Adult Social Care Services Research Articles

Multi-agency working and implications for care managers

Purpose To examine the association between multi-agency working and psychosocial characteristics of work, practitioner time-use and job satisfaction. Design/methodology/approach A comparison of practitioners working in multi-agency (health and social care) and single-agency (social care only) teams, using data from the 2008 evaluation of Individual Budgets pilots in England. Participants worked in care manager roles supporting adult social care service users, and comprised social workers and a smaller number of health professionals. Data was collected using a self-completed questionnaire. Findings Data were returned from 249 respondents (a 29 per cent response rate), with two-thirds working in single-agency teams. No significant differences were found between team type and job satisfaction. Respondents in multi-agency teams reported greater decision autonomy but poorer supervisory support than those in single-agency teams. The latter finding was robust to further exploration using regression to control for confounding factors. Research limitations/implications These data were not specifically collected for the study and response rates were relatively low due to organisational upheaval at the time of data collection, which may affect interpretation. Practical implications Government policy is dedicated to extending integrated forms of working, including multi-agency teamwork. This research suggests that such structures need careful planning for them to work effectively, with particular attention to supervision arrangements. Originality/value This research gives a systematic and objective exploration of the relationship between job characteristics, time-use and satisfaction of practitioners in single as compared to multi-agency teams.

Positive and Proactive Care – setting standards for care plans and auditing in a secure hospital setting

Positive and Proactive Care(DH, 2014) sets out guidance on the reduction of the use of a range of restrictive interventions. The guidance document provides a framework within which adult mental health and social care services should develop a culture where restrictive interventions are only ever used as a last resort. It identifies key actions that will better meet people’s needs and enhance their quality of life in order to reduce the need for the use of such interventions. It also sets out mechanisms to ensure accountability for making these improvements, including effective governance, transparency and monitoring (DH, 2014). This report describes the development of a set of standards that are based upon the key recommendations contained in the guidance. The resultant standards were used to audit care plans within a forensic hospital setting for men who have a diagnosis of autistic spectrum disorder and/or learning disability. This audit was conducted across the hospital, leading to recommendations about how aspects of care and the documentation supporting that care could be improved. Suggestions are made about how the audit standards could be improved for future audits of ‘restrictive interventions’ and in different settings.

Working together to improve health and social care outcomes in Scotland

Earlier this year, the Scottish Parliament passed the Public Bodies (Joint Working) (Scotland) Act 2014, which establishes a framework to ensure health and social care services in Scotland are planned, resourced and delivered jointly by Health Boards and Local Authorities, working with nonstatutory partners to improve outcomes for people using services, their carers and families. The Act sets out a core set of principles and the legislative framework for integrating health and social care. Health Boards and Local Authorities will establish integrated partnership arrangements, called Integration Authorities, which will deliver national outcomes for health and wellbeing from a pooled budget for health and social care services. Integration Authorities will set up locality arrangements with local professional leadership of service planning. The Act places a heavy emphasis on the importance of effective strategic commissioning of services underpinned by a good, shared understanding of the population’s needs, and informed by professional and local community input. The new law applies to adult health and social care services – Health Boards and Local Authorities can also include children’s health and social care services, criminal justice social work, housing support etc. in their integrated arrangements if they agree to do so locally. The legislation includes a strong role for the third and independent sectors, clinicians, social workers, other professionals, and local communities. What will the reforms look like? Two models of integration are available for Health Boards and Local Authorities to choose from: delegation of functions and resources between Health Boards and Local Authorities. delegation of functions and resources by Health Boards and Local Authorities to a body corporate. An integrated budget will be established in each partnership to support delivery of integrated functions, which will cover at least adult social care, adult community health care, and aspects of adult hospital care that are most amenable to service redesign in support of prevention and better outcomes. Ministers will establish in Regulations which functions (and therefore budgets) must be included in the integrated arrangement. International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117032 – http://www.ijic.org/ 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 2 Each partnership will establish locality planning arrangements at sub-partnership level, which will provide a forum for local professional leadership of service planning. Each partnership will put in place a joint strategic commissioning plan for functions and budgets under its control – the joint strategic commissioning plan will be widely consulted upon with nonstatutory partners, patient and service user representatives, etc. Where the body corporate model is used, a chief officer must be appointed by the partnership to provide a single point of management for the integrated budget and integrated service delivery. In the delegation between partners model, this single point of management falls to the Chief Executive of the “lead” agency (i.e., the partner to whom functions and resources are delegated). The Act focuses on the importance of effective joint strategic planning and commissioning of services. This approach builds on the wealth of evidence for successful integration of health and social care from elsewhere in the UK and further afield, which demonstrates that, while no single organisational approach is required to deliver improvement, the following characteristics are consistently displayed by successful systems: Local planning systems focus on population need, rather than historic structures. Health and social care systems plan together for older people, for example – or for adults with chronic obstructive pulmonary disorder, or for children with complex needs, or for any other care group that is a local priority – rather than planning separately in terms of “health” provision and “social care” provision. Resources across health and social care are pooled to support delivery of the population-based plan. Resources reflect population need, and are managed to follow patient/service user need in order to deliver maximum benefit. This approach eliminates the risk of cost shunting, which can permit financial gain from poor performance on the part of one partner, at the cost of the other. Mechanisms are in place to ensure the opportunity for leadership by local clinicians and professionals from across health and social care, particularly GPs, in planning service provision. Clinical buy-in and leadership of integration is fundamental to improving outcomes. Strong, effective, consistent local leadership retains a relentless focus on outcomes for patients and service users.

Integration in Action in the Highlands

For the last three years NHS Highland has been on a journey of transformational change of the delivery of health and social care across the North of Scotland. Under a lead agency mode all adult social care services were transferred to NHS Highland from the Highland Council in April 2012 under a partnership agreement.NHS Highland now holds responsibility for the delivery of all adult services. The aim was to achieve the best possible outcomes for the people of Highland NHS Highland has developed a locality based service with single point of access for professionals, clients, patients and their families co-located and co-producing, utilising the local assets available. Key findings have been that the lead agency model has been without additional bureaucracy but has clarified governance and maximised the expertise of individual professionals. This new model of service has made major service re-design of hospital and community services more acceptable leading proposals which would see rationalisation hospital services and development of community services, transport and community resilience.

Going round in circles? Joint working between primary health and social care

Purpose – The purpose of this paper is to examine research evidence on collaboration between primary and adult social care in strategic, rather than operational, activities at two different time points, following large-scale changes within the health and social care environments; and discuss the prospects for the future. Design/methodology/approach – This paper reports evidence from two substantial longitudinal studies (Dowling and Glendinning, 2003; Checkland et al., 2012) which followed the development of Primary Care Groups and Trusts (PCG/Ts) and Clinical Commissioning Groups (CCGs), respectively. Each used a combination of national surveys and local in-depth case studies to trace the early development of new structures and ways of working following major changes in the NHS and local government. Findings – PCG/Ts had limited success in collaborating with adult social care partners. Health and Well-being Boards offer a new overarching organisational framework for collaborative strategic working between GP-led CCGs and adult social care services. Mandated joint strategic needs assessments also provide a shared framework within which commissioning decisions by both CCGs and social services are made. However, there remains evidence of long-standing barriers, particularly differences in geographic boundaries and in organisational and professional cultures. Research limitations/implications – Evidence from both studies is based on the early years of the respective new organisations; later evidence may have yielded a different picture. Originality/value – This is the first paper reflecting on developments in strategic relations between primary and social care from researchers involved with two longitudinal investigations of the early development of PCG/Ts (1999-2002) and CCGs (2011-ongoing).

Ambiguity in practice? Carers' roles in personalised social care in England.

Carers play an ambiguous role within the personalisation paradigm currently shaping adult social care practice in England. Although carers have rights to assessments and support in their own right, these rights sit uneasily alongside the practices of assessment, support planning and personal budget (PB) allocation for older and disabled people. This paper reports how 14 dyads of older and learning disabled people with cognitive and/or communication impairments and their carers viewed the roles - desired and actual - played by carers in PBs. Interviews with carers and with older and disabled people were conducted during 2012 as part of a wider study into carers' roles in assessment, support planning and managing PBs. The interviews complemented a survey of reported practice in two English regions - interviews with adult social care services senior managers and focus groups with front-line care managers. Talking Mats(©) were used to support interviews with some service users. Interviews were transcribed and data analysed using the Framework approach. The interviews indicated that carers played important roles in service users' assessments and support planning, but were less likely to report receiving assessments or support of their own. While carers had the potential to benefit from PBs and support arrangements for service users, this did not reflect practice that aimed to enhance choice and control for carers. The paper draws on Twigg's typology of service conceptualisations of family carers and concludes that, despite the important social rights won by carers in England, current practice continues to regard carers primarily as a resource or a co-worker, rather than a co-client.

Social care mentorship and employee engagement in the transformation of the Social Care Workforce

Purpose – This paper presents the findings of a small scale research project exploring mentorship programme participants experiences and learning about their managerial role in an adult social care service seeking to build management practice, resilience and well-being in the context of transformation. Design/methodology/approach – A case study of one public sector workforce development project is presented. The programme involved the use of an individual social care mentorship model and continuing professional development framework to support and engage 60 social care managers in the facilitation of workforce practice transformation. A small scale research study of 15 managers was undertaken. Participants provided a written reflective review and narrative of their individual experience and of learning. The narrative of a purposive sample of 15 managers was analysed using a work by Tamboukou and informed by a work byLabov and Waletzky as a guide. Findings – Thematic analysis of managers' reflective accounts, identified the adaption of coaching methods and the used of role modelling skills in the workplace. Emotional well being and resilience was maintained during the mentorship programme. Structural analysis emphasised sequences or messages in the narrative indicating manager's cooperation with the organisation in achieving its' transformational goals and gaining employee engagement. Research limitations/implications – This is a small scale study exploring one aspect of the project's goals. Practical implications – The project delivery and research findings will be of interest to other organisations considering the implementation of mentorship to support transformation and change. Originality/value – There are very few evaluations and research studies of social care mentorship in the literature and this paper and the case study presented provides interesting new insights into the process and its possible outcomes.

Good practice in social care: the views of people with severe and complex needs and those who support them

This paper reports findings drawn from a study of good practice in English social care for adults with disability and older people with severe and complex needs. People with severe and complex needs are a relatively small proportion of adult social care service users, but they are growing in numbers and have resource-intensive needs. The study involved qualitative research with adults with disability and older people with severe and complex needs, family carers and members of specialist organisations (n=67), focusing on the features of social care services they considered to be good practice. Data were collected between August 2010 and June 2011. The approach to data collection was flexible, to accommodate participants' communication needs and preferences, including face-to-face and telephone interviews, Talking Mats(©) sessions and a focus group. Data were managed using Framework and analysed thematically. Features of good practice were considered at three levels: (i) everyday support; (ii) service organisation; and (iii) commissioning. Findings relating to the first two of these are presented here. Participants emphasised the importance of person-centred ways of working at all levels. Personalisation, as currently implemented in English social care, aims to shift power from professionals to service users through the allocation of personal budgets. This approach focuses very much on the role of the individual in directing his/her own support arrangements. However, participants in this study also stressed the importance of ongoing professional support, for example, from a specialist key worker or case manager to co-ordinate diverse services and ensure good practice at an organisational level. The paper argues that, despite the recent move to shift power from professionals to service users, people with the most complex needs still value support from professionals and appropriate organisational support. Without these, they risk being excluded from the benefits that personalisation, properly supported, could yield.

The Effectiveness of Local Authority Social Services' Occupational Therapy for Older People in Great Britain: A Critical Literature Review

Introduction: Older people are the main users of adult social care services in Great Britain. Evidence suggests that occupational therapists employed by local authorities are providing interventions that promote and maintain older people's independence, and decrease dependency on other services. However, such evidence is disparate in nature and lacks synthesis. Method: This literature review systematically selected, critically appraised, and thematically synthesized the post 2000 published and unpublished evidence on the effectiveness and cost effectiveness of occupational therapy interventions for older people in social care services. Findings: Identified themes established: the localized nature of social care services for older people; organizational and policy impacts on services, and factors influencing effectiveness and cost effectiveness. Although occupational therapists are increasingly involved in rehabilitation and reablement, there is a continuing focus on equipment and adaptations provision. A high level of service user satisfaction was identified, once timely occupational therapy services were received. Conclusion: Overall, occupational therapy in social care is perceived as effective in improving quality of life for older people and their carers, and cost effective in making savings for other social and healthcare services. However, the complex nature of social care services makes it difficult to disaggregate the effectiveness of occupational therapy from other services.

Guiding principle for inspectors: ‘would I be happy with this care?’

It is good to hear that the Care Quality Commission is setting up an inspection regime to ensure that adult social care services and care homes in England are safe, well led and staffed by caring employees (News October 23).

CQC to put up registration fees by 2.5%

The UK regulator of health and adult social care services, the Care Quality Commission, is proposing a 2.5% increase in the fees it charges all registered providers next year, it has announced. The fee hike has been prompted by …

A bibliometric approach demonstrates the impact of a social care data set on research and policy

The National Minimum Dataset for Social Care (NMDS-SC) has provided detailed data since 2006 on the workforce for adult social care services in England. In 2012, the organisation responsible for the data set commissioned an evaluation into the impact of the data set on researchers and policymakers. Discusses how a novel wide-ranging bibliometric approach, complemented by interviews of key informants, demonstrated the developing impact of the data set. The evaluation comprised web metrics to assess NMDS-SC-related traffic on relevant websites; bibliometrics to assess the use of NMDS-SC data in scholarly publications and grey literature; telephone interviews with 12 key users of the data set; and an online survey completed by 24 key users of the data set. A theoretical framework for research impact was used. The web metrics demonstrated increase in traffic on the relevant pages of the organisation's website. There were references to the data set in 175 separate publications (15% from academic journals, 50% as policy/practice reports and 35% as media communications. Interviews evidenced many impacts, for example provision of robust data for secondary analysis that challenged conventional views about the social care workforce. Bibliometrics plus interviews provided a rounded picture of the data set's impact.

Factors that promote and hinder joint and integrated working between health and social care services: a review of research literature

This article reports the results of a review of the research evidence related to joint working in the field of adult health and social care services in the UK. It explores whether recent reforms to joint working have met the objectives set by policy-makers. The review followed an established methodology: electronic databases were searched using predetermined terms, abstracts were screened against inclusion criteria, studies that met the criteria were read in full and assessed for inclusion and data were extracted systematically. The findings of the review suggest that there is some indication that recent developments, in particular the drive to greater integration of services, may have positive benefits for organisations as well as for users and carers of services. However, the evidence consistently reports a lack of understanding about the aims and objectives of integration, suggesting that more work needs to be done if the full potential of the renewed policy agenda on integration is to be realised. Additionally, while the review acknowledges that greater emphasis has been placed on evaluating the outcome of joint working, studies largely report small-scale evaluations of local initiatives and few are comparative in design and therefore differences between 'usual care' and integrated care are not assessed. This makes it difficult to draw firm conclusions about the effectiveness of UK-based integrated health and social care services.

An examination of factors influencing delayed discharge of older people from hospital

This study aimed to investigate the factors associated with the delayed discharge of older people from hospital and their length of stay (LOS). Data were collected retrospectively from inpatient records and adult social care services on older patients referred to the latter prior to hospital discharge. Data on two related measures--delayed discharge and LOS--were analysed separately within a four-stage sequential framework. Using bivariate analysis, we found that cognitive impairment and dependency were significantly associated with delay. Patients admitted to trauma and orthopaedics specialties were significantly more likely to be delayed on discharge. Respiratory illness was negatively associated with delay. Factors related to care received as an inpatient associated with delayed discharge from hospital were not being in the responsible consultant's bed for part of their stay, two or more moves between specialties and receipt of rehabilitation services. Admission to a care home and receipt of domiciliary care if returning to a private dwelling on discharge were associated with delay. In the multivariate analysis, dependence and cognitive impairment impacted differently on delay and LOS. Hospital variables were the most important predictors of LOS and social care variables in respect of delayed discharge. Patient characteristics and especially the organisation of care in hospital and the provision of services on discharge are related to the likelihood of delayed discharge and LOS. Improved services and structures to systematically assess and treat patient needs in hospital, together with the timely provision of services providing post-discharge services tailored to individual circumstances, are required.

The Care Quality Commission

Box 1 The regulation and oversight of healthcare in England has long been deemed to be overly convoluted, with responsibilities for regulating particular aspects of care split across a number of different bodies, including Monitor and the Care Quality Commission. The Health and Social Care Bill has recently reinforced the Care Quality Commission’s role as the quality regulator for health and social care. The Care Quality Commission (CQC) began operating in April 2009, replacing three commissions: the Healthcare Commission (until 2008, which launched 15 investigations over its 5 year history), the Commission for Social Care Inspection and the Mental Health Act Commission. It is an executive non-departmental body which is funded through a combination of registration fees and government grants. It independently registers and regulates all providers of health and adult social care in England. This means that its main role is to ensure that the care provided by hospitals, dentists, ambulances, care homes and services in people’s own homes meets government standards of quality and safety. It does this by licencing services which meet standards set by the CQC, checkingwhether they continue to do so and taking actionwhen the standards are not met. The CQC makes sure that the voices of people who use health and adult social care services are considered by asking people to share their experiences of services. These views are incorporated into its reports and reviews.

‘If they’re helping me then how can I be independent?’ The perceptions and experience of users of home-care re-ablement services

Home-care re-ablement is a short-term, intensive service that helps people to (re-) establish their capacity and confidence in performing basic personal care and domestic tasks at home, thereby reducing needs for longer term help. Home-care re-ablement is an increasingly common feature of English adult social care services; there are similar service developments in Australia and New Zealand. This paper presents evidence from semi-structured interviews conducted in early 2010 with 34 service users and 10 carers from five established re-ablement services in England. The interviews formed part of a larger, mixed-methods study into the immediate and longer term impacts and cost-effectiveness of home-care re-ablement services. There was clear evidence that interviewees felt that they had benefitted from re-ablement services; most service users and their families valued the intervention. However, the interviews also identified potential barriers to optimal independence for some service users, particularly those with progressive conditions, sensory impairments, specific cultural needs, or who lived alone. The beneficial impacts of re-ablement could also be reduced if users failed to understand the aims of the service, or if the service failed to provide support with activities or outcomes that were particularly important to the service user or carer. Putting the lived experiences of people receiving re-ablement at the centre of analysis, this paper concludes that re-ablement services have the potential for enhanced effectiveness, particularly if there is more understanding of users' own priorities and concepts of independence.

Personalisation and the Co-operative Tradition

There is growing interest in how enterprises based on co-operative values can help to meet needs relating to welfare and re-energise public services. The objective of this article is to examine critically the intersection of personalised adult social care services and the co-operative tradition, which emphasises mutual aid and value-led enterprise. We do this by retelling the story of personalisation through a co-operative lens, and ground this reading in case studies of two new co-operative enterprises that were supported under a Department of Health programme in England (2006–2009) intended to demonstrate how personalised adult social care could be extended by developing collaborative, co-operative organisational forms.

Is regulation good for skill development? Mediating actors and workplace practice in adult social care in England

The Care Standards Act (2000) regulates the provision of care services in the UK, specifying induction and competence requirements for managers and workers, and that workers should have access to 3 days of training a year. Applying Dickens' concept of the mediation of regulation by workplace actors to five award-winning organisations providing adult social care services, the authors analyse factors contributing to positive mediation. They identify the significance of triggers for innovation which ‘run in the same direction’ as regulation, and of cosmopolitan actors whose innovatory practices and wider social networks link different levels and contribute to capacity building in the sector.

Out for consultation.

The Care Quality Commission (CQC) has announced the start of a consultation on a new excellence award for adult social care services in England.

Quality, safety, and a new people's champion

The Care Quality Commission was set the task of bringing adult social care, NHS and independent healthcare services under the same regulatory umbrella. After two busy years, Cynthia Bower examines certain aspects of the commission's role and welcomes a new development that will amplify the voices of people who rely on care services.