Suchergebnisse

Summary This paper focuses on the impact of a personal budget – either in the form of a direct payment or managed personal budget – on the role of unpaid carers of older budget holders. Data were collected via postal survey of 1500 unpaid carers and semi-structured interviews with 31 carers. Findings Unpaid carers played a central role in supporting older budget holders irrespective of the type of budget received. The allocation of a personal budget may have decreased the amount of 'hands-on' care they provided, enabling them to do different things for and with the person cared for, but most did not relinquish direct involvement in care provision. Both kinds of personal budget provided greater flexibility to juggle caring tasks with other roles, such as childcare or paid employment. However, carers supporting direct payment users did experience higher levels of stress. This seemed linked to the additional responsibilities involved in administering the direct payment. Carers seemed relatively unsupported by their local Adult Social Care Department: the survey found that only one in five said they had ever received a carer assessment. Application The findings offer a detailed exploration of the impact of personal budgets on carers, suggesting that even in countries with relatively well-developed systems of support for carers such as England their impact remains overlooked. The paper may be of interest to social work practitioners, managers, academics and social work policy specialists working in countries that have, or are about to introduce, personal budgets or other forms of cash-for-care scheme.

Background
This paper discusses findings from a study of English Local Authority (LA) Adult Social Care Departments (ASCDs) that explored how managers use telecare. A decade earlier, a large clinical trial, the 'Whole System Demonstrator' project (WSD), funded by the Department of Health (DH) investigated telecare's effectiveness in promoting and maintaining independence among users. It found no evidence that telecare improved outcomes. Despite these conclusions, the DH did not change its policy or guidance, and LAs did not appear to scale back investment in telecare.


Aims and objectives
The present study explores how English ASCDs responded to WSD findings and why investment continued despite evidence from the WSD.


Methods
Data were obtained from an online survey sent to all telecare lead managers in England. The survey achieved a final response rate of 75%.


Findings
The survey asked questions focused on awareness and use of research in general, and specifically knowledge about the findings of the WSD. Most respondents were highly critical of the WSD methods, and its findings.


Discussion
Critical examination of telecare manager views found widespread inaccurate information about the trial methodology and findings, as well as the wider political and policy context that shaped it.


Conclusions
The WSD could not explain why telecare did not deliver better outcomes. A more nuanced understanding of the circumstances in which it might achieve good outcomes has received little consideration. LA difficulties in using evidence in telecare commissioning potentially leaves the sector at risk of market capture and supplier induced demand.

Summary This article explores the role of telecare assessment, review and staff training in meeting the needs of older people living at home. Using original empirical data obtained from an online survey of English local authorities it reveals considerable variation in assessment and review practice and in training given to social work and other staff who assess and review, which may impact on outcomes for telecare users. The study findings are situated within an English policy context and earlier findings from a large, government funded randomised controlled trial. This trial concluded that telecare did not lead to better outcomes for users. Findings Our survey findings suggest that it may be the way in which telecare is used, rather than telecare itself that shapes outcomes for people who use it, and that 'sub-optimal' outcomes from telecare may be linked to how telecare is adopted, adapted and used; and that this is influenced by staff training, telecare availability and a failure to regard telecare as a complex intervention. Application The findings may help to reconcile evidence which suggests that telecare does not deliver better outcomes and local authority responses to this which either discount or contest its value. The article suggests that to use telecare to achieve optimal outcomes for older people, social workers, care managers and other professionals involved in assessing for telecare will need to be given enhanced training opportunities, and their employers will need to perceive telecare as a complex intervention rather than simply a 'plug and play' solution.

Background: There is a shortage of Approved Mental Health Professionals (AMHPs), who are responsible for compulsory admission decisions under the Mental Health Act (MHA), 1983. Only 5% of AMHPs are health professionals, over a decade after the role was opened to them. Aims: The research aimed to identify factors motivating and discouraging health professionals from becoming and working as AMHPs. Methods: Semi-structured interviews (n = 52) with professionals enabled to become AMHPs by the MHA, 2007, including AMHPs; those that had not become AMHPs; and AMHP managers. Additionally, a survey of AMHP senior managers. Interviews and open-ended survey questions were analysed thematically. Results: Motivating and discouraging factors were grouped as intrinsic and extrinsic. Intrinsic motivations were: altruism; the dynamic and contained nature of the work; and fit with experience. Intrinsic discouraging factors were: damage to therapeutic relationships; the perceived clash between AMHP work and professional values. Extrinsic motivations were: career progression; and professional esteem. Extrinsic discouraging factors were: profile and reputation of the service; organisational commitment; management support; and level of remuneration. Conclusions: The research suggests that changes in organisational responsibility for running AMHP services and raising the profile of the role might help increase recruitment and retention of health professionals.

Summary This article explores the role of telecare assessment, review and staff training in meeting the needs of older people living at home. Using original empirical data obtained from an online survey of English local authorities it reveals considerable variation in assessment and review practice and in training given to social work and other staff who assess and review, which may impact on outcomes for telecare users. The study findings are situated within an English policy context and earlier findings from a large, government funded randomised controlled trial. This trial concluded that telecare did not lead to better outcomes for users. Findings Our survey findings suggest that it may be the way in which telecare is used, rather than telecare itself that shapes outcomes for people who use it, and that 'sub-optimal' outcomes from telecare may be linked to how telecare is adopted, adapted and used; and that this is influenced by staff training, telecare availability and a failure to regard telecare as a complex intervention. Application The findings may help to reconcile evidence which suggests that telecare does not deliver better outcomes and local authority responses to this which either discount or contest its value. The article suggests that to use telecare to achieve optimal outcomes for older people, social workers, care managers and other professionals involved in assessing for telecare will need to be given enhanced training opportunities, and their employers will need to perceive telecare as a complex intervention rather than simply a 'plug and play' solution.

Summary Internationally there has been much interest in the impact of the COVID-19 pandemic on the care and support of older people including those with needs arising from self-neglect and/or hoarding. During the pandemic English local authorities' legal duties remained to respond to concerns about harm about people with care and support needs living in the community. This paper reports interviews with 44 participants working for adult safeguarding/adult protective services (APS) in 31 local authorities recruited from all English regions. Interviews took place online in November-December 2020 as the pandemic's second UK wave was emerging. Analytic induction methods were used to develop themes. Findings Participants reported some of the variations in referrals to their services with more contact being received from community sources concerned about their neighbours' welfare. Participants provided accounts of the local organisation of adult safeguarding services during the pandemic, including in some areas the potential for offering early help to older people at risk of harm from self-neglect or hoarding behaviour. Online inter-agency meetings were positively received but were acknowledged to potentially exclude some older people. Applications This article reports observations from adult safeguarding practitioners about their services which may be of interest internationally and in renewing services that can sustain public interest in the welfare of their older citizens and in developing early help. The findings reflect those from children's services where online meetings are also predicted to enhance professional communications post-pandemic but similarly need to ensure effective engagement with service users and their families.

Context: People with prior health conditions are susceptible to severe and sometimes fatal outcomes of the novel coronavirus SARS-CoV-2, that causes the disease COVID-19. The protection of the capacity of systems for social care was thus an important consideration for governments in the early stages of the global pandemic. Objectives: This paper reports and discusses the results of a rapid review of international early policy responses for the protection of social care systems after the World Health Organization (WHO) announced that SARS-CoV-2 had evolved into a pandemic. Literature was collected in March 2020. Method: Rapid online review of government responses to the SARS-CoV-2 pandemic using official government statements and press reports from 13 countries. Findings: The analysis of early responses in and about social care to the pandemic suggested an initial focus on avoiding the outbreak of the virus in care homes, with first steps being to limit visitors in these contexts and considering ways to isolate residents with symptoms or a confirmed infection. Responses to protect people receiving social care in their homes and schemes to support informal or family carers were less prominent. Limitations: Only publications in the public domain and in local languages of the 13 countries were considered for this analysis. It is possible that further strategies and responses were not made available to the public and are therefore not included, which limits this article's scope for analysis. Implications: The findings of this article can support reflection on the trajectory of policy responses to the threats that SARS-CoV-2 poses to social care. They can thereby potentially inform planning and policy responses for enhanced pandemic preparedness and stronger social care systems in the future.