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Working together to integrate adult social care

Posted by: , Posted on: - Categories: Care and support, Guidance, Information sharing, Integrated care

cartoon image of multiple human figures expressing their health and care needsDemands on adult social care services are growing

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.

Graphic illustrating data flow
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.

Digging through the data

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.

Setting the parameters for quality

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.

Jigsaw pieces being slotted together

Closing the gap between intermediate care services - work to do

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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  1. Comment by Kathleen cooke posted on

    It is frightening to someone caring for their husband of 87 we have no family and it appears a minefield despite trying to ensure what will happen if I as a carer fell ill luckily I am a lot younger but have my own health needs and am capable. Have looked after others in my lifetime and worked. I feel that dementia carers and sufferers after a lifetime of work are left walking through a minefield of organisations with not good standards I only hope I keep well as I walk through my 70s looking after my husband with a good standard of care and quality of life and continue with the mantra do unto others as you would wish to be done by. I feel all governments do not have that in mind when they deal with vulnerable. 7 years and counting with my husband, looking after mother in law stepmother grandma and others, as I once vocalised who will take care of the carer when the carer can no long er take care? I retired after 50years working my husband did the same including 2 years in the forces. I despair but will carry on as so many do a dear friend called us the silent majority

    • Replies to Kathleen cooke>

      Comment by Maressa Hamilton posted on

      Hi Kathleen, I'm don't know the specifications of the equipment that was removed, but in Section 20.36 of the Care act Guidance clearly states the following

      “Equipment and adaptations

      20.36. Many people with care and support needs will also have equipment installed and adaptations made to their home. Where the first authority has provided equipment, it should move with the person to the second authority where this is the person’s preference and it is still required and doing so is the most cost-effective solution. This should apply whatever the original cost of the item. In deciding whether the equipment should move with the person, the local authorities should discuss this with the individual and consider whether they still want it and whether it is suitable for their new home. Consideration will also have to be given to the contract for maintenance of the equipment and whether the equipment is due to be replaced.”

      I know it had been collected now, but for future information these discussion should have happened before moving so that you don't have to go without essentials.

  2. Comment by Mrs Anita Atkinson posted on

    I have a situation whereby having moved properties within my area that all my equipment Millbrook removed :-
    Hospital Bed
    Shower Chair
    Mobile Hoist
    Toilet Seat Raiser
    But three weeks later still no bed as Social Services East Sussex County Council Adult Social Care haven’t completed an assessment. Hence I sleeping in an armchair at night or my wheelchair depending how uncomfortable I am.
    My PA’s have been chasing powers at be and yesterday was advised District Nurse has to authorise a hospital bed as its medical. Yet Adult Social Care been proving I with a bed for many years as I cannot lie flat due to reduced lung function and Adult Respiratory Distress Syndrome. I have complex health needs as Since Surviving a lengthy ITU stay in Dec ‘99 to March ‘2000 whereby I had a 30% chance of survival due to flu virus attacking my organs, pneumonia, septicaemia, lungs wouldn’t stay up hence was on life support with 8 chest drains and a tracheotomy and was left with A Hypoxic Brain Injury causing I to loose my peripheral vision hence registered Sight impaired, Multiple Bone Ossification, Rheumatoid arthritis, Spinal Cord Infarction causing I to have a Supra Pubic Catheter that after several years my bladder shrunk and required surgery to do an ideal conduit Urostomy with a high chance I wouldn’t survive said. Luckily I did albeit had Sepsis again and a months spell in hospital. I also have a under active thyroid for some years now. I have had to rent a stair lift myself via a monthly rental scheme as social services wouldn’t attend my new property they just said no a stair lift no good yet my PA’s are happy and feel safe using said. I sure this a funding issue again. Hence still the system failing us vulnerable persons. Yet told we have to give all our PIP care component to the local authority and more from EESA. Yet when on DLA the money was used by us for things to assistance with extra costs due to disability and health.

  3. Comment by Eric Wood posted on

    One very worrying aspect on social care is the impression that those who provide it appear not to be properly trained. There needs to be professional training to a set and approved standard which is officially monitored. In general clients are prepared to pay for assistance that it to a properly approved standard. And something more that a quick pop in our is required.

    • Replies to Eric Wood>

      Comment by Sheila Bawar posted on

      Having worked in social care for longer than I care to remember, from my experience most of the principles of professional training are open to what is often referred to "perspectives", which can be (and often is) interpreted as "whatever you think".
      From my experience, the nebulous way that even assessors are loathed to commit themselves to what "professional practice" means leads to a situation whereby it is only when overt examples of hard abuse lead to action, whereas, anyone who has experienced it knows, that "softer" forms of abusive practice eg verbal/emotional/bullying due to disrespectful attitudes are often left "hanging around". OK for those who are avoiding dealing with this form of behaviour. They still get paid and go home to their "safe haven". Not so easy for vulnerable people left to have to live with/put up with this form of persistent, undermining and degrading behaviour.
      I wonder whether these issues will ever be dealt with as Im sure those on the receiving end of this behaviour would like.
      There is only so much that training can do to address staff attitudes. It takes staff to take on the challenge and courage to question themselves for themselves, on an on going basis.

  4. Comment by Ian Rogers posted on

    The ways that the gap between care budgets and NHS budgets are being addressed is still very unclear to families particularly where elderly care is concerned. Although I am no longer directly concerned with this area as my Mum died a couple of years ago, I still have friends battling with different approaches in different areas.

    Is there any user friendly advice to point friends towards?