Local authorities are receiving more than 5,000 requests for care and support each day. As people are living longer and more people than ever are living with complex needs, it is vital that we look at the evidence for what works best, and what represents good value for money for the local health and care system.
Since 2013, NICE has played an important role in providing advice and guidance for adult social care, with the aim of improving outcomes for people with care and support needs.
We have published a suite of guidance, providing evidence-based recommendations to improve the quality of decision-making, advice and support offered to people by local services.
To demonstrate how NICE guidance might be making a difference in priority areas of adult social care, we have also published the latest in a series of NICE Impact reports.
As adult social care is delivered by thousands of different providers, there is very little centralised data available showing how NICE’s recommendations are being put into practice nationally.
NICE’s latest impact report therefore looks at the data that is available, alongside information about outcomes and examples of our guidance being used in practice. It also looks at areas where more progress in adult social care services is needed.
One such area relates to the provision of oral health care in residential care homes. A recent review by the Care Quality Commission (CQC) of oral health care within 100 care homes found that although 60% of the staff had heard of the NICE guideline and quality standard, only 28% had actually read it.
In fact, only a quarter of the interviewees said that their care home has a policy setting out plans and actions to promote and protect the oral health of their residents and around half said that they were not provided with relevant training in oral health care.
Clearly, this is worrying, but the CQC review is a good example of how close working between NICE and other national partner organisations can support the uptake of NICE guidance. This also demonstrates how crucial the NICE/CQC relationship is in identifying areas of improvement within local services.
The report also identifies positive case studies showing how social care providers have used NICE guidance to improve their medicines management.
One homecare provider carried out a baseline assessment of their service against the NICE guidelines on supporting adults with a learning disability.
The provider found that their staff needed and wanted to improve their skills in this area, and so all staff – including managers – were given appropriate training and competency assessments based on NICE guidance. Every person they support now receives a detailed plan and easy-to-read information about their medicines.
Another important focus of the impact report is our work on ensuring NICE quality standards are used in social care commissioning.
The NICE field team is working with the London branch of the Association of Directors of Adult Social Services (ADASS) and social care commissioners to develop a commissioning quality schedule based on NICE quality standards. As a result of this work, all 33 local authorities in London have now fully implemented the relevant NICE quality standards.
This is more evidence that implementing NICE recommendations could result in better quality of care and support to the people who need it the most. However, the Impact report also discusses areas where NICE recommendations are being overlooked.
For example, data from the National Audit of Intermediate Care shows only a 10% increase in integrated home-based intermediate care and reablement services, from 2017 to 2018.
The above suggests that although NICE guidelines published in 2017 recommended making transfers between different intermediate care services easier as people’s needs change, there are still some services that have not prioritised integration in this way.
Intermediate care is important as it enables people to be as independent as possible and provides support and rehabilitation to people at risk of hospital admission.
NICE’s latest impact report highlights how implementation of NICE recommendations could lead to better outcomes and personalised approaches for adults accessing social care support, through the commissioning of more efficient and supportive services.
However, there are still areas for improvement, particularly in terms of how the multiple providers and funders within social care can work together for a more integrated, streamlined system which places people at its heart.
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