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Purpose
– The purpose of this paper is to gain a greater understanding of the development of safer walking technology for people with dementia through contemporary literature.


Design/methodology/approach
– A two stage systematic approach to searching the literature was adopted. Initially this involved searching the literature to gain a broad overview of the development of safer walking technology and the context in which it has been developed. Then, this literature was examined in detail to look at published evidence surrounding the use of safer walking technology by people with dementia. These articles were quality appraised and a meta ethnographic approach taken to synthesis of the findings.


Findings
– There is a small but growing body of literature within this field. Whilst there is only limited evidence to support the use of safer walking technologies for people with dementia, the evidence to date indicates great potential for its use. If provided with the right support and guidance, safer walking technology has the potential to increase freedoms and independence for people with dementia; gaining them improved access to outdoor spaces and environments to support their health and wellbeing. However, if the safer walking technology continues to be associated with only risk management it will not achieve this potential.


Research limitations/implications
– The published literature within this field is small and has limited generalisability as much of it was generated in recent years has been by the same small research teams, often reusing data sets. There is also very little research that examines the experience of actually using safer walking technology and even less which explores the views of people with dementia. It is evident that a greater breadth and depth of knowledge is needed within this field to develop a clearer understanding of how this technology is used and perceived by all stakeholders concerned. In particular the literature would benefit from greater consideration of the views and experiences of people with dementia themselves.


Practical implications
– For many people with dementia, health and social care professionals can play an important role in ensuring appropriate assessment and support in the decision-making process when using safer walking technology. However, greater support is needed in decision making for all people with dementia, especially those people not currently engaged with specialist services. Therefore greater awareness of the benefits and limitations of this technology is needed by all health and social care professionals as well as the general public.


Originality/value
– At the time of conducting this review the author is unaware of any other systematic search of literature or overview of research on the use of safer walking technology and its use by people with dementia. Despite this safer walking technology is growing in popularity, commonly recommended by health and social care practitioners and often marketed and purchased directly by people with dementia and their families. This review offers an insight into the development of the technology and the current evidence base for its use.

AbstractPeople with care and support needs were often badly affected by Covid-19, although the impact on people employing Personal Assistants (PAs) has not been addressed. We aimed to explore the experiences of people employing PAs during the pandemic to inform care systems and social work practice. Remote qualitative interviews were conducted with seventy PA employers across England in 2021–2022. Data were analysed thematically to explore salient themes. The Covid-19 pandemic elucidated role tensions of PA employers: Navigating care arrangements during a time of unprecedented uncertainty reinforced participants' role as an employer, but exposed some aspects of employment responsibilities and legal obligations that participants felt ill-equipped to manage. Reports of contact with or by social workers were few and not perceived as helpful. The often-informal nature of PA arrangements and its blurred relational boundaries affected participants' expectations of their PAs. PA employers would welcome support from social workers in their employment role and flexibility with care plans, albeit with greater autonomy over their Direct Payment (DP) budget to enhance the potential of this arrangement. In the context of declining DP uptake in England, our study offers some potential explanations for this, with suggestions for systemic change and social work practice.

Personal Assistants (PA) or client‐hired workers are directly employed by people needing care and support, often making use of government funding. In the context of Covid‐19, questions emerged about how this workforce is supported to practice safely. This paper reports PAs' understanding and views of infection control during the early months of the Covid‐19 pandemic in England. Telephone interviews were undertaken with 41 PAs between 16th April and 21st May 2020. PAs were recruited from a sample that had participated in a previous study in 2014–16. Interview questions focused on changes arising from the pandemic. Data were transcribed and analysed using Framework analysis. This paper focuses on PAs' perceptions of their role and responsibilities in preventing and managing infection. Arising themes were identified about barriers and facilitators affecting infection control in five areas: accessing information, social isolation, handwashing, hygiene, personal protective equipment and potential attitude to vaccines. Infection prevention and control are under‐researched in the home care sector generally and efforts are needed to develop knowledge of how to manage infection risks in home settings by non‐clinically trained staff such as PAs and how to engage home care users with these efforts, especially when they are the direct employers.

Many people in England employ care workers using state funding or their own resources. This article explores working relationships, communications and experiences of personal assistants with their employers' family members. Data from interviews with 105 personal assistants (in 2016–17) were analysed to explore relationships and experiences. Three overarching themes related to personal assistants' engagement with family members arose: (1) possible complications over accountability and employment; (2) support for family; and (3) being part of care teams. This article provides new insights into personal assistants' relationships with employers' family members, highlights the relevance of the concept of immaterial labour and sets out a research agenda.

Purpose
The purpose of this paper is to describe the employment conditions of social care personal assistants (PAs) in England. In England, disabled adults have been able to directly employ people to meet their care or support needs for a number of years, little is known about the employment conditions of people who are directly employed.


Design/methodology/approach
PAs were recruited mainly through third sector and user led organisations. A total of 105 social care PAs took part in a semi-structured telephone interview, which on average was an hour long. Interviews were fully transcribed. Quantitative data were analysed using SPSS (v.24) and qualitative data by NVIVO software.


Findings
The paper focuses on employment conditions: contracts, pay, pensions, national insurance, overtime, holiday and sick pay, etc. Access to training and support are also described. Though PAs enjoyed considerable job satisfaction, many did not enjoy good employment conditions. Though employer abuse was uncommon, many PAs could arguably be described as exploited. Occupational isolation and lack of support to resolve disputes was striking.


Research limitations/implications
Though this may be currently the largest qualitative study of PAs in the UK, it is nonetheless relatively small and no claims for generalisability are made, though the geographical spread of the sample was wide and recruited from multiple sites.


Practical implications
PAs are an effective way of establishing relationship-based care, and confer direct control to disabled employers. Many PAs experienced high job satisfaction. However, lack of regulation and oversight creates considerable potential for exploitation or abuse. This may make the role less attractive to potential PAs in the medium term.


Social implications
Social care PAs may be a very effective means of achieving genuinely person-centred care or support for many people. However, PAs do not always appear to enjoy satisfactory conditions of employment and their role is largely unregulated. Growth and long-term sustainability of this emergent role may be jeopardised by these employment conditions.


Originality/value
Little is known about PA working conditions. This study suggests that much more needs to be done to improve these.

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.

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.

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.

Summary This paper reports on part of a research study carried out in three local authority adult social care departments in England, which explored links between adult safeguarding and personalisation. The study included statistical analysis of data on safeguarding referrals and the take up of personal budgets and qualitative interviews with managers, social workers, other staff working on safeguarding and with service users. The paper reports the findings from 16 interviews with managers and social workers, highlighting their perspectives and experiences. Findings Five main themes emerged from our analysis: contexts and risk factors; views about risks associated with Direct Payments, approaches to minimising risk; balancing risk and choice; and weaving safeguarding and personalisation practice. Social workers identified similar ranges and kinds of risks to those identified in the national evaluation of Individual Budgets. They described a tension between policy objectives and their exercise of discretion to assess and manage risks. For example, some described how they would discourage certain people from taking their personal budget as a Direct Payment or suggest they take only part of a personal budget as a Direct Payment. Application This exploratory study supports the continued need for skilled social workers to deliver outcomes related to both safeguarding and personalisation policies. Implementing these policies may entail a new form of 'care and control', which may require specific approaches in supervision in order to ensure good practice is fostered and positive outcomes attained.