-based decisions that incentivised transformation at a strategic level.

“If successful, this new approach will enable us to improve the day-to-day experience of people who use our homecare services and their care workers. It will also enable us to enhance the pay received by our local care workforce, increase the profitability of our homecare providers and ultimately help to secure the financial sustainability of our local care market.”

Christian Brailsford, Regional Lead for Nursing, Midwifery and Social Care (Workforce, Training and Education) with NHS England South West, said: “Integrated care plays a pivotal role in delivering high-quality services to the population of the South West. I’m genuinely enthusiastic about witnessing how AI technology can begin to positively influence the provision of domiciliary care, enhancing efficiency and enriching the experience for both care-providers and recipients within our communities.”

Mark Russell-Smith, Director of International Operations at Procomp, said: “We’re very proud to have been selected as the innovator in the Domiciliary Care Workforce Programme. Widely reported figures on the state of the domiciliary care sector and projections for the future underscore the need for changes to the way care is organised and delivered – the question is what changes? We proposed our Strategic Optimisation service for the programme as its AI-based modelling makes it an extremely powerful tool to answer the tough question of what changes to make to create a sustainable care system for the future.

“An important aspect of the programme is that it’s enabled a more system-wide approach by both councils and providers. Positive improvements have already been achieved, and there is massive scope for further improvement. Not all problems will be solved overnight, and there isn’t one single solution, but these are important steps. They show how Strategic Optimisation can play a pivotal role in guiding and shaping the future of care, allowing new discussions and genuine solutions to be found to the problems facing the domiciliary care sector.”

Next steps

The findings from the Domiciliary Care Workforce Programme present a strong argument for both commissioners and providers to explore the opportunities offered by the use of optimisation software in planning home care, as well as identifying and implementing much needed systemic changes.

To support this, Health Innovation West of England is sharing these findings with key stakeholders, including policy makers and influencers, to explore how we best take advantage of these opportunities and any barriers to change.

To find out more about the Domiciliary Care Workforce Programme and to get involved in these conversations, please email Alex Leach, Deputy Director of Programmes at alex.leach@nhs.net.

Read more

Evaluation report

Evaluation infographic

 The current challenges facing the domiciliary care sector

  • For the adult health and social care workforce, Skills for Care reported an average vacancy rate of 9.9% and a turnover rate of 28.3%, with 22% of workers on zero-hour contracts (Skills for Care, 2023).
  • Workforce underpayment is prevalent in social care. According to a UNISON survey of homecare workers in February 2023, only a quarter were paid for their travel time, and according to the Homecare Association public organisations frequently purchase homecare by the minute and for contact time only, not covering workers’ travel or waiting time (Low Pay Commission Report, 2023).
  • Commissioning organisations often disperse homecare contracts across a large number of providers based on the lowest price – using care workers’ time inefficiently and negatively affecting productivity (Low Pay Commission Report, 2023).
  • 818,000 people were using home care in England in 2020/21, including some of the most vulnerable people in society (King’s Fund, May 2023).
  • In its 2021/22 edition of ‘State of Care’, the Care Quality Commission (CQC) reported a further 500,000 people are on the waiting list for homecare, many with critical needs. In the first three months of 2022, 2.2 million hours of homecare could not be delivered because of insufficient workforce capacity, leading to unmet and under-met needs.
  • Delayed discharge from hospital is costing the NHS £2 billion per year (King’s Fund, March 2023).

 About Procomp

  • Procomp is a Finnish company with a background in logistics planning and optimisation. The company has worked with health and care since 2011 and now works with a third of the Finnish domiciliary care system. They use an AI-based solution to optimise planning, reduce mileage and improve carer utilisation as well as to support key decision-makers identify and implement systemic changes. They have shown positive results in Finland, Belgium and Netherlands, reducing care worker mileage by more than 40% and improving care worker utilisation by more than 25% with no reduction in care for service users.
  • Procomp solution offers two services: Strategic Optimisation (for local authorities and policymakers) and Operational Optimisation (for domiciliary care providers). Procomp applied to the Domiciliary Care Workforce Programme to evaluate their Strategic Optimisation service.
  • Procomp’s Strategic Optimisation service is AI technology-enabled and uses a snapshot of anonymised data from either a care provider’s patient management or enterprise resource planning (ERP) system or from the care commissioning management system or ERP. By using this real data to model different scenarios, the system evaluates potential changes to ways of working and organising that can lead to significant improvements in the utilisation of the domiciliary care workforce.
  • Modelling is a cost-effective way of understanding the impacts of possible changes on the workforce, service users and mileage before putting them into action.

References

Posted on May 8, 2024

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