2020 vision for Welsh 'public health'? Proposing 'public sector' footprints.

Background Social care provision is vital for ensuring the health of ageing and vulnerable populations. The UK relies on informal care for 50% of care provision, meaning that social care policies have significant implications for health services sustainability in this context. We present an agent-based simulation of UK informal care provision, demonstrating how this framework captures troubling trends and inequalities in social care. Methods We constructed an agent-based model in Python that simulates individual human agents in a virtual UK from the year 1860 to 2022. Population dynamics are driven by UK birth rates and mortality rates. Agents can form partnerships, reproduce, migrate domestically for work or other purposes, change jobs, and provide social care. Care decisions are taken based on employment status, salary, age, health status, geographical location, and their relationship to those in need of care. Simulated agents participate in a detailed economy, and are members of different socioeconomic status groups depending on their income. Output files track agents’ socioeconomic status, social mobility, informal care provision, and payment for formal care services. Simulation output includes individual-level agent statistics and population-level analyses of care provision by age, sex, socioeconomic status, and employment status. Simulation results were calibrated against 2011 UK Census data for key population dynamics measures. Results Simulation results in the year 2022 show significant inequalities in social care need and provision by gender and SES group. Agents in the lowest SES quintile (Group I) show a mean unmet care need of 19 hours/week, as compared to 12.5/week in in the highest (Group V). Carers in Group I supply an average 8.6 hours/week of care, compared to 3.6 hours/week in Group V. Thus, agents in Group I not only make a lower wage, they also lose more hours of work to care provision, and need more care themselves. In addition, female agents provide 1.9 times more informal care than males, while receiving lower average wages. Finally, the simulation shows a trend of growth in unmet care need from 1.17 hours per capita in 1976 to 2.38 by 2022. Conclusion This work demonstrates that a well-constructed agent-based simulation can provide a platform for investigating the influence of economic and social factors on social care provision. This framework thus provides a means to develop and test new social care policies which better account for the complexities and challenges facing informal carers across the country, and in turn better protect health services sustainability.

Introduction. The development of innovative high quality care forms is a challenging issue in rapidly aging society of Lithuania. The new shape integrated homecare services for people with chronic conditions have been constructed and have been functioning over the year as the pilot projects in the 21 municipality around Lithuania. In almost all integrated care pilot municipalities except two regions (in Alytus and Sakiai, with primary health care units as integrated care providers) the initiative to develop team based integrated homecare services to persons with chronic conditions has been taken by departments of social services. The purpose of this study is to identify the key contextual elements and related strategic, organizational processes from pilot municipalities as facilitators and obstacles in developing mobile team based integrated homecare services as contrast to traditional institutionalised care. Theory/Methods. Pettigrew and Whipp's context, content and process model of strategic change was used as theoretical framework for the case studies of team based integrated homecare pilots. According this framework the data collection focused on three entities: what external and internal contexts instigated municipalities and service providers to take the challenge to develop the new shape integrated team based homecare services and how service providers perceive, construct and implement integrated team based homecare; and finally, what outcomes have been shaped with new form integrated care. Data were analysed from transcripts of 20 focus groups with administrators, social and health care providers and 12 in depth interviews with care receivers (informal caregivers and patients) in ten purposively sampled municipalities: pilots executed by municipality social provision departments in partnership with private and state agencies, directly by social services departments and by primary health care unit. The findings were compared with factors and dimensions of Normalisation Process Theory (May et al. 2007). Results and discussion. The study revealed the obstacles and facilitators related to individual and different organizational levels in constructing team based integrated homecare. The study 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 1 International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117127– http://www.ijic.org/ revealed individual level topics such as trust and collaboration building between integrated team care providers and informal caregivers, challenges in building new routines and habits for patient in homecare process, resistance and adaptation to presence of constant changing strangers’ at home. The study exposed the organizational issues related to interaction between team members and administration, tensions issues in status difference between social and health care providers, tasks distributions between team members, perception diversity of team and care, lack of teamwork experience and sense of shared responsibility, issues of staff commitment due to termed pilots. The inter-institutional and intra-institutional hindering tensions between social and health care providers unclosed the competition over the homecare field; new institution as threat to monocracy of health care; lack of skills and early transition from hierarchical to dialog based horizontal structures; inequality of resource distribution between integrated team members uncompensated travel costs for social care providers vs. car with fuel coverage for health care providers. The mentality of monolog culture with highly hierarchic structures in health care system hinders recognition of nursing as separate profession with certain competencies: avoidance by nurses to take decisions on nursing issues without consultation with physician even in areas of their professional competence supremacy as care of bedsores. The important facilitators were the support of municipality in service development and participatory involvement of the unit from the beginning of project planning. The professionally organized integrated homecare services facilitated transition to collaborative relationship between health care and social care providers. The requirement to follow literally description of project activities even the performance of planned activities contradicted the reality in practice hinders development of new service. As study limitation is the administrators gatekeepers’ role in accessing research participants: patients, informal caregivers, health and social care providers. In some municipalities the presence of head of the unit in the focus group suppressed openness of the staff. The study had insufficient data on patients’ experience of care as the integrated care pilots addressed severely ill patients with limited communication abilities. Conclusions. The study revealed micro, mezzo and macro levels obstacles and facilitators in constructing team based integrated homecare. The distinction of developed models of team based integrated homecare services participatory interaction between stakeholders of the care with the traits of patient centred approach and collaborative practices between existing social and health care structures. The move from the tradition of hierarchical model of service development ( i.e. from “above” perspective constructing orders of ministers with limited perception of reality and municipalities as executive committees with resistance performing commandments and shaping service delivery imitation) grounded the participatory practice in service development.

This article explores the interactions between disabled forced migrants with care needs and professionals, and the restrictive legal, policy and practice context that health and social care professionals have to confront, based on the findings of a qualitative study with forty-five participants in the south-east of England. In-depth interviews were conducted with fifteen forced migrants who had diverse impairments and chronic illnesses (eight women and seven men), thirteen family care-givers and seventeen support workers and strategic professionals working in social care and the third sector in Slough, Reading and London. The legal status of forced migrants significantly affects their entitlements to health and social care provision, resulting in prolonged periods of destitution for many families. National asylum support policies, difficult working relationships with UK Border Agency, higher eligibility thresholds and reduced social care budgets of local authorities were identified as significant barriers in responding to the support needs of disabled forced migrants and family care-givers. In this context, social workers experienced considerable ethical dilemmas. The research raises profound questions about the potential and limitations of health and social care policies, provision and practice as means of protection and support in fulfilling the human rights of forced migrants with care needs.

Primary care organizations are increasingly collecting data on patients' social risks, bringing forth an unprecedented opportunity to present combined health and social data that clinical and social care providers could leverage to improve patient care and outcomes. Little is known, however, about how these data could be used and what combinations of specific data elements are most helpful. We explored how primary care staff who provide clinical or social care services view potential benefits of and use cases for combined patient-level clinical and social data. We conducted qualitative interviews or focus groups with 39 social and clinical care providers representing 6 healthcare organizations in San Diego County, California. Interviews were transcribed and analyzed using a deductive thematic analysis approach. Overall, both clinical and social care providers noted the value of access to both types of data. Participants highlighted 3 benefits from integrating social and clinical data. The data could: (1) offer providers a more holistic view of patients' circumstances; (2) strengthen their ability to tailor care to patients' medical and social conditions concurrently; and (3) enhance coordination across care team members. Interviewees cited specific examples of ways social and clinical data could be paired to improve care. Social and clinical care providers alike envisioned multiple uses and benefits of accessing combined individual-level clinical and social data, highlighting the potential for practice and policy innovations to facilitate access and uptake of combined data. Future research should focus on ways to increase accessibility of cross-sector data and evaluate the impact of care informed by combined data on patient social and health outcomes.

Health and Social Care Delivery Research (HSDR) Programme is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by funding evaluative research projects that have the potential to improve the quality, accessibility and organisation of health and social care services by providing useful outputs for decision-makers, staff, service users, academic, and public audiences. More information about the programme can be found on the NIHR website. A logic model is a visual way of showing how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can be used to support programme planning, implementation, and evaluation. NIHR logic models presentin a linear flow diagramthe key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps.

This article critically examines the impact of health and social care provision on separated categories of race, disability and neurodivergence. It deconstructs the racist impacts of the neoliberal individual budgets agenda as experienced by a young Black African person with intellectual disabilities and autism, living as a second-generation migrant in the UK. This article highlights intersectional methodological and practice implications for health and social care provision within England and Wales. The erasure of intersectional race, intellectual disability and neurodivergent identities in UK health and social care policies and practice procedures results in the invisibility, misrecognition and consequential misdiagnosis of the intersectional complexities of the needs and entitlements of young black people. The convergence of racist, disablist and elitist neoliberal agendas is identified as leading to increased risks of incarceration for young black people with intellectual disabilities and autism. The specificity of the individual needs of young black people with intellectual disabilities and autism demand anti-racist approaches that confront the assumption that Black African families in the UK ‘look after their own’ and require minimal social care involvement.

The Evidence Synthesis Programme (ESP) is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by generating high-quality evidence syntheses (ES) to support evidence-informed health and care policy and practice. More information about the programme can be found on the NIHR website. A logic model is a graphical way to show how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can then be used to support programme planning, implementation and evaluation. NIHR logic models represent in a linear flow diagram the key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps. This logic model sets out the essential elements of, and pathway to, impact for the NIHR ESP. Evidence syntheses are research projects that use formal techniques to bring together, evaluate and combine data from multiple studies to summarise and make sense of the existing body of research evidence on a particular topic.

Adult social care in England has been under sustained pressure for decades. The sector has long functioned in crisis mode due to cuts and chronic under-resourcing but, since early 2020, those using and providing adult social care and support services have experienced a period of unprecedented turbulence. The COVID-19 pandemic laid bare fault-lines and exacerbated existing problems in the system. The book critically examines the legal basis of adult social care law, policy, and provision in England. Having mapped out the historical and sociopolitical context, it views the pandemic as flashpoint during which many pre-existing issues came into the public awareness. It explores the impact of the Coronavirus Act 2020 and related emergency legislation on the delivery of social care services. Taking the West Midlands as a case study, it draws on empirical research with local decision-makers and practitioners to examine in detail the tensions between policy and practice, the increased and multifarious stresses on those who use social care services and on the workforce, and the broader practical and ethical considerations for the sector as it learns to ‘live with COVID’.

Older people (particularly 75 years+) are the main users of health and social care services. They are also the age group most likely to occupy non‐decent homes. Government health and social care policy is increasingly focused on enabling more older people to remain living independently in their own homes and on delivery of care ‘at or closer to home’. This article considers how greater recognition of the negative impacts of poor‐quality and inappropriate housing on older people's health and well‐being, combined with targeted housing repair and adaptation assistance, could contribute to achieving a range of current health and social care objectives, including enabling older people to live independently in mainstream housing and better management of chronic health conditions.

The concept of healthy or successful ageing dates back to the 1960s, where its goal is more realistic in today's ageing society as a result of effective interventions to control and reduce disability and health risks. The aim of this paper is to outline the importance of defining ageing, the semantics and indicators used, and to identify common challenges for health professionals' understanding and application of a healthy ageing approach in their everyday clinical practice. This discursive paper demonstrates how realistic ageing indicators are for highlighting the variation and impact of challenges associated with ageing. It examines the proportion of older adults requiring aged-care services and allocation of resources, focusing on health maintenance and secondary ageing prevention. Indicators of ageing commonly used in clinical healthcare settings are reviewed, and their appropriateness for determining functional and intrinsic capacity of older adults. Other indicators are introduced, i.e., the Healthy Life Expectancy (HLE), Disability Free Life Expectancy (DFLE), the Human Development Index (HDI), and the Active Ageing Index (AAI), for enhancing and promoting a healthy ageing model of healthcare. Healthy ageing models of health and social care are also considered. Outlining evidence on healthy ageing may facilitate health professionals to address realistic challenges regarding age-related health and social care provision, using a personalised approach for every older adult as opposed to cutting off chronological age parameters. Increasing health professionals' focus on healthy ageing will maintain good health in at least 80% of the ageing population for longer. No patient or public contribution.

Background Lower respiratory infections are amongst the top causes of death globally. In early 2020, COVID-19 was designated as a pandemic and despite our experience of pandemics (e.g., SARS), there is limited research about how health and social care staff cope with the challenges of caring for patients while potentially putting their own health at risk. The current study therefore examined the impact of providing health and social care during COVID-19 on nurses, midwives, AHPs, social care workers and social workers. Methods An online survey using validated scales and open-ended questions was used to collect data from health and social care staff from across the UK in May and June 2020. Questions focused on the quality of working life, coping and mental wellbeing. The survey also captured information on how health and social care employers had supported staff and lessons learned for future pandemics and for ongoing health and social care provision. Results The survey received 3,290 responses, mostly from social care workers and social workers, with lower response rates from nurses, midwives and AHPs. A multiple regression analysis showed that individuals using positive coping strategies, particularly active coping, emotional support, relaxation and exercise, had higher wellbeing scores. Lower wellbeing scores were associated with disengagement and substance use as coping strategies. Better quality of working life was associated with active coping, emotional support, work family segmentation and relaxation. Participants using disengagement and family work segmentation had lower quality of working life. No differences were observed between occupational groups. Implications Positive coping strategies seem to be playing a significant role in health and social care workers’ wellbeing and quality of working life and interventions may be needed to support those who are struggling to cope. These could take the form of employer-organised workshops to better equip staff with positive coping skills.

There is variation in provision of social care in prisons. Our research aimed to understand variation across adult prisons in England and Wales, including: (1) what social care is provided? (2) who delivers social care? (3) what peer support initiatives are used? (4) what social care indicators are relevant? and (5) are there differences between prison type and social care provision? We analysed Her Majesty’s Inspectorate of Prisons (HMIP) reports (published 2017–2020) from 102 prisons. From these reports we extracted and analysed data on social care provision. Elements of social care are not consistently delivered; need assessments (81.4 per cent) and referrals (75.5 per cent) were most frequently reported. Different providers (health care/social care/prison) deliver social care. Forty-one prisons (40.2 per cent) included peer support (formal to informal). We found no notable differences between prison categories and social care delivery, although, within category D prisons, a significantly larger proportion of those with a disability reported receiving support they needed. Inspection reports highlighted that prison social care should mirror community social care, but we could not fully evaluate this due to reporting issues. Social care provision varies; effectiveness of different models is not yet known. We provide recommendations to improve social care reporting within HMIP reports.

In 2011, the Scottish Government convened a National Health Literacy Action Group (NHLAG) to prioritise actions that would raise awareness of the impact of inadequate health literacy for all parts of the population in Scotland and stimulate a responsive, enabling culture to address the problem. Addressing health literacy requires a societal response, with significant contributions from education systems and communities. However, it also requires a healthcare system that is responsive across people’s entire lifespans. It was to this that NHLAG decided to devote its focus as a starting point. This case study describes the approach, rationale and processes that NHLAG took to formulate Scotland’s health literacy action plan, Making it easy. It describes the key actions that were developed and discusses the progress that has been made to implement these actions and the outputs that have been achieved. While much has been achieved, we also describe the learning that will help inform further progress. The provision of health and social care in the UK is a responsibility devolved to the four nations of England, Wales, Northern Ireland and Scotland. There is universal healthcare provision under the National Health Service (NHS) across the UK, although differences exist in the provision of social care. The Scottish Government, through its Healthcare quality strategy (Scottish Government, 2010) and 2020 vision (Scottish Government, 2011), has held a quality ambition for a safe, effective and person-centred healthcare system, along with an integration of health and social care and support for self-management to enable people to live at home or in a homely setting.

Self-report questionnaires can enable health and social care organisations to understand better a person’s views about their health and well-being, allowing them to provide effective, safe, individualised integrated care. Outcomes are the results from care and/or treatments people have received whilst in clinical or other care settings. Some outcomes, such as symptoms, quality of life and aspects of physical, mental, and social functioning can only be captured directly from the person themselves. These are called patient-reported outcomes (PROs) in healthcare settings, and this information is usually collected using electronic questionnaires that allow us to assess and measure these issues of individual importance. PROs can deliver person-centred care through individualised clinical assessments to support disease/treatment monitoring leading to improved patient–clinician communication which aids shared decision-making. At an organisational level, PROs are used to monitor provider performance, inform policy, and guide quality improvement. PROs in social care could be used similarly, to promote choice and autonomy, to ensure care meets a person’s goals for their health and wellbeing. At a service level, these self-report questionnaires could help identify unmet need and guarantee that measures of quality emphasise person-centred outcomes. PROs offer an opportunity to support effective integrated care in settings where individuals, particularly those with multiple long-term conditions, might receive both health and social care services. The National Institute for Health and Care Research Applied Research Collaborative West Midlands (NIHR ARC WM) leads a programme of research exploring the use and implementation of PROs in integrated care. A Priority Setting Group was established comprising people with lived experience of health and social care(n=3), experts in health, social care and PROs methodology (n=4) and representatives from a charity to support independent living (n=2), who identified the need to undertake a scoping review to explore the evidence on the use of PROs in adult social care. The scoping review, which included searches of 6 databases (years 2010-2023), identified 159 articles reporting on the international use of 216 PRO measures in social or integrated care. PROs were primarily used as research tools, but 5% studies reported PROs as part of an intervention; 23.9% papers focused on PROs use with participants in long-term residential care, with less published evidence of PROs use for those receiving supported living services (5.7%) and social day care services (3.1%). Only 3 articles (1.9%) referred to PROs in the context of the provision of integrated health and social services. The review highlighted a lack of coherence in purpose of use and poor reporting of implementation factors that could optimise PROs use to achieve potential identified benefits in these populations. Findings informed a mixed methods study (qualitative interviews and structured survey), designed in consultation with the NIHR ARC WM Public Advisory Group (n=18), to explore current and potential use of PROs in integrated care settings, involving persons with lived experience, carers and professionals across health, social care, voluntary and charitable organisations. Results will inform guidance on key considerations to optimise PROs use in integrated care.

Social care provision across high-income countries has been transformed over the last ten years by personalisation – a policy agenda to give people with eligible support needs more choice and control over their support. Yet the ideological underpinnings of this transformation remain highly mutable, particularly in the context of reduced welfare provision that has unfolded in many nations advancing personalisation. How the policy has manifested itself has led to an expectation for people to self-build a life as individual consumers within a care market. This article draws on a study exploring how people with learning disabilities in England and Scotland are responding to the everyday realities of personalisation as it is enacted where they live and show the relationality inherent in their practices. We propose that the personalisation agenda as it currently stands (as an individualising movement involving an increasing responsibilisation of individuals and their families) ignores the inherently relational nature of care and support. We propose that social care policy needs to recognise the relational ways in which people build their lives and to advocate a redistribution of responsibility to reduce inequalities in the allocation of care.