Title: Co-production of best practice recommendations for local authority reviews of double-handed homecare packages
Funder: Department of Health and Social Care

Abstract: Background The UK is facing a crisis in capacity to deliver and fund social care. Demand for homecare is rapidly increasing compounded by problems with recruitment and retention in the sector. Some local authorities are seeking to ameliorate this by reviewing double-handed homecare packages which require two workers. The aim is to determine whether care can be reduced to a single worker through further rehabilitation or specialist equipment. Although pilot studies have shown short-term cost savings, there is a dearth of research on the views of people receiving these reviews, their families, reviewing practitioners such as occupational therapists and social workers, and homecare workers. Practices vary widely between authorities and the outcomes for the person, their families and the homecare workers are not known. Aims and Objectives We seek to identify stakeholder views on the components which should be included in local authority reviews of double handed homecare packages in order to co-produce recommendations for best practice. Specific aims are: To identify, describe and evaluate current review processes and practices for double-handed homecare packages by local authorities with social care responsibilities in England. To explore service user and practitioner experiences of double-handed homecare packages and local authority reviews of double-handed homecare packages in order to identify facilitators and barriers to implementation and outcomes that are important to service users and their families. To co-produce recommendations for best-practice doubled-handed homecare reviews with stakeholders including recipients of double-handed care packages, their family members, social care practitioners and homecare workers. Methods We will embed thorough Public and Person Involvement throughout all stages of this research. We will form an interdisciplinary working group of stakeholders who will guide the following three workpackages: A national survey of all local authorities with social care responsibilities in England. Qualitative interviews with people receiving on-going double-handed homecare packages and/or reviews (n=10-15) and their family members (n=10-15), and focus groups with reviewers of care packages (n=10-15) and homecare workers (n=10-15) . A nominal group technique to identify and prioritise aspects of good practice based on the findings from workpackages one and two. We will then co-develop recommendations for double-handed homecare reviews and implement and test them in an iterative process including feedback from service users and practitioners. Timeline, Anticipated Impact and Dissemination This research will take place over 28 months. We will produce a range of outputs, in addition to our recommendations, including academic publications, conference presentations, a lay infographic and a policy and practice briefing. We will disseminate these via range of academic, practice and lay networks. The final output will be a protocol for delivery of the best practice recommendations which will inform a further programme of work to evaluate the effectiveness and cost effectiveness of double-handed homecare reviews. Depending on the extent and nature of usual care practices identified in the survey, we will seek further funding for either: A randomised controlled trial of the best practice review programme versus usual care Implementation of the best-practice review recommendations across local authorities in England.

Lay abstract: When people cannot get from one place to another by themselves, such as moving from their bed into a chair, they need help from another person and/or equipment. If equipment such as a mobile hoist is used within the home, or the moving procedure is complicated, a double-handed homecare package is usually provided with two care workers attending every visit. Such care packages may start after an event such as a crisis at home or a hospital discharge and often stay in place for the long-term. Some local authorities are conducting reviews of double-handed homecare packages, often led by social care occupational therapists. The aim is to assess whether two care workers are needed on a continuing basis or whether additional rehabilitation and/or specialist equipment might safely reduce the care package to a single worker. There is no research on the experiences of people receiving double-handed homecare packages and reviews, or the outcomes that are important to service users, their families and homecare workers. There is also widespread variation in whether authorities are reviewing these homecare packages and how they are doing it. We want to develop recommendations for best practice double-handed homecare reviews by local authorities. We will organise a working group of people with double-handed homecare packages, their family members, social care practitioners and homecare workers in order to guide the following three steps: A survey of all local authorities with social care responsibilities in England. The survey will include areas such as time-points for reviewing, staff groups involved and review outcomes. Interviews and focus groups with people delivering and receiving double-handed homecare packages and reviews. Interviews will explore experiences, processes, facilitators and barriers. Produce best practice recommendations for double-handed care reviews. We will use a technique with the working group to identify and rank key aspects of the review process based on the findings from steps one and two. We will produce our recommendations collaboratively and test whether they can be delivered by local authority reviewers. We will obtain two rounds of feedback from people receiving the new reviews and the staff who carried them out. There are two possible outcomes for which we will seek further funding: A randomised controlled trial of the best practice review programme versus usual care Implementation of the best-practice review recommendations across local authorities in England. Using a range of traditional and innovative methods, we will share our findings with academic, practitioner and public audiences. Lay members of our research team and working group will collaborate at all stages from design through to presentation of findings and the next steps for the research. All outputs will be authored jointly by researchers, practitioners and lay members.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE