Managing medicines in Shared Lives schemes

Shared Lives schemes are for people who need support with their day-to-day lives. They offer an alternative to living in a residential care home or having more traditional care at home services.

Shared Lives schemes recruit and support carers who provide care and support to people in the carer’s own home. The care and support can be temporary, a day service, or an overnight service.

The provider of a Shared Lives scheme should register with CQC to provide the regulated activity of Personal care. We regulate at the level of the scheme, through agency locations. We have no powers to enter the home of a Shared Lives carer

A provider that is registered with us to deliver personal care may also administer a person’s medicines as part of this. This is because medicines support is considered ‘ancillary to’ the personal care they are receiving.

A service might support people to take their medicines themselves but not provide personal care. In this scenario, the medicines support is not an ‘ancillary activity’. It does not fall into the scope of registration by CQC and the provider of the service therefore does not need to register for that regulated activity.

Guidance

NICE guideline NG67 ‘Managing Medicines for People Receiving Social Care in the Community’ includes the following populations and settings:

• adults (aged 18 years and over) who take or use medicines and who are receiving social care in the community (and their families and carers).
• Shared Lives scheme living arrangements

Supporting people with medicines

Where possible, people should make decisions about their own care and manage it themselves. This includes their medicines. Sometimes people need support when taking their medicines. Shared Lives schemes should make sure that carers think about:

• how to support the person to manage their own medicines, and whether this meets their wishes and abilities
• whether the person understands why they are taking their medicines and whether information about their medicines could be provided in a different way
• what support the person needs, for example helping them to read the labels on medicines, use inhalers or apply creams
• whether the person has any problems when taking their medicines, particularly if taking several different medicines
• any related social, cultural, emotional, religious and spiritual needs
• whether they have any specific nutritional and hydration needs, including the need for nutritional supplements or other support.

If a person does not or may not have mental capacity to make decisions about their medicines (permanently or fluctuating), Shared lives schemes and carers must follow the Mental Capacity Act Code of Practice when making assessments and decisions. This includes giving medicines covertly.

Joint working and information sharing

Shared Lives schemes and carers should work with health professionals and social care practitioners. This enables people to receive integrated, person-centred support.

Health and social care professionals should consider people’s communication needs and should meet the Accessible Information Standard. Medicine reviews should include people’s views, wishes and aspirations. If the person's care transfers to another service, for example on admission to hospital, health and social care professionals should share information about how people take their medicines.

Records and administration

People should be supported to take their own medicines when they want to if it is safe to do so. Shared Lives schemes should work with people and their shared lives carers to develop a self-management plan for medicines. This plan must consider the risks, values and benefits.

Shared Lives carers may administer or support a person to take their medicines. They must keep records in line with NICE guideline NG67. This includes details of all support for prescribed and over the counter medicines, such as:

• reminding a person to take their medicine
• giving the person their medicine
• recording whether the person has taken or declined their medicine.

Shared Lives schemes should have robust processes to make sure carers keep accurate, up-to-date medicines administration records. They should have assurance that people are taking their medicines as prescribed and in a person-centred way. People have the right to refuse to take a medicine if they have the mental capacity to make that decision.

Ordering and supply

Providers of Shared Lives schemes should be confident that people living with carers will get the medicines they need. People must have reliable access to both prescribed and over the counter medicines. Providers and carers should work with pharmacies or dispensing doctors as needed so that they make reasonable adjustments to help people manage their medicines. For example, large print dispensing labels, easy to read leaflets, and accessible administration charts.

NICE NG67 says providers should consider using a monitored dosage system only where:

• a health professional (for example, a pharmacist) has carried out an assessment, in line with the Equality Act 2010 and
• a specific need has been identified to support a person to keep taking to their medicines as prescribed.

This also involves taking the person's needs and preferences into account and involving them or their family members or carers and the social care provider when making decisions.

Transporting, storing and disposal

Responsibility for transporting, storing and disposing of medicines usually stays with the person or their family members or carers. Shared Lives schemes should work with people and their carers to store medicines safely. This includes medicines that might need to be stored in a fridge and controlled drugs. Shared Lives carers do not need a separate medicines fridge or a controlled drug cupboard. Providers should work with people to store medicines in a way that meets their individual needs and the manufacturer’s requirements. Unwanted or waste medicines can be returned to a community pharmacy for safe disposal.

Training and governance

Shared Lives schemes should check that carers have suitable training to support a person to manage their medicines safely and effectively. Providers must be confident that carers are managing medicines safely. They must give people and carers the support they need and make sure they know how to raise concerns about medicines and to report medicines incidents.