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Lay Summary
The economic determinants of home care provider quality
Stephen Allan and Florin Vadean, March 2023


Many people in England with long-term care needs are supported by staff working for home care services. It is important to know what changes the quality of these services so that they can continue to improve and to ensure public funds are spent in the best way. There is some research evidence for the US on factors that influence home care quality, but in England the evidence is more limited.


The objective of this study was to understand the factors which affect home care quality in England.


Using economic theory, we developed a model of home care quality whereby the inputs that go into the delivery of the service (such as the staff and equipment) lead to the change in wellbeing of those receiving the service. We used this as a basis for a statistical analysis of how the quality of a home care service, as assessed by the Care Quality Commission, is affected by service-level factors (e.g. sector and size), staffing factors (e.g. pay and training), and factors related to where the service provides care (e.g. local unemployment and wealth). We used a national staffing database which included information on each home care service. We added to this data on employment and income from the area each service was located. 


We found that service (sector, competition from other agencies) and staffing (number of staff and contract type) factors had important effects on the chance of a service being high quality. For example, services with a high proportion of care staff employed on zero-hours contracts were more likely to be low quality. We did not find that wage affected home care quality and believe this finding is likely due to data limitations. 


Increasingly people with long-term care needs are supported in their own homes by staff working for home care services. It is important that these services provide high quality. However, many have high levels of staff turnover which could affect the level of quality they can provide. This study has shown using data for England that there are a number of factors, including staffing, which affect the quality of a home care service. Overall, these findings are important for helping to find ways to sustain and develop home care services, including through improving the recruitment and retention of staff.


Stephen Allan,

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