Delivery Of Social Care Services Research Articles

Enabling social care services for older adults during periods of long-term social isolation: Service provider perspectives.

To investigate how small, local organisations were impacted by and responded to COVID-19 in their delivery of social care services to older adults (70 years and older). Lessons learnt and future implications are discussed. Six representatives from four social care services (five females and one male) participated in individual semistructured interviews. Responses were analysed thematically. The key themes identified were service providers' experience, perceived needs of older adults and adapting services. Service providers positioned themselves as front-line essential workers for their older adult clients, resulting in some emotional toll and distress for the service providers. They provided information, wellness checks and at-home assistance to keep their older adult clients connected. Service providers feel more prepared for future restrictions but flag the potential of training and supporting older adults to use technology to stay connected, as well as the need for more readily available funding to allow services to adapt quickly during times of crisis.

The Digital Skills, Experiences and Attitudes of the Northern Ireland Social Care Workforce Toward Technology for Learning and Development: Survey Study.

BackgroundContinual development of the social care workforce is a key element in improving outcomes for the users of social care services. As the delivery of social care services continues to benefit from innovation in assistive technologies, it is important that the digital capabilities of the social care workforce are aligned. Policy makers have highlighted the importance of using technology to support workforce learning and development, and the need to ensure that the workforce has the necessary digital skills to fully benefit from such provisions.ObjectiveThis study aims to identify the digital capability of the social care workforce in Northern Ireland and to explore the workforce’s appetite for and barriers to using technology for learning and development. This study is designed to answer the following research questions: (1) What is the digital capability of the social care workforce in Northern Ireland? (2) What is the workforce’s appetite to participate in digital learning and development? and (3) If there are barriers to the uptake of technology for learning and development, what are these barriers?MethodsA survey was created and distributed to the Northern Ireland social care workforce. This survey collected data on 127 metrics that described demographics, basic digital skills, technology confidence and access, factors that influence learning and development, experience with digital learning solutions, and perceived value and challenges of using technology for learning.ResultsThe survey was opened from December 13, 2018, to January 18, 2019. A total of 775 survey respondents completed the survey. The results indicated a workforce with a high level of self-reported basic digital skills and confidence. Face-to-face delivery of learning is still the most common method of accessing learning, which was used by 83.7% (649/775) of the respondents; however, this is closely followed by digital learning, which was used by 79.0% (612/775) of the respondents. There was a negative correlation between age and digital skills (rs=−0.262; P<.001), and a positive correlation between technology confidence and digital skills (rs=0.482; P<.001). There was also a negative correlation between age and the perceived value of technology (rs=−0.088; P=.02). The results indicated a predominantly motivated workforce in which a sizable portion is already engaged in informal digital learning. The results indicated that lower self-reported basic digital skills and confidence were associated with less interest in engaging with e-learning tools and that a portion of the workforce would benefit from additional basic digital skills training.ConclusionsThese promising results provide a positive outlook for the potential of digital learning and development within the social care workforce. The findings provide clear areas of focus for the future use of technology for learning and development of the social care workforce and considerations to maximize engagement with such approaches.

Prevention, Health Promotion, and Social Work: Aligning Health and Human Service Systems Through a Workforce for Health

The seminal Consensus Study by the National Academies of Science, Engineering, and Medicine released in September 2019 describes the benefits of integrating health and social care service delivery, underscoring the central role of social determinants of health (SDOH) in health outcomes. Although the report's focus on the integration of health and social care contributes a much needed perspective to the national discourse on SDOH and offers a useful framework for organizing service delivery activities, the omission of prevention and health promotion throughout the report is a substantial limitation.We call for increased attention to and investment in prevention and health promotion in the proposed 5As framework. We contend that effectively addressing SDOH and improving alignment between health and social systems require reconceptualization of the traditional health care workforce and renewed state and national advocacy efforts.A paradigm shift encompassing a broader "workforce for health" that is well trained in prevention, health promotion, and advocacy is critical to addressing SDOH, improving population health outcomes, and achieving health equity. Given their professional mission, training, expertise, and scope of practice, social workers are well positioned to lead this effort.

Commissioning social care for people with dementia living at home: Findings from a national survey.

To explore the complexities, circumstances, and range of services commissioned for people with dementia living at home. A national survey was used to collect data from English local authorities in 2015. Commissioners of services for older adults were invited to complete a questionnaire. An exploratory cluster analysis of nominal data was conducted using a TwoStep procedure to identify distinct groups. A total of 122 authorities (83%) responded to the request. Four approaches to commissioning were identified, reflecting commissioning practices at the organisational, strategic, and individual service user levels. Commissioning at the service user level was most apparent. Bivariate analysis found that these configurations were not associated with the types of dementia specific services provided but were related to the number available. Authorities delivered a greater range of specialist services when joint commissioning between social care and health partners was undertaken. However, the joint commissioning of services was less observed in services specifically for people with dementia than in generic services for all older people. There was limited evidence that local circumstances (population configuration and deprivation levels) were associated with this approach to commissioning. The significant role of health partners in the delivery of social care services to support older people living with dementia in their own homes is evident. As the population with dementia ages and physical health needs increase, how dementia specific services differ from and complement those services available to all older people warrants further investigation.

Explainable statistical learning in public health for policy development: the case of real-world suicide data

BackgroundIn recent years, the availability of publicly available data related to public health has significantly increased. These data have substantial potential to develop public health policy; however, this requires meaningful and insightful analysis. Our aim is to demonstrate how data analysis techniques can be used to address the issues of data reduction, prediction and explanation using online available public health data, in order to provide a sound basis for informing public health policy.MethodsObservational suicide prevention data were analysed from an existing online United Kingdom national public health database. Multi-collinearity analysis and principal-component analysis were used to reduce correlated data, followed by regression analyses for prediction and explanation of suicide.ResultsMulti-collinearity analysis was effective in reducing the indicator set of predictors by 30% and principal component analysis further reduced the set by 86%. Regression for prediction identified four significant indicator predictors of suicide behaviour (emergency hospital admissions for intentional self-harm, children leaving care, statutory homelessness and self-reported well-being/low happiness) and two main component predictors (relatedness dysfunction, and behavioural problems and mental illness). Regression for explanation identified significant moderation of a well-being predictor (low happiness) of suicide behaviour by a social factor (living alone), thereby supporting existing theory and providing insight beyond the results of regression for prediction. Two independent predictors capturing relatedness needs in social care service delivery were also identified.ConclusionsWe demonstrate the effectiveness of regression techniques in the analysis of online public health data. Regression analysis for prediction and explanation can both be appropriate for public health data analysis for a better understanding of public health outcomes. It is therefore essential to clarify the aim of the analysis (prediction accuracy or theory development) as a basis for choosing the most appropriate model. We apply these techniques to the analysis of suicide data; however, we argue that the analysis presented in this study should be applied to datasets across public health in order to improve the quality of health policy recommendations.

Maintaining social care provision in the context of financial austerity.

There is significant national interest in tackling issues surrounding the needs of vulnerable children and adults. At the same time, UK cities are under significant financial strain, as local government financial settlements (the distribution of central government resources) decrease in real terms and yet urban populations, which draw on local government services, continue to grow. This study focusses on the city of Birmingham, the UK’s largest and most populous city outside of London. In a data-led study, using data derived from personal social care records, we analyse the management and delivery of social care services by Birmingham City Council, which itself is the largest local authority in Europe. This research employs state-of-the-art data analytic techniques to analyse six years of Birmingham City Council social care data, to identify: (i) Service cost profiles over time; (ii) Geographic dimensions to service demand and delivery; (iii) Patterns in the provision of services, which may assist with future service planning and provision and (iv) The extent to which data value and data protection interact. In response to recent fiscal challenges, Birmingham City Council is expected to make savings of £815 million over the 9-year period 2011/12 to 2019/20. Delivering savings of this scale, whilst protecting and safeguarding the most vulnerable citizens within a growing urban population, is one of the biggest challenges facing the UK’s second largest city.

Solitary, merge or collaborate. Determinants of collaboration of elderly care organizations: a case survey approach

Introduction : Traditionally, elderly care organizations play a pivotal role in integrating care for an ageing population, but recently this role has been challenged due to competition from other service providers, such as for-profit organizations, hospitals, home- and primary care organizations. In addition, the increasing complexity of current health care, combined with ageing and housing issues as well as rising co-morbidity in Belgium leads to a rising demand for collaboration. Not only do elderly care organizations have to deal with more and more tasks that are unique, but also are resources distributed across various service providers. As such, elderly care organizations are moving slowly from managing mainly physical assets such as housing facilities towards more intellectual and relational capacities and treatment services resulting into shared service centers and tailor-made health and social care solutions. Theory/methods : Although a number of factors have been proposed how to integrate health- and social care service delivery, collaboration pervades most discussions. We argue in this article that elderly care organizations follow a combination of three underlying strategic motives based on effectiveness, efficiency and legitimacy criteria to make a conscious, intentional decision to establish a relationship with other organizations for explicitly formulated purposes. We conceptualize these relationships as three ideal types: solitary, merger or collaboration and propose that the presence or absence of these types is explained by a combination of the changing nature in the task, the organizational configuration and its interdependency on others in the external environment. The article presents a case survey approach of 18 elderly care organizations. Data were collected in a five months period of time by using semi-structured interviews of key representatives and a survey. In addition, five workshops were organized and secondary data on elderly care organizations was collected. We applied Fuzzy-Set Qualitative Comparative analysis to analyze what, if any, combination of determinants explains whether elderly care organizations act solitary, merge or collaborate. Results, conclusion and discussion : Implications of the findings for elderly care organizations are discussed in light of the rising health care issues and increasing competition in Flanders Belgium. In particular, we are interested in which combinatory recipes, if any, of task, organizational configuration, and interdependency explain the presence or absence of a particular ideal type of collaboration. Furthermore, future recommendations are presented to further the development of how elderly care organizations can deal with their changing role in the healthcare system.

Integration of health and social care for children with complex health conditions: an assessment of the policy and organisational context in Europe

Introduction : Across Europe, little is known about the policy, organisational and practical aspects of integrated health and social care for children with complex care needs (CCN) in Europe. This growing population of children typically have varying and extensive needs, that often require a coordinated and integrated response from multiple care providers. Aim : This study is part of a large EU funded project on children’s primary health care, Models of Child Health Appraised (MOCHA). This study seeks to examine the legal, policy and organisational structures for social care services for CCN in 30 European countries and to explore how they interface with primary care. Method : Using a network of child health and social care experts (Country Agents) across 30 EU countries, a standard set of questions were asked on the legal, policy and organisational structure for the delivery of social care services to these children and their families. The questions included a case vignette which sought to explore how both their health and social care needs were met in each country. Quantitative responses were analysed using descriptive statistics and qualitative responses were analysed using a thematic framework approach. Results : While some countries deliver social care through government agencies, many outsource services to non-profit and commercial organisations. Just over one-third of the countries surveyed have an established policy framework with specific recommendations on the integration of social care services with health care for children. Ongoing work will explore if this improved practice. Just under one third of the countries surveyed have a care coordinator in place for children with CCN; this role is identified as a positive facilitator of optimum care delivery. Discussion : The diversity of social care structures across the EU illustrates the challenge in trying to develop a model that can be applied across multiple countries. Further work in this project will explore optimum pathways for care delivery at the social healthcare interface. Conclusions : The results of this study suggest that meeting the wider needs (social care needs) of CCN requires a care coordination/management approach based on the wider needs of children so that they can lead an “ordinary life”. Lessons learned : Social care delivery is not uniform across the countries, however, the case vignette approach ensured some uniformity in response which was helpful in validating results. Limitations : The absence of national outcome data on social care needs for children with CCN in the participating countries adds to the complexity of comparing the effectiveness of country wide approaches to supporting this group of children and their families. Suggestions for future work : While most children with CCN require additional health and social care interventions, others may have complex social care needs without a complex health condition, for example, children who have child welfare and child protection requirements. The role of primary care in identifying and/or meeting these needs requires further exploration.

A Study on the Social Care Service Delivery System for Older People: Focusing on the Perspectives of Public Sector Employees and Private Service Providers

A Study on the Social Care Service Delivery System for Older People: Focusing on the Perspectives of Public Sector Employees and Private Service Providers

G229 What mothers do when there is a child with autism and younger siblings in the family: the implementation of the findings of a doctoral study, into a heuristic for the continuous improvement of service user family experience

Aim The purpose of this abstract is to; Present the results of a qualitative research study exploring the experiences of mothers of children with autism and other younger siblings, Present the conceptual framework emerging from the results of this research study, which have informed a heuristic, values based model for health and social care service delivery improvement to families raising children with autism and other continuing care needs, Introduce this children and young people’s rights and values based model, in terms of it’s implementation, in the form of a new charitable, membership organisation (Parent Action), which is being developed in Northern Ireland. Methods In the doctoral research study which is the subject of this abstract, Interpretative Phenomenological Analysis (IPA) was used as methodology and method to explore the experiences of six mothers in Northern Ireland. Eighteen semi structured interviews were carried out with the mothers, three with each mother over a twelve month data collection period. Each interview was four to six months apart and all interviews were carried out in the mother’s own homes. Data analysis was carried out on a continuous basis by the researcher, using critical reflection techniques to support the use of the six steps of IPA. Results Data analysis resulted in six themes of mothers experience, namely; ‘Children’s Development’; ‘Mother’s Expertise’; ‘Balancing’; Mothers Resilience and Adaptation’; ‘Mothers Confidence’; ‘Trusted Social Relationships’. The connetions and patterns between these themes, across all six mothers experience, comprise the study conceptual framework. Conclusion The results of this research have been developed into a children’s rights and values based model, which is forming the basis of activities of parent and organisation members of Parent Action. This Parent Action model is represented below.

PATIENT AND PUBLIC INVOLVEMENT IN HEALTH AND SOCIAL CARE IN ENGLAND

Signifcant changes were brought about in health and social care in England in 2013, as a result of the Health and Social Care Act 2012. As part of the changes in 2013, a network of local Healthwatch organisations was set up to act as the people’s champion for health and social care in their local area. Healthwatch Shropshire is one of these local Healthwatch. It gathers experiences and opinions from patients, carers, service users and the wider public about publicly funded health and social care services and uses this information to infuence health and social care service delivery. Healthwatch Shropshire also recruits and trains volunteers to support its work, in particular, specially trained volunteers visit locations where health and social care services are provided and report on their fndings. Healthwatch Shropshire also has information and signposting services, provides volunteering opportunities, and has a statutory authority to visit locations where health and social care services are being delivered.Keywords: patient participation, consumer participation, public opinion

The Vanguard Method as Applied to the Design and Management of English and Welsh Children’s Services Departments

This paper follows several case studies where the children’s services departments of English and Welsh local authorities have fundamentally redesigned the way they worked following the application of the Vanguard Method (Seddon, Systems thinking in the public sector, 2008), a particular form of systems thinking. After first studying the way the children’s social care service worked as a system, the social workers in these authorities were able to demonstrate the way that government-prescribed IT and performance measures were restricting the way they could do what was shown to matter to the children in their care. The paper will document how, after being granted ministerial permission to suspend the use of their old performance measures and IT, a new set of operating principles was developed and employed. The redesigned system has shown encouraging early results. Evidence from these case studies (following Yin 2009) is presented in the form of recorded operational improvements and statements from participants. The paper will be of topical relevance to all involved in social care in the light of the government-commissioned Munro Review (Munro, The Munro Review of child protection: final report, 2011). The issues discussed will also be germane to the many other public sector partner agencies involved in the delivery of social care services (e.g. police, health, housing associations).

Implementing personalisation for people with mental health problems: A comparative case study of four local authorities in England

BackgroundEnhancing choice and control for people using services is a mental health and social-care service priority in England. Personalisation is a new policy and practice for delivery of social-care services where eligible adults are allocated a personal budget to spend to meet their agreed support needs.AimsTo describe approaches to introducing personal budgets to people with severe and enduring mental health needs, and to identify facilitators or barriers encountered.MethodWithin four English local authority (LA) areas, purposively selected to provide maximum variation, semi-structured interviews were undertaken with 58 participants from LAs, NHS trusts and third-sector organisations. An Interpretive Framework analysis considered within- and across-site insights.ResultsIssues arising from the implementation of personalisation for people with mental health needs are presented under two general themes: “responsibility and power” and “vision and leadership”. Key challenges identified were complexities of working across NHS and LAs, the importance of effective leadership and engagement with service user representatives.ConclusionsImplementing personal budgets in mental health requires effective engagement of health and social-care systems. Change processes need strong leadership, clear vision and personal commitment, with ownership by all key stakeholders, including front-line practitioners.

Human rights and intellectual disabilities in an era of ‘choice’

Efforts to uphold and promote the human rights of people with intellectual disabilities (ID) are being affected by the increasing emphasis on 'choice' in the delivery of social care services. While rights presume subjects or selves to whom they apply, there is a disconnect between the subjects presumed within human rights frameworks and the variable capacities of a heterogeneous ID population. This disconnect is amplified by choice discourses which characterise current service provision based upon neoliberal ideologies. Conceptual assumptions and theoretical positions associated with human rights in relation to people with ID are critically examined. The analysis results in an argument that current conceptualisations of personhood in relation to human rights exclude people with ID. The adverse effects of this exclusion are exacerbated within services which emphasise the permissive rights associated with a neoliberal agenda of 'choice' over protective rights. In order to ensure that the human rights of people with ID are upheld, neoliberal emphases on choice need to be tempered and a more nuanced and inclusive notion of personhood in relation to universal human rights needs to be adopted.

Doing More for Less? Developing Sustainable Systems of Social Care in the Context of Climate Change and Public Spending Cuts

This article opens a debate on how to make social care in England more sustainable in the context of environmental, social and economic changes. Based on an innovative research project commissioned by the Department of Health through the Social Care Institute for Excellence, we provide an analysis of the policy context for sustainability in the social care sector as set out by New Labour and discuss the extent to which the new coalition government has taken this agenda forward. Drawing on case studies from England and Wales, the article describes a range of good practice for embedding sustainability within the commissioning and delivery of social care services. We then consider how to develop frameworks that support sustainable practices within social care services, and critically discuss some of drivers and challenges. We conclude that social care can only be sustainable if an integrated approach is taken that combines environmental, economic and social considerations. The current fiscal crisis has added urgency to the need to develop innovative systems of social care based on co-production, mutualism and localism. Piloting and mainstreaming approaches such as these can only be done with strong leadership, long-term thinking and meaningful incentives.

The SAIL databank: linking multiple health and social care datasets

BackgroundVast amounts of data are collected about patients and service users in the course of health and social care service delivery. Electronic data systems for patient records have the potential to revolutionise service delivery and research. But in order to achieve this, it is essential that the ability to link the data at the individual record level be retained whilst adhering to the principles of information governance. The SAIL (Secure Anonymised Information Linkage) databank has been established using disparate datasets, and over 500 million records from multiple health and social care service providers have been loaded to date, with further growth in progress.MethodsHaving established the infrastructure of the databank, the aim of this work was to develop and implement an accurate matching process to enable the assignment of a unique Anonymous Linking Field (ALF) to person-based records to make the databank ready for record-linkage research studies. An SQL-based matching algorithm (MACRAL, Matching Algorithm for Consistent Results in Anonymised Linkage) was developed for this purpose. Firstly the suitability of using a valid NHS number as the basis of a unique identifier was assessed using MACRAL. Secondly, MACRAL was applied in turn to match primary care, secondary care and social services datasets to the NHS Administrative Register (NHSAR), to assess the efficacy of this process, and the optimum matching technique.ResultsThe validation of using the NHS number yielded specificity values > 99.8% and sensitivity values > 94.6% using probabilistic record linkage (PRL) at the 50% threshold, and error rates were < 0.2%. A range of techniques for matching datasets to the NHSAR were applied and the optimum technique resulted in sensitivity values of: 99.9% for a GP dataset from primary care, 99.3% for a PEDW dataset from secondary care and 95.2% for the PARIS database from social care.ConclusionWith the infrastructure that has been put in place, the reliable matching process that has been developed enables an ALF to be consistently allocated to records in the databank. The SAIL databank represents a research-ready platform for record-linkage studies.

Editorial

Editorial