Social Care Teams Research Articles

Towards a theoretical framework for Integrated Team Leadership (IgTL)

ABSTRACT This study presents a framework for the leadership of integrated, interprofessional health, and social-care teams (IgTs) based on a previous literature review and a qualitative study. The theoretical framework for Integrated Team Leadership (IgTL) is based on contributions from 15 professional and nonprofessional staff, in 8 community teams in the United Kingdom. Participants shared their perceptions of IgT’s good practice in relation to patient outcomes. There were two clear elements, Person-focused and Task-focused leadership behaviors with particular emphasis on the facilitation of shared professional practices. Person-focused leadership skills include: inspiring and motivating; walking the talk; change and innovation; consideration; empowerment, teambuilding and team maintenance; and emotional intelligence. Task-focused leadership behaviors included: setting team direction; managing performance; and managing external relationships. Team members felt that the IgTL should be: a Health or Social Care (HSC) professional; engaged in professional practice; and have worked in an IgT before leading one. Technical and cultural issues were identified that differentiate IgTL from usual leadership practice; in particular the ability to facilitate or create barriers to effective integrated teamworking within the organizational context. In common with other OECD countries, there are policy imperatives in England for further integration of health and social care, needed to improve the quality and effectiveness of care for older people with multiple conditions. Further attention is needed to support the development of effective IgTs and leadership will be a pre-requisite to achieve this vision. The research advances the understanding of the need for skilled interprofessional leadership practice.

An exploration of how neighbourhood team members experience the transition from traditional health and social care teams to integrated care systems, within a defined health and social care economy

The following abstract presents a profesional doctorate study that explored how integration is experienced by the teams tasked with implementing the changes. Background: In the UK, the demographics of the population have significantly shifted dramatically. The median age rose from 33.9 years in 1974 to 40 years in 2014, a rise of 6.1 years. By 2024, it is predicted that there will be more people aged over 65 than aged 0-151. The population in the UK is getting older with 18% aged 65 and over and 2.4% aged 85 and over. However, perhaps of more relevant to the integration debate is not the changing age, but the shift in health conditions towards more people having long-term conditions and multiple co-morbidities. there are 15 million people in England with one or more long-term condition2. Which, has led to an increased drive towards integrated services that can provide a joined-up care across whole systems. Methods: The study is an Institutional Ethnographic conducted over nine months as part of a professional doctorate. Sample: The purposefully selected sample was a neighbourhood team in the north west of England. The team were selected due to their position as being at risk of being marginalised by the integration process and their experience of ‘doing’ integration. Ethics: University Ethics approval was obtained for the study, all participants were consented for observations and interviews and confidentiality was maintained across the study and presentation of the finding Results: The data was analysed using thematic analysis. The themes that emerged are briefly discribed below Integration as an idea - Before integration was real, it existed for the participants as ideas. One of the foremost ideas that immerged was that of ‘hopefulness’, which formed a powerful driver in the delivery of the changes required. Integration as practice - Practical issues plagued the early integration. Issues such as parking and IT were significant as they came to symbolise a divide between the local team and the wider organisation. Which, had an impacted the implementation of the organisational vision. Integration as professional practice - Previous studies have identified professional identity as a barrier; however, the study found that practitioner saw each other’s identity as an essential part of the development of their new integrated identity. Conclusion: The study supported previous studies that had demonstrated that ‘human factors’ were a key factor in the success of integration. However, the study also demonstrated that the teams observed viewed integration with hope and aspiration for improved practice. Professional Identity viewed as assets in developing team identity. Finally, team identity was a quickly established however; this led to the team distancing themselves from the identity of the wider organisation. Limitation: As an ethnography the finding of the study are not generalizable Time scale: as integration developed there could be challenges that had not yet emerged

Social workers’ negotiation of the liminal space between personalisation policy and practice

ABSTRACT As a result of a changing legal and policy context, statutory social work with adults in the UK has undergone a series of radical reforms. Underpinning these changes has been an ideological shift in the way adult social care should be provided. A clear ‘direction’ including a focus on autonomy, self-determination and personal responsibility is being promoted. These represent changes for both social workers and people receiving services. However, it has been suggested that policy may not fully acknowledge the factors that may undermine the ability of some individuals to take control of and manage their own needs. This paper draws on findings from two research projects, undertaken with social work practitioners located in statutory adult social care teams in the North East of England. The first explored the involvement of older people in adult safeguarding and the second considered capacity assessments and best interest decision making by social workers under the Mental Capacity Act [2005. Retrieved from https://www.legislation.gov.uk/ukpga/2005/9/contents]. This paper presents key findings regarding how social workers attempt to reconcile the gap between the profile of the service user in policy and the reality of the people that social workers are supporting in practice. Key recommendations for policy, practice, and further research are also discussed.

Measuring the effectiveness of embedding social workers in integrated primary health care teams working with older adults with complex needs

BackgroundDespite the policy agenda for health and social care collaboration currently focused on integrated care systems, there is limited evidence that examines whether embedding social workers in integrated primary health and social care teams working with older adults is effective.AimThe study aimed to establish whether embedding social workers in integrated primary care teams (IPCTs) for older adults in Nottinghamshire was cost-effective.MethodA mixed methods approach collected quantitative and qualitative data that was triangulated using a TRI-Q model. Cost and care quality data were collected from patients in receipt of social worker involvement in three different IPCTs. Patients with similarly complex needs, who were receiving involvement from social work only district teams in the same localities acted as a comparator group. Interviews were conducted with patients and carers and with social workers and GPs working in the IPCTs. Seven focus groups were conducted with IPCT members representing social work and health disciplines.ResultsThe cost data were analysed using ANCOVA to identify any significant differences in costs across the teams. The result showed costs in two of the IPCTs were significantly lower than controls. Care quality indicators were also greater in these IPCTs. Thematic analysis highlighted the important of knowledge exchange that arose from social work embeddedness as indicative of the optimal conditions for effective integrated working and care delivery to be achieved.ConclusionThe findings suggested that embedding social workers in IPCTs offers both higher quality and more cost-effective care for older people if the optimum conditions for integration are met.

Using developmental evaluation principles to build capacity for knowledge mobilisation in health and social care

This article contributes to Developmental Evaluation practice by highlighting the impact of embedding Developmental Evaluation principles into the learning approach of a capacity building initiative named Evidence for Change. The health and social care teams participating in Evidence for Change were operating within a complex environment requiring radical change to tackle health inequalities and provide modern, cost-effective, evidence-informed, quality of care for all. A gap in the literature around capacity building models for knowledge mobilisation led the authors to explore Developmental Evaluation as a potential approach. Naturally occurring evidence was used to develop Evidence for Change. Questionnaires, focus groups and structured interviews were used to assess the impact. Results demonstrated that Evidence for Change supported evidence-informed practice change and learning for individuals, teams, organisations and local communities. The report concludes that embedding Developmental Evaluation principles into Evidence for Change was instrumental in providing an innovative capacity building model for effective knowledge mobilisation in health and social care.

Social Work, Inter-Disciplinary Cooperation and Self-Neglect: Exploring Logics of Appropriateness

Abstract Working in a cooperative manner with other disciplines or agencies is often cited as an essential element of social work with adults who self-neglect. Cooperative working is now a legal requirement for agencies involved in adult social care in England. However, little is known about how social workers engage cooperatively with other disciplines in practice. This study sets out to explore this issue, employing the ‘Logic of Appropriateness’ perspective to theorise the ways in which social workers talked about working with other disciplines in self-neglect casework. The article presents a qualitative study, which was undertaken through semi-structured interviews with eleven social workers in an urban, adult social care team in an English local authority. Thematic analysis was not only used to draw out four key logics used by the social workers—leadership, joint-working, conflict and proxy—but also highlighted the ways in which social workers moved between different logics when talking about inter-disciplinary cooperation and working with adults who self-neglect. The results highlight the complex dynamics of cooperation and suggest that these dynamics need to be understood in assessing the implementation of integrated policies for social care in this area.

Development of a Social Work-Led Primary Palliative Care Model in Hospital Medicine (FR481C)

•Describe what is involved in an embedded primary palliative care program.•Describe how an embedded primary palliative care program model can improve patient outcomes. Due to palliative clinician workforce shortages and the growing number of patients with serious illness in need of palliative care, innovative primary palliative care models are essential to meet this population’s needs using the existing resources. To increase palliative care delivery, enhance appropriate hospice referral and decrease readmissions of seriously ill patients admitted to the hospitalist service. To meet unmet palliative care needs of patients admitted to the hospitalist service at Mount Sinai Medical Center, a social worker-led embedded primary palliative care model was developed. The social worker facilitated goals of care discussions, delivery of prognosis, discharge planning, and completion of advance directive documentation. In 2017, 184 patients received a primary palliative care consultation; those patients seen had an average age of 70 years, 43% were female and the median Karnofsky performance status of 40%, as compared to 20% for those seen by specialty palliative care. Overall, 51% of the patients seen met palliative care solid tumor oncology trigger criteria, 20% were triaged from the specialty palliative care team and 15% were direct referrals from hospitalists. Of those evaluated, 5% had documented goals of care in the electronic medical record before the consultation and 92% after the consultation. The hospice referral rate was 25% and the specialty palliative care referral rate was 25%. Reasons for referral to specialty palliative care were transfer to the palliative care unit (51%) and complex symptom management (49%). Of those who received the consultation, 30-day readmission rate was 5.3%, as compared to those who did not (16%). Patients seen by the social worker-led primary palliative care team were more functional, suggesting they were seen earlier in their disease course, and had fewer readmissions.

Implementation of a neighbourhood care model in a Scottish integrated context—views from patients

There is a need to test new models of integrated health and social care, particularly due to increasing financial and epidemiological pressures on services. One critical component of testing new models is the acceptability to patients. Here, the aim was to understand the acceptability of a new model of care to patients by understanding their experience of being supported by a self-managing, community-based, integrated, health and social care team. The INCA service consisted of three support workers and three nurses in two teams. These teams were self-managing and had autonomy over service operations and care delivery. Eight interviews and satisfaction questionnaires were conducted with patients. Interviews were transcribed and analysed thematically. Patients found the service highly acceptable (mean overall satisfaction of 98%), self-reporting a variety of benefits to their wellbeing. Central to this acceptability was the autonomy of staff to adjust care frequency and duration to patients' needs, in addition to describing an active engagement and partnership within their support plans. Future work should aim to ascertain the experiences of staff working in this model and whether receiving support in this way improves clinical outcomes.

Targeted social care for highly vulnerable pregnant women: design of the Mothers of Rotterdam cohort study

Introduction: Evidence shows that low socioeconomic status SES is related to decreased mental health of the individual. Exposure to determinants such as low income, unemployment, being a single parent, and living in a deprived neighbourhood increases levels of chronic stress. This results in diminishing overall resources to cope with stressful situations, making them more vulnerable for unhealthy and unfavourable behaviour, and a decreased health status of the individual. These negative effects do not only create a vulnerability in the individual for poor health, but effect the next generation already during pregnancy. Therefore, policies targeting highly vulnerable pregnant women potentially have far-reaching effects. Within the Netherlands, Rotterdam has the highest percentage of children growing up in poverty 25%, in a family living on welfare 19%, with a low parental level of education 20%, and with one or both parents being unemployed 10%. Furthermore, 57% of the children in Rotterdam grow up in a deprived neighbourhood. Description of policy context, objective and targeted population: In the Netherlands, social care is usually carried out by a community social care team: a multidisciplinary team of professionals located in the neighbourhood of their clients. Based on the needs of the client, care is either focused on adult issues such as financial problems or problems regarding children and adolescents such as underperformance at school. This strict separation of the social care in adult- and child-care is suboptimal in the care of highly vulnerable pregnant women, since impact of risk and adversity is not limited to one generation and can simultaneously affect both parents and children. Within Rotterdam, the Erasmus Medical Centre, the municipality, and a non-profit organization are combining their expertise to improve the psycho-social situation of highly vulnerable pregnant women. Ultimately, this will result in a healthy development of the unborn child. This targeted social care integrates medical and social care in a long-term and intensive support program. This support focusses on all issues a women and her child can encounter during pregnancy and after giving birth: health, housing, employment, social functioning, mother-child interaction and child development. In the “Mothers of Rotterdam” study, we aim to prospectively evaluate the effectiveness of the holistic approach compared to regular care provided by the community social care teams. Highlights and transferability: This program promotes societal valorisation of knowledge through valuable collaboration between academics, government and a non-profit organization by supporting the healthy development of future generations. Due to the pragmatic character of the study, randomization of participants is not possible, but is determined by a natural experiment. Therefore, this ecologically valid study design allows for results directly generalizable to the actual population, although it increases the risk of true effects being masked by unmeasured confounders. Conclusion: This study will provide unique insights into a notoriously difficult to reach population of highly vulnerable pregnant women, their problems and potential care pathways for these problems.

Mental health services for people with intellectual disability in the United Kingdom

PurposeServices for people with intellectual disabilities in the UK have evolved over the years from hospital-based care to more community provision. There are multiple reasons for these changes, however, often it was due to changes in social policy or following a scandal in provision. The paper aims to discuss these issues.Design/methodology/approachProviding services to meet the health and social care needs of people with intellectual disabilities is well-established in the four countries of the UK with support from legislation. There are often specialist mental health and social care teams. Dedicated professionals work with people with intellectual disabilities who experience mental health problems with a focus on support in the community. A range of services for children and adults and for offenders exist across the UK that often vary in composition and structure.FindingsThe challenges in providing mental health services for children and adults with intellectual disabilities in the future include recruitment and training of the workforce with the remit of enhancing community support and reduced in-patient care.Practical implicationsThis paper helps the reader to understand how ID mental health services are organised in the UK.Originality/valueThis paper gives a summary of the ID mental health services in the UK. Even though there are various papers looking at different aspects of mental health services for people with ID in the UK, this paper brings all that information together to help reader get a better understanding of the mental health services for people with ID.

How and why to write your article and get it published

Within this article the author sets out the basic principles that will assist the aspiring writer to become published author. Areas discussed include: why you should write and be published; where to send your article; content; and finally, the importance of following submission guidelines for authors, set by the individual editor and journal. Support workers are experts in what they do, bringing a wealth of knowledge, experience and skill to their role. This expertise needs to be recognised and disseminated both within the support worker community and the wider health and social care team of professionals. Support workers have a voice which needs to be heard and writing for publication is one important way this voice can be heard and quality care shared both locally, nationally and internationally.

Leadership in interprofessional health and social care teams: a literature review

PurposeThe purpose of this study is to review evidence on the nature of effective leadership in interprofessional health and social care teams.Design/methodology/approachA critical review and thematic synthesis of research literature conducted using systematic methods to identify and construct a framework to explain the available evidence about leadership in interprofessional health and social care teams.FindingsTwenty-eight papers were reviewed and contributed to the framework for interprofessional leadership. Twelve themes emerged from the literature, the themes were: facilitate shared leadership; transformation and change; personal qualities; goal alignment; creativity and innovation; communication; team-building; leadership clarity; direction setting; external liaison; skill mix and diversity; clinical and contextual expertise. The discussion includes some comparative analysis with theories and themes in team management and team leadership.Originality/valueThis research identifies some of the characteristics of effective leadership of interprofessional health and social care teams. By capturing and synthesising the literature, it is clear that effective interprofessional health and social care team leadership requires a unique blend of knowledge and skills that support innovation and improvement. Further research is required to deepen the understanding of the degree to which team leadership results in better outcomes for both patients and teams.

Frail older people with multi-morbidities in primary care: a new integrated care clinical pharmacy service.

Background Older people confined to their own homes due to frailty, multiple longterm conditions and/or complex needs, are known to be at risk of medicines-related problems. Whilst a health and social care team approach to supporting these patients is advocated, there is limited evidence regarding how pharmacists can best contribute. Objective To describe a new specialist pharmacy service (called the integrated care clinical pharmacist) in terms of how it works, what it achieves and its policy implications. Setting Patients' own homes in Lambeth, London, UK. Method Community matrons identified patients who were experiencing medicines related problems. These were referred to the integrated care clinical pharmacist who undertook a full medication review and recorded activities, which were independently analysed anonymously. Main outcome measure Medicines-related problems and the associated interventions. Result 143 patients were referred to the service over a 15-month period. A total of 376 medicines-related problems were identified: 28 (7%) supply issues, 107 (29%) compliance issues, 241 (64%) clinical issues. A diverse range of interventions were instigated by the pharmacist, requiring the coordination of community pharmacists, primary and secondary health and social care professionals. Conclusion This project demonstrated that including an integrated care clinical pharmacy service as part of the health and social care team that visits frail, older people in their own homes has benefits. The service operated as part of a wider inter-professional community team. The service also supported current health policy priorities in medicines optimization by identifying and addressing a wide range of medicines related problems for this vulnerable patient group.

Health Atlas Ireland - Resource Profiler

Introduction: The Resource Profiler informs decisions about meeting local health needs. The available local health resource (such as staff numbers) can be flexibly compared to the local patient case-mix, taking into consideration the makeup of that population group. Background: The national resource/case-mix proportion is used as the gold standard against which each local resource/case-mix proportion is compared. Variance from the national average is expressed in simple graphical, numeric, percentage, and map formats. In the primary/community care context, the demographic profile (i.e. age and deprivation) of the local population form the basis of the patient case-mix as these factors are the dominant drivers of health need. The Resource Profiler allows for the flexible adjustment (weighting) of age and deprivation in terms of their known impact on health and service provision as indicated by available evidence and/or local knowledge. The steps: The resource of interest is first selected, such as the whole time equivalent (WTE) staff type by health administrative area. Secondly, the health service area of interest (such as community health organisation, health and social care network or primary care team) is selected. The granularity of the analysis is dependent on the degree to which the resource is geo-referenced. Thirdly, the appropriate census of population, age range and gender is selected. Projected population per health service area may also be selected to inform longer term health planning projects. Fourthly, the population can be adjusted to take account of the impact of age and deprivation within each area. The age adjustment reflects the often dramatic differences in relative health need by age, as health care utilisation tends to be higher per capita in young children and to rapidly rise in the older age groups. The purpose of the deprivation adjustment is to reflect the poorer health status (and so greater need for healthcare services) that is associated with deprivation. Levels of deprivation is measured for each small area using the Haase & Pratschke (HP b) subtract existing resources from service areas; c) redistribute existing resources between service areas. The change may be applied to all areas, or to areas currently categorised as low, average, and/or high. Display: The Resource Profiler displays the relative distribution of resources against the inferred need by each service area in simple plot and table formats. The impact of population weighting and differences from average are clearly signalled and colour coded. Selecting the map options displays the relative resource/population result in a thematic format for the area type selected. Key services can be displayed on the map to help orientate the user. Health service boundaries and key service locations such as hospitals, health centres and general practice locations can be show in the context of the relative provision of local resources.

Weymouth and Portland Integrated Care Hub

Background; Weymouth and Portland Integrated Care Hub was started in November 2015, as a multiagency, co-designed project, aiming to support people who are frail, elderly or have complex needs. The 'hub', based in Westhaven Community Hospital, collocates duty workers and administrators from the locality's physical health, mental health, social care, ambulance services and third sector teams. Key features; No significant additional investment – reconfiguration of existing community services Local single point of access - reverting to Countywide SPOA overnight Admission avoidance and supported hospital discharge 'No hand offs' Systm One IT module for integrated referral management and information sharing to local teams, including primary care Three Health and Social Care Coordinator posts, working over 7 days Community Geriatrician Step up community beds Acheivements - one year on; The hub, very quickly moved from being a brave trial to a mainstream, sustainable and successful way of working. The team are working with people who have high and very high levels of frailty. Excellent patient and informal care giver feedback, gathered through semi structured interviews Reduction in acute bed days and ED admissions for over 65s Stabilisation of emergency admissions for locality against a predicted increase High referrer satisfaction - 'I make one call and things just get sorted' Staff are now seeing themselves as 'one team' and putting the patient at the centre of everything that they are doing. The hub is a factor in staff recruitment in the area. 50% step up use of community hospital beds - a community bed is now always available as an alternative to acute admission. Model being used as a blueprint to roll out to all other localities in Dorset Barriers to change: Key barriers that have needed to be overcome are; Working across different organisations with differing priorities/objectives Culture change for staff - 'one team' approach Trail blazer - creating and selling a vision Existing management structures are becoming a barrier to progress Insufficient data to fully evaluate work Future plans and next steps: Although Weymouth and Portland Integrated Care Hub is proving to be a successful model, advances are already being made. A proactive element to hub working - risk profiling, MDT meetings, and advance care planning and follow up for those referred in crisis to reduce the likelihood of deterioration in the future. Integrated working with Dorset County Hospital's acute hospital at home Consideration of rising frailty and patient activation/community support Can all community referrals be managed through the hub? Review of management structures to consider a full locality integrated team. Conclusions: Weymouth and Portland Integrated Care Hub was formed just over a year ago as a multiagency project, which has, with little additional cost, transformed the service provided to local people who are frail, elderly, and have complex needs. The learning from this project is being rolled out to all other localities in Dorset, and also used to make key developments that will improve the service provided going forwards.

Proactive, Integrated Care within Sustainable and Transformation Planning

In December 2015, the NHS shared planning guidance 16/17 – 20/21 outlined a new approach to help ensure that health and care services are built around the needs of local populations. This aimed at delivering the Five Year Forward View vision of better health, better patient care and improved NHS efficiency. The 3 CCGs collaborating in the Leicester, Leicestershire and Rutland Footprint serve a population of around 1 million which is one of the most culturally and ethnically diverse in England. Our service capacity encompasses 7 acute hospitals and 8 community hospitals serving patients from 146 primary care practices and combined annual health and social care budget of £.2.12 billion. The Leicestershire and Rutland Sustainability and Transformation Plan (STP) is based on a whole population management approach in turn informed by analytics drawn from the Johns Hopkins Adjusted Clinical Groups (ACGs) case-mix and risk-stratification system. We are also building on our experience using the Better Care Fund (BCF) to extend our out-of-hospital services which are fully integrated with primary and community care, social services, mental health and the voluntary sector. Under the BCF, the priority was to strengthen our reactive, rapid response services to create viable alternatives to hospital for patients in urgent need. These are now showing good outcomes in avoiding hospital usage. However, the ACG analytics has now identified some 23% of the population or 230,000 people who might form a clinically relevant cohort for a variety of interventions by Integrated Health and Social care teams centred around GP practices. Many would benefit from more pro-active services, utilising viable intervention pathways offered earlier in their condition trajectories These interventions range from more anticipatory care coordination for high-risk patients, supportive self-care and empowerment through health coaching for early diagnosis patients, pre-diagnosis assessment through to public health initiatives which strengthen community capacity to promote healthier lifestyles for individuals. In this presentation, we set out our challenges and objectives, document our progress to-date in integrated care against the triple-aims outcomes framework, and explain the detailed population needs identified by the ACG analytics, We will then set out the second phase of our integrated care transformation programme and share the findings of some early pilot work which we intend to inform this next , critical stage of development.

Defining the Role of the Community Health Worker within a Federal Healthy Start Care Coordination Team.

Introduction Federal and state policies often require utilization of evidence-based home visiting programs. Measurement of specified interventions is important for tracking program implementation and achieving program outcomes. Thus, the Strong Beginnings program worked to define community health worker (CHW) interventions, a core service of the program to improve maternal and child health. Methods A workgroup consisting of CHWs, supervisors and other program staff was created in order to develop and define specific CHW interventions within a nurse or social worker care team. Basic interventions were first compared to the nurse or social worker care coordinator home visiting interventions by risk topic. The evaluator then grouped each CHW intervention into categories per risk domain using thematic analysis and assigned a CHW core function or role based on literature review findings. The workgroup confirmed the results. The workgroup then continued discussions to further enhance CHW interventions per risk domain once the general structure was created. Results The workgroup identified seven core functions and 28 maternal and child health risk topics to be addressed by the CHW. The process resulted in a detailed document of program interventions that the CHWs use to guide care. Conclusions The process helped CHWs feel more valued with their role in team care. The specified interventions will help others understand the CHW role within the care team, ensure consistent interventions are delivered across program partners, provide a foundation to better understand how specific CHW contributions are related to health outcomes, and support program sustainability.

The new Health Research Authority framework: still work to do to facilitate high-quality public health research in English local authorities.

Will the new Health Research Authority (HRA) framework go far enough? Dr Emily Phipps, Professor Sian Griffiths of The Chinese University of Hong Kong, and Dr Mark Sheehan of the Nuffield Department of Population Health, Oxford University, consider the challenges facing the new HRA framework in addressing research into public health interventions on both an individual and a population level.IntroductionIn 2013, the public health functions of the National Health Service (NHS) in England moved to local government as part of reforms under the Health and Social Care Act 2012.[1] In this setting, the public health team commissions and manages a broad portfolio of programmes that aim to positively influence the local population's health and wellbeing, reduce inequalities and promote a healthy lifestyle.[2] The very nature of this work requires public health interventions to span the functions of health and politics, bringing together expertise from clinical, nursing, social care and local government backgrounds.Developing a robust evidence base for the delivery of public health interventions is key to ensuring that public health teams can provide the most effective and efficient service possible. Research governance processes regulate the design, implementation and dissemination of studies into public health interventions and are a legal requirement of health research conducted in England. However, there is currently significant variation in the quality and accessibility of research governance processes in local authorities in England to support the study of public health interventions.[1] In a recent nationwide study by Rainey et al.,[3] 35% of research governance leads listed on a national local authority database were no longer in post, and 25% of respondents from local authority public health and social care teams reported not having or not being aware of research governance arrangements in their local authority.Where such processes are available, a lack of familiarity with the relatively recently introduced public health functions to local authority can make it difficult for research projects to be assessed in a robust and appropriate manner. Research governance leads unfamiliar with governance issues pertinent to the study of public health interventions may be reluctant to pass review and approval. This risk may mean that projects are altered at the point of design to 'fit' the model most familiar to the research governance lead, rather than being of a methodology best suited to the hypothesis in question, in order to increase the likelihood of approval.Ethical review processes are a fundamental part of research governance, protecting the safety, dignity, rights and wellbeing of study participants. Researchers wishing to study public health interventions in local authorities rely on there being robust and appropriate ethical review services available in that organisation. As the nature of this research is unlikely to involve conventional methodology or typically medical interventions, local NHS research governance teams will likely not feel appropriately equipped to provide approval. In addition, academic research ethics committees often will not review the ethics of applications for research that is being conducted without university involvement, and vary widely in their approval processes and remit.[4] National guidance on the provision of research governance services, such as ethical review processes within local authority settings in England, may be one way to ensure standardised and appropriate services are available.In January 2015, the Health Research Authority (HRA) took over the responsibilities of the National Research Ethics Service and National Social Care Research Ethics Committee, so that all research involving health and social care in England is now governed by the same authority. The HRA are currently developing a high-level framework to guide the revision of local research governance policy which should recognise the changes to health and social care functions introduced in 2012. …

The behaviors and experiences of the community pharmacy team on the provision of multi-compartment compliance aids.

Multi-compartment compliance aids (MCAs) are repackaging systems for solid dosage form medicines. Acknowledging the lack of evidence that MCAs improve adherence or clinical outcomes, the Royal Pharmaceutical Society has expressed concern that MCAs have 'become regarded as a panacea for medicines use'. To determine the behaviors and experiences of the community pharmacy team around MCA provision. A cross-sectional survey was conducted in 26 community pharmacies in the north east of Scotland. Survey items were grouped into: current activities in the provision of MCAs; potential influences on these activities; reports of patient experiences; and demographics. Data were analysed using descriptive and inferential statistics, and content analysis of responses to open questions. Principal component analysis (PCA) was performed on the items of potential influences on activities. Data were collected from 136 community team members (median 4, range1-10 per pharmacy; 32.3% pharmacists). All were involved in some aspect of MCA provision and within the same pharmacy, several different staff positions were commonly involved in the same activity. PCA gave seven components; the lowest scores were obtained for the component of 'others expecting me to provide MCAs'. Participants agreed that GPs, patients and their families, and carers expected them to provide MCAs. Positive experiences of MCA provision were in themes of promoting patient adherence, reducing patient stress and enhancing patient monitoring. Further negative experiences were in of lack of shared patient decision making, worsening adherence and generation of medicines waste, and dealing with changing medicines. MCAs were not always considered to be the most appropriate solution. While community pharmacy teams value MCAs, there may be issues around staff assignment to particular roles, expectations from others and reports of negative patient experiences. A systematic approach to MCA provision and monitoring involving the multidisciplinary health and social care team is warranted.

'Nurses need to find a voice to challenge the status quo'.

What is your job? I have recently taken up a new and exciting role as director of health and well-being at the Royal Hospital Chelsea. I will lead the social care and health team, including the nursing team, who care for the 320 pensioners living at the hospital.