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Home care for older people

About

What is covered

This interactive flowchart covers personal care and practical support delivered to older people living in their own homes. Home care is one of several services that can be offered to people assessed as needing social care support. It can be funded by health or social care commissioners or by the person using services. Although the range and type of services that can be classed as home care varies, it usually encompasses:
  • personal care, for example help to wash
  • support with the activities of daily living, which might also include telecare (for example providing personal alarms)
  • essential domestic tasks.
Home care services may also help people to stay independent and take part in social and other activities.
Commissioners of home care services should ensure any service specifications take into account the recommendations in this pathway and associated quality standard.
NICE and The Social Care Institute for Excellence have co-produced Better home care for older people: A quick guide for people who arrange their own home care.

Updates

Updates to this interactive flowchart

21 June 2016 Home care for older people (NICE quality standard 123) added to this pathway.
16 December 2015 Link to NICE pathway on mental wellbeing and independence in older people added.
3 November 2015 Link to NICE pathway on social care of older people with multiple long-term conditions added.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on planning and delivering home care for older people in an interactive flowchart

What is covered

This interactive flowchart covers personal care and practical support delivered to older people living in their own homes. Home care is one of several services that can be offered to people assessed as needing social care support. It can be funded by health or social care commissioners or by the person using services. Although the range and type of services that can be classed as home care varies, it usually encompasses:
  • personal care, for example help to wash
  • support with the activities of daily living, which might also include telecare (for example providing personal alarms)
  • essential domestic tasks.
Home care services may also help people to stay independent and take part in social and other activities.
Commissioners of home care services should ensure any service specifications take into account the recommendations in this pathway and associated quality standard.
NICE and The Social Care Institute for Excellence have co-produced Better home care for older people: A quick guide for people who arrange their own home care.

Updates

Updates to this interactive flowchart

21 June 2016 Home care for older people (NICE quality standard 123) added to this pathway.
16 December 2015 Link to NICE pathway on mental wellbeing and independence in older people added.
3 November 2015 Link to NICE pathway on social care of older people with multiple long-term conditions added.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Home care for older people (2016) NICE quality standard 123

Quality standards

Home care for older people

These quality statements are taken from the home care for older people quality standard. The quality standard defines best practice in home care for older people and should be read in full.

Quality statements

Person-centred planning

This quality statement is taken from the home care for older people quality standard. The quality standard defines best practice in home care for older people and should be read in full.

Quality statement

Older people using home care services have a home care plan that identifies how their personal priorities and outcomes will be met.

Rationale

Discussing individual priorities and needs with older people can help to identify what is important to them, what they feel they can do, what they want to be able to do and what will make them feel safe. It should include identifying priorities arising from physical problems, mental health conditions or sensory loss. Including personal priorities and outcomes in the home care plan will enable home care workers to deliver effective and responsive care including identifying when additional support from another practitioner may be needed. This will help older people to maintain their independence for as long as possible.

Quality measures

Structure
Evidence of local processes to ensure that home care plans for older people identify how their personal priorities and outcomes will be met.
Data source: Local data collection. Person-centred planning is included within the Care Quality Commission’s Regulations for service providers and managers.
Process
a) Proportion of older people using home care services whose home care plan includes their personal priorities and outcomes.
Numerator – the number in the denominator whose home care plan includes their personal priorities and outcomes.
Denominator – the number of older people using home care services.
Data source: Local data collection.
b) Proportion of older people using home care services whose home care plan identifies how their personal priorities and outcomes will be met.
Numerator – the number in the denominator whose home care plan identifies how their personal priorities and outcomes will be met.
Denominator – the number of older people using home care services.
Data source: Local data collection.
Outcome
a) Older people’s involvement in decision-making.
Data source: Local data collection.
b) Health-related quality of life for older people using home care services.
Data source: Local data collection.
c) Social care-related quality of life for older people using home care services.
Data source: Local data collection. The Health and Social Care Information Centre’s Personal social services adult social care survey includes questions on social care-related quality of life.

What the quality statement means for service providers, social care practitioners and commissioners

Service providers (such as independent home care agencies, voluntary sector organisations and local authorities) ensure that older people using home care services have a home care plan that identifies how their personal priorities and outcomes will be met. This should include ensuring that any individual needs arising from physical problems, mental health conditions or sensory loss are identified and responded to in the home care plan.
Social care practitioners (such as home care managers, support workers and social workers) develop a home care plan that identifies how personal priorities and outcomes will be met for older people using home care services. This will include identifying and agreeing how any needs arising from physical problems, mental health conditions or sensory loss will be met.
Commissioners (for example local authorities and clinical commissioning groups) commission services that ensure that older people using home care services have a home care plan that identifies how their personal priorities and outcomes will be met, including any needs arising from physical problems, mental health conditions or sensory loss.

What the quality statement means for people using home care services and carers

Older people using home care services have a care plan that reflects what support they need, what is important to them, what they feel they can do, and what they want to be able to do. It should also take into account their specific health problems or disabilities.

Source guidance

Home care: delivering personal care and practical support to older people living in their own homes (2015) NICE guideline NG21, recommendations 1.1.1, 1.1.2, 1.3.8, and 1.3.13

Definitions of terms used in this quality statement

Personal priorities and outcomes
A discussion about personal priorities and outcomes should address the full range of support needed to help the person to live how they choose, including practical support, as well as personal care needs. This could include, for example, support to help a person manage their own financial and personal affairs, do their own shopping and cooking, or socialise. The discussion should include considering any specific needs arising from physical problems, mental health conditions or sensory loss and identify how any needs will be met. The focus should be on empowering the person as much as possible, by recognising what they can and want to do.
[Adapted from Home care: delivering personal care and practical support to older people living in their own homes (NICE guideline NG21), recommendations 1.3.8 and 1.3.13 and expert opinion]
Home care plan
This is a written plan put together after the local authority assessment of overall need. It sets out the home care support that providers and the person have agreed will be put in place. It includes details of both personal care and practical support.

Equality and diversity considerations

Many older people using home care services may have sensory loss or communication difficulties and it will be important to ensure that information is provided in a format that suits their needs and preferences. In particular, practitioners should identify, record and meet the information and communication needs of people who have hearing loss, sight loss or learning disabilities, as set out in NHS England's Accessible Information Standard.
People with limited independence as a result of a physical disability, mental health problem or cognitive impairment may need additional support, such as an advocate, to identify their personal priorities and outcomes for home care.

Plan for missed or late visits

This quality statement is taken from the home care for older people quality standard. The quality standard defines best practice in home care for older people and should be read in full.

Quality statement

Older people using home care services have a home care plan that identifies how their home care provider will respond to missed or late visits.
Rationale
Missed home care visits can have serious implications for an older person’s health and wellbeing and providers should make it a priority to avoid them. Late home care visits can also be a problem if it means the person’s needs cannot be met. An older person may not be able to alert others when a missed or late visit occurs. It is therefore important to ensure a back-up plan is in place so that the older person stays safe and they and their carers are kept informed if a visit is going to be missed or delayed.

Quality measures

Structure
Evidence of local processes to ensure that older people using home care services have a home care plan that identifies how their home care provider will respond to missed or late visits.
Data source: Local data collection.
Process
a) Proportion of older people using home care services who have a home care plan that identifies how their home care provider will respond to missed or late visits.
Numerator – the number in the denominator who have a home care plan that identifies how their home care provider will respond to missed or late visits.
Denominator – the number of older people using home care services.
Data source: Local data collection.
b) Proportion of planned home care visits for older people that are missed.
Numerator – the number in the denominator that are missed.
Denominator – the number of planned home care visits for older people.
Outcome
a) Older people’s satisfaction with the reliability of their home care service.
Data source: Local data collection.
b) Safety incidents among older people related to missed or late home care visits.
Data source: Local data collection. The Health and Social Care Information Centre’s Safeguarding adults annual report 2014–15 includes data on referrals made as a result of neglect and omission, and the source of risk including social care support.

What the quality statement means for service providers, social care practitioners and commissioners

Service providers (such as independent home care agencies, voluntary sector organisations and local authorities) ensure that older people using home care services have a back-up plan to be actioned if a missed or late visit cannot be avoided, that includes how they will communicate with the older person and their carers (if appropriate). Providers should ensure that they monitor missed or late visits and report this to the commissioner.
Social care practitioners (such as home care workers and personal assistants) ensure that they are aware of the back-up plan for responding to missed or late visits for the people they provide home care to and put the plan into action if a visit is late or missed.
Commissioners (for example local authorities and clinical commissioning groups) commission home care services that ensure that older people have a back-up plan to be actioned if a missed or late visit cannot be avoided. Commissioners should ensure that providers monitor missed or late visits and discuss how they responded at contract monitoring meetings.

What the quality statement means for people using home care services and carers

Older people who use home care services have a plan for what their home care provider will do if a visit is late or missed to ensure that they stay safe. The plan will include details of who will come if a home care worker misses a visit (for example a family member, carer or neighbour).

Source guidance

Home care: delivering personal care and practical support to older people living in their own homes (2015) NICE guideline NG21, recommendations 1.4.10, 1.4.11, 1.4.12, and 1.4.14

Definitions of terms used in this quality statement

Home care plan
This is a written plan put together after the local authority assessment of overall need. It sets out the home care support that providers and the person have agreed will be put in place. It includes details of both personal care and practical support.
Plan for missed or late visits
A plan for responding to missed or late visits should include:
  • how and when a missed or late visit will be communicated to the older person or their carers
  • emergency contact details
  • arrangements for a family member, carer or neighbour to visit instead
  • an assessment of risk and what should happen if a visit is late or missed.
[Adapted from Home care: delivering personal care and practical support to older people living in their own homes (NICE guideline NG21), recommendations 1.4.12 and 1.4.15]

Equality and diversity considerations

Home care providers should recognise that older people living alone or those who have cognitive impairment may be particularly vulnerable if visits are late or missed. Providers should therefore make it a high priority for back-up plans to be actioned as soon as possible for these specific groups.

Consistent team of home care workers

This quality statement is taken from the home care for older people quality standard. The quality standard defines best practice in home care for older people and should be read in full.

Quality statement

Older people using home care services receive care from a consistent team of home care workers who are familiar with their needs.
Rationale
Continuity of home care workers will help to promote the delivery of person-centred care. When the person knows their home care workers it can build their confidence in the service and help them to feel safe. When home care workers get to know the person using care they have a better understanding of their needs and preferences. They can communicate well with the person they are caring for, deliver care in the way the person wants and respond to any risks or concerns that may arise.

Quality measures

Structure
Evidence of local processes to ensure that older people using home care services receive care from a consistent team of home care workers who are familiar with their needs.
Data source: Local data collection.
Process
a) Total number of home care workers providing care to an older person using home care services.
Data source: Local data collection.
b) The average number of home care visits each older person receives per home care worker.
Data source: Local data collection.
Outcome
Older people’s satisfaction with the consistency of their home care team.
Data source: Local data collection.

What the quality statement means for service providers, social care practitioners and commissioners

Service providers (such as independent home care agencies, voluntary sector organisations, and local authorities) ensure that older people using home care services receive care from a consistent team of home care workers who are familiar with their needs. Providers should always inform older people in advance if new staff will be visiting.
Social care practitioners (such as home care workers and personal assistants) ensure that they get to know the people they provide care to and deliver care in the way they want.
Commissioners (for example local authorities and clinical commissioning groups) commission services that ensure that older people using home care services receive care from a consistent team of home care workers who are familiar with their needs.

What the quality statement means for people using home care services and carers

Older people who use home care services have the same home care workers who are familiar with their needs. Older people and their family members or carers are notified in advance if new staff will be visiting.

Source guidance

Length of home care visits

This quality statement is taken from the home care for older people quality standard. The quality standard defines best practice in home care for older people and should be read in full.

Quality statement

Older people using home care services have visits of at least 30 minutes except when short visits for specific tasks or checks have been agreed as part of a wider package of support.

Rationale

Home care visits should be long enough to ensure that the person’s identified outcomes can be achieved in a way that does not compromise their dignity and wellbeing. There is a risk that visits of less than 30 minutes will be rushed and not meet the person’s needs, and could compromise safety and dignity. The need to include short visits in a person’s care package should therefore be carefully considered and agreed in advance with the older person.

Quality measures

Structure
Evidence of local processes to ensure that older people using home care services have visits of at least 30 minutes except when short visits for specific tasks or checks have been agreed as part of a wider package of support.
Data source: Local data collection.
Process
a) Proportion of home care visits to older people lasting 30 minutes or longer.
Numerator – the number in the denominator lasting 30 minutes or longer.
Denominator – the number of home care visits to older people.
Data source: Local data collection.
b) Proportion of home care visits to older people of less than 30 minutes with a prior agreement that a shorter visit is acceptable.
Numerator – the number in the denominator with a prior agreement that a shorter visit of less than 30 minutes is acceptable.
Denominator – the number of home care visits to older people that are less than 30 minutes.
Data source: Local data collection.
Outcome
a) Older people’s satisfaction with the length of home care visits.
Data source: Local data collection.
b) Older people’s perception of the way they are helped or treated.
Data source: Local data collection. The Health and Social Care Information Centre’s Personal social services adult social care survey includes a question on how the way they are helped or treated makes people who use services feel about themselves.

What the quality statement means for service providers, social care practitioners and commissioners

Service providers (such as independent home care agencies, voluntary sector organisations, and local authorities) ensure that older people using home care services have visits of at least 30 minutes except when short visits for specific tasks or checks have been agreed as part of a wider package of support.
Social care practitioners (such as home care workers and personal assistants) provide home care visits of at least 30 minutes unless the older person has agreed in advance that some shorter visits for specific tasks or checks can meet their needs.
Commissioners (for example local authorities and clinical commissioning groups) commission services that ensure that older people using home care services have visits of at least 30 minutes except when short visits for specific tasks or checks have been agreed as part of a wider package of support. Commissioners should require exception reporting for any visits that are less than 30 minutes and have not been agreed previously.

What the quality statement means for people using home care services and carers

Older people who use home care services have home care visits of at least 30 minutes unless they, and their family members or carers, have agreed in advance that some shorter visits for specific tasks or checks can meet their needs.

Source guidance

Definitions of terms used in this quality statement

Short visits for specific tasks or checks
Home care visits shorter than half an hour should only be made if:
  • the home care worker is known to the person, and
  • the visit is part of a wider package of support, and
  • it allows enough time to complete specific, time limited tasks or to check if someone is safe and well.

Equality and diversity considerations

People with cognitive impairments, communication difficulties or sensory loss may need home care workers to spend more time with them to ensure effective communication and to ensure the person can be fully included in their care. This could include needing more time to help them eat and drink. Individual needs should be carefully considered before it is agreed that home care visits of less than 30 minutes are suitable for people in these groups.

Reviewing the outcomes of the home care plan

This quality statement is taken from the home care for older people quality standard. The quality standard defines best practice in home care for older people and should be read in full.

Quality statement

Older people using home care services have a review of the outcomes of their home care plan within 6 weeks of starting to use the service and then at least annually.

Rationale

Assessing whether the home care service is achieving the outcomes described in the home care plan will help identify any changes or improvements that are needed. An early review of outcomes with the older person within the first 6 weeks will ensure any initial problems are identified and addressed quickly. Regular reviews should be carried out in response to any changes in circumstances such as a hospital admission or deterioration in physical health, and at least annually, to check that the home care service is still meeting the person’s needs.

Quality measures

Structure
a) Evidence of local processes to ensure that older people using home care services have a review of the outcomes of their home care plan within 6 weeks of starting to use the service.
Data source: Local data collection.
b) Evidence of local processes to ensure that older people using home care services have a review of the outcomes of their home care plan at least annually.
Data source: Local data collection.
Process
a) Proportion of older people using home care services who have a review of the outcomes of their home care plan within 6 weeks of the service starting.
Numerator – the number in the denominator who have a review of the outcomes of their home care plan within 6 weeks of the service starting.
Denominator – the number of older people starting to use home care services.
Data source: Local data collection.
b) Proportion of older people using home care services who have a review of the outcomes of their home care plan within a year of their previous review.
Numerator – the number in the denominator who have a review of the outcomes of their home care plan within a year of their previous review.
Denominator – the number of older people using home care services for more than a year.
Data source: Local data collection.
Outcome
a) Older people’s satisfaction with the home care service.
Data source: Local data collection.
b) Health-related quality of life.
Data source: Local data collection.
c) Social care-related quality of life.
Data source: Local data collection. The Health and Social Care Information Centre’s Personal social services adult social care survey includes questions on social care-related quality of life.

What the quality statement means for service providers, social care practitioners and commissioners

Service providers (such as independent home care agencies, voluntary sector organisations, and local authorities) ensure that H3. Processes are in place for older people using home care services to have a review of the outcomes of their home care plan within 6 weeks of starting to use the service and then at least annually. The frequency of reviews will depend on individual circumstances and should be responsive to any changes in those circumstances. The frequency should be agreed with the older person but they should know who to contact if they want to request a review at a different time.
Social care practitioners (such as home care managers, support workers, and social workers) review the outcomes of the home care plan within 6 weeks of the older person starting to use the service and then at least annually. Social care practitioners should agree the frequency of reviews with the older person but arrange an earlier review if the person’s circumstances change.
Commissioners (for example local authorities and clinical commissioning groups) commission services that ensure that older people using home care services have a review of the outcomes of their home care plan within 6 weeks of starting to use the service and then at least annually. Commissioners should ensure there is an agreed approach to identifying the frequency of reviews based on individual circumstances and that there is capacity to undertake more frequent reviews if needed.

What the quality statement means for people using home care services and carers

Older people who use home care services have a discussion with a member of their care team about whether they are happy with their care and if it is helping them in the way that they want. This should happen within 6 weeks of starting to use the service and then at least once a year. Older people can involve a family member or carer in the review of their care if they wish. The home care provider should agree how often a review is needed but the older person and their family member or carer should know who to contact in case they want to arrange a review at a different time.

Source guidance

Definitions of terms used in this quality statement

Home care plan
This is a written plan put together after the local authority assessment of overall need. It sets out the home care support that providers and the person have agreed will be put in place. It includes details of both personal care and practical support.

Equality and diversity considerations

People with communication difficulties or sensory loss should be offered appropriate support to enable them to participate in a review of their home care plan. Any information provided should be in a format that suits their needs and preferences. In particular, practitioners should identify, record and meet the information and communication needs of people who have hearing loss, sight loss or learning disabilities, as set out in NHS England's Accessible Information Standard.
People with limited independence as a result of a physical disability, mental health problem or cognitive impairment may need additional support, such as an advocate, to identify whether their care is meeting their expectations and aspirations.
People with deteriorating conditions and those who are likely to be approaching the end of life may need reviewing more often.

Supervision of home care workers

This quality statement is taken from the home care for older people quality standard. The quality standard defines best practice in home care for older people and should be read in full.

Quality statement

Home care providers have practice-based supervision discussions with home care workers at least every 3 months.

Rationale

Regular supervision is important for home care workers who typically work on their own with older people in the community. Providing regular supervision, based on observation of practice, will ensure home care workers feel supported and will enable any development needs to be identified and addressed. This will reduce staff turnover and improve the continuity and quality of care delivered.

Quality measures

Structure
Evidence of local processes to ensure that home care providers have practice-based supervision discussions with home care workers at least every 3 months.
Data source: Local data collection.
Process
Proportion of home care workers supporting older people who had a practice-based supervision discussion within the past 3 months.
Numerator – the number in the denominator who had a practice-based supervision discussion within the past 3 months.
Denominator – the number of home care workers supporting older people.
Data source: Local data collection.
Outcome
a) Older people’s satisfaction with the home care service.
Data source: Local data collection.
b) Staff retention among home care workers.
Data source: Local data collection.

What the quality statement means for service providers, social care practitioners and commissioners

Service providers (such as independent home care agencies, voluntary sector organisations, and local authorities) ensure they have practice-based supervision discussions with home care workers at least every 3 months and identify any development needs to be addressed.
Social care practitioners (such as home care managers and home care workers) prepare for and take part in practice-based supervision discussions at least every 3 months and agree how any development needs will be addressed.
Commissioners (for example local authorities and clinical commissioning groups) commission services that ensure home care workers have a practice-based supervision discussion at least every 3 months and that any development needs are addressed.

What the quality statement means for people using home care services and carers

Older people who use home care services can be confident that they are receiving care from home care workers who are well supported and have regular discussions with their manager. The care workers work with their manager on improving their skills and approach if they need to so that the service they provide meets the needs of older people.

Source guidance

Definitions of terms used in this quality statement

Practice-based supervision discussion
Home care workers should have an individual supervision discussion at least every 3 months to help them deal with their day to day work and continuously improve their practice and the quality of the support they offer to older people. The discussion should be based on observed practice and identify individual strengths and development needs. A written record of the discussion should be given to the worker.
[Home care: delivering personal care and practical support to older people living in their own homes (NICE guideline NG21), recommendations 1.7.11 and 1.7.12 and expert opinion]

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Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Glossary

this is a written plan put together after the local authority assessment of overall need. It sets out the home care support that providers and the person have agreed will be put in place. It includes details of both personal care and practical support.
one of the people from among the group of workers providing care and support designated to take a coordinating role. This could be, for example, a social worker, practitioner working for a voluntary or community sector organisation, or lead nurse. Some aspects of this role may be undertaken by the person themselves, or their carer.

Paths in this pathway

Pathway created: September 2015 Last updated: July 2017

© NICE 2017

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