Home care implementation: getting started

This section highlights 3 areas of the home care guideline that could have a big impact on practice and be challenging to implement, along with the reasons why we are proposing change in these areas (given in the box at the start of each area). We identified these with the help of stakeholders and Guideline Committee members (see section 9.4 of the manual). The section also gives information on resources to help with implementation.

The challenge: delivering services that support the aspirations, goals and priorities of the person

See recommendations 1.1.1 and 1.1.2.

Providing person-centred care helps deliver:

  • better quality of life for people who use services and their carers; older people consistently value services that address their needs, choices and preferences

  • greater job satisfaction for the workforce, because they are able to establish and develop relationships with people and support good outcomes for them as highlighted by the Skills for Care workforce development strategy.

Some services are still built on a 'one size fits all' model and changing this may be a complex process that can take time.

What can home care providers and commissioners do to help?

  • Work together to review and negotiate contracts to ensure care is delivered flexibly. Identify whether improvements are needed to meet each person's needs and aspirations about how they want to live their lives. To do this, staff in local authorities, local home care managers and care staff can use this guideline, They can also draw on inspection reports of services rated 'outstanding' by the Care Quality Commission, NICE accredited Social Care Institute for Excellence (SCIE) guides and practice guidance about commissioning for better outcomes.

  • Home care managers and workers can use this guideline together with good practice examples and tools from NICE accredited guides and endorsed products to reflect on their own current practice. These resources can support continuous learning and development about person-centred approaches.

  • Ensure that people with cognitive impairment and those who live alone know about local community services that they can contribute to and get support from. These services include churches and faith groups, dementia cafes, befriending and volunteer schemes.

See our resources to help you to address these challenges and achieve best practice.

The challenge: working together to ensure care and support is coordinated

See recommendations 1.3.6, 1.3.7, 1.3.22 and 1.3.24.

Coordinated practice focused on the needs, preferences and experiences of the person can help deliver:

  • better health and care outcomes for people who use services

  • improved support for care workers

  • savings – because seamless care at home reduces overlap and duplication and staff can call on timely advice to maintain a person's wellbeing.

Good communication is essential to delivering good person-centred care and support. Care workers may feel unsupported in their role and anxious about the people they look after if they are not easily able to liaise with, or seek advice from, other practitioners. This can cause problems, for example, if they identify that a person's health or mental capacity is deteriorating or if they have concerns about medicines management.

What can commissioners and providers do to help?

  • Develop protocols for multidisciplinary working to ensure that more social care and health practitioners collaborate effectively. Identify a care coordinator and ensure that they have a full understanding of their role and the knowledge and experience to carry it out.

  • Establish the use of care diaries (or care records). Specify how all health and social care practitioners visiting the home might use the care diaries to record all care and support provided and to highlight the person's needs, preferences and experiences.

See our resources to help you to address these challenges and achieve best practice.

The challenge: strategic partnership working to deliver high quality and integrated home care

See recommendations 1.3.19, 1.4.1, 1.4.2 and 1.4.3.

Partnership working leads to:

  • improved outcomes for people using services when health, social care and voluntary sector managers work collaboratively and co-productively

  • savings – because better provision of home care avoids the need for costly acute services.

When organisations do not work in partnership with one another to plan, organise and deliver services, there may be a negative impact on the wellbeing of people who rely on them. For example, people who have cognitive impairment, communication difficulties or sensory loss may feel an increased sense of social isolation if care workers do not have time to help them make connections with other sources of support in their local community.

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.

Need more help?

Further resources are available from NICE that may help to support implementation.

  • Annual indicators for use in the Quality and Outcomes Framework (QOF) for the UK. See the process and the NICE menu.

  • Uptake data about guideline recommendations and quality standard measures are available on the NICE website.