Be Caring delivers neighbourhood-based home support across seven services in the North of England: Leeds, Bradford, Sheffield, Newcastle, North Tyneside, Liverpool and Manchester. Its Care Workers support older people to stay independent at home, covering personal care, medication, nutrition and hydration, reablement after a hospital admission or a fall, and reconnection into community life. The challenge Homecare in England is typically commissioned by the minute or by the visit, so care workers are paid only for time inside a person’s home. Commissioners fund travel as a percentage of the hourly rate, ignoring that travel time is fixed and falls hardest on short visits; they buy care in blocks of 15, 30 or 60 minutes regardless of what a person needs, and payment stops when someone goes into hospital or cancels a call. Care workers carrying that model earn low and unpredictable pay for lone working in all weathers, so turnover runs high and every departure costs that person receiving care the relationship their support depends on. A care worker meeting someone for the first time cannot know they are eating less, moving more cautiously or mixing up their family members, so deterioration surfaces at crisis point rather than before it. People supported at home can also drop out of routine health monitoring – for example, some have not had a blood pressure check in years and receive no home visits from their GP. Our Care Workers see these people more often than family or any health professional, and a task-and-time contract gives them no remit to act on what they notice.Commissioned time also goes undelivered. Where a package no longer fits, our Care Assessors find planned care nobody has reviewed, calls timed against a routine the person has outgrown, and public money not converting into contact time. Be Caring’s innovative approach Be Caring pays Care Workers for their whole shift, including travel, training, gaps in the rota and emergencies. Its Care Workers therefore hold time a pay-per-visit model does not fund, and use it to stay longer with someone who needs it, telephone a GP, or take a person to an appointment. A Care Assessor opens support with an About Me conversation, then completes an outcomes form covering four themes: independence, home, community and wellbeing. The person scores each theme from one to five against a statement, including “I am as independent as I can be”, explains the score, and states in their own words what they want to change. Our Care Assessor records what the person can already do before what they need, then writes the goal into the care plan tasks, the At a Glance task and the risk assessments, so a Care Worker arriving on shift sees what the person is working towards alongside what needs doing. Care Workers are guided to do with rather than do for. Service Managers, Care Assessors and Lead Coordinators track every open outcome at monthly outcome tracker meetings. Where independence has improved, a reduction is agreed with the person and family and the social work team notified. Where need has increased, the Care Coordinator increases support or refers on, to district nursing for clinical need, therapy for mobility, Adult Social Care where risk or safeguarding is involved, and housing or substance misuse services where those are the barrier. Service Managers also attend neighbourhood multidisciplinary meetings with social work and health colleagues, which brings the right professional to a person without a referral queue. Care Workers use Above and Beyond time for what sits outside the care plan, requested through the office for a named person and purpose. Care Worker Community Champions accompany people to a first session until they are ready to go alone. Trainers extend what Care Workers can do clinically. Having an Occupational Therapy Practice Lead as part of the Be Caring team emphasises its strength-based assessment, rehabilitation, positive risk-taking and workforce development. Who commissions the service? Local authority adult social care directorates commission all seven services. Leeds City Council commissions the Community Health and Wellbeing Service in West Leeds, with separate arrangements held by the commissioning authorities in Bradford, Sheffield, Newcastle, North Tyneside, Liverpool and Manchester. Be Caring holds neighbourhood prime provider arrangements in some areas, giving guaranteed volumes of work within a defined patch, and has negotiated continuity of income where a person is admitted to hospital or cancels calls, so rotas and Care Workers’ pay hold steady through fluctuations in demand. Be Caring introduced block pay in Leeds in 2020, extended it across all homecare services by 2023, and now only bids for contracts where block pay is viable within the rate offered. The “social enterprise difference”in action Be Caring is 100% owned by its workforce through an Employee Ownership Trust and an Employee Benefit Trust, with no external shareholders, no debt since November 2022 and reserves above £1m in July 2025. Surpluses fund colleagues rather than dividends: in 2025 colleagues shared £190,000 in bonuses, up to £400 each, alongside £89,000 in targeted recognition and retention payments, funded training and apprenticeships. Its VOICE council elects representatives who sit on the Board, attend bi-monthly senior management meetings, meet our Chief Executive five times a year and turn what Care Workers raise into decisions: a night-time safety survey secured torches, personal alarms and ponchos for lone workers, and colleagues in Liverpool using e-scooters secured mileage paid at the cyclist rate. “I have a good schedule with proper working hours, very few gaps between calls, and less travelling from one client to another… Here, my pay is accurate and reliable, so I don’t have to worry about checking it every month.” A Be Caring Care Worker. Social purpose shows in what Be Caring funds that no contract pays for. And the organisation declines contracts where the rate makes block pay impossible, accepting lost revenue rather than employing Care Workers on terms that produce turnover. Prevention Be Caring’s Care Workers support people to keep doing what maintains capability: walking to the shop, preparing a meal, managing medication, getting to a club. Care Assessors keep packages proportionate, because care that does more for a person than they need accelerates the loss of the skills they still have. A.A., 60, in Leeds lives with primary progressive multiple sclerosis on one visit a week and explained at review that reduced dexterity made cutting toenails unsafe, having previously used pliers and caused injury, with overgrown nails now catching on slippers and raising falls risk. A.A.’s Care Assessor arranged a chiropody home visit rather than more care, and A.A. remains on one visit a week. This is primary prevention: reducing falls, isolation and avoidable loss of function before any of them need a service response. Because the same Care Workers visit the same people, they notice change early (e.g. evidence which supported a memory clinic referral and an Alzheimer’s diagnosis). Care Workers also notice risk in people who are not Be Caring clients. This leads to secondary prevention, and is where an avoidable hospital admission or residential placement is often stopped. Where a person has already deteriorated, Care Assessors rebuild the plan around regaining what was lost, working on functional movement, activities of daily living and confidence, taking positive risks the person agrees to rather than removing independence to remove risk. This is tertiary prevention: reducing the impact of an established condition, supporting recovery and preventing readmission. Impact for workforce, commissioners and quality 92.7% of Be Caring colleagues would recommend Be Caring as a place to work, up from 49.1% in October 2021. For commissioners, Kate Sibson (Leeds Adults and Health Commissioning Manager) reports improved contact time, happier clients and colleagues and reduced staff turnover across the first year of the Community Health and Wellbeing Service. Shift pay delivered around 25% productivity gains in Leeds and Manchester, converting commissioned money into more contact time without extra expenditure. The Care Quality Commission rates the Leeds service Outstanding (including for caring and being well-led) and named block pay as a key innovation letting Care Workers give unhurried care, finding the service “helped people to lead their best lives.” Across 1,234 client surveys in 2025, 93.8% rated their care good or outstanding and 88% said they are involved in decisions whenever they want to be. Yorkshire Ambulance Service issued a formal GREATix excellence report in January 2025, commending a Be Caring Care Workers for care that “should be a template for care” for other providers. Financially, the direct saving comes from packages reduced or ended as people regain independence, agreed with the person and confirmed at review, and from planned time re-matched to actual need where a package was over-commissioned. Package reductions and endings, delivered against commissioned time, retention and length of service, self-scored outcomes, referrals and their results, and client satisfaction are all observable, measured and attributable. Four external bodies have tested the results: The Care Quality Commission inspected and rated Be Caring’s services. Leeds City Council commissioned York Consulting to evaluate the Community Health and Wellbeing Service independently. Skills for Care published Be Caring’s neighbourhood block-pay model as a national Practical Approach Toolkit, with checklists for providers and commissioners; Rob Hargreaves (Central Engagement Lead, Skills for Care) said it “strengthens continuity, improves working conditions and puts relationships back at the centre of care”. In February 2026 Be Caring became the first organisation to achieve Business Culture Certification, scoring 84% through an evidence framework assessed via Hult International Business School. Be Caring does not hold linked NHS and local asuthority data, so we claim no number of prevented hospital admissions, prevented falls or avoided residential placements, and hold no social return on investment figure. Policy changes to scale this more widely Commissioners should let longer developmental contracts, in the region of ten years with break clauses, because the investments prevention depends on do not return inside a three-year term. A provider needs that horizon to raise pay, build local partnerships, embed digital systems, recruit Occupational Therapy capability and then demonstrate the outcomes, with flexibility to pilot and refine rather than deliver a specification fixed at award. Commissioners should fund all time worked, including travel, training and gaps, and pay for outcomes rather than minutes. That means rates built on the real cost of delivery, sufficient volumes of work within a defined neighbourhood to plan rotas efficiently, continuity of income through hospital admissions and cancellations, and trusted review arrangements letting a provider and a local authority right-size packages together, including reducing them. Funding all time worked is also what pays for the preventative work: a Care Worker taking a blood pressure reading, telephoning a dental practice or accompanying someone to a first coffee morning is doing none of those inside a 30-minute commissioned call. Commissioners and the NHS should commission at neighbourhood level and share data. Aligning homecare with neighbourhood health teams, social work, district nursing, therapy and primary care puts the right professional around a person quickly, and linking homecare records to NHS and local authority outcome data is what would make avoided demand and avoided cost measurable across the system. What next? • More case studies of prevention in public service delivery
Be Caring delivers neighbourhood-based home support across seven services in the North of England: Leeds, Bradford, Sheffield, Newcastle, North Tyneside, Liverpool and Manchester. Its Care Workers support older people to stay independent at home, covering personal care, medication, nutrition and hydration, reablement after a hospital admission or a fall, and reconnection into community life. The challenge Homecare in England is typically commissioned by the minute or by the visit, so care workers are paid only for time inside a person’s home. Commissioners fund travel as a percentage of the hourly rate, ignoring that travel time is fixed and falls hardest on short visits; they buy care in blocks of 15, 30 or 60 minutes regardless of what a person needs, and payment stops when someone goes into hospital or cancels a call. Care workers carrying that model earn low and unpredictable pay for lone working in all weathers, so turnover runs high and every departure costs that person receiving care the relationship their support depends on. A care worker meeting someone for the first time cannot know they are eating less, moving more cautiously or mixing up their family members, so deterioration surfaces at crisis point rather than before it. People supported at home can also drop out of routine health monitoring – for example, some have not had a blood pressure check in years and receive no home visits from their GP. Our Care Workers see these people more often than family or any health professional, and a task-and-time contract gives them no remit to act on what they notice.Commissioned time also goes undelivered. Where a package no longer fits, our Care Assessors find planned care nobody has reviewed, calls timed against a routine the person has outgrown, and public money not converting into contact time. Be Caring’s innovative approach Be Caring pays Care Workers for their whole shift, including travel, training, gaps in the rota and emergencies. Its Care Workers therefore hold time a pay-per-visit model does not fund, and use it to stay longer with someone who needs it, telephone a GP, or take a person to an appointment. A Care Assessor opens support with an About Me conversation, then completes an outcomes form covering four themes: independence, home, community and wellbeing. The person scores each theme from one to five against a statement, including “I am as independent as I can be”, explains the score, and states in their own words what they want to change. Our Care Assessor records what the person can already do before what they need, then writes the goal into the care plan tasks, the At a Glance task and the risk assessments, so a Care Worker arriving on shift sees what the person is working towards alongside what needs doing. Care Workers are guided to do with rather than do for. Service Managers, Care Assessors and Lead Coordinators track every open outcome at monthly outcome tracker meetings. Where independence has improved, a reduction is agreed with the person and family and the social work team notified. Where need has increased, the Care Coordinator increases support or refers on, to district nursing for clinical need, therapy for mobility, Adult Social Care where risk or safeguarding is involved, and housing or substance misuse services where those are the barrier. Service Managers also attend neighbourhood multidisciplinary meetings with social work and health colleagues, which brings the right professional to a person without a referral queue. Care Workers use Above and Beyond time for what sits outside the care plan, requested through the office for a named person and purpose. Care Worker Community Champions accompany people to a first session until they are ready to go alone. Trainers extend what Care Workers can do clinically. Having an Occupational Therapy Practice Lead as part of the Be Caring team emphasises its strength-based assessment, rehabilitation, positive risk-taking and workforce development. Who commissions the service? Local authority adult social care directorates commission all seven services. Leeds City Council commissions the Community Health and Wellbeing Service in West Leeds, with separate arrangements held by the commissioning authorities in Bradford, Sheffield, Newcastle, North Tyneside, Liverpool and Manchester. Be Caring holds neighbourhood prime provider arrangements in some areas, giving guaranteed volumes of work within a defined patch, and has negotiated continuity of income where a person is admitted to hospital or cancels calls, so rotas and Care Workers’ pay hold steady through fluctuations in demand. Be Caring introduced block pay in Leeds in 2020, extended it across all homecare services by 2023, and now only bids for contracts where block pay is viable within the rate offered. The “social enterprise difference”in action Be Caring is 100% owned by its workforce through an Employee Ownership Trust and an Employee Benefit Trust, with no external shareholders, no debt since November 2022 and reserves above £1m in July 2025. Surpluses fund colleagues rather than dividends: in 2025 colleagues shared £190,000 in bonuses, up to £400 each, alongside £89,000 in targeted recognition and retention payments, funded training and apprenticeships. Its VOICE council elects representatives who sit on the Board, attend bi-monthly senior management meetings, meet our Chief Executive five times a year and turn what Care Workers raise into decisions: a night-time safety survey secured torches, personal alarms and ponchos for lone workers, and colleagues in Liverpool using e-scooters secured mileage paid at the cyclist rate. “I have a good schedule with proper working hours, very few gaps between calls, and less travelling from one client to another… Here, my pay is accurate and reliable, so I don’t have to worry about checking it every month.” A Be Caring Care Worker. Social purpose shows in what Be Caring funds that no contract pays for. And the organisation declines contracts where the rate makes block pay impossible, accepting lost revenue rather than employing Care Workers on terms that produce turnover. Prevention Be Caring’s Care Workers support people to keep doing what maintains capability: walking to the shop, preparing a meal, managing medication, getting to a club. Care Assessors keep packages proportionate, because care that does more for a person than they need accelerates the loss of the skills they still have. A.A., 60, in Leeds lives with primary progressive multiple sclerosis on one visit a week and explained at review that reduced dexterity made cutting toenails unsafe, having previously used pliers and caused injury, with overgrown nails now catching on slippers and raising falls risk. A.A.’s Care Assessor arranged a chiropody home visit rather than more care, and A.A. remains on one visit a week. This is primary prevention: reducing falls, isolation and avoidable loss of function before any of them need a service response. Because the same Care Workers visit the same people, they notice change early (e.g. evidence which supported a memory clinic referral and an Alzheimer’s diagnosis). Care Workers also notice risk in people who are not Be Caring clients. This leads to secondary prevention, and is where an avoidable hospital admission or residential placement is often stopped. Where a person has already deteriorated, Care Assessors rebuild the plan around regaining what was lost, working on functional movement, activities of daily living and confidence, taking positive risks the person agrees to rather than removing independence to remove risk. This is tertiary prevention: reducing the impact of an established condition, supporting recovery and preventing readmission. Impact for workforce, commissioners and quality 92.7% of Be Caring colleagues would recommend Be Caring as a place to work, up from 49.1% in October 2021. For commissioners, Kate Sibson (Leeds Adults and Health Commissioning Manager) reports improved contact time, happier clients and colleagues and reduced staff turnover across the first year of the Community Health and Wellbeing Service. Shift pay delivered around 25% productivity gains in Leeds and Manchester, converting commissioned money into more contact time without extra expenditure. The Care Quality Commission rates the Leeds service Outstanding (including for caring and being well-led) and named block pay as a key innovation letting Care Workers give unhurried care, finding the service “helped people to lead their best lives.” Across 1,234 client surveys in 2025, 93.8% rated their care good or outstanding and 88% said they are involved in decisions whenever they want to be. Yorkshire Ambulance Service issued a formal GREATix excellence report in January 2025, commending a Be Caring Care Workers for care that “should be a template for care” for other providers. Financially, the direct saving comes from packages reduced or ended as people regain independence, agreed with the person and confirmed at review, and from planned time re-matched to actual need where a package was over-commissioned. Package reductions and endings, delivered against commissioned time, retention and length of service, self-scored outcomes, referrals and their results, and client satisfaction are all observable, measured and attributable. Four external bodies have tested the results: The Care Quality Commission inspected and rated Be Caring’s services. Leeds City Council commissioned York Consulting to evaluate the Community Health and Wellbeing Service independently. Skills for Care published Be Caring’s neighbourhood block-pay model as a national Practical Approach Toolkit, with checklists for providers and commissioners; Rob Hargreaves (Central Engagement Lead, Skills for Care) said it “strengthens continuity, improves working conditions and puts relationships back at the centre of care”. In February 2026 Be Caring became the first organisation to achieve Business Culture Certification, scoring 84% through an evidence framework assessed via Hult International Business School. Be Caring does not hold linked NHS and local asuthority data, so we claim no number of prevented hospital admissions, prevented falls or avoided residential placements, and hold no social return on investment figure. Policy changes to scale this more widely Commissioners should let longer developmental contracts, in the region of ten years with break clauses, because the investments prevention depends on do not return inside a three-year term. A provider needs that horizon to raise pay, build local partnerships, embed digital systems, recruit Occupational Therapy capability and then demonstrate the outcomes, with flexibility to pilot and refine rather than deliver a specification fixed at award. Commissioners should fund all time worked, including travel, training and gaps, and pay for outcomes rather than minutes. That means rates built on the real cost of delivery, sufficient volumes of work within a defined neighbourhood to plan rotas efficiently, continuity of income through hospital admissions and cancellations, and trusted review arrangements letting a provider and a local authority right-size packages together, including reducing them. Funding all time worked is also what pays for the preventative work: a Care Worker taking a blood pressure reading, telephoning a dental practice or accompanying someone to a first coffee morning is doing none of those inside a 30-minute commissioned call. Commissioners and the NHS should commission at neighbourhood level and share data. Aligning homecare with neighbourhood health teams, social work, district nursing, therapy and primary care puts the right professional around a person quickly, and linking homecare records to NHS and local authority outcome data is what would make avoided demand and avoided cost measurable across the system. What next? • More case studies of prevention in public service delivery