In 2011, 1 in 6 people in England and Wales were aged 65 or over. This number is expected to grow to nearly 1 in 4 by 2035[1].

Professor Gillian Leng, deputy chief executive and director for health and social care at NICE, said: “We live in an increasingly ageing population. As more of us live longer, effective and high quality home care services will become more important than ever.”

A 2013 review of home care services by the Care Quality Commission (CQC) found that nearly three-quarters (74%) of those inspected were meeting the required national standards of care. However, a report published last year by the Local Government Information Unit (LGiU) highlighted concerns over some working practices within the home care system which could affect the quality of a person’s care.

Official figures show that about 470,000 people in England receive some level of support from local authority-funded home care services. According to the National Audit Office, many councils are prioritising care services to those with the greatest level of need and that the amount spent on social care services by local authorities fell by 8% between April 2010 and March 2013[2].

The CQC says this shows that “council-funded adult social care services are caring for fewer people, at a time when demand is increasing”.

Professor Leng said: “Without adequate support at home, older people can suffer from social isolation, malnutrition, neglect or may even end up in hospital, perhaps from a fall or other accident.

“Our guideline aims to support home care commissioners, managers and care workers to provide a high quality and consistent service to give older people the support they need to live as independently as possible for as long as possible.”

The draft guideline – the first of its kind to be developed by NICE for the home care sector – recommends that care should focus on the needs of the individual.

Professor Leng explained: “We recommend that services should support the aspirations, goals and priorities of each person. There should not be a ‘one size fits all’ approach. We also recommend that care workers should have enough time – generally not less than half an hour, although we recommend visits can be less in certain circumstances – to carry out the tasks properly without compromising the quality of care.”

The guidance provisionally states that shorter visits than half an hour can be made, but only if the home care worker is known to the person, the visit is part of a wider package of support and it allows enough time either to complete a specific, time limited task or check that someone is safe and well.

Other draft recommendations include:

Local authorities and health commissioners checking that support is delivered through a multidisciplinary team as a way of promoting integrated working. The team might include, for example:

• health care professionals,
• social care practitioners, including home care workers,
• people from other organisations involved in providing support such as those from the voluntary and community sectors and specialist and befriending services,
• advocates, including those appointed by the Court of Protection.

Home care providers making sure their workers have the knowledge and skills needed to perform their duties safely by providing ongoing training, including:

• what constitutes ‘safe’ care
• identifying and responding to possible or actual abuse or neglect
• identifying and responding to environmental risks
• safe care policies and procedures.

Home care managers to supervise workers in a timely, accessible and flexible way, at least every 3 months.

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission, said: “People who receive care at home have every right to expect services that are safe, caring, effective, responsive and well-led. The draft guidance from NICE gives clear signals about how this can be achieved.

“I welcome the clarity about the length of time for visits. If people have to choose between a bath or breakfast in the morning because staff do not have enough time, that is certainly not safe, caring, effective or responsive and no well-led organisation would allow it to happen.

“I hope people respond to the consultation and I look forward to the publication of the final guideline in due course.”

Anna Bradley, Chair of Healthwatch England, said: "The quality of home care services vary massively across the country, and care users are uncertain about the level of care they are entitled to and do not know how to complain when standards slip.

"National guidance from NICE could set a benchmark to help establish what we can all expect and provide local Healthwatch with a tool to challenge and advise providers and commissioners to deliver the compassionate and individualised care we all need.”

The draft NICE guideline has now been published for consultation. Local authorities, home care organisations and other social care groups are encouraged to comment on the draft recommendations before the consultation ends on Thursday 16 April 2015 to contribute to the further development of the recommendations.

The final guideline is expected to be published later this year.

Ends

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

Explanation of terms

1. Office for National Statistics (2012): Population Ageing in the United Kingdom, its Constituent Countries and the European Union.
2. National Audit Office (2014): Adult care in England: overview

About the guideline

Home care is one of several services that can be offered to people assessed as needing social care support. It can be funded by health or social care or by the person using services. Although the range and type of services that can be classed as home care vary, it usually encompasses:

• personal care, for example help to wash
• support with the activities of daily living, which might also include telecare (for example providing personal alarms)
• essential domestic tasks.