Waltham Forest Council, United Kingdom

Prior to 2014, day care services for older people in Waltham Forest had largely been commissioned by the council on behalf of all service users. A limited range of services were offered, and were generally building-based and did not facilitate increased independence or choice. The area faced increasing demand, a requirement for significant budgetary savings, and political desire for more personalised older people’s day care.

The council undertook a three-month consultation with service users, carers, providers and staff to design a new model for day services. This included a range of ‘change events’ and reviews with 100 service users to understand what was working and not working with the existing care model. From these inputs, the council established the themes and principles that underpinned a new model for older people’s care provision. The new model involved each person assessed as in critical or substantial need being assigned a personalised budget (in the form of a direct payment) – this result being that purchasing power was transferred to service users, who could then participate in activities that suited their personal needs.

To support the local service providers (who had been used to receiving block funding from the council) to transition to this new model, the council provided transformation funding to help providers change their business models and service offers. They also encouraged providers to plan for greater collaboration with each other, such as through sharing premises or back-office functions.

From 2014, the commissioning relationship became a direct one between service user and providers, with quality assurance provided by the council. The change in commissioning model also generated significant savings in its first year.