This high-impact change sets out to promote commissioning services that are flexible and responsive to people's needs and wishes.


Commissioning services that offer highly individualised, flexible services in response to the assessed needs and wishes of service users can achieve substantial benefits, such as improved daily living skills, greater independence and improved physical health. Small projects can have a big impact on outcomes for service users and reduce demand on statutory organisations.


Responsive and flexible services can be promoted by commissioning for this outcome.


Improved health and well-being

Case study

Age Concern Oxfordshire's city and county flexible care service responds to the needs of older people with dementia, depression, anxiety, personality disorders or enduring mental health problems who are unable to access day or home care. The service offers an active, home-based therapeutic support programme, planned in direct response to clients' specific needs and wishes.

Activities with the flexible carer could include letter writing, cooking, gardening or sharing a pot of tea and a chat.

An independent evaluation carried out by the Oxford Dementia Centre in 2001 found that users of the service experienced:

  • increase in social contact outside the home (84 per cent);

  • improvement in communication (70 per cent);

  • improvement in daily living skills (70 per cent);

  • improvement in mental health (58 per cent);

  • reduction in stress and anxiety (56 per cent).

Carers experienced:

  • gains from respite (70 per cent);

  • less stress and burden (66 per cent).

Success story

Mrs G lived alone in a rented housing association flat. She suffered high levels of anxiety and depression, compounded by severe fibromyalgia and a visual impairment. Mrs G received support from her GP and counselling. Her neighbours were very noisy and she perceived them to be hostile, which made her anxious. Mrs G was referred to the flexible care service by her GP in the hope that her flexible carer would be able to suggest and reinforce coping strategies for her to deal with day-to-day living. The flexible carer supported Mrs G to apply for better housing and she has since moved to a bungalow, which she calls "peace haven".