Social Care Partnerships Research Articles

Developing an evidence-based Making Every Contact Count (MECC) model of practice within MSK physiotherapy services

Purpose: Population health and prevention is a major priority of the recently formed Greater Manchester Health and Social Care Partnership and is an area in which physiotherapists can make a positive contribution.

Partnership in action: forging a new approach

Purpose Professional partnerships between housing and health are not impossible, but they take time, commitment and dedicated strategic leadership. The language and culture of the two sectors are sometimes complex and do not always match. There can be issues understanding each other’s motivation, ethics and terminology which can cause a barrier when working together. The purpose of this paper is to share the journey of how Wakefield District Housing (WDH) is working with the care and health sector to create sustainable partnerships that benefit both parties, getting to a stage where they could successfully integrate with healthcare providers in the Wakefield district. Design/methodology/approach The paper offers the reader an overview of how WDH’s membership of the Wakefield Health and Wellbeing Board enabled improved partnership working with NHS and other members, including the establishment of a Housing, Health and Social Care Partnership, the employment of dedicated senior staff, co-located multi-disciplinary teams and joint design of new services. Findings WDH has demonstrated that the organisation understands the challenges facing NHS colleagues, has acknowledged the complexities of the system that their partners work in and looked for solutions alongside them. The opportunities within partnership working are boundless and, if successful, the outcomes for tenants and the wider Wakefield population could be in excess of those envisaged in planning the project. Partnerships will almost inevitably encounter challenges along the way but if all partners keep their own and shared visions in mind, further success is within reach and all parties will get there faster by not going alone. Practical implications The paper offers useful guidance and ideas for other housing organisations aiming to improve their contribution to local integrated healthcare. Originality/value This paper provides an original perspective from inside the programme, offering practical, comprehensive and deliverable initiatives to improve health outcomes for local communities.

Conceptualizing “project resiliency”

PurposeTo meet the multidimensional needs of patients, health services are increasingly implementing complex programmes of care through partnerships between public, private and voluntary sector organisations. The purpose of this paper is to explore the implementation process of a complex, multi-innovative regional health and social care partnership to coordinate end-of-life care in the South East of England.Design/methodology/approachThe study adopted a pragmatic, pluralist design using primarily qualitative methods including observations, interviews, focus group and document review. Implementation theory provided the research framework.FindingsWhile progress was made towards greater collaboration in the provision of end-of-life care, regional coordination of care among the 13 partner organisations was not achieved as envisioned. Low engagement stemming from national health system changes delayed decision making and shifted partners’ priorities. Individual stakeholder interest and motivation carried the elements that were successful.Practical implicationsThe external political and economic environment hindered the involvement of some of the partners and suggests that a concept of “project resiliency” is particularly important for complex, multi-organisational projects which are implemented over time and by multiple stakeholders from different sectors. Future research should look further at what contributes to project resiliency and whether it might be operationalized so that projects can develop resilient factors for success.Originality/valueProject resiliency is a new concept that bridges a gap in understanding how time-limited multi-organisational projects function amid a changing environment.

Co-designing green social care services: Farmers and social entrepreneurs as new social care providers for vulnerable populations

Background: Local health and social care partnerships that stimulate community engagement of vulnerable populations are promising for health promotion. In the Netherlands, some of these partnerships include in addition to stakeholders from the health and social care sector, also stakeholders from the green, agricultural and voluntary sector. Examples are green care farms, farms that combine agricultural activities with social care and support services, e.g. day services for people with dementia and supported workplaces for vulnerable populations such as vulnerable youth and people with mental health problems or intellectual disabilities. Clients, or participants in the vocabulary of care farmers, are involved in agricultural production and farm-related activities. In addition to these initiatives in rural areas, an increasing number of green social care services is developed in urban settings. Examples are community gardens, green enterprises and urban farms. These initiatives are embraced by many municipalities because they aim to empower vulnerable populations and stimulate social participation. They are characterized by meaningful activities with plants and animals and an informal open atmosphere facilitated by a person-centred approach of the professionals and volunteers involved. Initiators of the green social care services design these services in collaboration with stakeholders such as participants, professionals and volunteers involved in the initiative and/or the community. During the last decade, researchers, farmers, social entrepreneurs, care organizations and municipalities collaborated to get a better understanding of the experiences with and impact of these green urban and rural initiatives. Although the initiatives are promising, they face many challenges and more knowledge is needed about their reach and impact and on individuals, communities and organizations. Aims and objectives: The aims of our workshop are to: 1. give an overview of the different types of green rural and urban initiatives, and how vulnerable citizens and communities are empowered and engaged respectively within these initiatives and 2. share the lessons learned from the different initiatives so far, e.g. the major obstacles for collaboration, how innovative initiatives gain legitimacy and access to funding and what conventional social care providers can learn from these initiatives. Format: During this session, we will present findings of different research projects on green care farms and green urban and initiatives offering services such as rehabilitation of different groups of vulnerable citizens and adult day services for people with dementia. Initiators of different types of initiatives will present their experiences and main challenges. After that, we will discuss the following topics with the audience: 1. What is the value of these initiatives?; 2. What is necessary to increase their impact and tackle challenges they are facing? and 3. To what extent is it feasible to implement such initiatives in other countries? Target audience: The workshop is targeted at researchers, policy-makers and practitioners who want to know more about innovative initiatives such as green social care services. Learnings: Participants obtain insight in green social care initiatives and their potential impact on wellbeing, participation and empowerment of different vulnerable populations. They will have learned about challenges initiators are facing and how these may be solved.

Development and Implementation of Core Competencies for Integrated Care Community Health Teams: a UK experience

Introduction: UK Integrated community care teams ICCT have been encouraged by policy initiatives and legislation 1, 2 to establish and provide better methods of integrating care IC across health and social care; reducing duplication of provision, improving efficiency and service experiences 3. A UK IC partnership identified the need for a set of core competencies for ICCT. This team supports people in their community to develop independence and self-management skills, and offers diverse health and social care input to improved mental and physical health. An initial literature review indicated few UK publications about ICCT competencies. Practice Change Implemented: Implementation of core professional competencies for ICCT. Aim and Theory of Change: The project is based upon the quality improvement model of Plan Do Study Act 4. Targeted Population and Stakeholders: The population served by the ICCT have complex multiple mental and physical health and social care needs. Stakeholder within the project included service users, ICCT including care navigators, nurses, OT's, psychologists, physiotherapists, and social worker and and the health and social care partnership organisations. Highlights: Core competencies for ICCT were developed through review of the international literature, telephone interviews with the stakeholders, analysis of international competency guidance and job descriptions/ competencies for all professional groups within the ICCT. The competencies were revised through focus groups and piloted with the ICCT. Feedback on the competencies was obtained. Principles from the international competency documents on integrated care were combined to produce a UK ICCT core competency document. ICCT found potential utilisation across the professionals and at all levels. ICCT found them useful in considering their collective understanding of IC and in facilitating their understanding of other professionals' roles within the ICCT. ICCT could see the value of them in assessing and developing their IC competence. Comments on Sustainability: The development led to a document containing eight core competency themes. The PDSA model requires continued adoption and adaptation the ICCT core competencies. Comments on Transferability: The competencies should be transferable and adaptable across the UK utilisng the PDSA model. Due to the incorporation of the published international competencies for integrated care the ICCT core competencies may have use internationally. Conclusion: Identification of ICCT Core Competencies that were acceptable to a wide range of professionals was possible. A variety of practical usages were identified. The ICCT Core Competencies have national and international potential. Lessons Learned: Wider evaluation of this primary care service improvement initiative is required. Gaining a shared understanding of ICCT is key to efficient working.

Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study.

General practice in the UK is experiencing a workforce crisis. However, it is unknown what impact prescribing support teams may have on freeing up GP capacity and time for clinical activities. To release GP time by providing additional prescribing resources to support general practices between April 2016 and March 2017. Prospective observational cohort study in 16 urban general practices that comprise Inverclyde Health and Social Care Partnership in Scotland. GPs recorded the time they spent dealing with special requests, immediate discharges, outpatient requests, and other prescribing issues for 2 weeks prior to the study and for two equivalent periods during the study. Specialist clinical pharmacists performed these key prescribing activities to release GP time and Read coded their activities. GP and practice staff were surveyed to assess their expectations at baseline and their experiences during the final data-collection period. Prescribing support staff were also surveyed during the study period. GP time spent on key prescribing activities significantly reduced by 51% (79 hours, P<0.001) per week, equating to 4.9 hours (95% confidence interval = 3.4 to 6.4) per week per practice. The additional clinical pharmacist resource was well received and appreciated by GPs and practices. As well as freeing up GP capacity, practices and practitioners also identified improvements in patient safety, positive effects on staff morale, and reductions in stress. Prescribing support staff also indicated that the initiative had a positive impact on job satisfaction and was considered sustainable, although practice expectations and time constraints created new challenges. Specialist clinical pharmacists are safe and effective in supporting GPs and practices with key prescribing activities in order to directly free GP capacity. However, further work is required to assess the impact of such service developments on prescribing cost-efficiency and clinical pharmacist medication review work.

イギリスにおける退院支援システムと医療・介護の連携( 高齢者ケアの供給システムとサービス従事者)

イギリスにおける退院支援システムと医療・介護の連携( 高齢者ケアの供給システムとサービス従事者)

Community nursing middle management: 'dealing with different people in different time zones on both sides'.

The overall aim of the investigation was to redress a knowledge gap by exploring community nursing middle managers' (CNMMs') experiences of role enactment through change within Community Health Partnerships (CHPs) in Scotland-now further evolved into Health and Social Care Partnerships (HSCPs). HSCPs play a key role in shifting care from the acute to the primary care/community setting. However, a literature review demonstrated there has been very little research into the role of CNMMs within the changing primary care context. This concept was considered important in understanding how CNMMs enacted their roles to implement service change. A qualitative longitudinal interpretative phenomenological analysis (IPA) ( Smith, 1996 ) study was conducted in four distinct phases, comprising the reflexive, foundational, recursive and expansive, from 2008-2011. Some 35 semi-structured interviews were conducted with 26 participants. CNMMs perceived that their responsibilities had increased, become more complex and wider ranging. Maintaining an implicit connection with service users was a primary motivation for CNMMs. They were proud to be members of the nursing profession aligning their identity with their career history. A small but significant proportion resigned during the study and some were considering leaving the NHS. The study addresses a gap in literature, contributes to the understanding of NHS community nursing, middle management, role, change and gives a voice to CNMMs in Scotland. They are the lynchpins in taking change forward and maintaining quality services. Much more attention needs to be paid to the needs, constitution and sustenance of middle managers in Scottish community nursing-which has policy, practice, education, and research and retention implications.

Setting up recovery clinics and promoting service user involvement.

Service user involvement in mental health has gained considerable momentum. Evidence from the literature suggests that it remains largely theoretical rather than being put into practice. The current nature of acute inpatient mental health units creates various challenges for nurses to put this concept into practice. Recovery clinics were introduced to bridge this gap and to promote service user involvement practice within the current care delivery model at Kent and Medway NHS and Social Care Partnership Trust. It has shaped new ways of working for nurses with a person-centred approach as its philosophy. Service users and nurses were involved in implementing a needs-led and bottom-up initiative using Kotter's change model. Initial results suggest that it has been successful in meeting its objectives evidenced through increased meaningful interactions and involvement in care by service users and carers. The clinics have gained wide recognition and have highlighted a need for further research into care delivery models to promote service user involvement in these units.

Helen Dickinson and Janine O’Flynn, Evaluating Outcomes in Health and Social Care (University of Bristol: Policy Press, 2016), pp. xviii, 144, £12.99, paperback, ISBN: 978-1447329763.

Evaluating Outcomes in Health and Social Care is the fifth in a series of five books on health and social care partnerships, recently updated to take account of new studies and changing policy developments since first published in 2008. The book is aimed at students, practitioners, managers and policy-makers in health and social work/care. Health and social care partnership is in itself a topic which has presented considerable challenges to policy and practice in different countries for decades. In addition, this book also aims to tackle the complex issues of evaluation and outcomes, which is no mean feat. The authors usefully blend context and history, an overview of evaluation methods, theoretical approaches, practical examples and links to reading and resources in pursuing their quest.

Resource allocation in integrated care settings: what works? Case of Health and Social Care Partnerships in Scotland

Background : The move towards integration between health and social care, as embodied in the Public Bodies (Joint Working) (Scotland) Act 2014 and similar acts in England and Wales, challenges local delivery organisations to consider the cost, quality and the value of services provided for local populations. To meet this challenge, especially when set against a background of public sector austerity, managers and staff need robust, effective frameworks to help them make decisions which are defensible and based on sound evidence. Given the intention of the above legislation, such frameworks for priority setting must also be able to aid decisions about the appropriate balance of care (i.e. the respective amounts of resources devoted to the NHS, social care and other relevant providers). One such framework for priority setting is Programme Budgeting and Marginal Analysis (PBMA). PBMA is a generic economic framework and offers an analytical approach for assessing the costs and benefits of alternative courses of action, which could assist with identification of the effects of resource shifts and areas for disinvestment among programmes. Programme Budgeting (PB) involves the presentation of estimates of expenditure and activity across and within ‘programmes’ of care or service delivery. Marginal Analysis (MA) involves evaluation of incremental changes in costs and consequences when resources in programmes are used in different ways; essentially analysing the effects of changing the balance of expenditure within a given budget. MA identifies where additional resources should be targeted, where reductions should be made if expenditure must be cut, and how resources can be reallocated to achieve an overall gain in benefits with no overall change in expenditure. In order to test out the feasibility of using such a framework in newly formed Health and Social Care Partnerships (H&SCPs), three pilot sites in Scotland were selected: Highland, Ayrshire & Arran and Perth & Kinross. We worked closely with Highland, who conducted the process in two localities (one urban and one rural), and I will focus on the lessons learned from using such a framework in these integrated care settings. Methods : Interviews were conducted with those working in Highland to learn about their understanding of current priority setting processes. Workshops outlining the economic principles and theory of PBMA were held in both localities and from this Advisory Groups were formed to lead the process in each site, and field notes have been gathered from working with these groups and associated events. Highlights : The PBMA process provided the pilot sites with a transparent, inclusive and structured approach to prioritisation. It promoted debate and critical appraisal of options amongst stakeholders based on an understanding of the benefits and costs associated with the potential choices and provided a basis by which decisions could be justified. By considering the current use of resources across a programme, alongside the potential alternatives, the PBMA process combines investment with disinvestment decisions. A particular strength was the role and composition of the Advisory Groups. The benefit of including other stakeholders, such as service users, carers and service providers, alongside statutory providers in a co-production approach was evident. The pilots required investment to apply the technique, generate buy-in, facilitate meetings, liaise with public representatives, perform analysis and present results. Although some of the time required for this will have been associated with establishing the process, there will be a recurrent cost required to administer it on a regular basis. In addition, clinician’s time will need to be protected to allow participation. To ensure the process is effective will require robust datasets on, for example, current service patterns, resource utilisation and outcomes, and population needs assessments. There is a risk that this places a significant additional demand on local systems. However, it could be argued that this level of information is what is required for effective prioritisation and its unavailability is a problem for current processes rather than for PBMA. Conclusion : Despite some barriers to implementation, the test sites were very positive about the approach taken and allowed them to progress with a decision making process while changing thinking of those involved of how decisions are made and resources can be (re)allocated within health and social care. The structured approach allows for organisations to be more explicit about the basis of decisions and focus on the entirety of resources. As a result, PBMA has been included in Statutory Guidance in Scotland as an approach for use in developing Strategic Commissioning Plans by H&SCPs established under the new legislation.

Scottish patients at risk of readmission and admission (Sparra)

Background: The healthcare system in Scotland is facing increased demands as a consequence of the aging population and budgetary constraints. There has also been a shift in government policy towards a more preventative and anticipatory approach to the management of long term conditions. The value of this is maximised when it is targeted at patients who are most likely to benefit. To achieve this, it is essential to have valid and robust techniques, which enable stratification of the population by risk. SPARRA is a stratification tool, developed for the National Health Service in Scotland. Launched in 2006, SPARRA is a predictive tool to evaluate an individual’s risk of being admitted to hospital as an emergency inpatient within the next year. In 2012, it’s cohort was widened to allow risk scores to be derived for more patients and for patients from lower risk strata, who may benefit from early preventative interventions. Risk scores are calculated for approximately 4.2 million patients and details of patients whose score indicates that they may be at increased risk are distributed to a range of health care professionalsDescription: SPARRA requires a patient-level history comprising information about each patient during a pre-prediction period and information on whether or not the patient experienced an emergency admission in the twelve months following this period. In the 2012 SPARRA (Version 3), national patient-level data on hospitalisations, prescribing, emergency department, outpatients and psychiatric admissions were linked and a range of variables were derived from this combined dataset. The SPARRA cohort was then divided into three sub-cohorts: ‘Frail Elderly’, ‘Long Term Conditions’ and ‘Younger Emergency Department’. Following the creation of these three sub-cohorts, logistic regression was used to test the variables’ predictive power in evaluating the risk of emergency admission for each sub-cohort. Performance of the resulting model was then tested by considering some relevant statistical measures, such as sensitivity and positive predicted value.Results: The modelling process identified a number of risk factors which improved the predictive power of the SPARRA algorithm. Some of these variables are relevant to each sub-cohort, some to only one or two. Widening of the cohort has meant that more than 95% of patients experiencing an emergency hospital admission within the year are captured. The remaining 5% that do not appear in the SPARRA cohort are largely unpredictable admissions, for example, trauma and orthopaedics patients. When we compared the performance of SPARRA against the Devon Prediction Model (a combined model based on a systematic review of around 26 models) at thresholds 50%, SPARRA performed better and reported a positive predicted value of 59.8% compared to Devon’s 54.6%.SPARRA also reported a sensitivity of 10.5% while Devon reported 8.4%. SPARRA risk scores can range from 1 to 99%; patients with a score of 40+% are generally regarded to be at increased risk.Highlights: SPARRA plays a key role in the shift to preventative, anticipatory approaches to healthcare, as a case finding tool and as a service planning tool. Details of patients at risk of emergency admission are distributed to the relevant NHS Health Boards, Health &amp; Social Care Partnerships, GP Practices and other health agencies. This allows anticipatory interventions at the individual patient level and, at a higher level, assists in service planning. For example, SPARRA data can define lists of polypharmacy patients that GPs and pharmacists can use to select the individuals most in need of a medicine review.Conclusion: SPARRA has proven very effective both as a case finding tool and as a service planning tool. For SPARRA to fully support health and social care integration, the linked datasets used in SPARRA will be widened to include data from GP systems, out-of-hours, NHS 24, care home and social care.

Hospital at Home as an Enhancement to an Existing Rapid Response Team in a Semirural setting in Scotland

Midlothian is the area to the south of Edinburgh with a population of 86,000 spread across an area of 354km2. Midlothian Council and NHS Lothian work together as a Health and Social Care Partnership governed by the Midlothian Integration Joint Board. The work described here is an example of fully integrated working at ground level. For many years, Midlothian has had a successful Rapid Response Team, with a team of Allied Health Professionals and carers who deal with a variety of crises in the community, including attending to people with falls, those that require intensive rehabilitation in their homes and anyone who has an immediate crisis affecting their care. In 2014, in conjunction with NHS Lothian, the team was enhanced by the appointment of a community based consultant geriatrician and four advanced nurse practitioners. This has enabled the provision of a “Hospital at Home” service for the population of Midlothian as a meaningful alternative to an acute hospital admission. Following the initial success of this venture, the team is expanding with further investment in additional nursing and medical time. The Hospital at Home team work with the pre existing Rapid Response Service and are fully integrated with them, working in the same office in a community setting. The doctor, nurses, physiotherapist and pharmacist are aligned with the NHS, while the administration staff, occupational therapists and carers are employed by the council. In practical terms the team functions as a single entity. This service is different from the other “Hospital at Home” teams around Scotland, as it has grown from its roots in Social Care, whereas other services have tended to be outreach ventures from hospital secondary care. The goal of the team is to offer an alternative to admission for frail older patients, though younger people can also be referred if appropriate. Patients are admitted to a “virtual ward” on the NHS Lothian computer based TRAK system and have identical access to the same medical investigations as acute hospital inpatients, including all laboratory tests, Radiology and physiological testing where appropriate. The patient however remains in their own home (or care home) throughout their admission. Usual length of stay in the “ward” is around 7- 10 days. Additional care support can be provided if needed and there is immediate access to allied health professionals as required. Daily observations are carried out by the nursing staff. For many patients the key intervention is adjustment of medication and support for the patient and their family through the acute illness. However a variety of more invasive treatments can be provided, including administration of intravenous or subcutaneous fluids. Intravenous antibiotics and also diuretics are also given. In the first 15 months of the service, up to September 2015, 294 patients were referred, of whom 260 (88%) were suitable. Of these 255 (87%) were referred by their GP, with 51 (17%) being referred by acute hospitals to support early discharge. The local Acute Medical Admissions Unit at Edinburgh Royal Infirmary has now started a daily geriatrician ward round and a rise in referrals is anticipated. Although somewhat subjective, the team’s perception was that hospital admission had been “definitely avoided” in 184 patients (63%), with another 49 (17%) “unable to comment”. Joining an ongoing National Multicentre Randomised Controlled Trial will help answer this question in future. As expected, the majority of the patients were elderly, with 221 (75%) over the age of 75 years. Females outnumbered males 59% to 41%. Patients are taken on with a wide variety of problems. The commonest scenario is of acute infection with 59 patients having this (20%). Cardiac problems accounted for 48 patients (16%) and those with respiratory issues including COPD numbered 34 (12%). Many have multiple problems, with falls, delirium and musculoskeletal problems being common in this population. In each case the benefits and risks of staying at home versus being admitted to acute care are carefully evaluated with the patient, their family and the GP. If the clinical situation changes, then patients can be admitted to the “real” hospital and the team is able to ensure this is to the most appropriate setting for them. This happens for around 10% patients. Until October 2015, the service was provided 5 days a week but it is now available 7 days, allowing a greater number of patients to be referred. The Midlothian Enhanced Rapid Response Service is popular with patients and staff. Ring fenced funding from an integrated Health and Social Care Board has been key to its success.

If Integration Is the Answer, What Was the Question? What next for English Health and Social Care Partnerships?

‘Integrated care’ has been a key policy priority in English health and social care in recent years – although the extent to which this commitment is real rather than rhetorical remains open to debate. While everyone working in health and social care knows that single agency responses are insufficient when trying to support people with complex needs, there is a danger that ‘integrated care’ becomes a buzzword, apparently capable of resolving a range of different longstanding policy problems at once. This is particularly the case in a very challenging financial climate, when some policy makers appear to assume that this way of working will be able to dramatically improve outcomes whilst also significantly reducing costs. Such is the faith in integrated care, indeed, that it has even spawned its own policy joke: if you rang up some policy makers in the middle of the night to say that your house was on fire (so the joke goes), they would say: “that’s a shame – what you need is more integrated care!” Despite all this, some of the initiatives being developed to promote more integrated care seem remarkably similar to those pursued by the New Labour government of 1997–2010 – whether this is pooled health and social care funds, joint health and social care governance arrangements, integrated teams, or local pilots to produce rapid policy learning. However, one of the key lessons throughout this period is that local services seeking to integrate care can find it very difficult to do so in a system not designed with integration in mind. While different areas of the country have made progress at different times and in different ways, longstanding barriers to joint working, a rapidly changing policy context, significant central control and the emergence of other single agency priorities over time have all made it difficult to join services up in practice. Against this background, both research and recent practical experience suggest one thing that probably will not work, and four things that might. Often, debates about integrating care can focus on integrating separate organisations, and the English NHS in particular is reorganised on a regular basis. While such structural ‘solutions’ look dramatic and bold, the evidence around mergers and acquisitions (in both public and private sectors) is that they rarely achieve stated objectives, often fail to save money and tend to reduce morale, productivity and positive service developments (often for some 18 months to two years after the initial change – if it is managed well). Moreover, the evidence from the NHS is that hospital mergers tend not to take place for the reasons stated in the consultation document – but in response to local/national politics, to save money (even though they tend not to) and to get rid of management teams that are deemed to be failing. None of this is to say that changing structures cannot be part of a broader solution; it is just that it often isn’t – and it certainly should not be the first place to start. More fruitful might be some or all of the following four approaches:

Brigid and I – Part III

The following piece was written from a recording of a conversation between a person living with dementia, C. Freitas (pseudonym), who here is the voice of both Brigid and ‘I’, and an assistant psychologist. The recording was transcribed and subsequently edited jointly. C. Freitas has also written two other pieces entitled ‘My friend Brigid and I’, one of which was published in a previous edition of FPOP Newsletter (now Bulletin; Saints, 2015). She is a member of the Forget Me Nots, a group co-run by people living with dementia and psychology staff from Kent and Medway NHS and Social Care Partnership Trust. The group aims to promote engagement and wellbeing, to encourage communities to be more dementia-friendly, affect national and local policy, and to challenge the stigma surrounding dementia.The piece was written as a way to engage the media and the general public in discussion around stigma, and the role of the media in maintaining or reducing it.

Exploring the opportunities and challenges of devolution and integration to community nursing.

What is the model for integration in the UK? There is much rhetoric about joining up health and social care to address more than the physical needs of patients. To cite Maslow’s (1943) theory of the Hierarchy of Needs, there are many factors that play into an individual being ‘well’. These include safe and secure housing, education and employment, friendship, and a feeling of belonging. The integration of health and social care provides the opportunity for a holistic view of individuals, to ensure that they are best equipped to maintain their psychological and physical health, wellbeing, and safety. The Greater Manchester Health and Social Care Partnership (GMHSCP) aims to achieve an integrated system as a result of the Devolution Agenda (HM Treasury and Greater Manchester Combined Authority (GMCA), 2014). The role of the community practitioner is pivotal to the devolution vision being achieved, as community practitioners treat, observe, and truly understand the community around them. This article will explore the process and journey Greater Manchester has undertaken, the programmes’ aims and challenges, and the opportunities it affords community nurses.

How effective is the “Eat Better Feel Better” community‐based cooking intervention at tackling barriers of time, cost, waste and knowledge of healthy eating in Glasgow, Scotland?

Barriers of time, cost, waste and knowledge hinder cooking practice which is linked to poor diets. We aimed to evaluate the short and mid‐term effectiveness of a community‐based cooking intervention developed by the National Health Service (NHS) in Greater Glasgow and Clyde (GGC), Scotland in tackling the barriers of time, cost, waste and knowledge of healthy eating.We used a single‐group repeated measures design. A 6‐week, 2 hour per week cooking intervention was delivered in community‐based facilities in four health and social care partnership localities in NHS GGC. All participants who enrolled in this intervention were asked to complete questionnaires at baseline and post‐intervention, a follow‐up evaluation was conducted after 3–4 months via postal questionnaires.Of the 117 participants who enrolled, 62 completed baseline and post‐intervention questionnaires and 17 completed questionnaires at all three time‐points. The majority (65%) were female, over 45 years old, of Scottish descent, and were considered socioeconomically deprived. Confidence constructs related to cooking skills were assessed with a scale between 1 (not confident) and 7 (very confident), and are reported as medians for baseline, post‐intervention and follow‐up (p for changes from baseline to follow‐up). For the participants who completed all three questionnaires, a positive and significant change in 10 out of 12 confidence constructs was seen. These were as follows: “following a simple recipe (5, 6, 7; p=0.038), “planning meals before shopping” (4, 6, 5; p=0.030), “shopping on a budget (4, 5, 6; p=0.037), “shopping for healthier food” (4, 5, 5; p=0.008), “cooking new foods” (2, 5, 4; p=0.002, “cooking healthier foods” (4, 6, 5; p=0,006), “storing foods safely” (4, 6, 7; p=0.011); “using leftovers for other meals” (3.5, 5, 5; p=0.040), “reading food labels” (3, 5, 6; p=0.001) and “food hygiene” ( 5, 6, 7; p=0.034).Baseline and follow‐up results for cooking practices such as eating ready‐meals changed from 59% to 24% of those who responded “yes” (p=0.034) and throwing away leftovers from a median of 3 (once a week) to 2 (&lt; once a week) (p=0.017). Similarly, frequency in eating healthier choices (e.g. oily fish) increased from 2 (&lt; once a week) to 4 (2–4 times a week) (p=0.039) while knowledge for correct portion sizes increased from 35% to 88% (p=0.004). The median values for self‐reported spending on food per week were identical between the three time points (£40.00, p=0.653). However, the median values for the amount of money spent on takeaway/fast food per week at baseline, post‐intervention and follow‐up was £8.00, £5.00, and £2.00, respectively.In conclusion, despite the limited number of respondents, the results clearly show that the intervention was effective in increasing confidence and reducing the barriers of time, waste and knowledge in the short and mid‐term and has the potential to be embedded as part of public health improvement strategies to improve diet in Scotland.Support or Funding InformationResearch supported by University of Glasgow and NHS Greater Glasgow and Clyde.

A psychologically informed model for supporting meaningful involvement of people living with dementia facilitated by undergraduate psychology students

The East Kent Forget Me Nots is a service user involvement group, which is run by and for people living with dementia, with the support of the local Trust: Kent and Medway NHS and Social Care Partnership Trust (KMPT). The group began as an extension of the Trust’s Dementia Service User Envoy position, held by Keith Oliver. As involvement opportunities began to exceed the capacity of a single person, this necessitated the formation of a small group of people living with dementia, among whom the workload could be shared (Asquith, Guss &amp; Oliver, 2013). By the time the Forget Me Nots reached their second anniversary in November 2014, the group comprised more than 20 people living with dementia, and had made a significant impact in the field of dementia care and social policy.The group has advised on alterations to the Mental Capacity Act (2005) (DEEP, 2013), on clinical guidance papers (Guss et al., 2014a) and service user oriented materials (Guss et al., 2014b). This has ensured that the voices of people living with dementia have not gone unheeded, both locally within the Trust and the community, and nationally. Members of the group regularly speak at conferences about the subjective experience of dementia, and advocate for the needs of those living with the condition. Other projects, such asWelcome to Our World: A collection of life writing by people living with dementia(Forget Me Nots, 2014), have also been completed by the group, challenging pre-existing ideas about dementia in the community and providing new and enjoyable experiences for group members.This article will describe in detail the aims and modus operandi of the group, and how the working of the group is facilitated by undergraduate psychology students from the University of Kent. This article comes from the perspective of those students.

Prevent rough sleeping; create a psychologically informed environment

Purpose – The purpose of this paper is to inspire services to create Psychologically Informed Environments (PIEs) to support people experiencing homelessness, complex trauma and multiple exclusion. Design/methodology/approach – It outlines key elements of PIEs and how these have been implemented at the Waterloo Project; a 19 bed hostel and integrated health and social care partnership in Lambeth. It considers the importance of meeting individuals emotional and psychological needs to support them out of homelessness. Findings – The service review found a reliable reduction in residents’ mental distress and improved health and wellbeing. Repeat homelessness, anti-social and self-harming behaviour decreased whilst engagement with services, self-care and esteem increased. There are early indications of cost benefits to health and social care services. Staff reported professional development and an increase in their sense of personal accomplishment. Originality/value – The paper aims to share learning, good practice and the outcomes of a psychologically informed approach to working with individuals who have not had their needs met by existing services. It illustrates the actual and potential social and economic impact and value on both individuals and public services.

Health and social care partnership improves lives

The coordination of health and social care services in south London is helping older people to stay healthy and independent for longer. Liam Benison reports