Across health and social care, few areas carry greater responsibility than the commissioning and oversight of complex care delivered at home and in other non-hospital settings. These are often high-cost, high-risk packages supporting people with profound needs, where failures in delivery can have life-altering or life-threatening consequences.
Yet despite the scale, complexity and risk involved, the governance and oversight arrangements applied to this type of care are stuck in a completely different era. In many cases, they are fundamentally misaligned with both contractual requirements and statutory financial responsibilities. That misalignment is becoming increasingly visible and is frankly untenable in 2026.
The sector now stands at an inflection point and accountability is coming. The question is whether commissioners act now, or wait for failure, scrutiny, and enforcement to force change. As a UK-based specialist in care administration systems and support services, Alocura is perfectly placed via its cloud-based, end-to-end care management software Rostrata to deliver the platform for commissioners and providers to work together to maintain a sustainable and accountable care market.
The legacy model for care delivered at home: Oversight designed for a different world
Many of today’s commissioning and audit processes were designed in the late 1990s, when personal social care budgets were typically modest – often £3,000–£5,000 per year – and care delivery was relatively straightforward.
Fast-forward to today and around 30% of care budgets are now complex, and frequently worth over £100k a year. Care is delivered across fragmented provider markets and the models include personal budgets, bespoke packages, and hybrid commissioning arrangements.
All of which means risk exposure – be that financial, operational, clinical or safeguarding – has increased exponentially.
And yet the core mechanisms of oversight have barely evolved. Audits remain largely manual, retrospective, and transactional, often relying on:
- Paper records
- Personal bank statements supplied once or twice per year
- Sampling exercises that provide no real assurance of actual care delivery
Real-time data, which is explicitly referenced in many contracts, is rarely accessed, analysed, or even requested. In over a decade of providing audit and oversight support, Alocura has not once been asked to supply the Electronic Time Management System (ETMS) data routinely written into contracts.
This is not a marginal gap, it’s a systemic failure. One for which Alocura has spent years developing a solution. That solution is Rostrata; working in collaboration with complex care providers and commissioners, we designed a system that addresses these gaps head-on, ensuring that operational, clinical, and financial requirements are met with transparency, accountability, and assurance.
Oversight vs Contracts and Standing Financial Orders: A growing disconnect that needs solving in 2026
On paper, contracts and Standing Financial Orders are clear. Commissioners retain statutory accountability for public funds and must be able to evidence that:
- Care has been delivered as commissioned
- Payments align to agreed care and support plans
- Providers comply with minimum/living wage requirements
- Purchase-to-pay processes are robust and auditable
- Safeguarding risks are identified and managed
- Public money is spent appropriately and lawfully
In practice, however, current oversight models make it impossible to provide this assurance. Budgets are often issued and spent entirely on trust, with no ongoing correlation between:
- Approved care plans
- Care actually delivered
- Care invoiced and paid for
This creates multiple points of exposure, where care is invoiced but not delivered, or only partially delivered. Care might also be delivered by staff without the required competencies, leading to safeguarding failures going undetected. And talking of staff, without full transparency of who they are or indeed where they are, there can easily be non-compliance with pay and employment obligations.
From an SFO perspective, this represents a material breakdown in financial control. From a commissioning perspective, it represents a failure of assurance. And most importantly, from a public perspective, it represents a growing risk to trust and confidence.
The public cost of inadequate oversight
The consequences of these weaknesses extend far beyond balance sheets. Where care is not delivered as planned, individuals may be left without essential support. Safeguarding risks can go undetected for months or years, hidden by the absence of real-time visibility.
At the same time, millions of pounds of public funds are wasted through inefficiency, misuse, and, in some cases, outright fraud.
These risks are no longer hypothetical; they are increasingly reflected in national news and investigative media coverage. Each high-profile case brings renewed scrutiny, yet too often the response is reactive, focused on managing the immediate issue rather than addressing the structural causes that made it possible.
This cycle erodes public confidence and delays the reform the system urgently needs.
Why current practice is no longer defensible
The current approach to governance and oversight in non-hospital care falls significantly short of the commercial and financial standards routinely applied in other regulated sectors. Even basic expectations are inconsistently met. Contractual data requirements are ignored. Audits are disconnected from operational reality and there is GDPR-questionable reliance on personal bank statements.
Most of all, there is no digital data to support meaningful quality assessment and no consistent system for commissioners to “see” care delivery.
In any other sector managing high-value, high-risk contracts, this would be indefensible. Health and care should not be the exception.
What must change in 2026
Commissioners must recognise that high-value, complex care requires a fundamentally different oversight model from low-value, low-risk support. Without this shift in mindset, meaningful improvement cannot begin.
Oversight frameworks must be:
- Proportionate to risk and value and not purely transactional
- Digitally enabled by default
- Consistently applied across all providers
- Capable of real-time visibility and assurance
Most critically, commissioners must have the ability to see care as it is being delivered, across all providers and all packages, through a system that is common, standardised, and enforceable.
While many providers already use digital systems, the gap has been the absence of a shared platform that enables commissioners to access, verify, and oversee care delivery in a consistent and transparent way. That gap has limited oversight, weakened assurance, and exposed public bodies to unacceptable risk.
Rostrata – moving from retrospective audit to real-time assurance
Designed as a framework management tool rather than a traditional rostering system, Rostrata enables open-book collaboration between commissioners and providers. It correlates care delivery, workforce data, and financial information directly against the agreed care and support plan, in real time.
This move from retrospective audit to continuous assurance, represents the future of oversight in complex care. Transparency replaces trust-based spending, data replaces assumptions and accountability is built in, not bolted on.
The current model of oversight is no longer sustainable, financially, operationally, or ethically. As public scrutiny increases and regulatory expectations tighten, the gap between contractual obligations and actual practice will continue to narrow.
Commissioners who act now – by embracing modern systems, piloting new models, and adopting evidence-based oversight – have the opportunity to lead this transition, strengthen their markets, and protect the people they serve.
Those who do not may find that change arrives anyway, driven not by innovation, but by failure.
The time to do this is now, with Rostrata.