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The purpose of this study is to examine changes in the nature, form and range of commissioning arrangements for home care.

Data from two discrete national surveys of English local authorities with social service responsibilities were used. In the first, undertaken in 2007, responses from 111 of the 151 local authorities (74%) were received; in the second, undertaken in 2017, responses from 109 local authorities (72%) were received. A combined data set of 79 complete cases, 52% of local authorities, was created. Percentage point differences across the two time periods were calculated and tested to identify significant changes and a systematic analysis of the free-text responses regarding intended changes to the commissioning process in each data set was undertaken.

Findings identified substantial changes in some aspects of the commissioning of home care in the 2007-2017 decade. Collaboration between stakeholders had increased, particularly regarding the identification of future needs. Improved conditions of service and remuneration for home care workers were evident within the commissioning process. Standardised charges for home care (regardless of time and day) had also become more widespread. Initiatives to prompt providers to deliver more personalised care were more evident.

This paper describes the evolution of commissioning arrangements for home care in localities in response to national policy initiatives. It provides guidance to commissioners in meeting the needs of current service users and emphasises the importance of collaboration with stakeholders, particularly providers, in securing future capacity.

It was hypothesised that there were variations in health and social care services available for older people with dementia and their carers, and that measurement of this between localities was possible. The purpose of this paper is to present a framework for examining this.

Using a case study approach, data from national surveys of local authorities providing social care and National Health Services Trusts providing old age mental health services conducted in 2014/2015 in England were used. From these, indicators of variation in services for people with dementia and their carers in different geographical areas were created. Measurement of the presence/absence of each service permitted the creation of a service mix score for each area.

The framework comprised 16 attributes each with indicators describing the characteristics of the organisations providing the services; the skill mix of community mental health teams for older people; and the health care and social care services available in localities. Variation was evident, confirmed by quartile analysis and exemplars, suggesting that older people with dementia and their carers in different localities are likely to experience differences in the range of provision available, particularly social care services.

The case study approach used achieved its objectives, and the resultant framework has potential for generalisability and utility, given acceptable ecological validity and discriminant validity in identifying variations in service mix. It could be used in both research and practice.

The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England.

Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process.

Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals.

The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed.

There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries.

The purpose of this paper is to explore the views of people with learning disabilities on issues associated with continuity of care in the transition from full-time education to adult care and support.

Data collection was undertaken with people with learning disabilities and staff in two advocacy organisations in one area of England in 2012. In total, 19 participants attended three focus groups. Analysis focussed on continuity of care and was guided by the framework approach to qualitative analysis.

Teachers, social workers in children’s services and youth workers were identified as making important contributions to the transition process. Information relating to learning and social development was identified as most important to inform transition planning with less priority accorded to health, communication, and self-care and independence. Participants appeared to value principles which underpin continuity of care.

This study provides insights into attributes of continuity of care valued by people with a learning disability. Possibilities of translating these attributes into practice within localities are explored. Findings could be used to inform strategic planning locally to promote service integration thereby contributing to continuity of care within transition planning.

Continuity of care in the transition planning process is highlighted in policy guidance with recognition that both practice and procedures require improvement. This research explores areas for development from the perspective of people with learning disabilities.

Long‐term care in general, and care homes in particular, have never enjoyed high status as a place to live and work. This remains the case. In large part this marginalised position is due to the continued failure to value the contribution that care homes make to supporting frail and vulnerable older people. In order to promote a more positive vision of what can be achieved in care homes, this paper argues for the adoption of a relationship‐centred approach to care. The need for such a model is described, and how it might be applied using the ‘Senses Framework’ is considered. It is argued that adopting such a philosophy will provide a clearer sense of therapeutic direction for staff working in care homes, as well as more explicitly recognising the contribution that residents and relatives can make to creating an ‘enriched environment’ of care.

This article describes a partnership project between staff, residents and relatives at a nursing home for older people with dementia, and researchers at the University of Sheffield. The aim of the partnership is to develop care within the home and to create a positive environment for living, working and learning. The main principle guiding our work is the need to ensure that all participants: residents, relatives and staff, feel that they are valued members of the community. The project is using an action research approach and a range of methods, including: observation; interviews; questionnaires; process recording of meetings; and focus groups, to gather evidence about the research process and impact of the project. The article includes a summary of achievements to date and suggestions for future activity.

This paper briefly describes the rationale for and the development of the CARE (Combined Assessment of Residential Environments) profiles. The CARE profiles represent a new approach to quality improvement in care homes for older people that seeks to gain the views of residents, relatives and staff, and to use these as a basis for celebrating what works well in a home and identifying areas that need attention. The paper begins with a consideration of the limitations of existing quality initiatives and argues for a model that is more inclusive. Subsequently, the theoretical underpinnings of the CARE profiles, positive events, the Senses Framework, and a relationship‐centred approach to care are outlined. The process by which the CARE profiles were developed is then described and a case study highlighting how they might be used is presented.

Arguably waste management, in its various guises, has been subjected to more analysis at the community level than any other environmental sector to date. This attention spans geographical boundaries with community-based waste organisations, particularly those focused on recycling, minimisation and reuse, subjected to critical analysis across Africa (Myers, 2005) and Asia (Forsyth, 2005), as well as in North America (Adhikari, Trémier, Martinez & Barrington, 2010; Weinberg, Pellow & Schnaiberg, 2000), New Zealand (White & du Preez, 2005) and the UK (Luckin & Sharp, 2003). While all focused broadly on matters of sustainability and governance, the first explicit analysis of community-based waste initiatives as grassroots sustainability enterprises was undertaken in Ireland in the mid-2000s (Davies, 2009).