Home care visits should be at least 30 minutes long, NICE says

BMJ 2015; 351 doi: (Published 23 September 2015) Cite this as: BMJ 2015;351:h5057
  1. Ingrid Torjesen
  1. 1London

Most home care visits should be at least half an hour long to enable carers to provide the personalised and dignified care that elderly patients need when being supported to stay in their own home, says a guideline on social care services from the National Institute for Health and Care Excellence (NICE).1

Shorter visits would be appropriate only rarely, said the finalised guideline on home care, published on 23 September. This might be when the visit is part of a wider package of support, made by a carer who is known to the patient, or made to complete a specific time limited task, such as checking that a medicine has been taken or that a person is safe and well.

The NICE guideline said that a “one size fits all” service was not the best way to provide home care and urged a person centred approach where the needs and wishes of the individual are heard and respected. Support should focus on what people can do and not just what they can’t do, it said, and it should be provided by trained and competent staff with whom the patient can become familiar.

Bridget Warr, chief executive of the United Kingdom Homecare Association, chaired NICE’s guideline development group. She emphasised that, for general visits, such as for personal care, 30 minutes was needed to provide the appropriate quality of care. “There is some very worrying practice in terms of what local authorities might be commissioning,” she said.

In December 2014 an investigation by Unison using the Freedom of Information Act found that three quarters (74%) of local authorities were commissioning at least some visits lasting only 15 minutes. These made up one in seven (14%) of the visits by the 110 councils commissioning these shorter visits.2

Asked whether local authorities would be able to fund 30 minute visits, Warr told a press conference on 21 September that many would struggle to do so under current funding constraints.

On the same day, the Association of Directors of Adult Social Services, the Care and Support Alliance (representing charities), the Care Provider Alliance, and the NHS Confederation put in a joint submission to the comprehensive spending review, due in November, calling for “adequate and sustained financing” for adult social care.3

They have urged the government to protect social care funding and to make provision for a funding gap in social care as it has done for the £8bn (€11bn; $12.3bn) NHS funding gap expected by 2020. The Local Government Association has estimated that the funding gap in social care is already growing by around £700m a year because of increased demand.

The United Kingdom Homecare Association was a signatory to the submission, and Warr commented, “We are deeply worried about the shortfall in funding, not only now, but particularly in April when there is the introduction of a national living wage.”

Noting that over 70% of home care was commissioned by local authorities or clinical commissioning groups, Warr said, “The funding for home care from those sources at the moment will not cover the introduction of the national living wage—hence that missive to the chancellor.”

She added, “There are a lot of things in that guideline that do not require extra money. They might require a change of attitude or a change of belief, but there are things that commissioners, providers, [and] workers can do without additional funding.

“Of course, it will be difficult for a provider to deliver all of the things in the guideline without sufficient resourcing to do so.”

Gillian Leng, deputy chief executive of NICE, emphasised that providing good care at home “is the best way to spend money” because it helped prevent admissions to residential care and hospital, which were much more expensive.


Cite this as: BMJ 2015;351:h5057


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