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Briefing 229
April 2018
NICE Guideline: People’s Experience in Adult Social Care Services: Improving the Experience of Care and Support
Introduction
This NICE guideline was published on the 20th of February 2018. Based on the views of adults and carers already using services, it makes evidence-based recommendations under the following 6 headings:
- Overarching principles
- Information
- Care and support needs assessment and care planning
- Providing care and support
- Staff skills and experience
- Involving people in service design and improvement
The implementation of the recommendations in the NICE guideline is not mandatory. However, there is an expectation that practitioners working in health, social care and provider services become familiar with the recommendations and consider them alongside their own professional expertise and judgement and the statutory duties of the Care Act 2014, the Mental Capacity Act 2005 or any other relevant legislation.
Using this Briefing
This briefing is not a replica of the NICE guideline, nor does it contain all of the recommendations made within it. Instead, key themes under each of the 6 headings are used to summarise the NICE recommendations that are either an enhancement of, or an addition to the legal duties already set out in existing legislation and statutory guidance.
Readers working in services and areas affected by the recommendations are encouraged to read the full guideline at https://www.nice.org.uk/guidance/ng86.
Summary of Recommendations
1. Overarching Principles
| Theme | Summary of Recommendations |
| Individuality | Always start with the person’s unique strengths, preferences, aspirations and needs. Find out what people want from their life and provide the support they need to achieve it. |
| Independence | Always support people to maintain their independence. Actively involve people in all decisions about them, respect their right to make their own decision and do not make assumptions about their capacity to take control. Allow time for people to express their views, preferences and aspirations, and provide support for them to do this. Make sure that other practitioners also know the best way to support communication. Provide information in an accessible way; seek to develop information, training and procedures with people who use services. |
| Access to the right services | Ensure access to the right services, taking into account all of the person’s needs including age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation and other aspects of their identity. |
| How to involve others | Ask the person who they would like to involve in discussions, respect their decision and ensure confidentiality. |
2. Information
| Theme | Summary of Recommendations |
| Availability of information | Make sure the right information is made available, and that it is comprehensive, including information about access to advocacy. Make information widely and publicly available and promoted in a range of relevant settings. |
| Range of information | Information should cover all community resources and support, including voluntary organisations, user-led organisations, disabled people’s organisations and available housing options. |
3. Care and Support Needs Assessment and Care Planning
| Theme | Summary of Recommendations |
| Advocacy | Make sure that advocacy is not only provided, but that the person is given sufficient time with the advocate before and after any assessment or care planning activity. |
| Assessment considerations |
In addition to the statutory requirements of the Care Act 2014 an assessment should specifically:
|
| Flexible, co-ordinated and comprehensive care and support plans |
Consider identifying a named care and support plan co-ordinator, competent to:
Record and address in the plan specific needs in relation to equality and diversity. |
| Arrange the right services | When arranging services, ensure the provider has a transparent process for matching care worker to people, taking into account need, skills and (where possible) shared interests. Ensure care workers are able to deliver care in a way that respects the person’s cultural, religious and communication needs. |
| Direct payments | Local authorities should provide peer support for people to use a direct payment (to purchase a service or employ a personal assistant), and also support the agency providing this support. |
| Access to personal assistants | Consider ways that access to personal assistants can be facilitated and enabled (e.g. providing training opportunities for people interested in becoming PA’s). |
4. Providing Care and Support
This part of the guideline makes recommendations for those organisations providing care and support services. However, it is important that health and social care practitioners arranging services understand the recommendations as this can be a helpful indicator of how effective and person centred an individual service is likely to be.
| Theme | Summary of Recommendations |
| Foster the right culture | Services should foster a culture that enables carer workers to respect and respond flexibly to individual choices and preferences, to support positive risk taking to achieve goals, to communicate openly and in an accessible way, to encourage independence and the learning of new skills, to take time to build relationships and to take responsibility for reporting concerns or abuse. Services should have effective mechanisms in place to train and support carer workers to work in this way, and to monitor they are doing so. |
| Continuity and consistency | Services should take steps to ensure that staffing and skill levels are sufficient, and that wherever possible, the same carer workers are supporting the person. Changes to carer workers, to how care and support services will be provided or to the service provision itself should be communicated in advance. Collaboration, good handover arrangements and support for people transitioning between services are essential. |
| Personal care | Specific steps should be taken by services to ensure that personal care needs are met to the person’s preference and in a timely, appropriate and dignified manner. |
| Promote positive relationships | Services should promote a sense of community and support between people using their services, by facilitating interactions and building social connections. |
| The right residential environment |
In addition to all the recommendations above, residential settings should take additional steps as necessary to ensure:
|
| Good end of life care in residential settings | End of life policies should be co-produced. Treatment and care preferences should be discussed and documented at the earliest opportunity, and access to legal support facilitated where required (e.g. if the person want to make an Advance Decision to Refuse Treatment). Specific training on on-going support for care workers to enable them to support people and carers/family near/at end of life. |
5. Staff Skills and Experience
This part of the guideline makes recommendations for those organisations providing care and support services. However, it is important that health and social care practitioners arranging services understand the recommendations as this can be a helpful indicator of how effective and person centred an individual service is likely to be.
| Theme | Summary of Recommendations |
| A caring and compassionate workforce | Services should use values based interviews and approaches to identify essential attitudes and attributes in care workers. |
| Involve people and carers | Services should consider involving people who use services and carers in recruitment and training. Services should provide opportunities for people to share their personal experiences of the service, and for care workers to learn from them (e.g. through audits, evaluations and forums). |
| Working well with other services | Care workers should understand the role and function of other services, and how to access them. Care workers should understand protocols for sharing information and confidentiality. Services should provide opportunities for inter-professional learning and development. |
6. Involving People in Service Design and Improvement
| Theme | Summary of Recommendations |
| Involve people in strategic decisions | In line with the Local Government and Public Involvement in Health Act 2007, local authorities should involve people in strategic decisions about the way that services are commissioned, run, governed and monitored. |
| Obtaining views | Local authorities and service providers should work with people to co-produce a range of mechanisms for obtaining their views about existing services (e.g. focus groups, interviews, surveys), and use evidence from a range of sources (e.g. from voluntary organisations). Steps should be taken to ensure that research and feedback mechanisms are accessible to all, and provide additional support should be provided where necessary (e.g. advocacy, amending formats). Service providers should create an environment that ensures people feel safe to express their views, and, when seeking views specifically seek views about the extent to which the things that are important to people are being addressed. Local authorities and service providers should consider employing and training ‘experts by experience’ to carry out research or seek feedback. |
| Use the information | Those person’s analysing information should have the right skills and, where relevant, analyse the information gathered in collaboration with other organisations to reduce duplication (e.g. health). The results of research should be made available, and organisations should ensure that it is used to inform improvement. |
Next Steps and Implementation
As stated in the introduction to this briefing, the implementation of the recommendations in the NICE guideline is not mandatory. However, there is an expectation that practitioners working in health, social care and provider services become familiar with the recommendations and consider them alongside their own professional expertise and judgement and the statutory duties of the Care Act 2014, the Mental Capacity Act 2005 or any other relevant legislation.
The following are next steps that readers of this briefing can take to ensure that relevant consideration is given:
- Schedule in time to read the full guideline at https://www.nice.org.uk/guidance/ng86;
- Refer to the recommendations when discussing care and support options; this can help differentiate between the quality and likely effectiveness of different services;
- Use the guideline to review and evaluate services; to recognise good practice and to try and resolve any service issues identified;
- Where appropriate, use the guideline to challenge the practice of others;
- If it is proving difficult to differentiate between possible services, use the guideline to help make a final decision;
- Share the guideline with the person and their family so they can make an informed judgement about services;
- Discuss potential difficulties in implementing some of the recommendations, and explore what steps can be taken to overcome them;
- Explore the recommendations for collaborative working.
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