Two and a half years ago the government made the National Institute for Health and Care Excellence (NICE) responsible for producing social care practice guidelines.
But it’s only now the first fruits of that change have begun to emerge. Last month saw NICE issue its first completed set of purely social care guidelines, setting out how domiciliary care should function and recommending that most home visits should last at least 30 minutes.
Dr Michael Mellors, social care advisor for NICE, will be part of the panel discussion on ‘Making integration work’ at Community Care Live
That, however, is just the start. More NICE guidance for social care is on the way, including documents concerning the transition from children’s to adult services, the social care of older people with multiple long-term conditions, and how to address child abuse and neglect.
Although the topics vary, the thinking and approach behind NICE’s social care guidance is rooted in the ongoing integration of health and social care.
“Integration is the key,” says Professor Gillian Leng, deputy chief executive and director of health and social care at NICE. “Everybody’s talking about integration, but the question is integration at what level? Is it the integration of planning services? Integration around money? Integration in terms of what it means for the patient?
“The important thing about NICE having a social care remit is that we can actually begin to integrate health and social care topics in a way that we couldn’t years ago,” she says.
It was previously a source of frustration their guidance on areas such as Parkinson’s, for example, couldn’t cover the care side as well as health, she adds.
NICE’s approach to developing social care guidelines follows the four-stage model it developed for health services. First NICE homes in on what topics to produce guidance on with input via consultations.
“That sounds like an obvious thing but it is important because getting the topic right in the first place means people will feel it is an important piece of guidance,” Leng says.
We don’t want anyone to say, ‘Why on earth has NICE developed guidance on that? What a waste of time’.”
Once a guideline topic is selected NICE scopes out the detail of what to cover, again consulting with social care practitioners to ensure the subjects being focused on are right.
After that the task of developing the guidance falls, in most cases, to the NICE Collaborating Centre for Social Care (NCCSC).
Launched in April 2013, the NCCSC is an external consortium led by the Social Care Institute for Excellence (SCIE) that also includes the London School of Economics’ Personal Social Services Research Unit. Its contract with NICE is due to end in March 2016, but NICE does have the option of extending the contract by a year before having to put its role out to tender again.
The model is similar to that which NICE uses when developing clinical guidelines where the various medical royal colleges are involved.
“It’s still a model that we think is helpful because it brings in support and engagement from key external organisations,” Leng adds.
Lack of evidence in social care
For each topic, the NCCSC forms a guideline committee of people with expertise relevant to the topic, who sift through the evidence, create recommendations and assess the financial implications.
“Some people at this point say, ‘Ah, but there’s not much evidence in social care’. So the important thing to say is that the recommendations are based on the best available evidence. And if there are important questions where there is absolutely no evidence then we do produce consensus-based recommendations based around best practice. That applies to health as well.”
NICE is also keen to ensure that its guideline committees consist of more than academics. “We want people who are working in relevant roles, people who understand the issues and understand enough about evidence to know, when they are sitting around a table, what it might mean,” she says.
Finally, once the draft guidelines are produced, they are put out for consultation before being published. The process is robust says Leng: “Our approach to developing evidence based guidance is fairly standard and it’s based on international criteria, so that bit is not going to change.”
Getting people to follow the advice
What happens once the guidelines are published, however, is trickier. NICE may be most famous for its binding decisions on NHS funding of new drug treatments but every other piece of guidance it produces is advisory rather than compulsory. As a result NICE has to work to encourage both health and social care organisations and professionals to follow the advice it produces.
But reaching the point where NICE’s social care guidance is taken as seriously as its health guidance is going to be a tougher challenge, Leng agrees.
“It has taken us a long time with health to have such a high profile, for people to know what we’re doing and to work with third parties to disseminate guidelines,” she says. “It’s still early days, but social care is much trickier. There are so many providers of care, so many professionals and there aren’t the professional bodies that there are for health.”
Leng admits the demise of the College of Social Work has been something of a blow to NICE’s plans.
Role of CQC and Ofsted
NICE currently looks to SCIE to help disseminate its guidelines within the social care world, but it also has a powerful ally in the form of the Care Quality Commission (CQC), which takes NICE guidelines into account when inspecting services. However, CQC inspections do not cover the entire social care sector and at present NICE doesn’t work with the children’s services inspectorate Ofsted in the same way.
“I would really like the CQC approach to be mirrored with the Ofsted work,” says Leng. She says they have begun talks with Ofsted but it is early days.
In an ideal scenario Ofsted would pick up any of the standards that we produce that are relevant to children and consider how they might fit into their inspection regime.”
Another way NICE is hoping to embed its social care guidance in everyday practice is by encouraging local government commissioners to incorporate the recommendations it produces in the contracts they award to external providers of social care.
If NICE can get its social care guidelines to be embraced by the social care sector, Leng believes it won’t just improve the quality of social care practice but could also give social workers and other care professionals more confidence about what they are doing.
“I would like the users of NICE guidelines to see them as useful documents that underpin what they do on a day-to-day basis to improve care,” she says. “In health, practitioners want to know they are following best practice by looking at NICE clinical guidelines. I’d like those working in the social care sector to similarly feel confident that if they know what they are doing is in line with NICE guidance then they are following best practice.”