Service users and carers help draw up homecare blueprint

Practitioners, carers and service users are helping the National Institute for Health and Care Excellence write guidance for improving homecare


  • Guardian Professional,
The members of the guideline development group are examining the issues and defining good practice, ‘with a reality check at every step’. 

Sandra is passionate about good homecare. Her mother had Alzheimer’s and Sandra watched carers come into the home for five years. Sandra knows, as an “expert by experience”, about the big homecare issues: reliability and flexibility of staff, continuity of care and the difficulty of having strangers in the house.

Sandra is a member of a group of people who are helping the National Institute for Health and Care Excellence (Nice) to produce its first social care guidance, on providing care and support in people’s homes. By highlighting the issues they know about, she and the other carers and service users are keeping them at the forefront of care providers’ minds. It’s a complex thing to get right, but carers and users must be at the heart of improving service provision “inch by inch,” Sandra says.

I chair the group and I know that each member brings their own perspective.

The group has a wide range of relevant experience and knowledge: employed care workers, commissioners, social workers, people who use homecare services and representatives of large and small, charitable and commercial homecare providers. Service users and carers have equal status – because of their unique perspective – with practitioners on the group, and together we’re shaping and deciding on recommendations; taking a co-productive approach.

This is all supported by the Nice collaborating centre for social care, a partnership led by the Social Care Institute for Excellence (Scie) and rooted in social care research and implementation. The consortium is made up of Scie, Research in Practice; Research in Practice for Adults; Evidence for Policy and Practice Information and Co-ordinating Centre; and Personal Social Services Research Unit. So we have plenty of advice about relevant research findings, on which we can base our discussions and deliberations.

As you can imagine, there is often lively debate, but working together as a group, we’re creating recommendations based on the evidence we find and also our combined knowledge about what good homecare looks like.

Right now, we’re looking at some of the research results and evidence reviews to help us find answers to the key questions about what works best for people in homecare. One challenge is that in social care there is sometimes no definitive research on a particular issue: because it’s an art rather than a science. Social care practice is developing fast so, by definition, research is retrospective and sometimes good practice moves on. The gaps in research mean some of the recommendations are likely to be based more on consensus, making the views of users and carers like Sandra even more important.

The dedicated research reviews being undertaken by the collaborating centre, to inform the group’s discussions, are probably a first for the homecare sector. The approach to selecting the evidence is systematic and very clear. It’s proving to be immensely useful just to gather all the findings together in this way.

The work is flagging up studies that we didn’t know about before. This adds to the existing knowledge and expertise that the guideline development group has; and we will also be hearing from expert witnesses at a later date.

The homecare guideline development group is Nice’s first since it took on the wider role of including social care, alongside its well established work on health. So, to some extent, we’re pioneering. Nice’s impressively well-developed systems for research- and evidence-based guidance provides both a firm basis and, at times, a stimulating challenge for us.

There are four other social care guideline development groups, so the learning from our group is being used to continually improve these processes for social care as well as health. It’s vital that the guidance we recommend to Nice is absolutely sound.

The specific relationship between the Nice homecare guidance and the standards required of providers by the Care Quality Commission, is currently being defined by the two organisations and needs to be clarified. I hope that adherence to the homecare guidance might be proudly publicised by providers as a badge of honour, demonstrating service quality for the benefit of people using and seeking homecare.

To have had that level of involvement in devising Nice’s first social care guidance in such a crucial area is a real honour. I believe our group is truly effective in examining the issues and defining good practice, with a reality check at every step.

When published the guidance will, I hope, be instrumental in the ongoing improvement of people’s experience of care at home.