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Home care staff should be given enough time to provide good service - watchdog

Published 23/09/2015

Nice said home help visits of less than 30 minutes are not acceptable unless part of a wider package of support
Nice said home help visits of less than 30 minutes are not acceptable unless part of a wider package of support

Home care workers must be given enough time to spend with elderly and disabled people and must have enough travelling time between appointments, a health watchdog has said.

The National Institute for Health and Care Excellence (Nice) said home help visits of less than 30 minutes were not acceptable unless part of a wider package of support.

It has published new guidance for councils that commission care as well as firms providing services.

Freedom of Information figures published in the Daily Telegraph in February showed rising numbers of appointments were taking place in a matter of minutes.

Eight councils provided more than 593,000 care visits lasting five minutes or less in the three years from 2010/11 to 2012/13.

Previous research in December from Unison found three-quarters of councils commission 15-minute visits.

Charities have raised fears that vulnerable people are being neglected and are being forced to choose between being washed or fed.

Care workers have also complained that they do not have time to spend with their clients and ensure they have taken their medicines.

Many are also not paid for travelling time between appointments.

The new Nice guidance says contracts should " allow home care workers enough time to provide a good quality service, including having enough time to talk to the person and their carer, and to have sufficient travel time between appointments.

"They should ensure that workers have time to do their job without being rushed or compromising the dignity or wellbeing of the person who uses services."

It said h ome care visits shorter than half an hour should be made only if the home care worker is known to the person, the visit is part of a wider package of support, and if the task can be properly completed.

People with disabilities and communication problems may need workers to spend more time with them, while some need help with eating and drinking, it said.

Government guidance published with the Care Act last year said short home care visits of 15 minutes or less "are not appropriate for people who need support with intimate care needs".

But it said such visits "may be appropriate for checking someone has returned home safely from visiting a day centre, or whether medication has been taken (but not the administration of medicine) or where they are requested as a matter of personal choice."

Bridget Warr, chief executive of the United Kingdom Homecare Association (UKHCA), chaired the group of experts which developed the Nice guideline.

She said the Nice guidance was clear.

"It suggests no visit should be shorter than 30 minutes unless it is part of a bigger package of care, that the person knows the carer - so you don't want strangers going in for less than 30 minutes - and crucially, that the task that needs to be done can be done safely and effectively within that time."

She said there were "very, very worrying practices around in terms of what local authorities are commissioning.

"There is quite a lot of payment by local authorities for payment by the minute, which is quite contrary to the wellbeing principle of the Care Act.

"It's impossible for the care workers to do the sort of work they want to do."

She said it was " hard to see the place for a five-minute visit," adding: "As far as I'm concerned, I think that given the people receiving the care are, by definition, people who need support, it can be quite difficult to get access to their home in five minutes, let alone deliver care."

According to Nice, 470,000 people used home care funded by local authorities in England in 2013/14, and almost 80% were at least 65 years old.

Since October 2014, when a new inspection regime was launched by the Care Quality Commission (CQC), more than two thirds (68%) of home care services have been rated good or outstanding.

The CQC has no regulatory powers covering the length of visits but says providers must ensure care needs are being fully met.

Minister for community and social care, Alistair Burt, said: " We asked Nice to develop this guideline so that everyone involved in providing home care has clear standards that we will expect them to follow.

"This will not only provide reassurance for countless families who rely on this care but for the thousands of workers who want the time and support to be able to give people the care they deserve."

Andy Cole, campaigns director at Leonard Cheshire Disability charity, which also provides home care, welcomed the guidance, including on visits of less than 30 minutes.

"Care workers need time to care, to talk to people, to deliver compassionate, personalised support, and to maintain safety and quality," he said.

On Monday, 20 care organisations submitted evidence to the Treasury ahead of the spending review, saying social care is facing a "deepening crisis" with regards to funding.

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