Should Service Users home care plans be reviewed more frequently?

person centered care plans can be a time consuming but essential process. Under the Care Act, councils should review care plans no later than every 12 months. However, a recent report by Healthwatch watchdog (2017), has said reviews of people’s care and support plans should be completed more frequently than once a year and should instead be a “continuous process. This applies particularly in cases where a person’s ability to do things for themselves might be changing rapidly.

Missed medication The report looked at the experiences of people using home care services. It included information from 52 local Healthwatch organisations, and the experiences of 3,415 service users, their families and frontline staff, collected through events, surveys and site visits. The report found that care workers were frequently unfamiliar with their clients’ care plans and when it was a staff member’s first visit, there was often not enough time to read the plan. In some cases, this was leading to “serious problems”, such as medication being missed. A survey of 363 people in Newcastle, found one in seven had experienced medication being missed because of the home care provider. One in six respondents also said they felt the provision of medication was either “partly” or “never” safe. The report recommended that automatic notification systems could be introduced to update staff about important changes to care plans, or prompts could be left around people’s homes as a reminder of their preferences.

Lack of time The report also said local authorities needed to be more realistic in care plans about how much is achievable in the limited time available in most home care visits. Comment: This is hardly surprising if a Service User is allocated less than half an hour support time. It found that only half (56%) of 73 people responding to Healthwatch Blackburn with Darwen’s survey felt there was sufficient time to complete all tasks set out in the care plan. A service user told Healthwatch Redcar and Cleveland: “Sometimes they give me a shower but they go over their time but most of the time they haven’t got time to give me one so I go a couple of weeks without one and that’s not right, I feel dirty.” Comment: if care workers spend more than the allocated time with one person, they are likely to be late for their next appointment with another. Home care workers in Torbay also reported “unrealistic staff rotas” that left them exhausted and having to carry out double-handed care tasks on their own. Some Service Users also reported that staff lacked basic skills such as being able to boil an egg or make a bed, which resulted in poor care. Neil Tester, deputy director of Healthwatch England, said: “We heard examples of compassionate care from dedicated staff, but people also talked about care that doesn’t meet even basic standards. Given the challenges facing the social care sector, it’s more important than ever than ever that people’s voices are heard.” Margaret Willcox, president of the Association of Directors of Adult Social Services, said: “Most adult social care services in England are providing people with safe, high quality and compassionate care. That they are doing this in the context of rising demand and inadequate funding is a tribute in itself, but there is always room for improvement.”

Suggestions for improvement Managers responsible for the services covered by this report may ask themselves, ‘are their service users satisfaction surveys working as intended’? Can they provide evidence that they are acting on feedback from Service Users? In the Bettal Quality Management System we have a spot check form which when completed by the service user along with a senior member of staff from the home care agency provides an ongoing opportunity for a home care service to learn about what service users feel about the service. Actions identified and taken can help to prevent the poor practice identified in this report.

Summary Management and staff fully understand the importance of person centred care plan reviews, especially when there are changes in the persons needs and circumstances. But the central issue is the time allocated by commissioners to carrying out the task. Good care planning should identify changes to the persons needs that should be communicated to all care staff who provide a service to the person. While lack of time can be a cause for not delivering care and in particular medication, it should not be used as an excuse for poor practice. Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy