Every year, thousands of safety incidents in home-based care go unanalysed because no one has clearly defined what “safe” means when care happens in a person’s own living room. This matters because home-based care is fundamentally different from hospital care. A care worker alone in a client’s house must constantly balance risks—like allowing a frail older person to walk unaided to preserve their dignity—against potential harms. Current safety frameworks, designed for institutional settings, fail to capture these trade-offs. Without a shared definition of safety and harm, regulators cannot measure whether care failures are increasing or decreasing, and the system cannot learn from mistakes. If this research succeeds, it will produce a practical taxonomy of safety priorities and a multi-faceted definition of harm that regulators like Care Inspectorate Wales can use to track real-world outcomes. The project will also generate principles for making risk-aware, context-specific care decisions—tools that care providers, commissioners, and families can use immediately to reduce preventable harm while preserving what matters to the person receiving care.
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Research question What does good care look like alongside the current risks and harms experienced by service users, and their families, receiving home-based care services? Background Without a clear conceptualisation of safety, risk and potential benefits/harms in the home-based care context, the ability to measure the consequences of service failures will be compromised and necessary changes cannot be made to improve systems and future practice, including safeguarding against harm for all those involved in caregiving (1). Aim To evidence a multifaceted conceptualisation of safety that accounts for live risk-benefit analyses in personalised care for people at home and prioritises developing a system that facilitates what matters to those receiving care. Objectives • Identify from existing published literature the concepts and constructs to conceptualise the evaluation of safe care, and how it is achieved, in the home-based care context. • Characterise safety incidents reported by the social care workforce to identify where and how the system can be improved. • Understand enablers and constraints within and between 1) professional groups, 2) organisations that provide social care and their workforce, 3) health and social care, and 4) organisations that influence safe outcomes, and how they relate to, or impact, planning, management, and delivery. • Understand how care recipients and their families / informal care givers experience home-based care and what are their safety concerns. Methods This mixed-methods study will use realist approaches throughout three work packages (WPs): • WP1: A realist synthesis of existing evidence about how safe home-based care is conceptualised and achieved. • WP2a: Characterisation of safety incidents (submitted as notifications to Care Inspectorate Wales) about home-based care from the social care workforce. • WP2b: Professional stakeholder focus groups and key respondent interviews. • WP3: Interviews with service users and informal/unpaid caregivers. Three stakeholder events will aid contextualisation and co-produce potential solutions/actions. Timelines and anticipated impact Our key milestones and related outputs /impact will be: • Month 9: Draft definitions for key concepts and constructs used to evaluate safety and aid comparability of future research. • Month 20: Identified safety priorities from home-based care safety incidents in Wales recommendations on where and how systems can be improved/sustained for safe care. • Month 20: Developed a taxonomy for learning that can be used by regulators for the ongoing identification of safety priorities. • Month 24: A multi-faceted definition of harm for future longitudinal measurement. • Month 24: With extensive stakeholder input, identified principles that can be used to support safe, risk-aware, context-specific care decisions to mitigate harm. Dissemination Social Care Wales, the Outcomes-focussed Community of Practice convened by the National Commissioning Board, and Care Inspectorate Wales have each agreed to support engagement with stakeholders from their extensive networks that will be critical to timely and impactful change. Key decision-makers from Wales and the devolved nations across social care, health, inspectorates, regulators and policy have agreed to contribute to an advisory group or attend stakeholder events. Inclusivity will be at the core of how we deliver the study and importantly how we communicate our findings widely.
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