What should NICE take into account when developing social care guidance?
Harrowing stories of child neglect and cases of elderly people being passed like a parcel between services have shone a spotlight on the need for greater integration between health and social care.
The government has acknowledged this and set out plans in the Health and Social Care Act 2012 for NICE to play a key role in helping to integrate services to drive up the quality of care.
From April this year, NICE will start producing guidance and quality standards on social care in adults and children. To reflect the move into social care, NICE will become known as the National Institute for Health and Care Excellence.
NICE has already awarded a contract to the Social Care Institute for Excellence (SCIE), and its partner organisations, to help support the development, adoption and dissemination of its social care guidance and quality standards, as the NICE Collaborating Centre for Social Care.
The NICE Collaborating Centre for Social Care will use NICE's methods and processes to develop social care guidance for NICE, which NICE will use as a basis for its quality standards for social care.
But working out which of NICE's current methods and processes should apply to social care, which may need to be adapted, and whether new methods should be introduced is an issue that NICE must get to grips with in order to produce effective and meaningful recommendations.
Balance between benefits and costs
The Health and Social Care Act states that NICE must take into account, the broad balance between the benefits and the costs of care and people's degree of need for care.
“There are many important aspects that come under these terms .for example benefits can include quality of care, dignity, personal cleanliness and comfort,” says Dr Sarah Garner, Associate Director for Research and Development at NICE.
“NICE has produced guidance for nearly 14 years. Our experience was that the methods that we used for health needed adapting for public health. We anticipate that they will also need adapting for social care as it is set up differently and trying to achieve different outcomes,” she says.
“What's more, the evidence base for social care is less well-developed than for health and as a result evidence-based practice is not as well established, adds Professor Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE.
With this in mind, NICE called upon its Citizens Council to consider the question of which aspects of benefit, cost and need NICE should take into account when developing social care guidance.
The Citizens Council consists of a diverse group of 30 individuals, reflecting the age, gender, socioeconomic status and ethnicity of the general public. It meets yearly to hear expert information on challenging topics and thoroughly discuss the issues raised. The Council helps to identify broad social values and how NICE might consider them in preparing its guidance.
Changing our approach
NICE's standard processes for judging the cost effectiveness of clinical and public health interventions use the quality-adjusted life year (QALY) to measure the benefits. This involves the use of standard questionnaires that ask about factors that impact on a person's health-related quality of life.
But social care interventions aim to increase capability and function, in addition to health-related quality of life. Therefore, a different approach may be needed. This includes the questionnaires that are used to ask people about their experience.
As part of the two day workshop the Citizens Council was asked to test out two different questionnaires- the adult social care outcomes toolkit (ASCOT) and the instrument of capability (ICECAP).
Highlighting best practice
Elsewhere, the group were shown examples of what is important in the delivery of social care services for people with dementia, and heard from experts who were able to give their perspectives on social care from the viewpoint of being both service users and commissioners of services.
Jennifer McGovern described to the group how Salford City Council develops its social care services. She says: “We look at the pressures facing our adult social and health services. Around 14 per cent of our population is over 65, 1 in 14 have dementia and there is a rise in the number of people living alone in the area. It is important to look at the needs of the area when developing services.
“We have an integrated approach which puts people in the centre of the service. There is a single point of entry and we wrap the right services around the person depending on what they need.”
A report on the Council's views will be available on the NICE website for public comment later this year, before the Council submits a report to the NICE Board setting out its findings.
11 February 2013