Improving the quality of care and support for older people: How can the NICE guidelines help? Webinar
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This document summarizes a presentation about how NICE guidelines can help improve care for older people. It discusses three NICE guidelines on home care, care for older adults with multiple long-term conditions, and transitions between hospital and community care. Common themes across the guidelines include person-centered care, supporting carers, assessment and care planning, integrated working, and information sharing. The presentation provides examples of how practitioners can apply the guideline recommendations in their work.
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Improving the quality of care and support for older people: How can the NICE guidelines help? Webinar
- 1. NICE Collaborating Centre for Social Care Improving the quality of care and support for older people: How can the NICE guidelines help? Lisa Smith: Research in Practice for Adults
- 2. NICE Collaborating Centre for Social Care • Overview of NICE guideline development • Highlights and recommendations from the guidelines: – Home care: delivering personal care and practical support to older people living in their own homes – Older people with social care needs and multiple long term conditions – Transition between inpatient hospital settings and community or care home settings for adults with social care needs • What does that mean for practice?
- 3. NICE Collaborating Centre for Social Care POLL- Are you using the NICE guidelines in your practice? Yes/No
- 4. NICE Collaborating Centre for Social Care National Institute for Health and Care Excellence (NICE) Commissioner Social Care Institute for Excellence (SCIE) Lead partner Personal Social Services Research Unit (PSSRU) Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI) Research in Practice (RiP) Research in Practice for Adults (RiPfA)
- 5. NICE Collaborating Centre for Social Care • Address transition to/from other services • Recognise the diversity of the social care workforce • Make links with wider policy and regulatory context • Focus on choice, control and independence • Draw on different types of knowledge • Recognise importance of both process and outcome • Adopt a broad analytic perspective • Use preference-weighted measures and/or modelling • Complement economic analyses with GDG/expert opinion Guidance should explicitly address the need for integrated working Social care interventions and outcomes are complex and multi-dimensional Measuring and valuing the effects of interventions needs pragmatism
- 6. NICE Collaborating Centre for Social Care Research evidence Practice evidence Evidence on views and experiences People who use services, carers, practitioners, commissioners
- 7. NICE Collaborating Centre for Social Care Scope Baseline service assessment Systematic evidence review Expert opinion
- 8. NICE Collaborating Centre for Social Care Home Care: delivering personal care and practical support to older people living in their own homes
- 9. NICE Collaborating Centre for Social Care Need for guideline • In 2013/14 883,000 people in UK made use of home care support; 326 million hours of care was delivered (UKHCA, 2015) • Nearly ¾ of these are supported by local authority but year-on-year decline in numbers of people state-funded (UKHCA, 2015) • A number of reports into the home care sector have raised concerns about the quality of services • Key issues identified include people using home care services experience poor support, neglect and/or compromised dignity and human rights (EHRC, 2011) • Some home care workers may not have the knowledge or skill of how best to care for people - particularly in relation to dementia – and how to work in a coordinated way (CQC, 2013)
- 10. NICE Collaborating Centre for Social Care Recommendation themes Creative Commons license image credit: jbarahona.com CHOICE, CONTROL, DIGNITY AND RESPECT ENSURING CARE IS PERSON-CENTRED PROVIDING INFORMATION INTEGRATED WORKING RECRUITING, TRAINING AND SUPPORTING WORKERS DELIVERING HOME CARE ENSURING SAFETY AND SAFEGUARDING PEOPLE PLANNING HOME CARE
- 11. NICE Collaborating Centre for Social Care Implementation challenges • Delivering services that support the aspirations, goals and priorities of the person • Working together to ensure care and support is coordinated • Strategic partnership working to deliver high quality and integrated home care
- 12. NICE Collaborating Centre for Social Care Older people with social care needs and multiple long term conditions
- 13. NICE Collaborating Centre for Social Care Need for guidance • Most users of adult social care services have one or more LTC. Estimated annual health and social care cost per person per year is £3,000 for those with one LTC, and to £8000 for those with three (compared to £1000 to those without) • Having one or more LTCs places people at greater risk of mental health problems, but services may not identify the need for assessment and treatment • People are less likely to be able to self manage a physical health condition if they are struggling with mental ill health • There is evidence that older people who have had a long-term mental health problem have poorer physical health outcomes than the general population
- 14. NICE Collaborating Centre for Social Care Recommendation themes Creative Commons license image credit: jbarahona.com CHOICE, CONTROL, DIGNITY AND RESPECT IDENTIFYING AND ASSESSING SOCIAL CARE NEEDS INTEGRATED CARE PLANNING SUPPORTING CARERS TRAINING HEALTH AND SOCIAL CARE PROFESSIONALS DELIVERING CARE PREVENTING SOCIAL ISOLATION
- 15. NICE Collaborating Centre for Social Care Implementation challenges • Empowering older people with social care needs and multiple long-term conditions and their carers to choose and manage their own support • Empowering practitioners to deliver person-centred care • Integrating different care and support options to enable person-centred care
- 16. NICE Collaborating Centre for Social Care Transition between inpatient hospital settings and community or care home settings for adults with social care needs
- 17. NICE Collaborating Centre for Social Care Need for guidance • The negative effects of poor transitions are felt both at the system and individual level (House of Commons, 2003; Lynch, 2011) • Figures released for Jan 2014 show that on the last of the month, 2683 patients in acute care settings had a Delayed Transfer of Care (DTOC), during the month there were a total of 123,306 delayed days, 69.4% of delays were attributable to the NHS, 24.6% were attributable to social care and 6% were attributable to both agencies
- 18. NICE Collaborating Centre for Social Care Creative Commons license image credit: jbarahona.com CHOICE, CONTROL, DIGNITY AND RESPECT DISCHARGE PLANNING PERSON CENTRED CARE Recommendation themes COMMUNICATION AND INFORMATION SHARING INTEGRATED WORKING SUPPORT AND TRAINING FOR CARERS ASSESSMENT AND CARE PLANNING
- 19. NICE Collaborating Centre for Social Care Implementation challenges • Improving understanding of person-centred care • Ensuring health and social care practitioners communicate effectively • Changing how community and hospital-based staff work together to ensure coordinated, person-centred support
- 20. NICE Collaborating Centre for Social Care Common themes • Person-centred care • Supporting carers • Assessment and care planning • Integrated working • Information and communication
- 21. NICE Collaborating Centre for Social Care What does that mean for practice?
- 22. NICE Collaborating Centre for Social Care Person-centred care • Use the guideline to support you to understand gaps the resources on the NICE website include baseline assessment tools • Learning from Making Safeguarding Personal • Outcomes focused ways of working • Co-production • http://www.nationalvoices.org.uk/ http://www.thinklocalactpersonal.org.uk/ http://www.scie.org.uk
- 23. NICE Collaborating Centre for Social Care Supporting carers • Use the Care Act 2014 as a lever • Co-production • Training for carers (Caring with confidence) • Skills for Care resources • NHS commitment to carers • Work with local carer groups
- 24. NICE Collaborating Centre for Social Care Assessment and care planning • Care Act 2014 principles: – Begin with person’s views, wishes, feelings and beliefs – Think about prevention – Don’t make assumptions – Ensure participation – Balancing adult and carer needs – Protection from abuse and neglect – Minimising restrictions • Good assessments lead to good care planning
- 25. NICE Collaborating Centre for Social Care Integrated working • Multiple models of integrated working • Guidelines contain a lot of detail as to how this can be achieved – Joint training opportunities – Establish named care coordinator roles – Review local relationships • Better Care Fund - how to guide
- 26. NICE Collaborating Centre for Social Care Information and communication • Importance of good information for people • Opportunity for making good use of advocacy with requirements of the Care Act 2014 • Good communication: – Improved coordination, therefore a better experience and outcome – Clarity about the needs and preferences of individuals • Information sharing protocols • IT systems..
- 27. NICE Collaborating Centre for Social Care How might the guidelines help? • Useful framework • Provides some leverage where there might be resistance to change • Conscious competence • Enable organisations to identify gaps as well as areas of good practice
- 28. NICE Collaborating Centre for Social Care POLL- do you now know how you might use the guidelines? Yes/No
- 29. NICE Collaborating Centre for Social Care Have you any examples of good practice that demonstrate the implementation of guideline recommendations?
- 30. NICE Collaborating Centre for Social Care Any further questions?
- 31. NICE Collaborating Centre for Social Care https://www.ripfa.org.uk help@ripfa.org.uk @ripfa
- 32. NICE Collaborating Centre for Social Care • Workshop details • https://www.ripfa.org.uk/latest-news/news-improving-the-quality-of-care/ • www.nationalvoices.org.uk • www.thinklocalactpersonal.org.uk • www.scie.org.uk • www.skillsforcare.org.uk • www.carers.org • www.carersuk.org • https://www.england.nhs.uk/ourwork/pe/commitment-to-carers/ • Skills for Care • Information and advice workbook (attached) could not find a web link • Link to Sam’s Story • http://www.kingsfund.org.uk/audio-video/joined-care-sams-story • Better Care Fund • https://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/
- 33. NICE Collaborating Centre for Social Care • Links to the guidelines • https://www.nice.org.uk/guidance/ng27/chapter/Recommendations • https://www.nice.org.uk/guidance/NG21/chapter/Recommendations • https://www.nice.org.uk/guidance/ng22/chapter/Recommendations • Social services and well-being act for Wales • http://gov.wales/topics/health/socialcare/act/?lang=en • http://www.legislation.gov.uk/anaw/2014/4/contents
Notes de l'éditeur
- Different types of knowledge
- Reviewing evidence in context
- Impact at the individual and system levels Hospital discharge, readmission, LoS, ED visits, Explore in further detail poor experience for the individual and their family Explore further poor outcomes- less independence, social isolation, less choice and control, health outcomes, risk of re-admission, Poor experience- dissatisfaction with care, worry for family about risks at home, feeling dependent, reliance on family, giving information multip
- Question- anything else?
- Theoretically nothing- these are all things that we do already- what the guidelines serve to do in many ways is a re-inforcement of what ‘good’ looks like in social care. Thoughts from the chatpod- is there anything we need to do differently? Is there anything in your local area that you could do differently to support good person-centred practice? Outcomes focused? Making Safeguarding Personal
- http://www.scie.org.uk/publications/elearning/person-centred-practice/ http://www.nationalvoices.org.uk/evidence Person-centred care involves placing people at the forefront of their health and care. It ensures people retain control, helps them make informed decisions and supports a partnership between individuals, families and services. Some of the main components of person-centred care involve: • supporting self-management • supporting shared decision-making • enhancing experience of healthcare • improving information and understanding, and • promoting prevention Learning from making safeguarding personal Outcomes focused. Not ‘what’s the matter with me, but what matters to me?’ IS THERE ANYTHING THAT YOU NEED TO DO DIFFERNETLY
- The Care Act sets out parity of esteem for carers, so that they are able to gain support from the Local Authority in their own right. This is a step change in the delivery of care and support for carers. Carers Trust and Carers UK resources http://www.skillsforcare.org.uk/Documents/Topics/Supporting-carers/Common-core-principles-for-working-with-carers.pdf http://php.york.ac.uk/inst/spru/research/summs/confidence.php https://www.carersuk.org/news-and-campaigns/news/caring-with-confidence-new-programme-for-carers https://www.england.nhs.uk/ourwork/pe/commitment-to-carers/ riPfA are currently doing some work on behalf of DH to develop tools to support good practice with carers- we recently held a workshop with carers- we asked the group to talk about their wish list for practice do’s and don’ts Practice do’s and don’ts DO • Be calm and human • Explain what a carers assessment is (that it’s about our needs, not an assessment of our caring ability) • Set out expectations • Talk about what can be done, rather than what can’t • Ask the carer if they would like a joint assessment or not • Be knowledgeable of services and possible options for help • Come prepared, having read the notes • See the carer as an asset • Make me feel as if I’m in a support network helping to support the person I care for – not that it’s a battle I have to fight against everyone else • See beyond me as just a carer DON’T • Use jargon or buzzwords (both in writing and when speaking) • Don’t appear to be, or be in a rush • Be overly clinical/detached • Don’t say you’re going to do something if it’s not realistic • Don’t assume can do forms/paperwork without support • Don’t be afraid of saying “I’ll get back to you as I don’t know the answer” • Don’t say ‘only the carer’ • Don’t make assumptions about the carers likes or abilities CHATPOD QUESTION IS THERE ANYTHING YOU NEED TO DO DIFFERENTLY?
- SCIE resources RiPfA resources What the evidence says Arguably good assessment underpins person centred care Wealth of resources- see end slide. The guidance also make some specific reference to forward planning- particularly with discharge planning- and also links in to information sharing and good communication.
- King’s Fund RiPfA resources Vanguards, pioneers, better care fund The King’s Fund report Place-based systems of care argues that providers of services should work together to improve health and care for the populations they serve. This means organisations collaborating to manage the common resources available to them rather than each organisation adopting a ‘fortress mentality’ in which it acts to secure its own future regardless of the impact on others. The King's Fund November 2015 Managers need to assess the factors affecting integrated working in their areas, and motivate and support practitioners to adopt attitudes and behaviours that support person‑centred approaches. Changing attitudes can be challenging, particularly if there are pressures on staff time and resources, and local capacity (or knowledge of alternative sources of support) is limited. What can health and social care managers do to help? Review local relationships across health, social care, housing and the voluntary sector and identify areas for improvement. Resources and organisations that can help include: The Local Government Association, NHS England and their partners' resources and tools to improve integrated working through the Better Care Programme. The LGA's Integration and the Better Care Fund is a summary of programmes relating to integrated working for health and wellbeing boards, local authorities and their partners in the health and voluntary sectors. This includes the Better Care Exchange, which offers the opportunity to share learning across systems, and a series of practice guides, such as How to work together across health, care and beyond. The Department of Health‑funded evaluation of the Homeless Hospital Discharge Fund shows that joint working across sectors reduces delayed transfers of care for homeless people with social care needs. The Social Care Institute for Excellence's Dying at home: the case for integrated working provides examples from practice, including case studies showing how working together can help to meet people's preferences. Establish a change programme that includes staff training based on the principles of the Care Act and the Mental Capacity Act, and the ambitions set out in the NHS Five Year Forward View. Depending on local needs and circumstances, the programme could draw on approaches identified in the Social Care Institute for Excellence's Organisational change in social care study resource. What can commissioners, providers and voluntary sector and community organisations do to help? Use existing forums or create new opportunities to meet people who use services and carers to review the quality of services for people living at home. Existing forums that could be used include health and wellbeing boards, quality forums and provider alliances. Use this guideline to review what training about common health conditions is available for home care workers. Draw on examples of good person-centred practice to inform local health and wellbeing planning and help commissioning plans realise the intentions of the Care Act. Consider innovative approaches and services that can support people to maintain links with their family and local community. The SCIE guide on commissioning home care for older people includes some practice examples to stimulate ideas. Working across boundaries Traditionally, health and social care services that support older people with social care needs and multiple long‑term conditions focus on managing separate health conditions, and the system is complex to navigate. Systems and structures may need to change to help professionals to work across service boundaries and specialisms. To do this, managers and commissioners could: Establish named care coordinators locally and ensure they have the authority to provide continuity of support and amend care and support plans as needed. Share information about their role and responsibilities widely to make sure it is fully understood. Provide care coordinators with the necessary training and support based on a clear understanding of their role, and the skills and knowledge they need. Review local relationships across health, social care and the voluntary sector and identify where more support is needed to work across service boundaries and professions. Resources such as The How to… guides produced to support the Better Care Fund can help with this. https://www.england.nhs.uk/wp-content/uploads/2015/06/bcf-user-guide-03.pdf.pdf
- Good information resources- pull in the Skills for Care stuff Generally people do not have a good understanding of adult social care and there may be stigma in approaching it (ADASS, 2011). Often people first seek information at a time of crisis (Bottery and Holloway, 2013). Information is affected by the complexity of the system and language used, and lack of join up between services. Since councils gatekeep services, it can be difficult for them to provide independent information. The quality of information is not always reliable, and technology can provide barriers to access. . (Anderson, 2011) There are more specific barriers for particular groups, for example, older people are less likely to use the internet or call centres (Horton, 2009), BME groups face cultural and linguistic barriers (Zahno and Rhule, 2008), self-funders may not be seen as a priority (Hudson and Henwood, 2009), and many people face difficulties with communication or capacity (IDEA, 2009). People who face stigma are less likely to engage with social care (RiPfA, 2013). People are more likely to seek information if they believe it will be available and accessible, relevant and understandable, useful and trustworthy. Involving customers in planning how information and advice are provided, having an organisational strategy and joining up with other agencies all help. Organisations should use a range of formats, media and places to provide information (IDEA, 2009). The third sector, including organisations led by users, can provide more independent information and advice to navigate the system (RiPfA, 2011b, 2012b). Tailored information and support is particularly important for groups who face barriers (Putting People First, 2009); often they will need face-to-face support (Zahno and Rhule, 2008). Personal relationships with individuals are important for access to information and advice. Social care staff and other professionals need skills and tools to signpost and advise people (Newbronner et al, 2011). Ideally, information and advice would be followed up on, and information services reviewed (RiPfA, 2013). Good communication systems enable: improved coordination of care and, therefore, a better experience for the person and improved outcomes practitioners to have a clear understanding about people's health, social care and support needs and preferences and the role practitioners need to play to promote wellbeing They might also enable more efficient and cost‑effective use of resources. Poor coordination of care, and poor communication between and within teams, can lead to poorer outcomes and a poor experience of care. Local health and social care organisations need to establish communications protocols, procedures and systems. These should make best use of technology to enable data‑sharing between all practitioners involved in the care and support of people in the area (subject to information governance protocols). Protocols for sharing information with people, their families and carers also need to be established to ensure that all communication arrangements are understood and used by all relevant practitioners. IT systems are oft cited as the reason why information isn’t shared and why there isn’t good enough communication- Sam Jones Director, New Care Models- so heads up the Vanguards To illustrate the point, she cited her 89 year old father-in-law, who is still defiantly living at home but is looked after by a team of 27 health and social care professionals – people who, because of the system in which they operate, aren’t able to communicate or coordinate properly with each other. “We have data that doesn’t cross populations, funding streams that don’t work and national policy that doesn’t encourage care around patients.” Does the Vanguard programme actually narrow choice – and is there a hint that they are not entirely democratically accountable? Not so, she insists. All seven arm’s length bodies have sponsored the care model programme and the systems really are working together. And, any accusation of Vanguards being elitist was firmly dismissed. “There have to be leaders, people who go first – and we should be behind them,” she says. WHAT DO YOU THINK THE PRACTICE NEEDS TO LOOK LIKE?
- Ask the chatpod