Abstract

Background
In the UK the National Institute for Health and Care Excellence (NICE), widely known for their health technology assessments, has published guidelines in social care since 2013. Care guidelines are increasingly developed and published by on behalf of governments internationally as means to enhance affordable high-quality care. Very little is known about how implementation needs to be designed to improve social care, and associated resource requirements.

Objectives
The Valuing Care Guidance (VCG) sought to investigate the processes, costs and benefits linked to the local implementation of social care guidelines in three local authorities in England and Wales.

Methods
A multi-site case study approach was undertaken that followed principles of being participatory, theory-informed and capacity-building. We gathered in-depth information on implementation processes (who did what, when, involving whom, and why), expected pathways to impact, and potential changes in knowledge, skills, practice, and outcomes. Methods for gathering data included (per site): two Theory of Change workshops with 5 to 10 council managers and lead practitioners, activity diaries with 2 to 4 managers and lead practitioners who had taken on roles of implementation leads, surveys with 5 to 20 service providers and literature reviews. Insights from the study's involvement group were used to include the perspectives of users and carers. Activities were coded and costed. Survey findings were analysed descriptively and responses on changes in services, based on service provider managers' narrative accounts and drawing from case records, were quantified in monetary terms.

Results
The three councils have implemented social care guidelines since 2019, covering topics such as safeguarding, self-neglect and care experiences. Activities to implement guidance varied substantially between sites and guidance topics but could be categorised by their purpose into: Creating organisational conditions (A); prioritising guidance and recommendations (B1); planning, conducting and reviewing a wide range of educational, auditing and knowledge exchange activities with service providers (B2); sustaining and scaling through sharing success and learning (C). The yearly costs to councils associated with staff time for these processes varied widely, averaging: £19,712 (A); £17,057 (B1), £62,383 (B2) and £3,102 (C). Cost drivers were the number of people involved, emphasising the participatory nature of some of the processes. The Theory of Change showed a path from changing staff awareness, confidence, competence, and wellbeing, establishing better relationships with the National Health Service and other partners, to achieving a shift towards more prevention-focused services over time that allowed more people to live independently. Some changes in staff knowledge and confidence were evidenced in survey results. If a monetary value was assigned to narratively reported impacts of adherence to good practice in line with guidance, such as reduction in care home admissions and crises and legal services, values per year were substantial (e.g. £4.6 million for one council). However, to fully implement guidance, more resources and wider system changes were needed.

Conclusion
This study is the first to highlight the challenges of and substantial efforts required to implement guidance in social care. Future research should focus on developing and testing implementation strategies and approaches.

Slides