Social Care Staff Research Articles

Older People and Carers’ experiences of ‘Hospital-at-Home’

Introduction: Hospital at home (HAH) is an acute model of care that provides episodes of care to acutely unwell persons in their usual residence, i.e., their own home or in a care home. Providing intense and integrated care and treatment packages enables people to remain in their familiar environment and avoid the potential harm from in-patient stays. 
 Background Research: Currently, hospital-at-home research in the United Kingdom and internationally is limited regarding the lived experiences of older people and their unpaid carers. When older people and carers are excluded from research or not considered, we cannot understand how their experiences of services impact their everyday lives. The research also provides insight into how professionals can support people outside of hospitals more effectively by integrating this care model with other statutory services, such as social care, occupational and physiotherapy. Hospital-at-home initiatives can potentially reduce the risks associated with hospitalisation, such as infection, mental health and physical decline. Older people, carers and health and social care professionals may find this exciting and helpful research.
 Involvement: The research is nested into a wider research programme which people with lived experience have framed. There is also a panel of people with lived experience of receiving adult social care and those who support them, all of which form the approach to public and patient involvement.
 Data Collection & Methodology: There will be approximately 65 participants in this qualitative study, including health and social care staff, older people, and unpaid carers. All participants will be offered a one-off 60-minute semi-structured interview allowing them to respond in their own words. This contrasts with previous HaH studies in the United Kingdom that rely on fixed yes or no responses in surveys or questionnaires. Inductive Thematic Analysis is being used to analyse the data. As the data collection and analysis is still in progress, results are not fully concluded; however, the aim is to have themes fully developed from the data before the conference in May 2023. Some initial themes have emerged from the interviews with professionals, including risk, person-centred care, communication, and service delivery.
 Findings: The findings will create learning opportunities for an international audience, for example, concerning effective interprofessional working and person-centred care in HAH. Indeed, there is evidence of international HAH models in the literature review so that any new learning can be cascaded internationally via this conference. For example, when referring to communication, there could be an effective communication system developed at the point of discharge from HAH back to the care of their general practitioner, as this is an area of concern emerging from the professional interviews. The next steps will be to complete the research and give feedback to the local site in England where the research is taking place and to the Applied Research Collaboration (ARC) that has funded the research. This will highlight ideas and improvements for the future of community-based health and social care for older people and their carers.
 

How to ensure the sustainability of good practices transfer to heterogeneous contexts? Sharing the results of the JADECARE Joint Action

Summary: This workshop presents the general results of the implementation process of JADECARE and explores the key elements to support the sustainability of good practice transfer beyond the Joint Action.
 It presents the JADECARE Sustainability strategy that sets three core elements: policy environment, ownership of sustainability and culture of collaboration and consensus seeking.
 Two Next Adopters (NAs) adopting and transferring good practices will present the results of the implementation of their local good practices and their work to build sustainability beyond JADECARE.
 Background: JADECARE (the Joint Action on digitally enabled integrated person-centred care) contributes to innovative, efficient and sustainable health systems, providing expertise and sharing good practices to assist the Member States in undertaking health system reforms. It enables the participating national authorities and those beyond the Consortium, to benefit from efficient solutions in digitally enabled integrated person-centred care via supporting best practice transfer to 21 other settings of Next Adopters.
 Aim: Share the results of the implementation process of JADECARE and explore the key elements to ensure the sustainability of local good practices beyond the Joint Action.
 Objectives:
 -Share the results of the JADECARE transfer and adoption process
 -Present the JADECARE Sustainability strategy
 -Promote the discussion among attendees to highlight the key elements to ensure sustainability and scale up of local good practices beyond the project
 Target audience: Policy makers, decision makers, health managers, health authorities, health and social care professionals, researchers, academia, health experts, and staff working on implementation of integrated care, digitalization and/or evaluation.
 Facilitators/speakers: Yhasmine Hamu and Ane Fullaondo (Institute for Health Services Research Kronikgune ) will introduce the workshop, present the general implementation results, moderate and facilitate the thematic discussion.
 Jelka Zaletel and Denis Opresnik (NIJZ) will present the JADECARE Sustainability strategy.
 Chiara Ferravante (ARS Tuscany) and Martina Zorko, Karmen Janša (ZZZS) with Jelka Lindič (Slovene Nephrology Society) representing two NAs will expound the results of their transfer and adoption process highlighting the holders of sustainability beyond JADECARE.
 Format: (90’)
 5’-Introduction and workshop objectives – Ane Fullaondo
 10’- JADECARE transfer and adoption general implementation results – Yhasmine Hamu
 15’- JADECARE Sustainability strategy – Jelka Zaletel and Denis Opresnik 
 15’- Implementation of local good practices within JADECARE with a focus on sustainability – Results from two NAs- Chiara Ferravante, Martina Zorko, Karmen Janša and Jelka Lindič
 40’- Thematic discussion. All participants will be divided into two stations where brainstorming about two topics related to “Key elements to ensure the sustainability and scale up of practices beyond a Joint Action” will be facilitated and harmonised by two moderators. After half of the time the groups will exchange the discussion topic.
 5’- Sharing of main conclusions and Take home messages
 Key Learnings/Take away:
 ‒Learnings on the JADECARE transfer and adoption implementation results
 ‒Understanding about the actions undertaken by the NAs for building sustainable local good practices
 ‒Awareness about the challenges related to the sustainability of good practices transfer to heterogeneous contexts

Supported: Supporting, enabling, and sustaining homecare workers to deliver end-of-life care: A qualitative study protocol

Background Homecare workers provide essential care at home for people at end-of-life but are often poorly trained and supported. Aim To explore the experiences and needs of homecare workers and the views of homecare clients and carers, and other community-based health and social care staff about the homecare worker role, including identification of good practice. Methods In this qualitative exploratory study, we will conduct 150 semi-structured interviews with homecare workers within three geographic English localities chosen for maximum socio-demographic variation. Eligible participants will be consenting adults providing care services (workers [n = 45], managers [n = 15] community practitioners [n = 30]), receiving care (clients thought to be in the last 6 months of life [n = 30], family carers [n = 15], or commissioners of homecare services supporting end-of-life care [n = 15]. Interviews may adopt a Pictor-guided or standard semi-structured approach according to their preference. Managers and commissioners can contribute to an online focus group if preferred. A range of recruitment strategies will be used, including through homecare agencies, local authorities, local NHS services, charities, voluntary sector groups and social media. Interviews and focus groups will be recorded, transcribed, anonymised, and analysed adopting a case-based approach for each geographic area within-case and then comparison across cases using reflexive thematic analysis. The design and analysis will be informed by Bronfenbrenner’s Adapted Ecological Systems theory. This study is registered on the Research Registry (No.8613). Contribution We will provide evidence on ways to improve the experiences and address the needs of homecare workers in relation to caring for people nearing end-of-life. It will offer insight into good practice around supporting homecare workers including responding to their training and development needs. Findings will inform subsequent stages of an evaluation-phase study of a training resource for homecare workers.

Implementation and Impacts of California Senate Bill 1152 on Homeless Discharge Protocols.

In recent decades, there has been a growing focus on addressing social needs in healthcare settings. California has been at the forefront of making state-level investments to improve care for patients with complex social and medical needs, including patients experiencing homelessness (PEH). Examples include Medicaid 1115 waivers such as the Whole Person Care pilot program and California Advancing and Innovating Medi-Cal (CalAIM). To date, California is also the only state to have passed a legislative mandate to address concerns related to the hospital discharge of PEH who lack sufficient resources to support self-care. To this end, California enacted Senate Bill 1152 (SB 1152), a unique legislative mandate that requires hospitals to standardize comprehensive discharge processes for PEH by providing (and documenting the provision of) social and preventive services. Understanding the implementation and impact of this law will help inform California and other states considering legislative investments in healthcare activities to improve care for PEH. To understand health system stakeholders' perceived impact of SB 1152 on hospital discharge processes and key barriers and facilitators to SB 1152's implementation, we conducted 32 semi-structured interviews with key informants across 16 general acute care hospitals in Humboldt and Los Angeles counties. Study data were coded and analyzed using thematic analysis informed by the Consolidated Framework for Implementation Research. Participants perceived several positive impacts of SB 1152, including streamlined services, increased accountability, and more staff awareness about homelessness. In parallel, participants also underscored concerns about the law's limited scope and highlighted multiple implementation challenges, including lack of clarity about accountability measures, scarcity of implementation supports, and gaps in community resources. Our findings suggest that SB 1152 was an important step toward the goal of more universal safe discharge of PEH. However, there are also several addressable concerns. Recommendations to improve future legislation include adding targeted funding for social care staff and improving implementation training. Participants' broader concerns about the parallel need to increase community resources are more challenging to address in the immediate term, but such changes will also be necessary to improve the overall health outcomes of PEH.

Improving safety at scale via concise, impactful diabetes training for all health and social care staff

Abstract Diabetes 10 Point Training (D10PT) was developed collaboratively due to evidence that there is an urgent ongoing need for diabetes training among all levels of health care workers.A good understanding of diabetes is key to patient safety across the entire patient pathway including health and social care sectors.D10PT is translatable across all care settings with ability to reach staff and now, utilising the Cambridge Diabetes Education Programmes (CDEP) online platform, is available at scale and provides frontline staff with readily‐accessible basic diabetes training that is highly relevant to their role.We want to share our experiences of providing high‐quality, standardised and scalable, but appropriately targeted diabetes training to frontline non‐diabetes specialist staff and the impact it has on the outcomes of people living with all types of diabetes. Copyright © 2023 John Wiley & Sons.

“What is my experience of what I am in relation to people who I have shared my life with for the last 34 years?”: exploring care relationships at the end of life in two life-sharing communities for people with a learning disability

Old age is still an under-researched stage in the lives of people with a learning disability. Providing support to people towards the end of their lives can be challenging for services and involves complex ethical decision-making processes. This study explores the experiences of social care staff in two life-sharing communities where adults with a learning disability and staff live together. Four main themes were identified, highlighting different dimensions of care. These included an emphasis on relational care, responsive care and collaborative care, and an acknowledgement of barriers to care and caring that allowed people to live and die within the communities.

A96Whole System Transformed: Making Discharge Everyone’s Business

Delayed discharges are a challenge in every hospital. The Scottish Government are ‘committed to significantly reducing the number of people who are waiting to move from hospital wards to more appropriate settings [1]. This transformative simulation has been designed for all multidisciplinary team members involved in a patient’s care to engage in discharge planning; and to ‘respond to health service needs [2]. This simulation was created to break down barriers between acute and community care, reduce silo mentality and share the decision-making and risk around discharge. Empower any member of staff to have discharge conversations. Emphasis on early discharge conversations. Join up acute and community staff involved in the discharge process. The simulation involves a three-hour session with three scenarios. The session has run in both acute and community hospitals. Participants are multidisciplinary, and have included doctors, nurses, allied-health professionals (AHP), flow team, carers representatives, social workers, social care staff, home care staff and NHS Education for Scotland (NES) staff. The participants, in pairs, have a simulated conversation with a patient’s relative about discharge. The learning objectives from the scenarios are around realistic medicine, managing risk and dealing with anxious families. To assess the immediate impact of the simulation, participants complete a pre-simulation questionnaire on arrival and a post-simulation questionnaire at the end of the session. The results were from the pilot session pre and post simulation questionnaires in March 2023. Participants ( Prior to the simulation participants were asked ‘What makes it difficult to have these conversations?’ Themes from the qualitative answers were family expectations and managing uncertainty, both of which were learning objectives in the scenarios. Our participant feedback has shown that this Discharge without Delay Simulation has ‘made discharge everyone’s business.’ This simulation can provide transformative change to help healthcare professionals have early discharge conversations. This provides better patient-centred care by returning the patient to a homely environment, to reduce delayed discharges and increase patient safety. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

"Palliative care is so much more than that": a qualitative study exploring experiences of hospice staff and bereaved carers during the COVID-19 pandemic.

The way in which end-of-life care was provided changed significantly during the first 2 years of the COVID-19 pandemic. The national lockdown restrictions reduced formal care support services and increased the burden on many carers taking on the caring role for the first time. We aimed to explore decision-making about the place of care during the COVID-19 pandemic and the impact on experience from the perspectives of carers and hospice staff caring for people at the end-of-life. A qualitative study using virtual interviews was conducted between October 2020 and April 2021. Data were analyzed thematically using framework analysis, an analytical framework that enables qualitative research to be organized into defined themes derived from the research question. Findings were presented to stakeholders in policy roundtables between March 2022 and March 2023 and discussed collaboratively with staff, stakeholders, and the public to inform policy and practice change. A total of 37 participants (15 bereaved carers and 22 staff) were recruited via hospice services in England and Scotland. Four key themes were identified: (1) changing preferences relating to decision-making about the place of care and the impact at the time of death and into bereavement; (2) missed opportunities related to not being there, not having others around, and being robbed of memory-making; (3) the lone carer during a period of high intensity and reduced home support; (4) process vs. person-centered care resulting from changing rules and restrictions and prioritization of regulations over essential palliative care. The study provides valuable global implications for all involved in end-of-life care. Despite great efforts to provide dignified, quality care, palliative care during the pandemic changed, focusing on essential 'physical care'. The psychological suffering experienced by staff and carers may need longer-term support mechanisms put in place, which will benefit from a public health approach. Policymakers should consider improving carer identification and resources for wider end-of-life care education to support the needs of carers, health and social care staff, and citizens.

The Fundamentals of Advocacy: Designing an online learning course for health and social care staff

Abstract Background The Health Information and Quality Authority (HIQA) develops national standards for health and social care services and tools to assist with implementation. In 2023, HIQA developed resources to help health and social care staff support advocacy in their work. This followed a recommendation of the COVID-19 Nursing Homes Expert Panel Report (2020). As this project is founded in human rights-based practice and in lessons learned from COVID-19, it is relevant across health and social care. Objectives We wanted to know: 1. the barriers to advocacy in health and social care services; 2. how best to address this. We found knowledge and understanding of advocacy to be a significant barrier, and therefore developed an online course. The course was informed by focus groups with health and social care staff, service-users and inspectors, and by user-testing. The objectives are that learners understand: • what advocacy is • the role of health and social care staff in advocacy • how to support people to have their will and preference met • the boundaries of their role as advocates, including any conflicts of interest • how to raise awareness of independent advocacy services, and when to support people to access these services. The course includes case studies, interviews and self-assessment. We are measuring impact through surveys, interviews and focus groups. Results Through stakeholder engagement and a review of evidence we identified knowledge and understanding as a significant barrier to advocacy. Since the course was launched in April 2023, 90% of participants report that, based on the course, they will make changes to the way that they work. A selection of these participants will be interviewed after six months to measure impact. Conclusions Our research identified a need to improve knowledge and understanding of advocacy among health and social care staff. The course evaluations to date have shown that the course has achieved this. Key messages • There is a need to improve knowledge of advocacy among health and social care staff. HIQA has developed an online learning course to address this, informed by extensive stakeholder engagement. • Advocacy is about supporting and empowering people to communicate their will and preference, secure their human rights, or represent their interests.

Exploring medication safety through a social determinants of health and health literacy lens

Abstract Background The study addressed an evidence gap in Northern Ireland (NI) on social determinants of health & medication safety. Almost 50% more prescription items are prescribed in the most deprived areas and they suffer a heavier burden of illness & higher mortality rates. Low health literacy is associated with medication adherence & more negative beliefs about medication. The research aimed to discover the social circumstances behind unsafe medication practices and avoidable medication-related harm to inform the implementation of the Transforming Medication Safety in NI plan. Methods This exploratory study used a community-based participatory research (CBPR) approach that engaged community members to share their unique perspectives & local knowledge. A community survey & interviews with key stakeholders informed the sample & topic guides for focus groups with people in the community (63 participants) & health & social care staff (25 participants). Data underwent thematic analysis & findings were discussed & interpreted at a Knowledge Exchange Workshop. Results Many social factors influence medication safety, such as busy lives, prioritising others, social support, work, physical & psychological capabilities, mental health, addiction, income, transport, access to healthcare & social stigma. Health literacy was a key theme; people have varying abilities accessing, understanding, appraising, remembering, & using information about their medication. Health & social care staff can assume people to know & understand how to take their medication correctly. Health literacy was influenced by many sources including friends’ & family's experiences, individual research, health & social care staff, social media, & stories in the media. Conclusions The research gathered people's lived experiences on medication use at home. It is evident that the social determinants of health, health literacy and social practices and norms need to be considered in medication safety.

Multi-disciplinary support for families with complex needs and children on the edge of care in the UK: a mixed methods evaluation

ABSTRACTFamilies on the ‘edge of care’ face complex intersecting issues that can work against positive changes and lead to the re-involvement of social care. A multi-disciplinary service working alongside social work and community services teams to respond to the multiple needs of vulnerable families was evaluated. A mixed methods evaluation drew upon service data and cost saving modelling, interviews and a survey of social care practitioners. The evaluation data relates to the period February 2021 -July 2022 and covers 81 families, of whom 41 families had their cases closed. There was a high level of engagement with families with complex issues who struggle to engage with community-based services, with improvements in parental and child risk factors. The programme was successful for many of the families that engaged and half of the children had their safeguarding level stepped down. Significant net cost savings were estimated for avoided care placements plus additional savings such as reduced social care staff hours. The service was clearly seen as an effective and valuable service by social care practitioners and was characterised as having good working relationships, good communication and distinct but complementary roles. The service offered a positive support service model to families based on trust, consistency and immediacy.

Community Health Center Staff Perspectives on Financial Payments for Social Care.

A growing crop of national policies has emerged to encourage health care delivery systems to ask about and try to address patients' social risks, e.g., food, housing, and transportation insecurity, in care delivery contexts. In this study, we explored how community health center (CHC) staff perceive the current and potential influence of fee-for-service payments on clinical teams' engagement in these activities. We interviewed 42 clinicians, frontline staff, and administrative leaders from 12 Oregon CHC clinical sites about their social care initiatives, including about the role of existing or anticipated financial payments intended to promote social risk screening and referrals to social services. Data were analyzed using both inductive and deductive thematic analysis approaches. We grouped findings into three categories: participants' awareness of existing or anticipated financial incentives, uses for incentive dollars, and perceived impact of financial incentives on social care activities in clinical practices. Lack of awareness of existing incentives meant these incentives were not perceived to influence the behaviors of staff responsible for conducting screening and providing referrals. Current or anticipated meaningful uses for incentive dollars included paying for social care staff, providing social services, and supporting additional fundraising efforts. Frontline staff reported that the strongest motivator for clinic social care practices was the ability to provide responsive social services. Clinic leaders/managers noted that for financial incentives to substantively change CHC practices would require payments sizable enough to expand the social care workforce as well. Small fee-for-service payments to CHCs for social risk screening and navigation services are unlikely to markedly influence CHC social care practices. Refining the design of financial incentives-e.g., by increasing clinical teams' awareness of incentives, linking screening to well-funded social services, and changing incentive amounts to support social care staffing needs-may increase the uptake of social care practices in CHCs.

Views about perceived training needs of health care professionals in relation to socially assistive robots: an international online survey

Background As Artificial Intelligence and social robots are increasingly used in health and social care, it is imperative to explore the training needs of the workforce, factoring in their cultural background. Objectives Explore views on perceived training needs among professionals around the world and how these related to country cultures. Design Cross-sectional, descriptive, mixed-methods international online survey. Methods Descriptive statistical analysis explored the ranking across countries and relationships with three Hofstede cultural dimensions. Thematic analysis was conducted on the open-ended text responses. Results A sample of N = 1284 participants from eighteen countries. Knowing the capabilities of the robots was ranked as the top training need across all participating countries and this was also reflected in the thematic analysis. Participants' culture, expressed through three Hofstede's dimensions, revealed statistically significant ranking differences. Conclusions Future research should further explore other factors such as the level of digital maturity of the workplace. Impact Statement Training needs of health and social care staff to use robotics are fast growing and preparation should factor in patient safety and be based on the principles of person- and culture-centred care.

A reflective space for social care staff: Preliminary findings from Schwartz Rounds

Over the last year, the Keeping Well in South East London service have offered Schwartz Rounds to social care staff in response to the significant impact of Covid-19 on staff wellbeing and ongoing post-pandemic pressures (e.g. recruitment and retention). This text shares preliminary evaluation data and key learnings around implementation.

Implementing psychological support for health and social care staff affected by the COVID-19 pandemic: a qualitative exploration of staff well-being hubs (‘Resilience Hubs’) using normalisation process theory

ObjectivesEvaluate the implementation of Hubs providing access to psychological support for health and social care keyworkers affected by the COVID-19 pandemic.DesignQualitative interviews informed by normalisation process theory to understand how...

Healthcare staff mental health trajectories during the COVID-19 pandemic: findings from the COVID-19 Staff Wellbeing Survey.

Cross-sectional studies have shown that the COVID-19 pandemic has had a significant impact on the mental health of healthcare staff. However, it is less well understood how working over the long term in successive COVID-19 waves affects staff well-being. To identify subpopulations within the health and social care staff workforce with differentiated trajectories of mental health symptoms during phases of the COVID-19 pandemic. The COVID-19 Staff Wellbeing Survey assessed health and social care staff well-being within an area of the UK at four time points, separated by 3-month intervals, spanning November 2020 to August 2021. Growth mixture models were performed on the depression, anxiety and post-traumatic stress disorder longitudinal data. Two class solutions provided the best fit for all models. The vast majority of the workforce were best represented by the low-symptom class trajectory, where by symptoms were consistently below the clinical cut-off for moderate-to-severe symptoms. A sizable minority (13-16%) were categorised as being in the high-symptom class, a group who had symptom levels in the moderate-to-severe range throughout the peaks and troughs of the pandemic. In the depression, anxiety and post-traumatic stress disorder models, the high-symptom class perceived communication from their organisation to be less effective than the low-symptom class. This research identified a group of health service staff who reported persistently high mental health symptoms during the pandemic. This group of staff may well have particular needs in terms of the provision of well-being support services.

Birth supporters experiences of attending prisoners being compulsorily separated from their new-born babies

ABSTRACT There is growing evidence demonstrating increased mental ill-health in women compulsorily separated from their babies. For imprisoned women, the risk of self-harm and suicide may be further exacerbated. Birth supporters caring voluntarily for women in prison having their babies removed is valued and beneficial for wellbeing. Little is known about the effects on those supporting women in these circumstances. The aim of this study was to better understand the experiences of birth supporters when caring for imprisoned women experiencing compulsory separation from their babies. A qualitative approach explored the experiences of 12 birth supporters through: one to one in-depth online interviews. A thematic analytical method was utilised to analyse the data. Four key themes resulted from thematic analysis: vicarious trauma, transference of pain, standout cases and support networks. Birth supporters witnessing traumatic events such as the separation of imprisoned mother from her new-born baby may need additional supervision and therapeutic support. Birth supporters may experience Secondary Traumatic Stress (STS) and appropriate support and debriefing should be afforded to them equal to paid health and social care staff. The main argument of this paper is that strong support networks can serve as a benchmark for helping individuals affected by vicarious trauma, particularly in complex situations involving women who are being compulsorily separated from their babies. Due to the value clearly placed upon those who do volunteer by women, this kind of support should be consistent across criminal justice settings especially considering the impact on women’s mental health and wellbeing.

Knowledge of autism gained by learning from people through a local UK Autism Champion Network: A health and social care professional perspective.

The Autism Act 10 Years On found few autistic adults thought health and social care professionals had a good understanding of autism. Autism training has been made law in the United Kingdom for health and social care staff to tackle health inequality. The county wide Autism Champion Network evaluated here is an equal partnership of interested staff across sectors (Autism Champions) and autistic experts by virtue of lived experience (Autism Advisory Panel). With knowledge flowing both ways, the Autism Champions take learning back to teams to support continuous development of services to meet autistic need. Seven health and social sector professionals from the Network participated in semi-structured interviews on sharing knowledge of autism gained with their teams. All participants provide care and support for autistic people, some working in specialist positions. Results showed that developing new relationships with people outside their own team to signpost to, answer questions and share resources, and informal learning from autistic people, was more valued and used in practice than information gained from presentations. These results have implications in developing learning for those who need above a basic knowledge of autism and may be useful for others considering setting up an Autism Champion Network.

Development, use and evaluation of a web based mental capacity assessment tool for staff working with people with learning disabilities

PurposeThis paper aims to describe the development, use and evaluation of a web-based mental capacity assessment tool (MCA WAT) within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust in England.Design/methodology/approachThe MCA WAT was developed to ensure there was contemporaneous recording of each capacity assessment; help staff improve their knowledge, confidence and satisfaction in completing assessments of capacity; and analyse the number and type of capacity assessments completed. Three questionnaires were developed: a 12-item multiple-choice knowledge questionnaire, a nine-item confidence questionnaire and a 10-item satisfaction questionnaire, which reflect the five core principles of the MCA (2005). Eight-five health and social care staff who were trained to use the MCA WAT and had used it at least once had their scores from pre- and post-use of the questionnaires analysed using Wilcoxon signed-ranks tests. Data on the use of the MCA WAT was analysed.FindingsResults showed a significant increase in knowledge, confidence and satisfaction from pre- to post-questionnaires. Concerns remain regarding staff understanding of who is the decision maker and the use of communication aids to enhance capacity. These issues are being addressed through training and updating the information boxes in the MCA WAT. The MCA WAT has been used to complete 3,645 capacity assessments over a five-year time scale, covering a wide range of decisions.Originality/valueThis project demonstrates the effectiveness of a contemporaneous method of conducting and recording MCA assessments.

Care Workers and Managers’ Experiences of Implementing Infection Control Guidance in an Epidemic Context: A Qualitative Study in the South East of England, during the COVID-19 Prevaccination Era

The national response to COVID-19 has had a severe impact on adult social care settings, with high mortality amongst people receiving and providing care in England. Care workers had to rapidly adapt to new infection control measures to protect themselves, their colleagues, and the people receiving care. Infection control in residential and domiciliary care is always complex, but COVID-19 infection control measures impacted exceptionally on care workers’ working and everyday lives. We undertook qualitative interviews with care workers and managers (n = 10) in residential and domiciliary care for older people in the Southeast England during the first wave of the pandemic to understand their experiences, solutions, and concerns to implement guidance in practice. Data were analysed using framework analysis, and the following eight themes were identified: (1) Increasing visibility and support for the sector; (2) the impact of negative messaging about the sector; (3) feelings of isolation; (4) accessibility and usability of guidance; (5) social care staff as agents in producing and sharing good practice; (6) managing expectations and the impact of conflicting messages in the media; (7) improving communication with hospitals; and (8) problems in the early pandemic. The findings reveal widespread concerns for the marginalisation of the sector in the policy response and the inadequacy of infection control guidance. Guidance would benefit from a better understanding of domiciliary and residential care settings. This might involve the following steps: (a) coproduction of guidance with adult social care stakeholders, including those in direct-care roles and (b) a shift away from a clinical model of infection control towards a more flexible approach that attends to the inherent variability of care settings.