Suchergebnisse

With contributions from a range of experts across OECD countries, this book examines changes in long-term care systems throughout those countries, discussing and comparing key changes in national policies and examining the main successes and failures of recent reforms

AbstractEver since the failed 1999 Royal Commission, England has been attempting to reform its long‐term care funding system. More than a decade later, significant changes to the means tested arrangements are yet to be introduced, whilst the pressure to achieve long‐term reform mounts linked to increases in public expenditure and ever growing demand for better services. This paper examines the pros and cons of alternative options for reforming the English long‐term care funding arrangements by examining the rationale for and consequences of the recent long‐term care developments in Germany, Japan and France. In particular, the paper examines the implications of the reform options adopted in the different countries examined for equity and efficiency in the use of long‐term care resources and for the sustainability of the long‐term care system as a whole.

AbstractUsing a stochastic frontier approach, this paper explores efficiency in the commissioning of publicly funded social services among 148 English Councils through a six‐year panel database (2002‐2007), covering institutional and community care. Our estimates provide key policy evidence in a context in which optimization is critical both for social and financial purposes. Results suggest a slight decrease in the average inefficiency score, moving from 1.080 in the first year to 1.076 in the last year. Cost‐output elasticity of institutional care is greater than those of community care services. Greater savings are obtained when the market is open to independent providers.

The paper uses two-years worth of data from 150 English local authorities to quantify the extent to which local variations in social care resources are associated with variations in performance in the acute sector, and particularly on the rates of hospital delayed discharges and hospital emergency readmissions. Results indicate social care services play a significant role in explaining local variations in acute sector performance.

Abstract
There is a growing emphasis on prevention to reconcile demographic pressures, resource scarcity and expectations of better quality care and support. The Care Act 2014 placed a statutory duty on English local authorities to prevent and delay the development of needs for care and support. However, evidence suggests that the prevention approach has secured less impact than intended. Given that existing approaches have achieved such limited results, new ways of addressing this apparently intractable challenge should be considered. We argue here that theory-based models that support the understanding of, and responses to, implementation barriers and facilitators can provide tools to support the development of more successful implementation. Drawing on in-depth interviews (n = 20) in selected English councils and analyses of their policy documents, we explore the 'Ready, Willing and Able' (RWA) model, which posits that those three preconditions must be satisfied before new practices can be implemented sustainably. We argue that RWA can provide a straightforward and parsimonious framework for identifying implementation barriers and facilitators. Using the model to identify potential bottlenecks prior to the implementation can help local actors clarify baseline barriers to progress. RWA could help to inform opportunities to target identified problems, by reinforcing facilitators and moderating barriers.

The Care Act 2014 amended legislation relating to government responsibilities for adults with care needs. It set out new statutory responsibilities for the support of family or informal carers. As part of a study investigating the impact of the Care Act 2014 on family carers in England, we undertook a contextual literature review, focusing on parliamentary debates available online from Hansard. We describe the content of debates seeking to amend the law relating to carers and aspirations for the proposed reforms. We highlight the role of parliamentary carer champions, as well as carer-related themes and the lack of controversy over this subject.

AbstractIn common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long‐term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in‐kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end‐user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better‐quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.

As in other countries, improving collaboration between health and social care services is a long-established objective of English social policy. A more recent priority has been the personalisation of social care for adults and older people through the introduction of individualised funding arrangements. Individual budgets (IBs) were piloted in 13 English local authorities from 2005 to 2007, but they explicitly excluded NHS resources and services. This article draws on interviews with lead officers responsible for implementing IBs. It shows how the contexts of local collaboration created problems for the implementation of the personalisation pilots, jeopardised inter-sectoral relationships and threatened some of the collaborative arrangements that had developed over the previous decade. Personal budgets for some health services have subsequently also been piloted. These will need to build upon the experiences of the social care IB pilots, so that policy objectives of personalisation do not undermine previous collaborative achievements.

• Summary: This study examines the early impact on care coordinators' (care managers') work activity patterns of implementing the current personalization agenda within English local authorities. The Individual Budget (IB) pilots operated between 2005 and 2007 and provided a basis for personalization that, ultimately, sought to give personal care budgets to every eligible service user in England. Of particular interest was how the pilots impacted upon the roles, responsibilities and activity of care coordinators, who are expected to play a key role in this transformation of social care. A self-administered diary schedule was completed by 249 care coordinators, including teams directly involved in delivering IBs and a comparative sample of teams not involved in the pilots. These data were supplemented by semi-structured interviews with 48 care coordinators and 43 team managers. • Findings: The study found that on most measures there were no differences in working patterns between care managers with and without IB holders on their caseload. However, the results do show that – contrary to expectations – more time was spent assessing needs, and that more time generally was required to conduct support planning activities. • Application: The findings are necessarily dependent upon the early experiences of the pilot phase of IBs. As personal budgets are rolled out across all eligible service users, it will be interesting to examine whether the time-use of frontline staff, and indeed the wider organization, structure and function of local authority frontline teams, changes further.