UK Social Care Research Articles

Ambidextrous working in health and social care services: A configurational view

This study evaluates how middle and front-line managers contribute to organizational ambidexterity through their engagement with long-standing organizational dilemmas, supplementing earlier senior management focused work. Based on a multi-level exploratory study conducted within the UK health and social care sector, we investigate how middle and front-line managers were able to work on a collective and redistributive basis to address the tension between exploratory and exploitative innovation. Middle managers served as ‘horizontal integrators’ facilitating the emergence of shared understandings, learning capabilities and the distribution of knowledge-based resources, a process shaped by the constraints and opportunities provided by the broader intra-corporate environment. We conclude that the transition to ambidextrous working was impeded by restrictive bureaucratic dimensions, and facilitated by a distributed pattern of interaction, shared responsibility and more empowering bureaucratic forms.

Specialist alcohol inpatient treatment admissions and non-specialist hospital admissions for alcohol withdrawal in England: an inverse relationship.

ABSTRACTAimsWe assessed the relationship between specialist and non-specialist admissions for alcohol withdrawal since the introduction of the UK government Health and Social Care Act in 2012.MethodsUsing publicly available national data sets from 2009 to 2019, we compared the number of alcohol withdrawal admissions and estimated costs in specialist and non-specialist treatment settings.ResultsA significant negative correlation providing strong evidence of an association was observed between the fall in specialist and rise in non-specialist admissions. Significant cost reductions within specialist services were displaced to non-specialist settings.ConclusionsThe shift in demand from specialist to non-specialist alcohol admissions due to policy changes in England should be reversed by specialist workforce investment to improve outcomes. In the meantime, non-specialist services and staff must be resourced and equipped to meet the complex needs of these service users.

Accepting what we do not know: A need to improve professional understanding of brain Injury in the UK.

Acquired brain injury (ABI) can lead to life-long changes and disability. The complex and extensive nature of behavioural, cognitive, executive, physical and psychological difficulties mean ABI survivors and their families may come into contact with a range of health and social care services as part of their long-term care. This study aimed to understand the ABI knowledge base of professionals across a range of organisations within the UK, and to identify areas for improvement. This was achieved through a mixed methods approach using a mixed methods questionnaire (117 participants) and qualitative semi-structured interviews about service experiences (31 participants) of professionals and service users (families and individuals with ABI). Participants included UK health and social care professionals, ABI specialists, ABI survivors and family members. Data were collected from February 2017 to April 2018. The results of the study identified a lack of knowledge and understanding of ABI among health and social care professionals in the UK, from those involved in acute care through to long-term community services. Poor knowledge was associated with a lack of understanding of "hidden" disabilities associated with ABI, a lack of empathy and a lack of knowledge regarding specific safeguarding. Health and social care professionals across a range of services could benefit in ABI-specific training to improve their knowledge and improve the service currently being provided to individuals with ABI and their families.

Continuing professional development requirements for UK health professionals: a scoping review

ObjectivesThis paper sets out to establish the numbers and titles of regulated healthcare professionals in the UK and uses a review of how continuing professional development (CPD) for health professionals...

Global citizenship: an exploration of the relevance to UK health and social care professions.

Global citizenship: an exploration of the relevance to UK health and social care professions.

Perceptions and Experiences of Health and Social Care Utilisation of the UK-Nepali Population

With the growing UK Nepali community, understanding their health and social careneeds is an essential to reduce health and social care inequalities. However, very littleis known about the health, wellbeing and utilisation of health and social care servicesamong the Nepali population in the UK. Therefore, this study set out to identify healthand social care needs of Nepali community. The mixed-methods study was conducted with the Nepali population living in London. Itconsists of a semi-structured survey (N = 345); three focus group discussions and threekey informant interviews. The mean age of the participants was 40.6 (± 17.6). About 28% of our sample reportedhaving chronic health problems. About 60% currently consume alcohol and 21% weresmokers. Male participants (35%) more likely to be physically active than females(21%). Registration with a family doctor/general practitioner (GP) was high (96%).However, uptake of disease screening was very low (28%). In the preceding year, 17%had experienced poor mental or emotional health. The findings also suggest language is a key barrier to utilise health and social careamong UK Nepali. We suggest removing the language barrier is essential step to improve access toavailable health and social care services. A culturally sensitive educational initiativecreating awareness about the structure of UK health and social care services isrequired to offer to this community.

Ethical Approval and Being a Virtuous Social Work Researcher. The Experience of Multi-site Research in UK Health and Social Care: An Approved Mental Health Professional Case Study

ABSTRACTSeeking ethical approval and conducting research in an ethical manner are necessary components of research with human participants. Using the experiences of four individual studies undertaken separately into the same role, that of the Approved Mental Health Professional (AMHP), this article critically examines the challenges for multi-site research in health and social care settings. Issues arising are discussed: these are systemic and procedural, or barriers encountered using the integrated approach of the National Research Ethics Service. We discuss the lessons learned and argue that seeking ethical approval in multi-site research is currently a static construct involving the satisfying of what are in effect closed systemic and procedural requirements. We suggest that being a virtuous social work researcher, which we explore in the context of contemporary debates in social sciences, should instead afford open-ended integrity whereby the ‘permission’ granted is constantly revisited by the researcher or, in other words, that the integrated approach should allow being a virtuous researcher. We suggest that this cyclical activity has particular resonance for those researchers who are, simultaneously, health and social care practitioners. The article adds to the literature on ethics, conduct and integrity in health and social care.

Commissioning Home Care for Older People: Scoping the Evidence

Context: Many people over the age of 65 receive support from home care providers to enable them to continue to live at home. In the UK, local authorities (England, Wales and Scotland) and Health and Social Care Trusts (Northern Ireland) commission these support services. However, little is known about these arrangements. Objectives: To address this knowledge gap through identifying the lessons from research for commissioners of home care for older people. Method: A scoping review was undertaken to extrapolate the lessons from research for future practice. Searches were conducted in 2016/17 and the analysis was completed 2017/18. Electronic and manual searches of UK literature were undertaken using distinct terms to investigate the people, organisations and processes intrinsic to commissioning home care for older people. Findings: From a total of 1,819 papers and government reports, 22 met the inclusion criteria, indicative of a limited body of knowledge. A variety of research methods and designs were included with mixed methods most frequently used. Four lessons were identified relating to: the marketisation of home care; the future of care at home; promoting integration with local partners in commissioning home care; and areas for future research. Limitations: The focus on research evidence may have meant that potentially interesting insights to inform future commissioning strategies from conceptual articles were omitted from the review. Implications: Understanding the complexities of market management in commissioning home care for older people is still at an early stage of development. This review provides evidence to inform its future development of value to policy makers and practitioners.

Women speakers in healthcare: speaking up for balanced gender representation

Women comprise the majority of the UK's health and social care workforce, yet remain underrepresented in senior leadership positions. This is reflected in the balance of speakers, chairs and panels convened for healthcare conferences, with disproportionate gender balance. Accumulating evidence suggests that greater diversity across multiple characteristics, including gender, improves staff experience, organisational performance and patient outcomes. Conferences provide opportunities for inclusivity and new ideas only when attendees feel empowered to speak up. If we are to increase diversity of our current leadership, aspiring leaders need to see relatable role models. This article explores the issue of 'manels' and male-dominated speaker lineups, offering practical suggestions for conference organisers, women speakers and male allies to address the issue. We also outline the background to 'Women Speakers in Healthcare': a grassroots initiative founded by a team of aspiring leaders, which aims to achieve balanced gender representation at all healthcare conferences and events.

Zero-hours contracts and labour market policy

SUMMARYThe evolving nature of atypical work arrangements is studied. A particular focus is placed on one such form of work relation: zero-hours contracts (ZHCs). The paper uses existing secondary data and new survey data collected for the specific purpose of studying alternative work arrangements to describe the nature of ZHC work in the UK labour market. The interaction with labour market policy is explored, in the context of the 2016 introduction of the UK’s National Living Wage. ZHC work is shown to be an important feature of today’s work arrangements, and the wage cost shock induced by the new, higher minimum wage resulted in an increased use of ZHCs in the UK social care sector, and in low wage sectors more generally.

Roadmap layers and processes: resilient and sustainable care facilities

Purpose Health and social care facilities are usually complex buildings that require continuous effort to provide resilient and sustainable responses to changes in demographics, technologies, diseases and models of care. Despite resilience and sustainability concepts being frequently used by practitioners and researchers, ambiguities in their definitions often result in a lack of operational solutions to record, monitor and improve the resilience and sustainability of health and social care facilities. Although the importance and complexity of the issues are widely acknowledged, there is little strategic guidance as to how they should be achieved. The purpose of this paper is to assess the suitability of developing a roadmap for improving the resilience and sustainability of UK health and social care facilities, and to identify the layers and processes needed to construct such a roadmap. Design/methodology/approach A qualitative approach was adopted, starting with a literature review of different types of roadmaps and their suitability to support the desired improvement objectives. Layers and processes were thus developed using the key issues identified in three recent research streams, and the roadmap was structured. Findings The major findings have been captured within a three-layer, four-step process generic roadmap for improving the resilience and sustainability of health and social care facilities that can be used to monitor performance, plans future actions and implement response to change. Practical implications This paper targets decision makers, especially estate managers, but the proposed layers and processes can be modified for other stakeholders. Originality/value This paper suggests an original approach for the development of a roadmap for resilience and sustainability of health and social care facilities, and specifically of how to structure layers and processes, envisioning a more integrated development of service provision and infrastructure asset management.

Internal coordination of social security in the United Kingdom

Although social security is traditionally viewed as a highly centralised function in the UK, health care and long-term social care have long been devolved to sub-state governments, an arrangement requiring extensive internal coordination agreements. This coordination has various objectives, including ensuring parity of benefits provision in Northern Ireland (where social assistance is devolved) and Great Britain (where it is centralised), securing financial reimbursements for cross-border health care provision, and determining responsibility and eligibility criteria for individuals in need of social care. Further devolution and decentralisation of social security benefits over the past decade have made such coordination arrangements even more essential.

'We're passengers sailing in the same ship, but we have our own berths to sleep in': Evaluating patient and public involvement within a regional research programme: An action research project informed by Normalisation Process Theory.

BackgroundPatient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI.MethodsWe purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation.ResultsWe interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI.ConclusionCombining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI.

Positioning the ageing subject: articulations of choice in Swedish and UK health and social care

ABSTRACT What happens when similar measures are being introduced in different national contexts? This article studies the ways in which patient choice has been articulated in public and official reports on health care in the two contexts of Sweden and the UK, whose welfare systems are typically comprehended as different. Specific interest is directed towards the construction of patient positions, and policy documents are analyzed using discourse theory. The results show many similarities between the national contexts; choice is primarily articulated with individuality, autonomy, consumption, and responsibility, as well as with support from state agencies, and patient choice is relentlessly normalized as the way forward. But there are also important differences that reveal that the presuppositions differ, for example, when pinpointing the stakeholders of patient choice reforms and how the different policies work to take the well-known edges off of patient choice ideology.

What does Brexit mean for the UK social care workforce? Perspectives from the recruitment and retention frontline.

The UK's departure from the European Union (Brexit) is likely to result in greater immigration and employment restrictions on European Union/European Economic Area (EU/EEA) nationals within the United Kingdom. EU/EEA citizens constitute a significant proportion of the current social care workforce. Research evaluating the impact of Brexit on social care has highlighted potentially severe future workforce shortfalls, but has not engaged in detail with the experiences of social care personnel involved in day‐to‐day recruitment and retention activities. This article explores how social care managers evaluate Brexit's prospects for future workforce sustainability, through the prism of their organisation's workforce requirements. This qualitative study incorporated in‐depth semi‐structured interviews and questionnaire surveys with domiciliary and residential care managers. Data collection focused on an urban conurbation in south‐west England, with demographic characteristics likely to make post‐Brexit recruitment and retention in social care particularly challenging. A key finding is that, irrespective of whether they employ EU/EEA workers or not, research participants have deep concerns about Brexit's potential impact on the social care labour market. These include apprehensions about future restrictions on hiring EU/EEA nurses, as well as fears about increased competition for care staff and their organisation's future financial viability. This article amplifies the voices of managers as an under‐researched group, bringing their perspectives on Brexit to bear on wider debates on social care workforce sustainability.

The complex spaces of co‐production, volunteering, ageing and care

The care of older people is being radically reformulated by placing the individual at the centre of care process through the introduction of individual care plans. This marks a significant transition for the care of older people away from acute responsive clinical care towards a greater emphasis on co‐produced preventative health and social care and relations of care “with” older people. Geographies of volunteerism are yet to consider the effect of co‐production as a dominant rhetoric in UK health and social care. In this paper we show that the Health and Social Care Act (2012) and the Care Act (2014) has the potential to fundamentally alter discourses of care by introducing new spatialities to older people's care. New spatialities of care will not only rely on the reciprocity and interdependence of care between individuals and organisations but also the mobilisation of a voluntary care‐force to be attentive to individuals. Spatialising co‐production reveals the institutional and professional boundaries that prevent the type of open partnership that sits at the heart of the rhetoric. Our ethnographic and qualitative methodology was developed to understand how our case study of Living Well (Cornwall, UK), as a philosophy of care, is realised in practice and to consider the main collaborators’ views of different methods of co‐production involving volunteers. We discuss two principal spaces of co‐production, highlighting the opportunities provided for, and barriers to, co‐production expressed by volunteers and other partners by attending to the relations of care that are recognised through: (1) formal meetings and coffee mornings, which provide spaces for volunteers to contribute, and (2) multi‐disciplinary team (MDT) meetings, in which volunteers are largely absent.

Children’s services in the age of information technology: What matters most to frontline professionals

SummaryThe last two decades have seen information systems featuring prominently in calls for the modernisation of the UK social care system. However, critics have maintained that these systems are ...

The provision of services in the UK for UK armed forces veterans with PTSD: a rapid evidence synthesis

BackgroundOur research arises from anticipated increases in demand for psychological trauma services in the UK, with particular reference to armed forces veterans with post-traumatic stress disorder (PTSD). Commissioning and service provider activity to improve veterans’ health is evolving.ObjectivesTo explore what UK services exist and establish potentially effective models of care and effective treatments for armed forces veterans with PTSD.DesignA four-stage rapid evidence synthesis comprising information gathering on UK service provision; an evidence review on models of care; a metareview on treatment effectiveness; and a synthesis highlighting research priorities.SettingFor the evidence reviews, any setting that was relevant to the UK health and social care system.ParticipantsUK armed forces veterans with PTSD following repeated exposure to traumatic events.InterventionsAny model of care or treatment.Main outcome measuresAny relevant outcome.Data sourcesInformation about current UK practice. Searches of databases [including MEDLINE, PsycINFO and PILOTS (Published International Literature on Traumatic Stress)], guidelines and relevant websites, up to November 2016.Review methodsWe screened titles and abstracts using EPPI-Reviewer 4 (EPPI-Centre, Social Science Research Unit, Institute of Education, University of London, UK) and EndNote X7 [Clarivate Analytics (formerly Thomson Reuters), Philadelphia, PA, USA]. Decisions to include papers were made by two reviewers independently. We conducted a narrative synthesis of research literature on models of care and on treatments, guided by information from UK practice. In our evidence reviews, we assessed (when appropriate) the quality of included studies using established criteria. To help interpret our findings, we consulted recently published public and patient involvement data, a veteran service user and experts with academic, military and commissioning backgrounds.ResultsWe gathered information about current UK practice. Sixty-one studies were included in the rapid evidence review on models of care and seven systematic reviews in the rapid metareview of treatments. The quality of evidence in both evidence reviews was limited. Promising models of care from more robust studies (three randomised controlled trials and one qualitative study) were collaborative arrangements and community outreach for improving intervention access and uptake; integrated mental health services and behavioural intervention on increased smoking abstinence; and peer support as an acceptable complement to PTSD treatment. A poor fit was noted between the research literature and UK service provision. Promising treatments were psychosocial interventions (eye movement desensitisation and reprocessing, cognitive processing therapy, trauma-focused and exposure-based intervention) and pharmacotherapy (selective serotonin reuptake inhibitors, antidepressants, anticonvulsants, antipsychotics) for improving PTSD and mental health symptoms.LimitationsThe literature pool was larger than anticipated. Evidence for potentially effective models of care and potentially effective treatments is limited in quality and quantity. Although we aimed for a comprehensive evidence synthesis, pragmatic decisions in searching, screening and inclusion of studies may mean that relevant studies were overlooked.ConclusionsThere is tentative support for the effectiveness of some models of care and certain treatments currently delivered in UK practice. Our findings are timely for commissioners and service providers when developing present activity in veterans’ health care.Future workWe report potential implications for future health-care practice, including early intervention for veterans transitioning from military life, improving general practitioners’ knowledge about services, implementing needs-based service design and tackling wider-system challenges. Regarding potential areas of future research, we have identified the need for more-robust (and longer) evaluative studies in the UK setting.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes.

Introductioncare home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use.Methodsa realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners.Resultscontext-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which ‘wraps around’ care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites.Conclusionactivities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise.

Piloting different approaches to personalised offender management in the English criminal justice system

ABSTRACTVarious approaches to personalisation are well-established in the UK social care sector and are now starting to ‘travel’ to other sectors. In this paper we report findings from an evaluation of a pilot to test elements of personalisation in the management of offenders in probation services within the English criminal justice system. Following a review of evidence from social care, three different approaches to personalised-practice were developed and tested on a small-scale in three separate sites. The evaluation finds that all three approaches were implemented reasonably successfully, but challenges were identified including that personalised approaches are more time-consuming, that staff need support to exercise professional discretion and that balancing greater choice with managing criminogenic risk requires new ways of conceptualising the relationship between case manager and service user. Overall, ‘deeper’ approaches to personalisation, such as co-production, will take time to emerge. This paper makes two important contributions to the debate on personalisation in public services. First, it addresses the question of how transferable the concept of personalisation is from the social care sector to other sectors in the UK, in this case the criminal justice system. Secondly, it outlines a methodology for developing and evaluating personalisation pilots, prior to a wider roll-out.