Suchergebnisse

Introduction: Long-term neurological conditions are a major cause of disability in the UK and internationally. Their successful management, in order to enhance health and well-being, requires both sophisticated organisation across a number of health, social care and other service boundaries, and the real involvement of people with neurological conditions and members of their support networks. Policy development: This paper reports on part of the preliminary scoping phase of a study designed to evaluate the impact of the National Service Framework for long-term neurological conditions on integrated care. It describes current policies in England and reports on discussions with a range of people involved in the planning, provision or use of services, which took place during the scoping exercise. These interviews inform how policy affecting people with long-term neurological conditions has been received and implemented so far. Conclusion and discussion: Findings suggest that progress towards integrated service provision is patchy and slow. In the competing priorities within government policy, neurological conditions have tended to be marginalised, within healthcare policy generally and in initiatives to support people with long-term conditions in particular. The reasons for this are explored and will inform the next stages of the research.

AbstractBackgroundDemand for formal social services support for adults with intellectual disabilities is increasing internationally. Initiatives which empower individuals with intellectual disabilities to improve their health, develop living skills or manage chronic illnesses may promote independence and reduce unnecessary dependency on social services.MethodsA "preventative framework" to managing demand comprising several domains was developed from existing literature to guide the search strategy.ResultsFourteen papers related to three domains in the predetermined preventative framework were selected for inclusion in the review, including twelve economic studies. Outcomes included measurement of care needs, and cost‐comparison between social care models or cost‐effectiveness of interventions. Due to the heterogeneity, the present authors were not able to quantitatively synthesize findings.ConclusionsThe present authors conclude that evidence linking initiatives across sectors to demand for adult social care is lacking. The present authors identify several gaps in the literature and make recommendations for future research and data recording in practice.

Purpose
The purpose of this paper is to present findings from one element of a study exploring the relationship between personalisation, in the form of personal budgets (PBs) for publicly funded social care and safeguarding.


Design/methodology/approach
Semi-structured interviews were conducted with 12 people receiving PBs who had recently been the focus of a safeguarding investigation. Participants were recruited from two English local authority areas and data were subject to thematic analysis.


Findings
The analysis identified three main themes: levels of information and awareness; safeguarding concerns and processes; and choice and control. Many of the participants in this small study described having experienced multiple forms of abuse or neglect concurrently or repeatedly over time.


Research limitations/implications
This was a small scale, qualitative study, taking place in two local authorities. The small number of participants may have had strong opinions which may or may not have been typical. However, the study provides some rich data on people's experiences.


Practical implications
The findings suggest that adults receiving PBs may need information on an ongoing and repeated basis together with advice on how to identify and address poor quality care that they are arranging for themselves. Practitioners need to be aware of the influence of the level of information received and the interaction of organisational or legal requirements when responding to safeguarding concerns when care being supplied tries to reflect the benefits of choice and control.


Originality/value
This paper reports original research asking adults with care and support needs about the interaction between two key policies of safeguarding and personalisation.

Purpose
– The purpose of this paper is to report on a part of a study examining the interrelationships between personalisation and safeguarding practice. Specifically the authors aimed to examine how safeguarding practice is affected by the roll out of personalisation in adult social care, particularly when the adult at risk has a personal budget or is considering this.


Design/methodology/approach
– A sample of annual reports from Adult Safeguarding Boards in England was accessed for content analysis covering the period 2009-2011. One part of this sample of local authorities was selected at random; the other authorities selected had been early adopters of personalisation. The reports were analysed using a pro forma to collect salient information on personalisation that was cross-referenced to identify common themes and differences.


Findings
– The authors found variable mentions of personalisation as part of the macro policy context reported in the annual reviews, some examples of system or process changes at mezzo level where opportunities to discuss the interface were emerging, and some small reports of training and case accounts relevant to personalisation. Overall these two policy priorities seemed to be more closely related than had been found in earlier research on the interface between adult safeguarding and personalisation.


Research limitations/implications
– There was wide variation in the annual reports in terms of detail, size and content, and reports for only one year were collected. Developments may have taken place but might not have been recorded in the annual reports so these should not be relied upon as complete accounts of organisational or practice developments.


Practical implications
– Authors of Safeguarding Adults Board reports may benefit from learning that their reports may be read both immediately and potentially in the future. They may wish to ensure their comments on current matters will be intelligible to possible future readers and researchers.


Originality/value
– There does not appear to have been any other previous study of Safeguarding Adult Boards' annual reports. Documentary analysis at local level is under-developed in safeguarding studies.

Reablement – or restorative care – is a central feature of many western governments' approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority – to develop an evidence base on models of delivery – is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare‐ and social care–related quality of life, functioning, mental health and resource use (service costs, informal carer time, out‐of‐pocket costs). In contrast with the majority of other studies, self‐report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow‐up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self‐report outcome and resource use measures in evaluations of reablement.