How do we improve the quality of the care services that older people receive? Better pay and status for care workers, consistent higher government funding and a regulator with the teeth to root out bad practice must all form part of the answer. But arguably, a shared vision for what quality really looks like is also critical: what should older people be able to expect from the care services they use? 

Better known for ruling on the cost-effectiveness of various drugs and treatments, the National Institute for Health and Care Excellence (NICE) also has a remit to develop ‘quality standards’ that set out what service users and carers can expect of social care services. Earlier this summer it released for consultation a draft standard on ‘People’s experiences of using adult social care’. This comprises four statements:

Statement 1: People using adult social care services have a care and support needs assessment that takes into account their personal strengths, preferences, aspirations and needs.

Statement 2: People using adult social care services have as much control as possible over the allocated funds for purchasing care packages

Statement 3: People using adult social care services have continuous and consistent care and support.

Statement 4: People using adult social care services’ views are used to inform service improvement.

Although these statements contain much we agree with and welcome, we think they are problematic in two ways:

The wrong balance of realism vs aspiration

The four statements are in some ways too ambitious but in others not ambitious enough. ‘Continuous and consistent care’ is going to be very difficult to achieve in a sector where turnover rate for social care workers is nearly 30% a year. And while we want to see care assessments that go beyond just meeting basic needs, we know that even getting an assessment can be a struggle. It is not uncommon for people to wait more than two months for an assessment, living without the support they need in the meantime. Statements that bear little relation the reality of where we are now can quickly feel irrelevant.

On the other hand, some of the statements also do not go far enough. The fourth says that the feedback that users provide should be ‘used to inform service improvement’. But rather than using people’s views to improve existing services, truly ‘user centred’ approaches ensure that service design begins with what individuals themselves would prioritise. Likewise, in statement one, the idea that assessments should ‘take into account’ strengths, aspirations and needs is quite a weak requirement given how easily ‘taking account’ of these can quickly become a box ticking exercise which has little impact on the care package that is offered. Care assessments that put older people in the centre would instead begin with their preferences.

If you can’t measure it you can’t improve it

None of the four statements are unmeasurable in theory. The draft quality standard includes suggestions for the types of data collection that would enable improvement against each statement to be tracked. But the fact remains that very little data that would assess these statements is actually collected in any consistent way. At a national level there are some tools for assessing older people’s experiences of social care (for example the Personal Outcomes Evaluation Tool, POET). But this is used by only a handful of local authorities, so tracking progress at this level is not possible for the majority.

The lack of consistent data to measure quality and outcomes in social care (particularly in contrast with NHS data) has long been recognised. In fact in 2015, the National Audit Office stated that it believes the Care Quality Commission does not have access to routine information about adult social care good enough to monitor risk or trigger inspections. If the data is not there for the regulator to identify possible malpractice, it is certainly not there to assess the overall quality of experience.

Our response to the NICE consultation highlighted these points and we will be tracking closely how this quality standard progresses – the final version is due by the end of this year. More widely, our campaigning over the next year and beyond will be focused on quality in social care.  Ultimately, we want to see the government and the sector overall championing ambitious new standards for high quality social care. These must speak to the reality of where we are today while also setting a high aspiration for a care system that supports older people to live the lives they want to.

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