People In Scotland Research Articles

Editorial

Some conferences are really good for encouraging thinking, and I am fortunate in just having attended an excellent event in Scotland. Equal, Connected and Contributing: Research perspectives on the citizenship and human rights of people with learning disabilities was a joint venture organised by the Scottish Consortium for People with Learning Disabilities with the Open University and the Institute for Research and Innovation in Social Services. It was attended by a large audience of people with learning disabilities, professionals, families and carers from across Scotland along with a small group from Ireland. The subject of the conference was of relevance to the British Journal of Learning Disabilities, and a number of things struck me in particular. Some of these were about the United Kingdom itself and how things are both similar and different in the countries of Britain. As an editor, I am used to asking authors to be clear about the geographical scope of their work: some contributors tend to confuse their regional or national experience as being universal. However, this normally involves debates about the United Kingdom within an international perspective. I have not previously asked an author to discuss relevance within the United Kingdom in the context of devolution. However, a strong message that I took away from the conference was that social policy is significantly different in England and Scotland and that the divergence is growing. For example, I had not really appreciated that there were differences between the Scottish Mental Incapacity Act and the Mental Capacity Act that applies in the rest of the United Kingdom. Federal states must be quite used to such differences, but I am not sure that we have fully understood them yet in the United Kingdom. One of the key differences is the closeness to national decision-makers enjoyed in Wales, Scotland and Northern Ireland compared to England. For example, a larger proportion of people in Scotland have met, been listened to and heard the Minister for Health in Scotland than will ever be possible in the much larger jurisdiction of England. I am not sure how this impacts on policy itself, but such accessibility of ministers certainly helps with the perception of involvement in the decision-making process. Despite the differences in legislative and administrative processes, I was also struck by many of the similarities in issues affecting people with learning disabilities both sides of the border. For example, the mental capacity/incapacity acts may be different, but the experience of struggling to get health practitioners to understand the nature of informed consent was almost identical. The debates about the value of and access to paid employment for people with learning disabilities were just the same as were some of the identified gaps in research such as that into commissioning, forensic services and human rights. The demand by people with learning disabilities that they are not, but should be involved at all stages of the research process was also a common theme. The organisers of the conference are currently considering editing the papers for a special edition of the British Journal of Learning Disabilities, and I look forward to the results of their discussions. Following the last special issue that concentrated on the history of services, this edition returns to our usual mix of approaches and disciplines. I remain convinced that the inclusion of such a wide spectrum of material related to learning disabilities is one of the major strengths of this Journal, and I hope you enjoy methods and subjects that are familiar, as well as those that are new to you.

Healthcare associated infection in care homes for older people in Scotland: results from a pilot survey

The prevalence of infection in Scottish care homes is currently unknown. The aim of this survey was to estimate the prevalence of infection within a small sample of care homes for older people and to develop and test a methodology for point prevalence surveys which would allow local care home staff to monitor infection in care homes for older people that employ trained nurses. The pilot survey was undertaken by Health Protection Scotland (HPS) in collaboration with the Care Commission and two volunteer service providers. Data collection within 18 volunteer care homes was undertaken between 6 April 2009 and 1 May 2009. A total of 922 residents from 18 care homes were included. On the day of survey, 87 infections were identified in 86 residents. The prevalence of infection was 9.3%. The most common infections types were urinary tract infections and respiratory tract infections. The results from this small survey of volunteer care homes have provided valuable insight into the previously unmeasured prevalence of infection in Scottish care homes for older people. It is hoped that the rollout of a larger scale survey that includes a representative sample of all Scottish care homes can be implemented.

‘It's just like another home, just another family, so it's nae different’ Children's voices in kinship care: a research study about the experience of children in kinship care in Scotland

ABSTRACTGrowing acknowledgement of the importance of the role of kinship carers in caring and supporting children and young people in Scotland has led to a burgeoning of research on this topic. However, most research has tended to focus on the role of kinship carers. A significant gap has been direct studies into the views and experiences of children and young people living with relatives or friends. This paper seeks to address this by drawing on the findings from a small‐scale qualitative collaborative research project with 12 children and young people living in informal and formal kinship care in the Northeast of Scotland. The literature on foster and kinship care is reviewed and key themes identified. The qualitative research data is outlined employing a thematic analysis approach. The key findings are analysed with a view to the potential implications for policy and practice. The paper concludes with proposals for potential future research.

Modern Concepts of Quality and Risk

This article is about the complex interplay between quality and risk in the context of care for older people in Scotland. We review relevant theoretical literature underpinning the concept of ‘quality’ and its relationship with ‘risk’ to discover a wide range of regulatory challenges related to issues such as an increasing number of older people; intense press scrutiny; private care home provision; and, healthcare professionals increasingly shifting focus from generic care needs towards a personalized approach focusing on the care needs of the ‘individual’. In this environment, risk control must be ‘negotiated’ against resultant impact on the quality of life for individuals. We relate the existing literature to the approach devised by the Care Commission for Scotland to enforce published government standards: the adoption of a modern risk-based approach to regulation involving the use of a risk assessment scoring tool to determine and justify the level of regulatory intervention; and the development of a quality assessment framework that articulates the existing government standards. We conclude that if regulation and quality assurance are to concern themselves more with risk, then this will best occur within the context of integration and simplification rather than increased complexity —; perhaps with a unified set of care principles and quality themes that make direct provision for the management of risk. While this is of specific relevance to the regulator in Scotland, the principles we discuss have application to other parts of the UK and to other countries that face similar challenges.

The needs and strengths of unaccompanied asylum‐seeking children and young people in Scotland

ABSTRACTUnaccompanied asylum‐seeking children seeking refuge in safer parts of the world have a wide range of needs. This paper discusses the main needs of unaccompanied minors drawing upon the views of service providers who work with or for unaccompanied asylum‐seeking children and young people in Scotland, as well as the perspectives of unaccompanied minors themselves. The complexity of the children's needs is explored with a framework considering their process of resettlement, looking at the present first, the future next and the past last. We also explored the strengths and resilience of the unaccompanied children consulted.

The International handbook on aging: current research and developments

The United Nations World Assembly on Aging has made advancing health and well-being into old age a worldwide call for action. And this text at hand shows us what researchers worldwide are doing to answer that call. Here, three of America's most esteemed experts on aging lead a global team of contributors - each an expert in his or her country - to show us what the top challenges of each nation are, and what top research is being done there to meet those. While we cannot predict with absolute certainty all of the issues that will arise over the next 20 years, we can anticipate some and we must start now to prepare for these challenges, an expert from the U.S. Department of Health and Human Services warned at a recent UN World Assembly on Aging. Needed response to the global population shift is not just the responsibility of governments, but will be a product of wise, long-term decisions made by individuals and societies, she explained. In most nations globally, populations are graying and the number of people aged 65 and older is vastly increasing, creating a larger segment of senior citizens than the world has ever before seen. Across human history, the elderly accounted for no more than 3 percent of the world population. By the year 2030, the elderly are expected to make up about 25 percent of the world population. And while longevity is of course seen as a great success, longer lifespan for such masses also creates dilemmas. For example, the incidence of dementia has already increased significantly with an 11-fold increase in people aged 65 and older in the US since the turn of the century, and a similar increase in aged people in Scotland has researchers there scrambling to find treatments for what they expect will be a 75 percent increase in dementia over the next 25 years. Chronic diseases that come with aging are already taxing health care systems in the US and around the world to Japan, with most experts aware their current health systems would be overrun and lack enough staff and facilities to handle the needs of an elderly population multiplying largely in the coming two decades. Increases in psychological issues such as dealing with the depression often striking aged people are impending, too, as are social issues such as how families, and public policies, will deal with the changing shape of the family.

Life with the Saltire Society

For many people in Scotland in the last seventy years, and I am one of them, the Saltire Society has played an important part in our lives. It has given us a means of meeting our desire to contribute to the cultural revival of Scotland. That was why the Society was established in 1936, 'to encourage everything that might improve the quality of life in Scotland and restore the country to its proper place as a creative force in European civilisation.' 1 It was a time of extreme pessimism about the state of Scotland and of its chance of surviving as a valuable and distinctive source of culture and ideas. This was partly a consequence of the heavy losses in the 1914-18 War and of the long period of emphasis on the Empire and not on the needs of Scotland itself. Many books were written at this time which lamented the sorry state of the country. Edwin Muir, for instance, in his book, Scottish Journey in 193S said that Scotland was becoming 'nothing more than a name on a map' because 'it was now falling to pieces for there is no visible and effective power to hold it together. ' 2

The role of primary mental health workers in child and adolescent mental health services in Scotland

It is estimated that approximately 10% of children and young people in Scotland have mental health problems (Scottish Government, 2008), resulting in a rapidly increasing need for child and adolescent mental health services (CAMHS). Primary mental health workers (PMHW) have been identified as one of the key professional groups within a multidisciplinary CAMHS team to progress the agenda of early intervention and identification of mental health problems among children and young people. One discrete aspect of the PMHW role is the facilitation and delivery of consultation services to a wide range of agencies. Consultation, in this context, is understood as a community activity for disseminating knowledge, creating understanding and facilitating non‐CAMH professionals to support children and young people with psychological difficulties (Scottish Executive, 2005). This paper discusses a smallscale study that aims to deconstruct the concept of consultation and explore the professional expertise and service requirements necessary for effective delivery. It concludes that complex and multifaceted skills are required if a consultation is to be meaningful and effective. Consequently, and despite competing discourse, there remains a strong debate for retaining the role of the PMHW, specifically for the delivery of early intervention and health promotion activities, such as consultation. The study took place in Scotland, but UK‐wide data is drawn on to provide a more comprehensive picture.

Network 1000 Scotland: A report on the opinions and circumstances of blind and partially sighted people in Scotland

The report provides an insight into the views, experiences and needs of blind and partially sighted people in Scotland, helping to inform Scottish policy. Direct interviews with 165 blind and partially sighted people in Scotland were undertaken by telephone. The interviews took place as part of a UK-wide data collection exercise in 2006 (Douglas et al., 2006). A range of findings were produced: 52 per cent of the population lived alone; 10 per cent of the population did not know the name of their eye condition; only 25 per cent of the working-age population were in employment; 70 per cent of the population reported having long-term health problems in addition to their visual impairment; and 40 per cent of the population said they would like to leave home more often. The report highlights for the first time the situation facing registered blind and partially sighted people in Scotland at the beginning of the 21st century.

End-of-life obligations ignored in many care homes in Scotland.

FOUR OUT of ten care homes for adults and older people in Scotland are failing to provide palliative and end-of-life care to residents with life-limiting illnesses, inspectors have found.

The International Cooperative Ataxia Rating Scale shows strong age‐dependency in children

REFERENCES 1. Department of Health. (2007) National Service Framework for Children, Young People and Maternity Services: Children and Young People who are Ill: Standard 6. Assessment of the Ill Child. http:// www.dh.gov.uk/en/Publicationsandstatistics/ Publications/Publicationspolicyandguidance/ Browsable/DH_4867832 (accessed 12 January 2009). 2. Committee on Paediatric Emergency Medicine. Emergency preparedness for children with special health care needs. Paediatrics 1999; 104: 53. 3. The Scottish Government. (2006) Emergency Care Framework for Children and Young People in Scotland. http:// www.scotland.gov.uk/Publications/2006/ 09/19153348/13 (accessed 15 January 2009). 4. Wolff A, Hollingsworth S, Whitehouse P. Use of personal plans in children with lifelimiting conditions. Arch Dis Child 2006; 91(Suppl 1): A83. 5. Dyer C. London hospital to face High Court for allegedly refusing to resuscitate disabled girl. BMJ 2004; 328: 125. 6. Dyer C. Hospital breached boy’s human rights by treating him against his mother’s wishes. BMJ 2004; 328: 661.

Concessionary bus fares for older people in Scotland – are they achieving their objectives?

Since April 2006, people aged 60 and over and disabled people have been eligible for free travel by bus throughout Scotland at all times. This paper examines who uses this concession, what use is made of the concession in terms of frequency and purpose of trip, and whether the concession succeeds in enhancing social inclusion. Data from two recent evaluations and a survey examining the needs of disabled people for public transport are reviewed in the present study. The findings show that there have been significant changes in concession use among wealthier senior citizens, which means that the average passholder is younger and more likely to own a car than when there was no free concession. Although there is some evidence that the new concessions are promoting social inclusion among the elderly, they also appear to be promoting modal shift. In addition, there are large portions of the population for whom the concession is of limited use, since they face barriers to bus use other than cost. With the concession, local authorities have less flexibility in their spending on transport, including on specialized transport services for the disabled, leaving this segment of the population socially excluded.

Abstract 2630: Lower Socioeconomic Status is Associated with Higher Rates of First Hospitalization for Stroke and Subsequent Case Fatality: A Population Study of 5.1 Million People in Scotland 1985–2005

Introduction Small, age or geographically restricted studies suggest that stroke incidence and case fatality increase with lower socioeconomic status (SES). We examined the relationship between SES and stroke incidence and case fatality in a whole country. Methods Linked morbidity and mortality data were used to identify all first hospitalizations in Scotland where stroke was coded in the principal diagnostic position at discharge from 1986 –2005. SES was measured using the quintiles of Carstairs index of deprivation (quintile 1= most affluent, 5=most deprived). Age and sex specific incidence rates by SES were calculated. Cox regression was used to model case-fatality by SES at 30 days, 1 and 5 years adjusted for comorbidities. Results From 1986 –2005 73,676 men and 88,808 women were admitted with a first stroke. In men (women) 11575 (14713) occurred in individuals in deprivation quintile 1 and 15800 (19022) in quintile 5. Rates of stroke were higher in the most deprived vs the most affluent individuals. In 1986, in men aged <55, 55– 64, 65–74, 75– 84 and >85 years, the rate ratios (deprived vs affluent) were 2.05(1.46 –2.87), 1.82(1.38 –2.38), 1.56(1.27–1.92), 1.06(0.87–1.31) and 1.16(0.78 –1.74) respectively. In women the respective ratios were 2.57(1.71–3.87), 2.06(1.50 –2.83), 1.62(1.32–1.99), 1.27(1.09 –1.49) and 1.36(1.07–1.74). These gradients persisted from 1986 to2005 in both men and women and in all ages. Adjusted case fatality did not vary by SES at 30 days,, HR (deprived vs affluent) = 1.01(95%CI 0.96 –1.06) in men, 1.03(0.99 –1.08) in women. However, at 30 days-1 year the HR was 1.17(1.09 –1.24) in men and 1.11 (1.05–1.17) in women. At 1–5 years the HRs were 1.20(1.13–1.26) in men and 1.14(1.09 –1.20) in women. The effect of SES on case fatality and hospitalization rates did not vary by year or stroke subtype (p for interactions >0.05). Conclusion Not only are stroke hospitalization rates highest in the most deprived individuals, but adjusted longer term case fatality after discharge is also higher. There is no evidence that this disparity is decreasing over time.

Assessing pressure ulcer risk in long-term care using the Waterlow scale

This article reports on a mixed-methods study examining the use of the Waterlow scale by nurses working in long-term care for older people in Scotland. Eight nurses from four long-term care facilities in two health board regions took part. They were observed carrying out 16 pressure ulcer risk assessments, after which they were interviewed about their assessment and plan of care. Results from the observations and interviews suggest that an assessment of pressure ulcer risk and plan of care went beyond the information that was contained in, or produced by, the Waterlow scale.

Hepatitis C Action Plan for Scotland: Phase II (May 2008-March 2011)

In 2004, the Scottish Government recognised that 'Hepatitis C is one of the most serious and significant public health risks of our generation' [1]. By December 2006, Health Protection Scotland (HPS) estimated that 50,000 people in Scotland had been infected with the hepatitis C virus (HCV) and that 38,000 were chronic carriers (Figure 1) [2]. Following an extensive consultation in 2005, the Health Minister and Chief Medical Officer launched Scotland's' Action Plan for Hepatitis C' in September 2006 [3]. Its aims are to prevent the spread of hepatitis C, particularly among intravenous drug users (IDUs), to diagnose hepatitis C-infected people, particularly those who would most benefit from treatment; and to ensure that those infected receive optimal treatment, care and support. The plan is a two-phased one. Phase I, undertaken during September 2006 to March 2008, involved increasing awareness about hepatitis C among professionals and gathering evidence through numerous surveys and other investigations to inform proposals for the development of hepatitis C services during Phase II (2008-2011)[4]. This paper presents the key findings of the evidence gathering exercise, recommended actions stemming from the evidence and funding associated with the actions.

Working with older people in Scotland – A framework for mental health nurses

Working with older people in Scotland – A framework for mental health nurses

Willingness-To-Pay in Contingent Valuation: A Matter of Interview Situation or Respondents?

This paper analyses the factors influencing the estimated values of Willingness-To-Pay (WTP) for environmental land-based resources stated by people in Scotland in a number of Contingent Valuation (CV) studies. It explores how different frameworks influence the level of Willingness-To-Pay (WTP) by a meta-analysis. The results of nine different CV studies have been compared and analysed with the help of an Ordinary Least Squares regression model. The dataset consists of 157 observations, i.e. WTP values for a variety of such resources, ranging from £0 per household and year up to £106.23. In particular the influence of different goods and services, different samples and different methodical approaches inter alia are tested. Three regression models had an adjusted r2 of at least 0.66 and showed high statistical significance at a 99% level. The WTP had a significant dependency on the interviewed sample, the questionnaire design, the elicitation format, the interview situation and the client. The results show that WTP of both the Scottish population and visitors to Scotland is highly dependent on framing effects. The paper confirms that the specific characteristics of the valued good are of lesser importance for the stated WTP.

Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey

Objective To detect any change in exposure to secondhand smoke among primary schoolchildren after implementation of smoke-free legislation in Scotland in March 2006.Design Comparison of nationally representative, cross sectional, class...

Free Personal Care for Older People in Scotland: Issues and Implications

Drawing on recent quantitative and qualitative research, we consider lessons of the Scottish policy of free personal care for older people. The policy is embedded in political debates about devolution and interacts with various changing policies on care and support for older people. Evaluation is complicated by these interactions and by gaps in relevant data, especially concerning costs. Operationally, policy implementation has presented varying difficulties for local authorities. For clients and informal carers it remains popular, but is part of a service-led model of provision which does not reflect their own views of their care and support needs.

Inter-Ethnic Relations among Children at School: the perspectives of young people in Scotland

In the UK, policies and academic writings about inter-ethnic relations have witnessed many changes in recent decades, with a growing focus on the effects of different forms of racism and anti-racism. Opinions have been diverse on the extent to which both the majority and minority populations should respect and adapt to each other's traditions. Relatively little research has been undertaken on the experiences and perceptions of children. This article reports on findings from three linked studies which highlight the viewpoints of white and minority ethnic children as they made the transition to secondary schools. With a few exceptions, the children felt that their schools respected their religious practices and other customs. Most children of minority backgrounds had mixed friendship groups and the range of achievements, experiences and attitudes in relation to school were largely unrelated to ethnic background. Hardly any young people saw teachers as overtly racist, though small numbers believed teachers discriminated in favour of other groups. Peer racism was endemic and reported to be more frequent in secondary school than primary school. Teacher responses were often seen as inadequate.