Adult Social Care Services Research Articles

Joining Up Government by Integrating Funding Streams? The Experiences of the Individual Budget Pilot Projects for Older and Disabled People in England

Individual Budgets (IBs) were piloted in 13 English local authorities during 2005–2007. Similar to personal budgets and “cash-for-care” schemes in other parts of Europe and beyond, IBs built upon previous English government initiatives to increase choice and control by users of adult social care services. A key aim of the IB pilots was to bring together resources from different funding streams to which an individual was entitled, and integrate or align those funding streams, thereby reducing the number of assessments and reviews; then allow those resources to be spent flexibly according to individual wishes and needs. IBs, available only to those eligible for adult social care services and support, could include resources from up to five other funding streams which, among them, were the responsibility of three different government departments: Access to Work, Disabled Facilities Grants, Integrated Community Equipment Services, Independent Living Funds, and Supporting People. Qualitative interviews with IB lead officers and funding stream lead officers formed part of the larger evaluation of the IB pilots (IBSEN study) and revealed deep disappointment that only minimal progress with integration had been possible, with the exception of Supporting People. This article explores possible reasons for the failure to integrate funding streams despite strong aspirations at local and national levels: legislative barriers; continuing accountability to individual funding streams; concerns over destabilizing the market; and concerns over the budgetary implications of an expected increase in demand.

Supporting adults with an acquired brain injury in the community ‐ a case for specialist training for support workers

Acquired brain injury (ABI) can happen to anyone at any time. As a result, the person can experience a wide range of difficulties related to a combination of physical, cognitive, behavioural and emotional changes. It is the less obvious social and emotional difficulties in particular that present challenges to community integration and require major life adjustment.The type and level of support needed by people living with a brain injury is as unique as the person and their experience. The role of the support worker is open‐ended and tailored for each client; therefore, support workers are expected to have a wide and dynamic range of skills and qualities. Support workers need not only to understand the effects of ABI and its impact on the lives of individuals and their families, but also the influence of different values and attitudes on the support worker/client relationship.This article discusses some of the particular needs of a person after an ABI, what makes the role of the support worker different when working with this client group and what, as practitioners, we need to consider in terms of support worker training. Consideration is given to the influence of new Care Quality Commission (CQC) regulations and the introduction of a personalised system of care, two recent and significant changes related to the provision of adult social care services. Finally, the article goes on to look at an accredited programme ‘Supporting an Individual with Acquired Brain Injury’ as an example of one approach to providing specialist training.

The Partnership Project: learning from experts by experience in mental health services; the Jersey Partnership perspective

Partnership between people who use services, their carers, and professionals is seen as an increasingly important aspect of providing a quality service across health and social care. The concept is enshrined in national policy, but the application of it is patchy at best, and has partly been undermined by constant restructuring and organisational change ‐ both in partnership working and in the organisations set up to deliver health and social care. Partnership that recognises service user/survivor expertise and assets and promotes equal and reciprocal working between staff and users is being recast as ‘co‐production’ or ‘co‐creation’ in UK public policy. The Jersey Partnership Project demonstrates a co‐productive approach, which is being seen as a way forward for adult social care service development and design.The Partnership Project, which commenced in the summer of 2009, and which is reaching the conclusion of its first stage at the time of writing, brings together experts by experience and mental health professionals, including a number of the latter who use services themselves, in a way that is designed to map out a new way of working, in partnership, across services. The Project is due to complete its first stage in June 2010, and further stages, perhaps bringing in a wider range of community services, are under discussion, following a presentation to the Jersey Minister for Health in November 2009.This article explores the notion of partnership as both ‘truth‐telling’ and ‘walking on common ground’, allowing those who provide and those who make use of services to enter into a sharing of experiences and knowledge, and an integrated spirit, that provides a clearer direction for developing adult mental health services in Jersey. The article then goes on to consider some of the barriers to more inclusive ways of working and looks at the current discourse and practices around the ‘co‐production’ agenda. Finally, the article covers the practical operation of the Partnership Project looking at structure and learning points and concludes by looking to the final six months of the Project and beyond.

The challenge and the choice ‐ providing evidence‐based employment support within mental health services

Commissioners of adult health and social care services in the London Borough of Camden are keen to see the spread of evidence‐based practices in mental health and employment services. Jobs in Mind, a trusted third sector provider already delivering employment support services in the borough since 1999, was uniquely placed to expand its service delivery into a partnership with the local NHS trust to deliver an innovative individual placement and support (IPS) pilot. A Life in the Day went to Camden to find out how it is going.

Guidance looks at standards needed to achieve registration.

THE CARE Quality Commission (CQC) has launched a consultation on guidance outlining what health and adult social care services will need to do to meet new legally enforceable registration standards.

Implications of the Mental Capacity Act 2005 for adult health and social care service providers

This paper assesses the impact that the Mental Capacity Act 2005 has had on service providers, the level of understanding of the Act in practice, and changes to the regulatory framework by reference to the Commission for Social Care Inspection, the new Court of Protection and the Office of the Public Guardian. It gives examples of key issues where there is evidence of some misunderstandings about the provisions and operation of the Act. It identifies practical steps that managers need to address, in particular in relation to policies, procedure and training, and in relation to contracts.

Beyond Modernisation? Social Care and the Transformation of Welfare Governance

AbstractThis article reflects on the process and outcomes of modernisation in adult social care in England and Wales, drawing particularly on the recently completed Modernising Adult Social Care (MASC) research programme commissioned by the Department of Health. We begin by exploring the contested status of ‘modernisation’ as a descriptor of reform. We then outline some of the distinctive features of adult social care services and suggest that these features introduce dynamics likely to shape both the experiences and outcomes of policy ambitions for modernisation. We then reflect on the evidence emerging from the MASC studies and develop a model for illuminating some of the dynamics of welfare governance. Finally, we highlight the emerging focus on individualisation and on user-directed and controlled services. We argue that the current focus of modernisation involves a reduced emphasis on structural and institutional approaches to change and an increased emphasis on changes in the behaviours and roles of adult social care service users. This focus has implications for both the future dynamics of welfare governance and for conceptions of citizenship.

The Effectiveness of Home Care Reablement — Developing the Evidence Base

Adult social care services are increasingly establishing reablement services as part of their range of home care provision, sometimes alone, sometimes jointly with NHS partners. Typically, home care reablement is a short‐term intervention, often free of charge, that aims to maximise independent living skills. This paper describes two small studies examining the impact of home care reablement on subsequent service use. The evidence so far strongly suggests that a period of home care reablement can reduce the subsequent use of home care services and that, for some people, these benefits may last for a year or more. However, a number of organisational and cultural factors can limit the immediate and longer‐term benefits of home care reablement.

Examining the state of adult social care research 1990-2001: a systematic synthesis of research methods and quality

This article reports on a systematic synthesis of the research methods and quality of peerreviewed empirical research relating to adult social care services (1990-2001). The range of research questions, research designs and methodological quality varied within and across four service user groups. Factors associated with variation in methodological quality included the type of research question, strategies and designs adopted, service user group, number of authors, unit of analysis and year of publication. The findings demonstrated a dearth of rigorous social care evaluations in the UK. These findings contribute to current initiatives aimed at improving the standard of health and social care research.

Risk and adult social care: Identification, management and new policies. What does UK research evidence tell us?

Risk is a central defining feature and area of concern in adult social care provision, but what do we actually know about how service users, carers and practitioners define and manage risk? This question is increasingly important as current policy advocates greater service user choice and control through a range of self-directed support mechanisms, and statutory duties and professional boundaries are challenged. This paper reports the results of a recently completed UK based scoping review that investigated how different groups of adult social care service users and service providers perceive and understand the everyday risks they face. It highlights how different management strategies are also adopted by different groups of people, which can lead to tensions and potential conflict between practitioners, service users and informal carers. However, whilst some areas of risk in adult social care have been the focus of considerable research, others appear to have been largely ignored. The voices of some groups of users remain hidden and apparently of little concern. These gaps and inconsistencies will be identified and discussed in relation to current policy developments and their implications.

Individual Budgets: Lessons from Early Users' Experiences

Within the context of modernization, there has been a trend towards 'cash-for-care' schemes designed to bring choice and control closer to the service user. In England, Individual Budgets (IBs) are being piloted, with the aim of promoting personalized support for disabled people and other users of social care services. This paper reports on the experiences and outcomes of early IB users two to three months after first being offered an IB. The users included adults with physical/sensory impairments, learning difficulties, mental health problems and older people. Semi-structured interviews were carried out with nine service users and five proxies. The findings suggest that IBs have the potential to be innovative and life-enhancing. However, achieving this potential in practice depends on a range of other factors, including changes in the routine practices and organizational culture of adult social care services and ensuring users have access to appropriate documentation and support. Any conclusions drawn from the experiences of these early IB users must be treated with caution. The findings nevertheless indicate some of the issues that will need to be addressed as IBs are implemented more widely to replace conventional forms of adult social care provision.

Editorial.

I WOULD LIKE to ask the Audit Commission to assess how much time directors of nursing spend on preparing for inspections, responding to strategic health authority challenges or participating as partners in inspections of children or adult social care services.

Partnership in social care services

Andrea Rowe is Chief Executive of Skills for Care and Chair of the Skills Forum in the northwest region. Before taking the reins of Skills for Care, she was head of the Central Council for Education and Training in Social Work, Northern England. Skills for Care is the employer-led social care workforce development organisation that aims to improve adult social care services across the country. It is part of the Sector Skills Council, Skills for Care and Development.

Safety first

The new Care Quality Commission will oversee both health and adult social care services to toughen up standards. Is it any more likely to guarantee safety and quality than the three existing regulators?

Making informed choices in social care: the importance of accessible information

The current policy trend is to encourage greater choice in the use of welfare services. To make informed choices, people need information. The process of finding and using information has costs for individuals in terms of effort, time and material resources. These costs are different for different people and impact on their use of information in different ways. Thus, the accessibility of information is important in ensuring those people who need to make choices can do so in an informed way. This paper discusses the importance of information in making informed choices about social support by drawing on the findings of a scoping review of government research and development activity on the accessibility of information about adult social care services. The scoping review was carried out in spring 2006. Details of recent, current and planned projects were obtained through discussions with staff in government departments, government agencies and other related organisations identified using a snowballing technique. Forty-two contacts were made. Eleven research and 36 development projects were identified that aimed to investigate or improve the accessibility of information about social care services. A limited literature search was undertaken on information needs in areas not already under investigation by government. Eighteen articles were identified. Information and helpline staff from six voluntary organisations gave their views on the accessibility of information about social care services. Our findings show that there is no government-related or other recent research evidence on the specific information access needs for some user groups and services, for example, people from ethnic minority groups. For other user groups, such as people with chaotic lifestyles, there is evidence on information needs but no current or planned development projects to address these needs. The implications for the costs of finding and processing information to aid informed choices are discussed.

Merging for success

Plans to reform health and adult social care services in England have taken a step forward with the publication of a new government consultation document.

New Labour and the Public Sector: A Tale of Two Green Papers

Public sector reform will be at the heart of Labour's third term of office. The changes under way or planned in children's services and adult social care services in England are prototypes of the pursuit of services that are person‐centred, seamless and proactive, with a focus on positive outcomes and well‐being. This article examines the similarities in approach between the two sets of changes, and warns that implementation will be a difficult task.

The Healthcare Commission and CSCI merger

The Commission for Social Care Inspection (CSCI) is to merge with the health regulator, the Healthcare Commission, by 2008. The new body, a single inspectorate, will regulate all adult health and social care services. Is this a good thing?

The ‘Joined up’ Management of Adult Health and Social Care Services in Northern Ireland: Lessons for the Rest of the UK?

This article describes and critically analyses the development of the ‘integrated service’ in Northern Ireland, with particular reference to community care for adults. Evidence from a number of studies is used to identify the strengths and weaknesses of this service.