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The purpose of this paper is to compare data from national social care statistics on day services and home care for people with learning disabilities across England, Scotland, Wales and Northern Ireland.

National social care statistics (England, Scotland, Wales and Northern Ireland) reporting the number of adults with learning disabilities accessing day services and home care were reviewed, with data extracted on trends over time and rate of service use.

Regarding day services, despite some variations in definitions, the number of adults with learning disabilities in England, Scotland and Wales (but not Northern Ireland) using building-based day services decreased over time. Data from Scotland also indicate that adults with learning disabilities are spending less time in building-based day services, with alternative day opportunities not wholly compensating for the reduction in building-based day services. Regarding home care, there are broadly similar rates of usage across the four parts of the UK, with the number of adults with learning disabilities using home care now staying static or decreasing.

Similar policy ambitions across the four parts of the UK have resulted (with the exception of Northern Ireland) in similar trends in access to day services and home care.

This paper is a first attempt to compare national social care statistics concerning day services and home care for adults with learning disabilities across the UK. With increasing divergence of health and social service systems, further comparative analyses of services for people with learning disabilities are needed.

The modernisation of mental health day services has been shaped by concerns about the social exclusion of people with enduring mental health problems. Initiatives have emphasised the use of mainstream facilities and an individualised approach. In contrast, service users have sought to safeguard opportunities for peer support in safe places. This participatory action research brought together service users, staff and others involved, to explore how these different views could be transformed into modernised services. The research took place in an outer London borough from 2003‐2007, using varied methods to explore social networking, including a visual method, action research groups and individual interviews. The research was designed and adapted to enable the involvement of people with different capacities and interests. Each stage generated findings for local modernisation, pointing to the importance of a safe space, service user knowledge of social and recreational activities and how self‐help groups develop and thrive. The final reconfiguration of local services reflected these research outcomes. Credible and useful outcomes can be achieved from collaborative research, allowing time and creating opportunities to shape interpretations of policy. Emerging initiatives are more likely to reflect service user perspectives and receive their support.

A postal survey and semi‐structured interviews were under taken with mental health day centre staff in two regions of England, investigating whether criticisms levelled at buildings‐based day services are justifiable. The majority of respondents agreed with recommendations outlined in From Segregation to Inclusion (National Institute for Mental Health in England/Care Services Improvement Par tnership, 2006), believing that mental health services should ideally be based in community locations. Respondents believed that this would help to challenge stigma, facilitate community integration, and provide service users with more oppor tunities. However, concerns were expressed as to the availability of mainstream facilities and whether this approach would be suitable for all service users. Suggestions on how day services could be improved included having access to reliable sources of funding, relaxing access criteria, and having greater service user involvement.

The concept of social inclusion features prominently in current policy and practice developments in mental health services. The Social Exclusion Unit (2006) highlighted the need for mental health day services to promote inclusion and participation, by integrating with the wider community, and by supporting and encouraging users to access opportunities in the local community. The Leeds i3 (inspire, improve, include) project aimed to modernise local mental health day services accordingly. The aim of our study was to develop and validate a measure of social inclusion to be used in mental health day services in Leeds. The underlying assumption was that recent changes in mental health day service provision would substantially improve social inclusion of the service users.The social inclusion questionnaire was developed through extensive iterative consultation with mental health service users and staff, and its reliability was proven using test‐retest statistics. It was shown to be a simple, inexpensive, user‐friendly and repeatable measure that could be used routinely by mental health day services. Factor analysis of the questionnaire showed that social inclusion had seven important components. We suggest that these components form a useful basis for discussion with service users, as well as for planning and evaluating services.

This article describes the approach to modernisation of adult mental health day services taken in Sandwell, which retains a building‐based element to provide for attachment and belonging, while developing community‐based models that promote social integration and recovery.

Modularity promises to relieve problems of complexity in service systems. However, limited evidence exists of its application in specialized hospital services. The purpose of this paper is to identify enablers, constraints, and outcomes of modularization in specialized hospital services.

A qualitative comparative study of a hematology unit with modular service architecture and an oncology unit with integral service architecture in a university hospital is performed to analyze the service architectures, enablers and constraints of modularization, and outcomes.

A framework and five propositions combining the characteristics of specialized hospital services, enabling activities, and outcomes of modularization were developed. Modular service architecture was developed through limiting the number of treatment components, reorganizing production of standardized components into a separate service unit, and standardizing communication and scheduling in interfaces. Modularization increased service efficiency but diluted ownership of services, decreased customization, and diminished informal communication. This is explained by the specific characteristics of the services: fragmented service delivery, professional autonomy, hierarchy, information asymmetry, and requirement to treat all.

Modularization can increase efficiency in specialized hospital services. However, specific characteristics of specialized care may challenge its application and limit its outcomes.

The study identifies enabling activities and constraints that hospital managers should take into account when developing modular service systems.

This is the first empirical study exploring the enablers, constraints, and outcomes of modularization in specialized hospital services. The study complements literature on service modularity with reference to specialized hospital services.

The National Day Services Modernisation Network was launched in January 2009 and is a collaboration between the Inclusion Institute (taking on the role previously held by the National Social Inclusion Programme), Mind, Rethink and Richmond Fellowship. The Network came about in recognition that many of those involved in modernising mental health day services were struggling with the same issues, often in isolation, and that there was a need for a forum to discuss and develop approaches to these issues.

The current policy context demands that health service providers demonstrate that services are effective, efficient, value for money and of good quality. Recent Government interest in intermediate care has increased pressure on day hospitals in particular to supply such evidence, because they face competition for their core services (such as rehabilitation care) from other community‐based providers. This review was conducted as part of a small study to evaluate a day hospital service in North London. Findings suggest that the outcomes of day hospital care are especially difficult to appraise because of the highly variable nature of both individual facilities and the needs and capabilities of patients attending. Traditional quantitative methods, such as randomised controlled trials or the use of standardised tools to assess treatment outcomes, face severe methodological problems owing to this variability. Three problems in particular would appear to hamper such research: comparability difficulties, owing to great variations in facilities and patient profiles; defining outcomes, because varying need may result in very different intended treatment outcomes, and determining complete costs, because patients rarely receive day hospital treatment in isolation from other health and social care services. The review suggests therefore that future researchers take a more user‐focused and qualitative research approach to the evaluation of day hospital care, such as by evaluating joint care plans with patients and staff, by assessing costs, by following small numbers of users through treatment and by studying users' and carers' views of (and preferences for) care.

A year‐long review of services was carried out in South Essex by local authority and primary care trust commissioners to help inform future commissioning plans. The review included a focus group to consult service users, carers, project staff and referrers across the area. This was undertaken by SE‐SURG, a group of current and former service users who carry out research and consultation work for mental health service commissioners and providers. The results of the consultation are presented here, particularly in relation to the strengths and limitations of current services, service user aspirations and staff expectations.

The aim of this study is to identify the methods used by providers to evaluate their food services and identify elements of their service that would benefit from adopting a benchmarking system.

In‐depth interviews were conducted with 26 food services providers and key informants in day‐care settings in Surrey.

Few providers formally evaluated their service provision and most had not considered benchmarking their services against other food service providers. Factors such as food variety, food quality, cost and environment have been identified as issues that could be benchmarked and may benefit from the adoption of this process.

The study was conducted only in one country – in the UK – further research is needed into the evaluation practices of other local authorities. The benchmarking model that has been developed by the authors needs to be applied in a food service setting to establish its usefulness to food service managers.

A model has been developed from the outcome of this research, which could aid evaluation processes for food service providers to identify aspects of the service in need of improvement.

There has been little research conducted on the evaluation of food service provision for older people, especially for congregate meals. This paper provides a model, that food service providers may find useful, to identify areas of their food services that are suitable for benchmarking.