Tag Archives: best practice

Devolving health and social care in England: an opportunity to transform how we approach health and care?

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In recent years, the Department of Health and Social Care (DHSC) has increasingly encouraged the transfer of powers over health and social care in England away from central government and towards city regions. These bodies, DHSC argues, are uniquely placed to understand the challenges faced by their local populations, the capacities and expertise of their local NHS and to develop plans for the future. This should enable them to approach health at a local level, promoting increased delivery of care in the community, and a greater integration between health and care services.

Putting local places at the centre of “Build back better”

In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, like taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.

The NHS Long Term Plan has also outlined a new direction for the NHS based on the principle of collaboration rather than competition, and the introduction of new structures such as Integrated Care Systems, Integrated Care Providers and Primary Care Networks. These partnerships bring health and social care commissioners together to plan and deliver integrated and person-centred care.

In the context of “building back better”, awareness of how our external experiences and contexts impact our health and wellbeing (for example the impact of poverty, deprivation, housing, and unemployment) is increasingly important.

Beyond the immediate recovery from the pandemic, health devolution could be one way of opening up the possibility of integrating not just disparate services within the NHS – or even NHS and social care services in a locality – but bringing together in a combined strategy and structure all of the services, systems and partners in a community that have an impact upon the health of a local population, and the care services to better meet their health needs.

“It doesn’t have to be a battle”- partnerships and balance are the key to effective devolution

The move away from centralised processes and organisations towards more local ones can sometimes be portrayed as a rejection or an attempt to “break free” from central government. However, practitioners have been increasingly stressing that devolution does not mean complete independence, and that while improved local decision making will improve outcomes for local people, that does not mean that the need for some centralised decision making is completely removed.

On the contrary, some decisions should and will be taken at a national level, but the ability to distribute power, decision making and accountability to a local level will have significant positive impacts for improving “citizen voice”, transparency and co-production in decision making.

This is where the Health Devolution Commission argues that balance, communication, and partnership between the local and national infrastructure needs to be aligned so that devolution can be successful and sustainable. Integrated planning and management of long-term health care strategies is important, as is the ability to bring citizens and local decision makers into discussions about national health policy.

The Voluntary, Community and Social Enterprise (VCSE) sector, including patient voice and carers organisations, also plays an important role in linking together services and communities. As well as partnering to deliver services, these organisations also often offer vital bridges between statutory systems and those communities which can often be excluded from engagement with services or who can find it harder to access them. The commission also emphasised the importance of bringing these bodies into the conversation on devolution going forwards as they will be invaluable partners in the process.

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DevoManc providing the blueprint?

In 2016, as part of a pilot, control of the health and social care budget for Greater Manchester was transferred to a partnership team in the area comprising local authorities, clinical commissioning groups, NHS foundation trusts and NHS England.

The combined authority identified that the health of its population was one of the key obstacles to its economic growth. By relating the concept of regional economic prosperity with health, they began to see health in a completely different way – as part of a wider plan and an investment for growth, not a burden.

“It’s better to have decisions made locally, because local people understand what local problems are and what Greater Manchester needs. We need to work together.”

Lord Peter Smith, Chair of Greater Manchester Health and Care Board

The Greater Manchester Health and Social Care Partnership are working in partnership with other sectors including education and housing to support everything from good eating habits and exercise to education and everyone’s ability to earn a decent living. The partnership is taking action to give children the start they need, support independence in old age, tackle illness earlier on and even prevent it altogether by improving the lifestyles of local people.

Other areas of England are also currently undertaking their own health devolution journeys, including London, West Yorkshire and Harrogate, as well as some other combined authority areas. However, one of the big challenges is that currently, while we can learn from the experiences of those already on their devolution journey, there is no common, consistent or comprehensive understanding of what good heath devolution looks like, full evaluations of the benefits it brings or overarching strategies on how it should be developed.

This is something that will need to be addressed if health devolution is to be successfully rolled out across England.

Final thoughts

Devolution of health to a more local level provides an opportunity to tackle the big public health challenges of our time at source, and to create a better, more joined up community health ecosystem. It also provides the chance to share and collaborate, learning from best practice and delivering improved health and social care services at a regional and national level.

It has been suggested that the coronavirus pandemic, while traumatic in more ways than one for the NHS and its staff, may provide the re-setting point needed to implement some of the changes proposed in relation to greater health devolution. Proponents of this view argue that improved funding to support effective and high quality care, improved integration between health and social care, and greater positioning of health and assessment of the impact of decisions on health across all policy areas, should be among the top priorities as the country looks to recover from the pandemic.

As the Health Devolution Commission underlines:

The pandemic has shown we cannot go back to the way things were. We need a ‘new normal’ and we believe that comprehensive health devolution is the only viable solution to the challenges the country now faces.”

If you enjoyed this article you might also like to read:

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Scottish Learning Festival 2019: getting back to the basics in Scottish education

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by Rebecca Jackson

The Scottish Learning Festival (SLF) is the annual conference and exhibition for educational practitioners across Scotland. Across two days thousands of delegates and over 200 exhibitors from across the spectrum of Scottish education gathered at the SEC in Glasgow to take part in over 100 workshops and seminars reflecting the best of Scottish Education.

The conference theme this year was Achieving Excellence and Equity and across the two days delegates and speakers discussed a range of topics related to this, including the empowerment agenda for teachers and learners, how to drive improvement across all areas of education and the importance of wellbeing in developing a healthy and successful learning community, able to achieve the best possible outcomes.

Back to basics in Scottish Education

This year’s keynote address was delivered by the Deputy First Minister and Cabinet Secretary for Education and Skills, John Swinney MSP. In his speech Mr Swinney encouraged delegates to get back to basics on education, emphasising his belief in the importance of the core principles of Scottish Education and how increasing the focus on the “four capacities” can help learners achieve their potential. The four capacities allow learners to become: successful learners; confident individuals; responsible citizens and effective contributors.

Giving teachers autonomy to teach

He emphasised his belief that the autonomy of teachers should be key in the classroom and that teachers are best placed to make the key calls in relation to the learning of their students.  Mr Swinney suggested that helping teachers feel like they can take responsibility for their own workload and to prioritise tasks that directly impact on learning over admin tasks was pivotal in ensuring that curriculum for excellence and the new qualifications recently introduced worked effectively for both teachers and young people. However it was clear from the reaction in the auditorium and in subsequent discussions, that there are some teachers who feel they are quite a way from being able to truly take control of their workload with many highlighting significant amounts of marking and administration and “teaching to test” which prevented them from teaching in the way they would like.

The Cabinet Secretary also faced a number of questions from the floor, including on the funding of special educational needs provision and the idea of mainstreaming (as opposed to funding specialist provision for SEN pupils), as well as questions on teacher workload, the value of National 4 qualifications and multi-level teaching, where national, intermediate and higher levels are all being taught in the same lessons. Mr Swinney said that multi-level teaching was working in some areas, and in some areas it helped to expand the range of subjects pupils are able to choose from, but he admitted that it may not work in all instances and that a review of the practice would be included in a more general review of senior education which has been ordered by the Scottish Government.

The gap that is proving difficult to close

The attainment gap was also high on the agenda,  both in the keynote and in the breakout seminars. Closing the gap and raising attainment among children, young people and learners from disadvantaged backgrounds is something which is clearly a focus of people working across the education sector  in Scotland, but the results and outcomes they are seeing look to be a mix of outstanding success stories and those young learners who are still falling through the net (who provision is not reaching and whose outcomes are not improving). Continuing the work of raising attainment through the Attainment Challenge (which has been granted funding beyond its current deadline to 2021) was highlighted, as was the effective and important work already being done in many schools to help and support those children from poorer backgrounds through their learner journey. The overriding message was to keep going because the gap is closing, even if it is not as quickly as we might like.

Everyone working together for common aims

The breakout seminars spanned topics across education, including early years, special needs education and the engagement of people from outside the school environment to create a holistic approach to the care and support of young people, including through youth work. The resounding tone of the discussions was that there is so much good work being done to support young learners in Scotland, that not only should we recognise it but we should try to share knowledge and learn lessons from it.

The conference ended with a call to action, encouraging practitioners from across the education sector in Scotland to come together, to work in partnership to improve outcomes for young people in Scotland and encourage practitioners and learners alike to strive to be the best they can be for the benefit of Scotland now and in the future.

If you enjoyed this article, keep an eye out for our second blog on the SLF, which reflects on one of the seminars attended by our Research Officer, Scott Faulds.

We have also blogged on a range of topics around education, including on Child and Adolescent Mental Health Services in schools. You can read more here.

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“For many children we are the first point of contact”: supporting children’s mental health in schools

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A 2018 evidence review from Public Health England reported that one in 10 young people have some form of diagnosable mental health condition. This, the report suggests, equates to as many as 850,000 children and young people with a diagnosable mental health disorder in the UK. It also reported that half of all mental health problems emerge before the age of 14, and children with persistent mental health problems face unequal chances in life.

Research has also highlighted the impact of “key factors” like poverty and adverse childhood experiences (ACEs), including emotional trauma, abuse or neglect (which people living in higher areas of deprivation are more likely to experience) on an individual’s chance of developing a mental illness. However, an additional factor often cited in surveys around child mental health and wellbeing is the impact of school, including exam stress, and bullying. Mental ill health has also been found to have an impact on attainment, behaviour and a child’s ability to learn. As a result, teachers are often part of the front line of supporting adults for children who are suffering from mental ill health, with increasing pressure being placed on teachers and schools to identify and signpost children to other services.

Schools, as well as teachers,  are increasingly becoming a focus for the delivery of Child and Adolescent Mental Health Services (CAMHS) in their community. Often schools are at the centre of their local community, so it is logistically convenient to coordinate services there; it can for some be a less intimidating or stigmatising environment than attending a clinic at a GP surgery, for example. School is the primary developmental space that children encounter after their family, and children’s learning and development and their mental health are often interrelated, so it makes sense for teachers to take an interest in terms of attainment and progress in learning. In December 2017, the Department of Health and Department for Education (DfE) published the Green Paper Transforming children and young people’s mental health provision which highlighted the role of schools as key in promoting a positive message about mental health and wellbeing among school age children and young people.

Good work is already being done, but how can we do more?

Research has shown that there is already a lot of good and effective practice being done in schools around children’s mental health. Many schools already work in partnership with local health teams to provide in house CAMHS support in the form of mental health nurses and social workers who are posted on site for children to access. One of the major recommendations in a 2018 Audit Scotland report on child mental health in Scotland was to encourage more of this type of partnership working. The report stressed the importance of joint working between public services if child mental health is to be improved, and where possible to include as wide a spectrum of public services in the delivery of CAMHS support, including criminal justice and housing practitioners, as well as health and social care and education staff.

In some schools senior pupils and designated members of staff are being offered mental health first aid training, and wear lanyards to help students identify them should they ever need to talk to someone. While it is important – particularly for students who participate in mental health first aid programmes – to be made aware of the challenges the role may entail, it can be a rewarding experience for young people to participate in and can also be a vital in-road to support for some students who would otherwise feel uncomfortable talking to a member of staff.

Other programmes like those developed by the Anna Freud National Centre for Children and Families, Centre for Mental Health and the ICE PACK and Kitbag tools (which have been used widely in UK schools) look at resilience building  and promoting coping mechanisms among young people, as well as encouraging the creation of trusting relationships which focus on nurturing and normalising mental illness to encourage children and young people to feel comfortable discussing their feelings and thoughts. These programmes also integrate early intervention and prevention approaches, hoping to identify children and young people who are suffering from mental illness as early as possible and signpost them to appropriate support.

The specific role of teachers

Teachers need to remember that they are not health or social care professionals and that – as much as they would like to completely solve all of the problems of their students – they can only do what they can, and that is enough.

It is also very important for teachers to practise what they preach in as much as teacher self-care is as important as signposting children and young people who are struggling with mental health issues. A 2016 survey by the National Union of Teachers (NUT) found almost half of teachers had sought help from their doctor for stress-related condition. Teacher stress and burnout and those leaving the profession due to conditions like stress do not help to create an environment that is supportive of good mental health in the classroom. Teacher wellbeing is so important and building their own resilience is one way that teachers can start to embed good mental health in their practice. If you are doing it yourself it will be easier to help and show children how to do it if they come to you for advice!

Teachers simply being there and offering a safe space and first point of contact for many children is important. Listening and signposting can be so valuable for those pupils taking the first step and teachers should not be put off by any personal perception of a lack of expertise in mental health – a small amount of knowledge or understanding of what to do next is more than enough. In some respects, teachers should feel almost privileged that a student has chosen to come to them, someone they feel they can trust and talk to.

A poll conducted as part of a webinar held for educational practitioners found that rather than requiring more information about mental illness, what teachers actually wanted was more practical examples of how to apply support in the classroom and how to embed mental health into their teaching and the learning of their students.

A unique opportunity

Schools and teachers are on the front line of public services and have a unique opportunity through regular contact with children to help to build and promote resilience among pupils, and embedding this within the whole school can be an effective way of ensuring pupils feel the benefit without being singled out. Taking nurturing approaches to learning and teaching, and promoting the creation of trusting relationships is key to some of the already effective practice going on in schools. Sharing the learning and best practice that is already happening will be vital to ensuring that support for children suffering from mental ill health improves and adapts to changing needs in the future.

If you liked this article, you may also be interested in reading:

Writing and recovery: creative writing as a response to mental ill health

Addressing social mobility through education – is it enough?

The Changing Room Initiative: tackling the stigma of poor mental health in men through sport

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Unlocking the potential of smart cities: All-Party Parliamentary Group calls for coherent UK Government strategy

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Hong Kong city

By Steven McGinty

“The role of smart cities is not to create a society of automation and alienation, but to bring communities together”. (Iain Stewart MP)

In June, the All Party Parliamentary Group on Smart Cities published a report outlining the findings of its recent inquiry into how the UK Government can support the expansion of smart cities and enable the UK to become a world leader in the field.

It explains that although some people have concerns that smart cities are expensive gimmicks, or even something more sinister, the potential in becoming smarter could have a tremendous impact on the lives of citizens.  And ‘smart’, the report makes clear is not just about clever technologies, but any innovative approach or solution that brings together industries or government departments to solve everyday problems.

Included in the report are the number of ways smart approaches can improve city life, such as:

  • Making cities accessible for all – improving the design process can ensure that people with physical disabilities are not prevented from enjoying the public spaces.
  • Empowering citizens in democracy – new technologies can give citizens a voice by connecting them with each other, as well as those running services or those making decisions.
  • Reducing the strain on our health service – providing citizens with access to their own health records can encourage greater responsibility for their own healthcare.
  • A more efficient, flexible transport system – improving transport information can help citizens plan journeys and smart ticketing options can allow citizens to travel easily between transport services.
  • Creating a cleaner environment and enhancing air quality – smart technologies can help address environmental challenges, such as improving traffic flow to help limit harmful emissions in congested areas.

If cities are looking for a blueprint to success, there have been numerous smart city initiatives introduced across the world. For example, the report highlights how the Scottish Cities Alliance, a joint initiative between Scotland’s seven cities (Aberdeen, Dundee, Edinburgh, Glasgow, Inverness, Perth and Stirling) and the Scottish Government, is encouraging collaboration and the take-up of technologies designed to improve air quality, traffic flow and cut pollution.

There’s also two examples from further afield. Estonia, which is widely recognised as a smart city leader, is viewed as an example of best practice in data sharing. The country provides citizens with control over their data by providing easy access to their education, medical and employment records through an online portal (with the option to request changes). And in Singapore, the “Smart Nation” initiative has become known for its use of a coordinating body to provide leadership to their smart cities agenda.

In concluding the report, The APPG make a series of recommendations to effectively drive forward the smart cities agenda. This includes:

  • encouraging the promotion of a smart culture;
  • convening smart standards and data; and
  • promoting the UK’s smart city expertise overseas.

In particular, a number of interesting points are raised about how to promote a smart culture, from ensuring smart city initiatives focus on the outcomes for citizens to putting collaboration with other cities (and the sharing of best practice) before any form of competition.

Iain Stewart MP, chairman of the APPG on Smart Cities, summarises the report’s main message, as well as calling for the UK Government to create a strategy. He argues:

“A coherent strategy from central government is needed to ensure a joined-up approach between businesses and those who work most closely with and on behalf of their citizens – local government. By fully embracing the smart cities approach, central government can empower local authorities to show ordinary people how smart can positively impact on their everyday lives.”

Follow us on Twitter to see what developments in public and social policy are interesting our research team. If you found this article interesting, you may also like to read our other smart cities articles. 

SURF conference 2017 – What Scotland has learned from 25 years of regeneration

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Mural of a taxi being elevated by ballons, Glasgow

Fantastical floating taxi mural, part of Glasgow’s City Centre Mural Trail

By Steven McGinty

“If regeneration has been so successful, why are there still so many pilots?”

This was just one of the many thought-provoking points raised at the Scottish Urban Regeneration Forum’s (SURF) 25th Anniversary Conference, where the very activity of regeneration was put under the microscope.

In a packed room of delegates, the day opened with two opposing views.

  • The first argued that although regeneration had undoubtedly had its failures, there had been a number of important successes, which had resulted in better places and opportunities for both communities and individuals.
  • The second – and more pessimistic perspective – was that regeneration policy had entirely failed, and that the areas experiencing poverty and deprivation had barely changed over the past 25 years (particularly in Glasgow, where much of the regeneration activity has been focused).

This provided a useful lens through which to view regeneration, as we moved onto a day of workshops and debates on 25 years of regeneration policy, starting from New Life for Urban Scotland all the way up to City Region Deals.

Below I’ve outlined some of the most interesting points to come from these sessions.

Universal income

There was broad agreement that regeneration was about more than building homes, and that one of its core purposes was to tackle inequality.

Universal Basic Income is a policy in which everyone in society is given a sum of money, without any conditions. This policy – likely to be popular – was proposed by a delegate, highlighting its potential for addressing increasing levels of income inequality. A pilot study is already underway in Finland, with participants reporting lower stress levels and greater incentive to work. The Scottish Government has also recently committed to funding local experiments in Fife, Glasgow and North Ayrshire Councils.

Communities need assets

In many of the debates, it was felt that community ownership of buildings and land was key to ensuring a fairer distribution of society’s wealth. Other benefits of community ownership include protecting key local services/facilities (which may have otherwise been lost) and offering better stewardship, as the community have a greater understanding of local needs.

Research has also shown that local communities – who have replaced private landlords – have outperformed the landlords they have replaced. In the past two decades, the value of their land has increased by almost 250%.

Distinctiveness of place

Delegates highlighted that local areas often need local solutions.  For instance, a representative from the Bute Island Alliance noted that addressing their declining population was key to their regeneration goals.

Community consultation

There was a strong feeling that communities had to be consulted. A representative from a local charity explained that “if you are working for a community, then it must include the community”. Others, suggested that some communities would not have the capacity to make decisions on regeneration projects. Yet, this was quickly deemed patronising, with many noting the series of failures by public officials.

Charrettes were seen as an ideal tool for consulting with communities. The Scottish Government define a charrette as:

“an interactive design process, in which the public and stakeholders work directly with a specialised design team to generate a community vision, masterplan and action plan.”

The representative from the Bute Island Alliance highlighted that this process had been very helpful in the development of their regeneration plans.

Bringing communities together

It was widely acknowledged that communities are becoming more diverse, and that it’s important to include all members of society. One delegate recounted her experience of Social Inclusion Partnerships (SIPs) – an initiative which aimed to reduce social exclusion – explaining that this model was very successful at engaging with black and minority ethnic (BME) groups. We’ve also seen the Scottish Government recognise the need to encourage young people to get involved in local planning decisions.

Building an inclusive economy

Regeneration has always found it difficult to respond to wider political, economic, social and technological factors. Over decades, deindustrialisation and the change to a more knowledge-based economy has caused significant challenges for communities. For regeneration policy to be successful, it was suggested that people would need to be equipped with the skills to take part in future industries; otherwise we may see inequalities widen. Cities such as Dublin have seen rents increased dramatically due to the inward migration of highly-skilled technology workers, putting pressure on household budgets and showing the challenge for regeneration.

Final thoughts

In the past 25 years there has been an important shift in regeneration, moving from house building programmes to a more holistic approach, which includes policy areas such as health, employment, and the environment. However, the most recent Scottish Government regeneration strategy was published in 2011. It might therefore be time to revisit this strategy and provide a new vision for regeneration, taking recent learning and the changing environment into account. Maybe then, in the next 25 years, there will be no doubt over the successes of regeneration.

The Knowledge Exchange provides information services to local authorities, public agencies, research consultancies and commercial organisations across the UK. Follow us on Twitter to see what developments in policy and practice are interesting our research team. 

Buurtzorg: reinventing district nursing in Scotland

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Buurtzorg roughly translates from its native Dutch as “neighbourhood care”. The model, used extensively in the Netherlands, has attracted international attention as a novel way to deliver community based nursing programmes. Its positive reputation and recorded successes in areas of Holland are attributed to its innovative use of locally-based and locally-aware nursing teams to deliver high-quality person-centred, but low-cost, care.

Seeking to improve core health outcomes

In the Netherlands, Buurtzorg was designed to engage three key health priorities:

  • Health promotion
  • Effective management of conditions (in a community setting)
  • Disease prevention

It focused particularly on the elderly, those who move regularly between hospital and home, and those with long term, constant care illnesses. It has also been used with patients with progressive illnesses such as dementia, with some nurses within the teams being given training to become dementia specialists where appropriate.

The model includes the following key elements:

  1. Holistic and personalised care – where assessments of need are integrated into and form the foundation of agreed care plans
  2. Mapping networks of informal care, and assessing ways to involve these networks in treatment plans
  3. Identifying other formal carers and organisations who provide care services and coordinate their input
  4. Taking steps to support the client in his/her own environment
  5. Promoting self-care and independence on the part of patients.

A number of studies of pilot sites across the UK and beyond have identified the positives and some challenges of applying the Buurtzorg model in different contexts. Some of these are outlined in the table below.

Applying the model in Scotland

In a Scottish context, the model has been applied in a number of areas, with the initial pilots making way for a wider roll out of adaptations of the model. In March 2017, as part of a wider research project, nurses and management staff from NHS boards across Scotland met in Perth to discuss learning and exchange best practice around how the model could be adapted and further rolled out in the future.

It highlighted the different stages that many Buurtzorg areas were at in their roll out, with some like Aberdeen and the Borders far more established than Argyll, who were at the time only in the earliest stages of their Buurtzorg journey. The research and learning event gave practitioners the opportunity to engage and further cement both formal and informal learning networks, which have been identified as key to the success of the Buurtzorg model both in the UK and elsewhere.

The importance of information sharing and informal learning

Rolling out the model in test sites highlighted the importance of planning and learning, and of creating a strong sense of trust between practitioners and NHS management, but also between the Buurtzorg nurses and their service users and other professionals. This change in mindset regarding ways of working, and a change in the chain of accountability was something, which, according to those practitioners who attended the Perth event, many sites have found to be a significant barrier to effective implementation.

However it was also highlighted that promoting and facilitating the creation of formal and informal learning networks and learning spaces can be an effective way to generate conversation about best practice as well as allaying some fears that may persist regarding working culture and approaches, including partnership working with other agencies and understanding risk in the working environment.

In Scotland, approaches have varied, from encouraging nursing teams to create videos and then post them to an online forum, employing more formal training plans to incorporate multiple agencies and ensure that everyone is “singing from the same hymn sheet”, or holding informal drop-in or open space events where staff are supported in their role and given advice to alleviate and find potential solutions to issues.

Practitioners also highlighted that it is important to provide a space where teams can examine what did not work well, and why. Learning from mistakes can often be as beneficial as learning from good practice, as these can provide insights into issue management and resolution as well as how to implement the programme effectively.

It is also clear from feedback, that while a strong core network of nurses and other community based practitioners is vital to the success of Buurtzorg care models, the back team support is also just as important. Creating efficient and streamlined processes leaves nursing teams free to care for patients and allows them more time to develop and deliver the person-centred care which is a key element of the Buurtzorg model.

Final thoughts

Learning from the experiences of the trial projects in Scotland has provided invaluable insights on how the model can be applied and some of the challenges that can be encountered because of the differing context. This knowledge can then be used to shelter and steer newer projects away from danger areas toward best practice and innovative collaborative working. Applying Buurtzorg in Scotland gives the potential to create and implement new models of holistic person-centred care, where practitioners with local and specialist knowledge interact at a local level with other care providers, join up approaches and create a better care experience for service users.

Follow us on Twitter to see what developments health, social and community care are interesting our research team.

If you enjoyed this blog, you may also be interested in our other articles on health care and reablement care

 

World Social Work Day: promoting community and environmental sustainability

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Tomorrow is World Social Work Day (WSWD), and this year the focus is on community sustainability. The theme is inspired by the third pillar of the Global Agenda for Social Work, which was created in 2010 to integrate the aims and aspirations of social workers across the world. It stresses the important role of social workers in prompting sustainable communities and environmentally sensitive development.

This includes:

  • working closely with other partner agencies – including those beyond social work – to create communities of practice, particularly in relation to environmental sustainability;
  • promoting community capacity building, through environmentally friendly and sustainable projects, where possible; and
  • responding to environmental challenges, including helping communities to be resilient to and recover from environmental and natural disasters, as well as in relation to “human disasters” which includes refugee families fleeing persecution or war.

But how does this play out in everyday practice?

Supporting integration

Across the world, social workers are being asked to address ‘human disasters’ as they seek to support and integrate refugee families fleeing persecution and war in conflict zones. Some of the biggest challenges for social workers today relate to refugee and displaced communities. As well as dealing with the effects of trauma, they also help integrate refugees successfully into existing communities and build bridges with others to promote cohesion, reduce tensions and help them make positive contributions to society. Social workers also have a responsibility to encourage all members of the community to help with this support and integration process.

However, in a UK context, supporting people to make positive contributions to their community is not limited to refugee families. It also relates to intergenerational work, valuing the experience of older people, developing the skills of vulnerable adults, or encouraging children to feel connected to a place and community so that they might better take care of it as they grow up.

Supporting sustainability

The role of social workers in supporting the sustainability agenda may not be so obvious. The ability of social workers to adapt and respond to the needs of communities which are experiencing environmental sustainability issues is of growing importance in developing countries. However, social workers in the UK can still contribute to this element of the global social work agenda.

This includes behaving in a way that recognises the need to protect and enhance the natural environment. In practice, this may mean social work departments having policies on going paperless where possible, recycling in offices, and reducing the use of cars, or car sharing (for frontline social workers, however, this is often impractical).

Social work practice can also consider how it supports sustainable social development outcomes within a community, and maintaining personal CPD, education and training levels to reflect this. There should also, as always, be an attempt to share best practice and learn from others.

Final thoughts

This World Social Work Day, let’s take a moment to reflect on the positive contributions that social work professionals are making to their communities as well as to the lives of individuals. It’s also a chance to consider what the future might hold for the profession and how it can continue to promote and support the growth and development of sustainable communities.

If you would like to follow the events going on to mark World Social Work Day or, share any of your own stories you can do so on twitter using the hashtag #WSWD17.

We regularly write on social work topics. Check out some of our previous articles:

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Secure care in Scotland: measuring outcomes and sharing practice

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By Rebecca Jackson

There are five centres which offer secure care in Scotland, with around 100 of Scotland’s most vulnerable children and young people placed within these units. Placements happen if they are deemed to be a risk to themselves, or others, within their communities, and it is felt that they can only be managed effectively within a secure care setting. These placements are arranged via the courts or the children’s hearing system.

 

National Secure Care Project

In 2014 the Scottish Government granted funding to the Centre for Youth and Criminal Justice (CYCJ) for a fixed term project to build on the work of the Securing our future initiative (SOFI) report in 2009. The SOFI report was a comprehensive analysis of the secure care estate in Scotland. It made recommendations for future practice in secure care and also suggested ways that the system could be made more efficient and young person centred. These included implementing and embedding the Getting It Right for Every Child approach and making full use of the Children’s Hearing and Early Years frameworks, including the SHANARRI indicators on well-being.

A scoping study was completed by CYCJ in 2015 which considered the current legislative and academic frameworks, as well as current practices of the 5 centres of secure care in Scotland. This followed the streamlining and takeover by Scotland Excel in 4 of the centres and Edinburgh City Council in the other.

The scoping study report, along with the project plan, highlights the aims and objectives of this new national programme:

  • identifying and promoting current best practice
  • identifying and exploring alternatives to secure care
  • building capacity within the secure care sector to draw comparisons and learn from the rest of the UK (and from each other)

Other key issues that the studies identified as needing to be addressed included:

Outcomes in secure care

One of the key issues raised by academics, policy makers and practitioners within secure care is the concept of outcomes. It’s been suggested that there is a need for both individual outcome targets for each child within secure care but also for a wider framework of general agreed outcomes to allow for better comparison between centres, which it is hoped will help raise standards of practice.

It is also recognised that long term, as well as the immediate, outcomes need to be assessed and researched. This ties in with the need for more emphasis on transitionary care and support. Although there is an expectation that local social workers will follow up on behalf of the secure care units, this isn’t always the case.

Key questions also have to be addressed from within the sector itself with regards to:

  • what are the aims of the centres
  • what exactly is meant by positive outcomes
  • what counts as an outcome
  • how can we look at a child or young person and say that a certain objective has been met, and can this be attributed to any one particular event, intervention or placement

These questions are not unique to the secure care sector but they do need addressed. Similarly there needs to be a wider acceptance that there are multiple outcomes and that these can be in terms of quality of life, process or change outcomes.

Sharing best practice and using staff as “knowledge brokers”

There is concern among practitioners and academics that, as a result of the changes to secure care provision implemented in 2014, secure care units are now reluctant to collaborate and share best practice.

The nature of the new secure care framework agreement means that, despite being referred to as a “secure care network”, the five centres are now in effect “in competition with one another” for individuals to be placed with them.

There is a risk that this constrains the sharing of best practice, ultimately reducing the collective standard of all five centres and therefore reducing the standard of care afforded to some young people. This was particularly highlighted in the 2015 CYCJ scoping report.

One of the key ways to share information and best practice is to allow the people who work within the centres, working with residents on a day to day basis, a platform to discuss and contribute to a wider discussion of best practice outside of their own individual centre.

Another potentially useful strategy would be to integrate approaches from traditional social work with regards to sharing ideas and information. This may also make it easier for social workers within and outside the secure care context to liaise with one another. Using staff members as “knowledge brokers” could be an efficient and effective way to allow staff to communicate best practice. Tools such as a digital platform, interactive app or online forum could help staff to share their experiences.

With the project scheduled to run until 2017, some of the issues highlighted here were discussed at an event hosted by CYCJ and WithScotland at the University of Strathclyde in April 2016. The hope is to increase collaboration and move the provision of care and creation of successful and useful outcomes frameworks forward as part of the wider National Secure Care Project.

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Telecare in the UK: lessons from Barcelona

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By Rebecca Jackson

Telecare is technology to help people live independently, usually in their own homes, for longer. Usually delivered as part of a package of care, telecare devices can include things like: bed sensors, to detect if someone is out of bed at an unusual time; fall sensors; medication reminders; and alerts on screens or over loudspeakers. Such devices have led telecare to be heralded as a new dawn in patient-centred, independent living.  However, despite initiatives  to drive its application forward, not everyone in the UK is convinced about the benefits of telecare.

Practitioners and carers are sceptical about the potential of replacing traditional care with digital models to save money and the impact that this could have on standards of care. In addition, many patients themselves are uncertain about the use of telecare and digital health solutions, with many who have telecare systems within their homes choosing to continue to interact with primary and home care services in the same way as before. Much of the academic and expert-led research and evaluation of telecare programmes in the UK by organisations such as the Nuffield Trust and the Kings Fund has found little to no improvement in service, reduction in cost or reduction in workload for care teams in areas where telecare has been deployed.

While telecare in the UK appears to have stalled, elsewhere digital health solutions are not only successfully integrated into traditional care models, but are having a positive impact on the people in receipt of care, and reducing the burden of work on care providers.

Lessons from Barcelona

In Spain, the law has guaranteed access to telecare since 2006. Economic austerity has led to individual local authorities in Spain being given control over their budgets and therefore their provision of telecare. The approach in Barcelona has been highlighted as an example of best practice in telecare.

The system there – a cooperative venture between an independent provider and the local authority – sees carers take a proactive approach to telecare. The system does not just monitor and provide assistance in times of distress, but proactively engages with service users at regular intervals to help carers provide reassurance and build relationships.

As well as the emergency measures, such as fall sensors (typically the primary use of telecare in the UK), calls are made to check up on service users, provide reassurance, deliver general public health information and to mark important occasions, like birthdays. This can help to reduce feelings of isolation and loneliness, which in turn can lead to better general health and wellbeing.

Calls can also be made to highlight important information, such  as weather warnings; safety alerts and local events which the service users may wish to attend. These calls are backed up by visits from the care team, who work for the telecare provider. These visits supplement visits from municipal care and social workers and the two teams communicate and share information via digital platforms.

Digital healthcare as an enabler

The case of Barcelona shows us how digital healthcare solutions, and more specifically telecare, can be used as an enabler – a tool to allow the local authority to pursue a joined up and preventative approach to healthcare which has positive benefits for recipients.

Such approaches could also have a significant impact on the UK’s 3.8 million unpaid carers. Telecare has the potential to reduce some of the burden and stress of caring for a relative, which in turn can have positive effects on the health of the person in receipt of care. It can also  form an effective part of reablement programmes – supporting people as they leave hospital or return to independent living.

However the approach to delivering telecare in Britain is as much about culture as it is about the technological infrastructure. Using telecare as part of a preventative, person-centred approach should produce better outcomes. In this sense, implementation of telecare in the UK still lags behind other countries. Key lessons could also be learnt from programmes in Norway and the Netherlands in relation to telecare in dementia settings.

Generally, the targeting of telecare services also differs – in the UK it tends to be aimed at elderly people with complex and diverse needs, while in Norway and the Netherlands the focus has shifted to those suffering from chronic illnesses.

Local solutions

In the UK, some local authorities have been experimenting with digital healthcare, although local authority budget cuts have meant that in many cases these have been cut back to focus delivery on the most vulnerable clients.

The lessons in digital healthcare that Britain can learn from places like Barcelona could be key to the successful roll out of digital healthcare solutions in the future. The Barcelona example highlights the enabling role that telecare can play in joining up health and social care and promoting a more preventative approach to healthcare.

Opportunities to develop telecare strategies and deliver them in partnership, as in the Barcelona model, show that it cannot be delivered in isolation, or be used as a replacement for existing carer-led services. Instead telecare has the potential to be a supporting tool to ensure effective care outcomes. It could also help care services in Britain to tackle the increasing demand of an ageing population.

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