Social Care Services In England Research Articles

Integrated Care Systems in England: Progress towards forming new multi-stakeholder partnerships to develop quality.

Background: Health and social care services in England have been restructured to 42 Integrated Care Systems (ICS). ICSs are responsible for delivering integrated services in their local area to prevent illness; identify and treat illness effectively; and provide support to improve quality of life for people with long-term illness or disability. Under the umbrella of ICSs, previously siloed organisations need to work together to deliver quality care. This study aimed to understand how these new ways of working impact on the development of their quality agenda.
 Methods: Semi-structured interviews were undertaken with senior representatives in demographically and geographically diverse ICS. Interviews were audio recorded, transcribed verbatim and analysed in NVivo using a thematic framework approach. Two Patient and Public Involvement team members contributed to the study design and data analysis. The study is conducted at two points in time; the data reported here is the baseline collected shortly (November 2021 to May 2022) before the ICSs’ formal constitution in July 2022.
 Results: Sixty interviews across four ICSs were conducted with senior representatives (e.g. ICS CEO, chief nurse, quality leads, director of social services, director of public health, the public and local communities). Across all ICSs, progress had been made with creating ICS specific committees, with new roles created and leaders appointed, and new partnerships emerging. Positive learning on collaborating with diverse partners had occurred during the COVID-19 pandemic and through previous local initiatives to integrate services. In two ICSs, there was less history of such collaborative work and their new partnerships were emerging more slowly. 
 Generally, it was agreed that strong leadership, supported by broad and effective system partnerships, was essential to develop the ICSs’ structure and to deliver quality. Key partners to support the leadership were senior partners in acute hospital trusts, primary care, social care, public health, Healthwatch (the health and social care champion for service users), voluntary services, and patient representatives. 
 Some concerns were raised that made collaborations more challenging, including differences in language and work culture between the key partners, and health dominating the quality agenda. Overall, it was felt that social care, public health and voluntary services were heard less. They were being consulted, but rarely had leadership roles and leaders from these communities often felt that they were not equal partners. Most participants highlighted the importance of consulting patients and the public and acknowledged that this was not done effectively yet with too few people, who lacked diversity, consulted; and an overreliance on Healthwatch. 
 Discussion: This restructure of the health and social care system shows that new partnerships can be formed between previously siloed organisations but that these take time to develop. In particular, organisations or people who have traditionally been less consulted such as social care, public health, and patients and the public still need to become more equal partners in developing the quality agenda. Follow up interviews will bring greater clarity on how this restructure will maintain and promote quality across services. 

Outsourcing and children's social care services: an observational longitudinal analysis of inspection outcomes among English children's homes and local authorities

BackgroundMost children's social care services in England are operated by for-profit companies, but the implications of this development are not well understood. We aimed to evaluate the associations between for-profit outsourcing and quality of service provision among local authorities and children's home providers in England, UK. MethodsWe did an observational longitudinal analysis of inspection outcomes among English children's homes and local authorities. We created and analysed a novel, longitudinal dataset of inspections from Ofsted (ie, the independent regulator of children's social care in England) over a period of 7 years (2014–21; n=13 452). We also analysed the association between Ofsted local authority ratings (n=147) and the use of for-profit outsourcing. FindingsWe found that for-profit children's home providers are significantly more likely to be rated of lower quality than both public and third sector services across all provider level Ofsted inspection domains. For example, for-profit providers have 33·7% lower odds (odds ratio [OR] 0·663; 95% CI 0·522–0·842) than local authority providers of being rated “Outstanding”, “Good”, or “Requires Improvement”, as opposed to “Inadequate” in the main “Overall Experiences” Ofsted category. For-profit services also violate more legal requirements (OR 0·380 [95% CI 0·186–0·575]) and receive more recommendations (0·391 [0·242–0·540]) than local authority providers. These findings are robust to model specification and consistent over the full analysed period. Further, we found provisional evidence that local authority Ofsted ratings are negatively correlated with the percentage of for-profit outsourcing, suggesting that poorly performing local authorities tend to outsource a greater amount of their services than well performing local authorities. InterpretationOur findings are of considerable concern given the focus of these services on society's most vulnerable service users. However, caution is needed in terms of regulating the sector going forward, as the role of for-profit providers cannot be replaced without substantial coordination and long-term planning. FundingThe John Fell Fund and the Carlsberg Foundation.

Outsourcing and children's social care: A longitudinal analysis of inspection outcomes among English children's homes and local authorities

Most residential children's social care services in England, including children's homes, are operated by for-profit companies, but the implications of this development are not well understood. This paper aims to address this gap by undertaking the first longitudinal and comprehensive evaluation of the associations between for-profit outsourcing and quality of service provision among English local authorities and children's homes. To enable investigation of the implications of outsourcing children's residential social care services, we create and analyse a novel and longitudinal dataset covering more than 13,000 children's home inspections by Ofsted (the independent regulator of children's social care in England) over a period of 7 years (2014–2021). We also investigate the association between Ofsted local authority (LA) ratings and the reliance of LAs on for-profit and third sector outsourcing of children in care placements. Our analysis shows that for-profit providers are statistically significantly more likely to be rated of lower quality than both public and third sector services. For-profit children's homes also violate a greater number of requirements and receive more recommendations compared to other ownership types. These findings are robust to model specification and consistent over the full analysed period. At LA level, we find provisional evidence that LA Ofsted ratings are negatively correlated with the percentage of for-profit outsourcing, suggesting that LAs which outsource a greater amount of their children in care placements perform less well than those which do not. These findings are of significant concern given the focus of these services on society's most vulnerable service users. However, caution is needed in terms of regulating the sector going forward, as the role of for-profit provision cannot be replaced without substantial coordination and long-term planning.

The cumulative proportion of children receiving social care services in England: a whole population administrative data cohort study.

ObjectivesChildren who receive social care services have high levels of need, but the proportion of the population they comprise is unknown. We aimed to estimate the cumulative proportion of children in England who ever become looked after (CLA) or placed on a child in need (CiN) plan by age 18.
 ApproachWe analysed longitudinal administrative children’s social care data: the CLA dataset (available from 1992) and the CiN census (from 2011/12) which respectively contain information on all children in England who become CLA and are assessed as being CiN. The number of CLA in birth cohorts from 1992 to 2016 was divided by Office for National Statistics population denominators to estimate the overall cumulative proportion and by EthPOP denominators to describe ethnic variation. Because of incomplete coverage of CiN data, we combined estimates from different birth cohorts, making reductions to the numerator to address left-censoring.
 ResultsThe cumulative proportion of children who became CLA before their 18th birthday was 3% for those born in 1992, rising to 4% for those born in 2000. For subsequent cohorts (who had not yet reached age 18), the cumulative proportion by earlier ages also rose over time, but plateaued with the 2012 birth cohort. The cumulative proportion varied by ethnicity: among children born in 2000, it was 18% for those of other ethnicity (many of whom were unaccompanied asylum seeking children), 11% for black children and 7% for those of mixed ethnicity. Most children first became looked after before age 2, with a secondary peak around age 16. Finally, we estimated that 42% of all children in England were recognised as CiN before age 18.
 ConclusionSignificant proportions of children receive social care services in England. The ethnic variation we observed may indicate systematic differences in how the care system responds to CLA from different backgrounds. These results have implications for service design, as well as preventive strategies to improve child health and well-being.

From ‘no further action’ to taking action: England’s shifting social work responses to extra-familial harm

In 2018, England’s safeguarding guidelines were amended to explicitly recognise a need for child protection responses to extra-familial harms. This article explores the feasibility of these amendments, using quantitative and qualitative analysis of case-file data, as well as reflective workshops, from five children’s social care services in England and Wales, in the context of wider policy and practice frameworks that guide the delivery of child protection systems and responses to harm beyond families. Green shoots of contextual social work practice were evident in the data set. However, variance within and across participating services raises questions about whether contextual social work responses to extra-familial harm are sustainable in child protection systems dominated by a focus on parental responsibility. Opportunities to use contextual responses to extra-familial harm as a gateway to reform individualised child protection practices more broadly are also discussed.

What does Success Look Like for Leaders of Integrated Health and Social Care Systems? a Realist Review.

Introduction:Health and social care services in England are moving towards greater integration, yet little is known about how leadership of integrated care teams and systems can be supported and improved. This realist review explores what works about the leadership of integrated care teams and systems, for whom, in what circumstances and why.Methods:A realist synthesis approach was undertaken in 2020 to explore English language literature on the leadership of integrated care teams and systems, complemented by ongoing stakeholder consultation.Results:Evidence was identified for seven potentially important components of leadership in integrated care teams and systems: ‘inspiring intent to work together’; ‘creating the conditions’; ‘balancing multiple perspectives’; ‘working with power’; ‘taking a wider view’; ‘a commitment to learning and development’ and ‘clarifying complexity’.Discussion:Research into the leadership of integrated care teams and systems is limited, with ideas often reverting to existing framings of leadership, where teams and organisations are less complex. Research also often focuses on the importance of who the leader is rather than what they do.Conclusion:This review has generated new perspectives on the leadership of integrated care teams and systems that can be built upon, developed, and tested further.

Exploring the impact of Ofsted inspections on performance in children’s social care

Children’s social care services in England are inspected by a government agency, Ofsted. This paper reports on the impact of Ofsted inspections on rates of intervention and other performance measures, such as expenditure and workforce, drawing on a quantitative analysis of national datasets. Annual published returns from 150 English local authorities from 2009 to 19 were combined with results from Ofsted inspections under the Single Inspection Framework (2014–17), which covered all local authorities. Interrupted time series (ITS) analysis was undertaken to find out whether an inspection had a significant effect on performance in the context of trends pre- and post-inspection, and whether this effect varied according to the type of judgement. The results showed discontinuities in a range of indicators in the year of an inspection and the year afterwards. An increase in rates of child protection interventions occurred at the time of an inspection, which was most pronounced in local authorities receiving an inadequate judgement. An inadequate judgement led to a steep rise in spending and use of agency workers compared to other local authorities. The findings suggest that a short-term spike in intervention rates is an unintended consequence of inspections, which is sustained only in local authorities judged to be performing badly. Implications are discussed for performance in the sector and the purpose of inspection.

Coronavirus-driven innovation and inspiration from the CQC

The article focuses on Care Quality Commission was established in 2009 to regulate and inspect health and social care services in England and duty to give sometimes damning assessments on how individual healthcare institutions are performing make it an organisation that is feared rather than loved.

Environmental impact of personal protective equipment distributed for use by health and social care services in England in the first six months of the COVID-19 pandemic.

To quantify the environmental impact of personal protective equipment (PPE) distributed for use by the health and social care system to control the spread of SARS-CoV-2 in England, and model strategies for mitigating the environmental impact. Life cycle assessment was used to determine environmental impacts of PPE distributed to health and social care in England during the first six months of the COVID-19 pandemic. The base scenario assumed all products were single-use and disposed of via clinical waste. Scenario modelling was used to determine the effect of environmental mitigation strategies: (1) eliminating international travel during supply; (2) eliminating glove use; (3) reusing gowns and face shields; and (4) maximal recycling. Royal Sussex County Hospital, Brighton, UK. The carbon footprint of PPE distributed during the study period totalled 106,478 tonnes CO2e, with greatest contributions from gloves, aprons, face shields and Type IIR surgical masks. The estimated damage to human health was 239 DALYs (disability-adjusted life years), impact on ecosystems was 0.47 species.year (loss of local species per year), and impact on resource depletion was costed at US $12.7m (GBP £9.3m). Scenario modelling indicated UK manufacture would have reduced the carbon footprint by 12%, eliminating gloves by 45%, reusing gowns and gloves by 10% and maximal recycling by 35%. A combination of strategies may have reduced the carbon footprint by 75% compared with the base scenario, and saved an estimated 183 DALYS, 0.34 species.year and US $7.4m (GBP £5.4m) due to resource depletion. The environmental impact of PPE is large and could be reduced through domestic manufacture, rationalising glove use, using reusables where possible and optimising waste management.

Do performance indicators predict regulator ratings of healthcare providers? Cross-sectional study of acute hospitals in England.

ObjectiveTo determine whether a large set of care performance indicators (‘Intelligent Monitoring (IM)’) can be used to predict the Care Quality Commission’s (CQC) acute hospital trust provider ratings.DesignThe IM dataset and first-inspection ratings were used to build linear and ordered logistic regression models for the whole dataset (all trusts). This was repeated for subsets of the trusts, with these models then applied to predict the inspection ratings of the remaining trusts.SettingThe United Kingdom Department of Health and Social Care’s Care Quality Commission is the regulator for all health and social care services in England. We consider their first-inspection cycle of acute hospital trusts (2013–2016).ParticipantsAll 156 English NHS acute hospital trusts.Intervention(s)None.Main Outcome Measure(s)Percentage of correct predictions and weighted kappa.ResultsOnly 24% of the predicted overall ratings for the test sample were correct and the weighted kappa of 0.01 indicates very poor agreement between predicted and actual ratings. This lack of predictive power is also found for each of the rating domains.ConclusionWhile hospital inspections draw on a much wider set of information, the poor power of performance indicators to predict subsequent inspection ratings may call into question the validity of indicators, ratings or both. We conclude that a number of changes to the way performance indicators are collected and used could improve their predictive value, and suggest that assessing predictive power should be undertaken prospectively when the sets of indicators are being designed and selected by regulators.

Screen, Ration and Churn: Demand Management and the Crisis in Children’s Social Care

Abstract This article presents findings from a quantitative study of the national data-sets for statutory children’s social care services in England. The aim of the study was to examine how demand management varied in local authorities with differing levels of area deprivation. About 152 local authorities census returns and other statistical indicators covering the period 2014–2017 were combined into a single data-set. Statistical analysis was undertaken to explore trends over time and correlations between indicators that might indicate patterns in the way demand was managed. Findings showed that high levels of deprivation have continued to be strongly linked to high levels of activity and that local authorities have continued to increase their use of protective interventions relative to referrals. Evidence was found for three interconnected mechanisms, through which local authorities tended to manage demand for services: screening, rationing and workforce churn. The article describes these mechanisms and comments on their significance for the current crisis of demand in the sector.

Did government spending cuts to social care for older people lead to an increase in emergency hospital admissions? An ecological study, England 2005–2016

ObjectivesGovernment spending on social care in England reduced substantially in real terms following the economic crisis in 2008, meanwhile emergency admissions to hospitals have increased. We aimed to assess the...

Cohort profile: Children in Need Census (CIN) records of children referred for social care support in England

PurposeThe Children in Need Census (CIN) is a case-based administrative dataset on children referred to social care services in England. CIN includes information on the ‘needs’ of children, and whether...

Social care managers and care workers’ understandings of personalisation in older people’s services

PurposeThe purpose of this paper is to explore the impact of personalisation policy on the providers of social care services in England, mainly to older people, within the context of austerity and different conceptions of personalisation.Design/methodology/approachThe paper draws on part of a longitudinal study of the care workforce, which involved 188 interviews with managers and staff, undertaken in two rounds.FindingsFour themes were identified: changing understandings and awareness of personalisation; adapting services to fit new requirements; differences in contracting; and the impact on business viability.Research limitations/implicationsThe paper reflects a second look at the data focussing on a particular theme, which was not the focus of the research study. Furthermore, the data were gathered from self-selecting participants working in services in four contrasting areas, rather than a representative sample.Practical implicationsThe research raises questions about the impact of a commercial model of “personalised care”, involving personal budgets (PBs) and spot contracts, on the stability of social care markets. Without a pluralistic, well-funded and vibrant social care market, it is hard to increase the consumer choice of services from a range of possible providers and, therefore, fulfil the government’s purposes for personalisation, particularly in a context of falling revenues from local authorities.Originality/valueThe research presents an analysis of interviews with care providers and care workers mainly working with older people. Their views on personalisation have not often been considered in contrast to the sizeable literature on PBs recipients and social workers.

Care Quality Commission report highlights shortfalls in service provision for over 65s

Beyond Barriers takes a holistic look at the interaction of NHS and social care services in England

An analysis of Ofsted inspection reports for children's social care services in England

AbstractThe Office for Standards in Education, Children's Services and Skills (Ofsted) is responsible for inspecting services that care for children and young people in England and Wales. This paper presents findings from an independent study of Ofsted inspections into children's social care in England, covering reports under three inspection frameworks during the period 2009 to 2016. The research aimed to identify the main themes of recommendations made in Ofsted reports and to explore similarities and differences between frameworks and between local authorities. The methodological approach was document analysis. A stratified sample of 60 reports was prepared on the basis of inspection framework and local authority characteristics such as local deprivation, Ofsted rating, and urban/rural category. A thematic analysis was conducted of the recommendations in each report, with emerging themes subjected to an iterative process of coding and categorization. The findings identified nine categories of themes, the most common of which were performance management, casework, oversight of practice, and multiagency working. Overall, the recommendations were strongly oriented towards process issues and compliance with standards. Recommendations were found to differ somewhat between inspection frameworks but remained largely consistent between local authorities with different characteristics. The paper concludes by examining the implications of findings for the current regulatory framework in children's social care.

A review of Care Quality Commission criticisms of English community substance misuse treatment

The Care Quality Commission (CQC) monitors, inspects and regulates health and social care services in England to ensure they meet fundamental quality and safety standards. This article describes a review of 60 CQC inspection reports of community substance misuse services in England, to identify the topics that were evaluated negatively and were most frequently made the subject of requirement notices. Each report contains four types of statements: descriptive, evaluative, advisory and requirement notices. The evaluative and advisory statements, as well as the requirement notices, were recorded and categorised by topic, and frequency charts were constructed to show how often different topics were rated positively or negatively. The article highlights overall shortcomings of the English substance misuse treatment system and discusses possible causes, aspects of the inspection process and the potential effect of these reports on practice.

Paying for Care Costs in Later Life Using the Value in People\u2019s Homes

With the number of U.K. citizens aged 75+ doubling to 10 million by 2040, and with 1.3 million people already receiving social care services in England alone, social care funding is a key public policy challenge. The government has launched a set of reforms designed to get social care funding onto a sustainable footing by establishing a new level for what individuals and the state will pay. The reforms are designed to encourage individuals to explore how best to use their available wealth and assets to meet care costs through a mixed system of local authority and private sector care-funding options. One option is to use the value in the home to bridge the cost between out-of-pocket costs and care home fees. In this article, we consider two new financial arrangements designed to meet the needs of people in different financial circumstances based on releasing equity from the home. These are an equity-backed insurance product and an “equity bank” that lets a person draw down an income from their home.

Factor structure and construct validity of the Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer).

BackgroundThe ASCOT-Carer is a self-report instrument designed to measure social care-related quality of life (SCRQoL). This article presents the psychometric testing and validation of the ASCOT-Carer four response-level interview (INT4) in a sample of unpaid carers of adults who receive publicly funded social care services in England.MethodsUnpaid carers were identified through a survey of users of publicly funded social care services in England. Three hundred and eighty-seven carers completed a face-to-face or telephone interview. Data on variables hypothesised to be related to SCRQoL (e.g. characteristics of the carer, cared-for person and care situation) and measures of carer experience, strain, health-related quality of life and overall QoL were collected. Relationships between these variables and overall SCRQoL score were evaluated through correlation, ANOVA and regression analysis to test the construct validity of the scale. Internal reliability was assessed using Cronbach’s alpha and feasibility by the number of missing responses.ResultsThe construct validity was supported by statistically significant relationships between SCRQoL and scores on instruments of related constructs, as well as with characteristics of the carer and care recipient in univariate and multivariate analyses. A Cronbach’s alpha of 0.87 (seven items) indicates that the internal reliability of the instrument is satisfactory and a low number of missing responses (<1 %) indicates a high level of acceptance.ConclusionThe results provide evidence to support the construct validity, factor structure, internal reliability and feasibility of the ASCOT-Carer INT4 as an instrument for measuring social care-related quality of life of unpaid carers who care for adults with a variety of long-term conditions, disability or problems related to old age.

Exploring resource use and associated costs in end‐of‐life care for older people with dementia in residential care homes

The goals of this study are to describe end-of-life care costs of older people with dementia (OPWD) residents in care homes (CHs) with no on-site nursing and evaluate the economic case for an intervention designed to improve end-of-life care for OPWD in CHs. Phase 1 tracked for a year, from March 2009, health services received by 133 OPWD in six residential CHs in the East of England. CH and resident characteristics were obtained through standardised assessment tools, interviews with CH managers and publicly available information from the independent regulator of social care services in England. Phase 2 used a modified Appreciative Inquiry intervention that ran for 6 months from January 2011, in three of the six CHs. Wilcoxon matched-pairs sign-rank tests were conducted to compare total cost and cost components during Phases 1 and 2 for those residents who had participated in both. Costs for each resident in Phase 1 were about £2800 per month, including service, accommodation and medication. Resource use was associated with resident characteristics. The intervention was perceived as having a positive impact on working relationships between CHs and visiting health care practitioners. Following the intervention total service costs fell by 43%. Hospital care costs fell by 88%. Results presented here represent early work in an under-researched area of care. Appreciative Inquiry appears to improve and change working relationships with promising outcomes, but more research is needed to test these findings further with larger samples and more robust controls.