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People with learning disabilities are at risk of poor health and premature death. Due to these inequalities, NHS trusts are required to make reasonable adjustments to their care, such as longer appointment times, with the legal duty on them being “anticipatory”. The paper aims to discuss these issues.

Secondary analysis of CQC acute hospital inspection reports asking the following research questions: Do CQC inspection reports mention people with learning disabilities? Where issues concerning people with learning disabilities are reported in CQC hospital inspection reports, what issues and reasonable adjustments are reported? Are there any relationships between comments made in the inspection reports and CQC ratings of the trusts?

In total, 29 of the 30 trust-wide inspection reports (97 per cent) and 58 of the 61 specific site reports (95 per cent) included at least one mention of people with learning disability/ies. Most comments about practices for people with learning disabilities were positive across all CQC inspection output types and across all CQC overall ratings, although the proportion of positive comments decreased and the proportion of negative comments increased as CQC ratings became less positive.

Overall the authors found that CQC inspection reports routinely contained some information regarding how well the hospitals were working for people with learning disabilities. The depth of information in reports varied across trusts, with the potential for CQC reports to more consistently report information collected during inspections.

The report updates and extends a report published by the Public Health England Learning Disabilities Observatory in 2015.

The purpose of this paper is to understand how inspection team members work together to conduct surveys of hospitals, the challenges teams may face and how these might be addressed.

Data were gathered through an evaluation of a new regulatory model for acute hospitals in England, implemented by the Care Quality Commission (CQC) during 2013-2014. The authors interviewed key stakeholders, observed inspections and surveyed and interviewed inspection team members and hospital staff. Common characteristics of temporary teams provided an analytical framework.

The temporary nature of the inspection teams hindered the conduct of some inspection activities, despite the presence of organisational citizenship behaviours. In a minority of sub-teams, there were tensions between CQC employed inspectors, healthcare professionals, lay people and CQC data analysts. Membership changes were infrequent and did not appear to inhibit team functioning, with members displaying high commitment. Although there were leadership authority ambiguities, these were not problematic. Existing processes of recruitment and selection, training and preparation and to some extent leadership, did not particularly lend themselves to addressing the challenges arising from the temporary nature of the teams.

Conducting the research during the piloting of the new regulatory approach may have accentuated some challenges. There is scope for further research on inspection team leadership.

Issues may arise if inspection and accreditation agencies deploy temporary, heterogeneous survey teams.

This research is the first to illuminate the functioning of inspection survey teams by applying a temporary teams perspective.

As part of their inspection of care homes in England, the statutory inspector (the Care Quality Commission [CQC]) makes a judgement on the quality of the home’s leadership. Their view is critical as it is intended to inform consumer choice and because the statutory nature of inspection means these views hold considerable authority. The purpose of this paper is to look at the content of a selection of reports and seek to determine what the CQC understands by the concept of “good leadership”.

A purposive sample of recent CQC inspection reports was selected and subjected to a qualitative content analysis. Inspections are structured around five main questions. The resulting themes describe areas of focus within the section of reports that feature the question “Are they well-led?”.

Inspection reports were found to focus on four main themes: safety and quality of care; day-to-day management of staff; governance and training in the home; and integration and partnership working. In the discussion section, the authors reflect on these themes and suggest that the CQC’s view of leadership is rather limited. In particular, while an emphasis is placed within the literature and policy on the importance of leadership in delivering change and quality improvement, little attention is paid to this within the leadership section of inspection reports.

The authors’ research is based on a small-scale sample of inspection reports; nevertheless, it suggests a number of avenues for further research into the way in which leadership and management capabilities are developed and monitored in the sector.

The analysis in this report offers a view of how the inspection regime implements its own guidance and how it assesses leadership. The reports, as public-facing documents, are artefacts of the inspection regime and critical not just as evidence of the practice of inspection but as influence on care home operations and the choices of care home residents and their families.

Patients detained in high-security psychiatric hospitals are particularly vulnerable to excessive restrictions and exploitation. In the UK, the care quality commission (CQC) monitors and regulates forensic healthcare provision. The purpose of this study is to identify key concerns highlighted in CQC inspection reports of the three high-secure hospitals in England between 2010 and 2018.

In this qualitative study, 49 CQC inspection reports from three high-secure hospitals were subjected to thematic analysis.

Five central themes emerged: staffing and management; restrictive practice; physical environment and ward atmosphere; patients’ needs and involvement in their care; and legal and statutory matters. There was some variation in the overall quality of care between the hospitals. Positive staff–patient interactions and good practice in assessing and delivering care were consistently observed. However, enduring staff shortages within each hospital were experienced negatively and sometimes co-occurred with concerns over restrictive practices, poor care-plan procedure and inadequate legal documentation. Over time, Rampton and Broadmoor Hospitals appeared to worsen with regard to staffing levels, staff morale and management involvement. While services progressed over time in providing patients with access to advocacy and information concerning their rights, in some recent inspections it remained unclear whether patients were adequately involved in the care-plan process.

These findings provide preliminary indicators for areas requiring further attention from policymakers, clinicians and advocates.

This study appears to be the first systematic analysis of key concerns expressed in CQC reports of English high-security hospitals.

The research reported here aims to explore the problems facing individuals searching for information about available options in choosing care services.

It presents data drawn from an on‐line survey, follow‐up telephone calls and a focus group, which reveals the preferences people have in searching for information about care services and the difficulties encountered.

It finds that people need information but find it complicated, unwieldy and inaccessible. In addition to using on‐line sources, they value person‐to‐person contact and information tailored to meet their specific needs.

This study is original in raising issues and presenting findings that open up the topic of information in care decision‐making. While it relies on a self‐reporting survey and the direct participation of a small number of subjects, future research based on random sampling and a larger sample of subjects would enable these findings to be tested more thoroughly.

High quality, accurate information is an essential element in enabling individuals to make appropriate choices about the care they seek for themselves or their loved ones. Service providers, councils and commercial undertakings each have a part to play in facilitating that choice.

This research highlights issues that confront both information searcher and provider, making recommendations about overcoming them. The concept of individual choice is a cornerstone of social policy but findings reveal the complexity facing individuals, providers and practitioners in making this a reality.

The importance of information in making decisions about care is under‐researched; this study raises issues and presents findings which open the topic for further exploration.

The purpose of this paper is to present findings from face-to-face interviews undertaken with 16 care and nursing home managers employed in homes situated in two English local authorities. The research sought to explore managers’ perceptions of the role of contract monitoring in the prevention of abuse.

Semi-structured interviews were undertaken with 16 care and nursing home managers.

Though personnel employed by the local authority who conducted contract monitoring were generally thought of positively by care home managers on a personal level, their effectiveness was perceived to be limited as a result of their lack of experience and knowledge of providing care, and the methods that they were required to use.

Though the research draws upon the experiences of only 16 care and nursing home managers in two local authorities, data suggest that current contract monitoring activity is of limited utility in determining the true nature of care and the presence of abuse.

Unusually, the paper explores care and nursing home managers’ perceptions of contract monitoring processes in terms of how they perceive their effectiveness in preventing abuse.

Hospital mergers are common in the United Kingdom and internationally. However, mergers rarely achieve their intended benefits and are often damaging. This study builds on existing literature by presenting a case study evaluating a merger of two hospitals in Oxford, United Kingdom with three distinct characteristics: merger between two university hospitals, merger between a generalist and specialist hospital and merger between two hospitals of differing size. In doing so, the study draws practical lessons for other healthcare organisations.

Mixed-methods single-case evaluation. Qualitative data from 19 individual interviews and three focus groups were analysed thematically, using constant comparison to synthesise and interpret findings. Qualitative data were triangulated with quantitative clinical and financial data. To maximise research value, the study was co-created with practitioners.

The merger was a relative success with mixed improvement in clinical performance and strong improvement in financial and organisational performance. The merged organisation received an improved inspection rating, became debt-free and achieved Foundation Trust status. The study draws six lessons relating to the contingencies that can make mergers a success: (1) Develop a strong clinical rationale, (2) Communicate the change strategy widely and early, (3) Increase engagement and collaboration at all levels, (4) Be transparent and realistic about the costs and benefits, (5) Be sensitive to the feelings of the other organisation and (6) Integrate different organizational cultures effectively.

This case study provides empirical evidence on the outcome of merger in a university hospital setting. Despite the relatively positive outcome, there is no strong evidence that the benefits could not have been achieved without merger. Given that mergers remain prevalent worldwide, the practical lessons might be useful for other healthcare organisations considering merger.

The purpose of this paper is to describe the findings from a pilot and a follow-on study in which care assistants in care homes were trained to use sporting memories work to better help and engage with residents with dementia and low mood. Care homes have to support increasingly more fragile people and often the range of activities in the homes do not offer the best engagement between residents and staff to benefit the residents. This is for reasons of time to run activities in a busy home, and because of the need to find financially viable means of running a range of activities. Care assistants in care homes are a group of non-professionally educated workers and are often overlooked for training beyond basic health and safety training to help them improve their work and the care they provide. This work sought to explore whether sporting memories work was viable as an activity to offer in care homes via the training of care assistants.

The paper discusses the evidence from a pilot and then follow-on project in care homes in one city area. In the pilot observation was made of a training session and follow up interviews were undertaken with care home managers to see how the implementation of sporting memories was going. In the follow-on project the support to those undertaking the training was modified to include three learning network sessions. Data were collected on the experience of participants and their use of sporting memories work.

The findings were that care assistants could be trained in using sporting memories work and they often found it easy to use and fulfilling for them and people they cared for. This was despite the care assistants who participated often not having much interest in sports and little experience in this kind of work. However, practical barriers to maintaining the use of sporting memories work did remain.

The evidence to date is of case studies of training staff in care homes in the use of sporting memories work, which provides good grounding for proof of the concept and key issues, but further research is needed on the costs and impacts of sporting memories work in care homes. The lack of direct feedback about experiences of care home residents of sporting memories work and its impact on them is a further limitation.

Sporting memories work is a flexible and readily adoptable intervention to engage older people in care homes and the evidence to date is that care assistants in care homes can be trained to use this approach to engaging older people. Practical challenges still remain to using sporting memories work in care homes, notably the issue of time for staff to do the work, but it is an approach for care homes to have available to them to match up to the interests of residents.

Sporting memories work can be an important part of meeting some of the challenges society faces with an ageing population profile and to enhancing the care home environment and care assistants can be trained to use the approach.

This is the first paper to discuss training care home staff in the use of sporting memories work.

The purpose of this paper is to consider the role of the Mental Health Act (MHA) 1983 in safeguarding adults at risk of abuse and neglect. The author has undertaken a thematic review of Safeguarding Adults Reviews (SARs) commissioned in England and Adult Practice Reviews (APRs) commissioned in Wales where the MHA 1983 was a central aspect to the review.

Reviews were included based on specific determinants, following analysis of SARs, APRs and executive summaries. This should not affect the credibility of the research, as themes were identified in conjunction with analysis of literature regarding use of the MHA in the context of adult safeguarding. Consequently, this review has been underpinned by evidence-based research in the area of study.

The interaction between statutes, such as the MHA 1983 and Care Act 2014, signify challenges to professionals, with variable application of mental health legislation in practice.

Lack of a complete national repository for review reports means that it is likely that the data set analysis is incomplete. It was noted that limitations to this research include the fact that Safeguarding Adults Boards in England may not publish SAR reports or may choose to publish an executive summary or practice brief instead of the full SAR report, therefore limiting the scope of disseminating learning from SARs, as this is difficult to achieve where the full report has not been published. The author aimed to mitigate this by undertaking comprehensive searches of Local Authority and SAB websites, in addition to submitting Information requests to ensure that this research encompassed as many relevant review reports as possible.

This is an important and timely topic for debate, given that the UK Government is proposing reform of the MHA 1983. In addition, existing thematic reviews of SARS tend to be generalised, rather than specifically focused on the MHA.