Change Brings Opportunity, But We Must Protect Choice and Stability
Across Herefordshire, commissioners (the people who plan and purchase social care services) and providers of homecare support are currently discussing proposed Care in Your Home (CIYH) changes. The ambition behind these proposals is understandable. We all want to create a sustainable social care system that delivers high-quality support, makes best use of limited resources and helps people remain independent in their own homes for as long as possible.
At Services for Independent Living (SIL), we support the principle of reform. Social care cannot continue to operate exactly as it does today if we are to meet growing demand and increasingly complex needs. However, change must be carefully designed and implemented if we are to avoid unintended consequences that could reduce choice, destabilise the provider market and ultimately affect the people who rely on support every day.
The Risks of a Prime Provider Model
One of the most significant concerns raised by local providers relates to the proposed use of Lead or Prime Providers across geographical areas. While this approach may appear attractive from a commissioning perspective, it transfers considerable financial, operational and governance risks onto those organisations taking on the lead role.
A Prime Provider would be responsible for providing all care paid for by Herefordshire Council in a set location and all hospital discharge support. They would not be able to turn down work if they don’t have enough staff capacity, either as result of the ongoing recruitment challenges or exceptionally high sickness levels, etc. The council are trying to provide some additional funding to provide higher staffing levels, but recruitment and retention of staff is still a real challenge in a traditionally low paid sector. This will mean many of the current local providers would not be able to put themselves forward for this role.
There is also a broader question: what happens if a Prime Provider fails?
Concentrating a significant proportion of community support within a small number of organisations inevitably increases system risk. If one provider experiences financial difficulties, recruitment challenges or operational failure, the impact could be felt across an entire locality. Social care already operates in a fragile environment. We should be cautious about creating arrangements where too much depends on the success of a single organisation.
A resilient market is usually one that spreads risk across multiple providers rather than concentrating it.
The Workforce Challenge Cannot Be Ignored
Whilst discussions often focus on structures, contracts and commissioning models, the reality is that social care’s biggest challenge remains recruitment and retention. Herefordshire has a low unemployment rate.
Changing who holds the contract does not create more care workers, or encourage people into the sector.
Many providers continue to experience difficulties recruiting staff, particularly in rural areas. If organisations lose commissioned work or uncertainty causes providers to exit the market, there is a real risk that experienced workers could leave the sector altogether.
That would be a loss for everyone.
Social care depends on skilled, compassionate people. Once workers move into other sectors, attracting them back becomes increasingly difficult. Any transition must therefore prioritise workforce stability and seek to retain the dedicated staff who already support local people every day.
Protecting Choice Through Direct Payments and Individual Service Funds
One of the more encouraging aspects of ongoing discussions is the continued commitment to Direct Payments and the expansion of Individual Service Funds (ISFs).
These approaches place choice and control in the hands of the person drawing on support. They allow individuals and families to select the provider that best meets their needs rather than having services allocated to them.
Importantly, Direct Payments and ISFs should enable many people to remain with their existing provider even if commissioning arrangements change.
For people receiving care, continuity matters. Relationships matter. Trust matters.
Where someone has built a successful support arrangement with a provider they know and value, there should be every effort to preserve that relationship.
However, this will only be possible if providers remain active in the market. If organisations decide that future arrangements are too uncertain or financially unsustainable and therefore withdraw from Council-commissioned services entirely, people could still face disruption. This is why maintaining a healthy and diverse provider market remains essential.
Partnership is the Key to Success
Perhaps the most important lesson from social care reform across the country is that successful change is rarely imposed. It should be designed collaboratively.
Providers, people who use services, family carers, community organisations and commissioners all bring valuable perspectives. The strongest solutions emerge when these voices are heard early and continuously.
The social care sector has demonstrated remarkable resilience over many years. Providers have adapted to increasing demand, workforce shortages, changing regulations and financial pressures, all whilst continuing to support people to live independent lives.
That experience should be recognised and harnessed.
Looking Ahead
The Care in Your Home proposals represent one of the most significant changes to community support in Herefordshire for many years. They offer opportunities to rethink how support is delivered and how communities can play a greater role in helping people remain independent.
Reform should strengthen choice, not reduce it, It should increase resilience, not concentrate risk and it should support the workforce, not create further uncertainty.
Whatever structure ultimately emerges, we must remember that success will not be measured by contracts or procurement models. It will be measured by whether people continue to receive reliable, high-quality support from people they know and trust.
At SIL, whilst we remain committed to working in partnership with commissioners, providers and local communities to help create a care system that is sustainable, person-centred and true to our shared vision of Independent Living for All, we may not be able to embrace the model as it is currently proposed.
We will of course continue to provide first class services and constructively challenge the people planning and developing new approaches where we feel it is in the best interests of local people.
