Going grey behind bars: meeting the care needs of older people in prisons

The population is ageing. People are living longer, and are in need of greater levels of care than ever before. But how is this increase in life expectancy and demand for care being met in prisons? Our prison population is also ageing, at a time when the sector is under increasing pressure, low staff numbers, higher levels of prison violence and disorder, and poor, crowded living conditions. In an environment which is largely designed to support young, able bodied men, how are prison staff and care teams liaising to help meet the needs of older prisoners?

A care plan for ageing prisoners

A report published in 2017 by the Scottish Prison Service called for a specific care plan for ageing prisoners to react to and provide planning to reflect the change in demographic of the prison population. The report found that between 2010 and 2016, the number of men aged over 50 in Scotland’s prison population rose by more than 60%, from 603 to 988. According to a Ministry of Justice report on prison population, the number of inmates aged over 50 is projected to grow from 12,700 to 13,900 by the end of June 2020, a rise of 9.5%, while the number of over-60s behind bars will grow by 20% from 4,500 to 5,400 over the same period.

In July 2017 Prisons and Probation Ombudsman produced the Thematic Review: Older Prisoners, which stated that HM Prison and Probation Service needs a national strategy to address the needs of the increasing numbers of elderly prisoners. It highlighted six areas where lessons still needed to be learned: healthcare and diagnosis, restraints, end-of-life care, family involvement, early release and dementia, and complex needs.

The difficulties older prisoners face on prison estates are far reaching. Not only are there physical barriers to moving around and living within a prison environment, but the increased mental health and social care burden is significant, as well as the potential need to begin end-of-life care. Many prison inmates suffer from multiple, longstanding and complex conditions, including addiction, and these conditions are exacerbated by a phenomenon known as “accelerated ageing”, which suggests that prisoners age on average 10 years faster than people of the same age in the wider community.

While some prisons have effective care plans which allow older prisoners to live with dignity, often older prisoners rely on the goodwill of officers and fellow inmates to meet the gaps in their care needs. And while in England and Wales the Care Act means that, a statutory requirement to provide care lies with the local authority within which the prison is located, this is not a guarantee. Calls have been made for care planning in prisons to become more robust, with minimum standards of care and a clear pathway of delivery, with accountability and responsibility of specific bodies being made explicit.

 

Prison staff, care teams and the NHS in partnership

Any care planning for older people needs input from a number of different sources, and care planning for older people in prison is no different. It will require input from professionals across health, social care, and housing and the criminal justice system as well as wider coordination support and legislative and financial backing from central and local government.

Prisoners with physical disabilities or diseases such as dementia need specialist care at a level that standard prison officers cannot give. Research has suggested that prison staff are being expected to shoulder this extra burden, often having to perform beyond their duty to care for and look for signs of degeneration in prisoners, particularly those who show signs of Alzheimer’s and dementia.

A number of research studies have looked at the provision of training and the use of additional, multi-agency staff to try to bridge the gap in care for elderly prisoners. In 2013 a review was conducted of multiple prisons, including some in England, the USA and Japan, which examined the training available on each estate for prisoners with dementia and similar conditions.

A number of schemes have been trialled, including extra training for staff, the allocation of specific wings or cells adapted to cater to the specific needs of older and vulnerable prisoners, and the use of peer to peer buddying or befriending services to help with care and support. Some prisons have also trialled the introduction of “dementia champions” to identify and support those with early signs of dementia or Alzheimer’s.

Extra challenges on release

As well as social care needs inside prison, specific rehabilitative needs of older prisoners being released from prison is also something that prison charities and reform bodies are keen to raise onto the agenda. A report from the Prison Reform Trust in 2016 highlighted the challenges of rehabilitative and parole needs of older prisoners, commenting that older people released from prison are being “set up to fail” by a lack of adequate provision to meet their health and social care needs on release. It highlights the limited and inconsistent housing, employment, debt and substance abuse advice available specifically for older offenders and suggest that their particularly vulnerable position puts them at risk of serious harm or reoffending.

Final thoughts

The population of older prisoners in our prisons is growing, and it is clear that a comprehensive strategy is needed to ensure that the specific, and at times unique care needs of these prisoners are met. This will mean greater cooperation from social care, health and criminal justice agencies, but will also mean reassessing how we think about social care, how it should be delivered and funded. The needs of older prisoners go beyond physical adaptations, to mental health, dealing with social isolation, the onset of chronic illnesses and at times the provision and planning of end of life care.

Follow us on Twitter to see what developments are interesting our research team.

If you enjoyed this blog, you may also be interested in our other articles:

Helping people with dementia to live well through good urban design

Planning for an ageing population: some key considerations

Co-production in the criminal justice system

Buurtzorg: reinventing district nursing in Scotland

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

 

Zero suicide cities: learning from Detroit in the UK

Suicide is the biggest killer of men under the age of 45. Yet people still experience stigma when seeking help for mental illness, despite high-profile discussions of mental health issues such as those by members of the royal family and sportspeople. And a report into the Government’s suicide prevention strategy in March 2017, suggested that although 95% of local authorities now have a suicide prevention plan, there is little or no information about the quality of those plans, or whether adequate funding is available to implement them.

The lack of progress made on improving suicide and general mental health provision has led to a growing frustration among professionals and resulted in attempts to create new approaches to tackle mental health issues, and in particular to improve access to support for people in crisis or at risk of suicide.

The idea of a “zero suicide city” was first adopted in Detroit in the late 2000’s, with others following its lead in subsequent years. With reports finding that around 14 Londoners a week took their own life in 2015 (735 in total), an increase of a third from the 2014 statistics, a report in February 2017 by the London Assembly Health Committee suggested that London too should take this approach.

So what can London, and other areas of the UK, learn from Detroit’s approach? And how can services act to reduce the number of people taking their own lives?

Zero-suicide cities

Poverty and high unemployment in Detroit are contributing factors to high levels of depression among city residents. As a result of these high rates of depression and very high suicide statistics, Detroit-based mental health professionals adopted a new approach to tackle the stigma around mental illness and use identifiers to highlight cases of crisis, or potential crisis. The focus is on preventative care, encouraging professionals to act upon signs of mental illness before a suicide or attempted suicide takes place.

Patients attending health clinics for other illnesses, including diabetes or heart failure, are also now screened for depression and other mental health issues before they are released. This allows people deemed to be ‘at risk’ to be identified as soon as they come into contact with medical professionals, who can then refer the patient to a mental health specialist if needed, rather than reacting to mental illness once it reaches crisis point.

In order to support this approach, a centralised IT system was created which means results are traceable, and surveys and information are standardised so they can be used and accessed across clinics throughout Detroit. Coordination with non-medical practitioners, including social workers, employers and family members, has also been key in identifying people at risk and signposting them to help at every possible opportunity. There has also been additional training for staff to improve recognition of identifying factors. Patients can email their clinicians or liaising staff directly and attend regular drop-in appointments. Up to 12,000 patients using mental health facilities are tracked each year in the city and some statistics suggest that the clinics reduced suicides by over 80%.

There have been some criticisms of the system however, despite the reduction in the number of suicides in the city. Critics highlight the fact that many of the poorest and most severely in need of help are not reached as they do not have health insurance and so do not attend those clinics involved in the scheme.

Ultimately, however, the scheme seeks to provide better preventative, coordinated and targeted care to those who are at risk or show some signs of mental health crisis. And some in the UK have suggested there are lessons that could be learned from this approach.

Whole system approach to suicide prevention in the East of England

Four local areas in the East of England (Bedfordshire, Cambridgeshire & Peterborough, Essex and Hertfordshire) were selected in 2013 as pathfinder sites to develop new approaches to suicide prevention based in part on the Detroit model.

Since then, Mersey Care, Cambridge and Peterborough Clinical Commissioning Group and Teesside councils have also become aligned with the programme and are continuing with their approach towards improved suicide prevention. The Centre for Mental Health evaluated the work of some of the sites during 2015.

The evaluation found there were a range of activities that had taken suicide prevention activities out into local communities. They included:

  • training key public service staff such as GPs, police officers, teachers and housing officers
  • training others who may encounter someone at risk of taking their own life, such as pub landlords, coroners, private security staff, faith groups and gym workers
  • creating ‘community champions’ to put local people in control of activities relating to promoting positive mental health and signposting to help services
  • putting in place practical suicide prevention measures in ‘hot spots’ such as bridges and railways
  • working with local newspapers, radio and social media to raise awareness in the wider community
  • supporting safety planning for people at risk of suicide, involving families and carers throughout the process
  • linking with local crisis services to ensure people get speedy access to evidence-based treatments.

However, subsequent research also highlighted some of the challenges. The marketing of the pilots was seen to be damaging and misleading with regards to creating “zero suicide areas”, rather than suicide prevention areas. It has also been suggested that although the campaigns serve to raise publicity and awareness, there is little evidence that the schemes actually reduce the number of suicides in an area any more than “traditional campaigns” to better signpost people to available support.

In addition, many of the projects struggled past the initial implementation stage to have long-term impact, as the buy-in from local GPs and other service professionals was not as high as was expected.

Final thoughts

Widening and improving access to support and services for people at risk of mental ill health or suicide is a big challenge for health and social care professionals. Identifying those people at risk is one of the key barriers and taking inspiration from schemes like those trialled in Detroit is one way for professionals in the UK to adapt their approaches in order to overcome these barriers.

Providing more opportunities for people to get help, and better training for professionals who may come into contact with people with mental illness are some of the ways that current schemes are trying to address mental health and suicide in particular.

However, as many of the evaluative studies from test sites in the UK have found, going beyond that to take mental health into the community, in order to create whole system pathways of care across multiple settings and professions, remains a challenge.

As the London Assembly report pointed out, another key aspect is creating an open environment for people to talk about how they are feeling. This week is Mental Health Awareness Week 2017 and the theme is ‘surviving to thriving’ – and emphasising that good mental health is more than the absence of a mental health problem. Whether in the workplace or in the home; with friends, family or colleagues; it’s important that everyone feels that they have a space where they can talk, and to cultivate resilience and good mental health.


If you enjoyed this blog, you may also be interested in our other articles on mental health in the workplace.

To see what other topics our researchers are interested in, follow us on Twitter.

“All it takes is one song to bring back 1,000 memories”: using music therapy in dementia care

unsplash-ipod-music

Earlier this month, it was reported that dementia had overtaken heart disease as the leading cause of death in England and Wales. And caring for those with dementia is becoming the major social care challenge of the 21st century – over 1 million people in the UK are expected to have dementia by 2021.

Despite significant research into the condition, there are no long-term cures. As a result, health and social care teams, and researchers into the health and well being of older people, have started to promote non-pharmacological ways of alleviating symptoms and reducing distress to the patient and their family.

Many of these techniques are widely accessible, require little to no formal care training and can take place either in the patient’s own home or in a care home setting. One of these techniques is the use of music as a form of therapy. While specially trained dementia and Alzheimer’s music therapists exist to give formal therapy, carers and family members can also use music to help improve the quality of life of a person suffering from dementia or Alzheimer’s.

Benefits of music therpay in dementia care

Research and experiences from practice regularly show similar outcomes when using music with dementia care patients. The benefits that are consistently highlighted include:

  • Music evokes emotion and this in turn can evoke memories which can help sufferers and family members to connect together.
  • Musical aptitude and appreciation are two of the last remaining abilities in dementia patients – it is one of the first cognitive skills we develop as new-born children and is one of the last things to leave us in degenerative cognitive diseases.
  • Music can bring an emotional and physical closeness the association that a patient makes with a song can encourage them to complete actions such as dancing or hugging which they associate with that piece of music. It can also enhance feelings of security and safety among vulnerable patients.
  • Singing can be used as a way to engage and to encourage people to express feelings, even if it does not include words or sentences. It can be a way to encourage participation and socialisation, as well as stimulating brain activity, dexterity and physical activity if actions are also introduced to go along with the words.
  • Music has been proven to stimulate the release of hormones which gives it the ability to shift mood and manage stress.

“Come fly with me … Let’s make a cup of tea”

One project from Purple Angel music has rewritten and altered the lyrics to some well-known songs which are loaded onto an iPod and can be placed in a person’s home to remind them to carry out day-to-day tasks such as eating and drinking, locking their front door, turning off their fire and showering.

The pre-loaded iPod, which comes in a number of musical genres, contains two 12-hour tracks  one which plays the lyrically-amended songs at two hour intervals throughout the day to act as a reminder service, and the other which is 12 hours of silence, designed to allow the patient to sleep without having to remember to turn off the iPod.

Examples of the altered tracks include:

  • L.O.V.E,  I’d love a cup of tea a song to encourage rehydration via a cup of tea
  • That’s Amore, That’s a bath day a song to encourage taking a shower or bath
  • Let There be Love, Let there be lunch a song to encourage eating
  • Can’t take my eyes off of you – a song to encourage night time requirements, like locking the door and turning off the fire.

A playlist for life

In August 2016, the Care Inspectorate backed a scheme called ‘playlist for life’ which encourages care homes to integrate music into their care for patients with dementia. Moving beyond just allocating a time to place headphones onto a patient and leaving them to listen alone (although at times this may be helpful too), the aim is for music to be a vehicle for connected care. It allows carers to use music as a tool to find out more about the person they are caring for and encourage them to engage through the music.

“Music can reveal previously hidden aspects of the patients to their carers; likes and dislikes, talents and memories – it all helps piece together the jigsaw of an identity obscured by illness.”

As the video above shows, using music can also be a way for family members to re-engage with the person suffering from dementia. It also  allows them to feel like they are directly involved in a positive element of care, as they are often invited to create the playlist, using songs that they know will evoke specific memories or emotions for the patient, and then listen along with them, interacting as they do so.

Similarly, Music for Life, a project run jointly by London’s Wigmore Hall and the charity Dementia UK brings specially trained musicians into care homes to work with patients, carers and family members in group and 1-2-1 sessions, creating and listening to music. Musicians, care home staff and managers meet after each session to reflect on what they have learned about the patients – knowledge that helps in future care and treatment.

Music as a communication tool

Formal research has supported the use of forms of music therapy, whether they be formally delivered by trained specialists or integrated into day to day caring by family or social carers. As mentioned above, research has demonstrated the positive effect it can have, both on the patient but also on their family.

Over 800,000 people currently live with the condition and roughly 25 million people  nearly half the UK population  are affected by it through knowing someone with the condition.

Music offers a way to care for people suffering from dementia in a sensitive, person-centred and cost effective manner. It can also be a vital tool to support families who can reconnect with their loved ones through a piece of music, even when other forms of communication have become difficult.


Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Enjoy this article? Read some of our other blogs:

Parental capacity to change: a new approach to child protection assessments

“Current assessments focus more on harm to the child and its causation than on capacity to change”

The assessments undertaken by social workers on children who are on the edge of care are significant. Very few, if any, assessments are straight forward; many cases are complex, with children and their families facing multiple social barriers, poverty, crime, addiction or mental health issues.

paper family on hand

Very little standardisation of practice exists and the pressure and scrutiny on social workers and their professional judgement can sometimes be unbearable. Increasingly there has been a development in the literature around child protection which suggests that social workers’ assessments should reflect the complexities of family life and should acknowledge efforts of parents to positively adapt their lifestyle in order to allow them to care for their child.

The parental capacity to change, as well as the capacity to parent effectively should be considered in these assessments.

Assessing a combination of motivation and ability, professionals it has been suggested, should work with parents to assess their readiness to accept or deny the need for change when completing their assessments. Provided that change can occur in an appropriate time frame for the child in question, professionals can work with the parents to achieve the best outcome for the child remaining with parents where possible, and returning to parents when possible, if additional action to change is necessary.

bambole di stoffa

C-Change Approach.
There has been a push of late to encourage social services to look at the needs of the parent as much as the needs of the child, and to offer support to families throughout the period the child is with them, particularly when the child has been returned to them after a period in social care.

This approach is about developing relationships between social workers and families and creating realistic, clear and accessible targets for parents, to show their change process, and progress,  and to build an understanding of what is expected of them, with the social worker acting as an assessor but also as a motivator and a facilitator to change. Plans should be long term to create stability and a solid goal, but should also be short term enough to show regular results to keep morale high and to regularly show positive progression.

This new long term approach seeks to change behaviour in parents, but evidencing behaviour change can be difficult. Previously, research suggested that parents changed in part, so as to re-gain custody of their children, but that after time they often relapse which led to the child being taken back into care. This inconsistent approach is something which government and the third sector are trying to address through relationship building and long term consistent and implemented strategies, although it is becoming increasingly difficult given the increased demands on budgets and calls for greater efficiency within the sector.

As a result, guidance on the C-Change model emphasises that there must also be tangible consequences for those who fail to comply or who relapse – it is about altering a mindset and a behaviour – and rewards should be agreed for milestones and achievements in the same way as consequences should be in place for non-compliance.

Image by Jerry Wong, via Creative Commons License

Image by xcode via Creative Commons

Shaking the negativity
The literature which considers parental capacity to change as a way to approach social work assessment highlights a common trend – the apparent failure of social services to provide sufficient support to parents and children once the child has been returned. This in turn, the research suggests, leads to more children being taken back into care.

This is often viewed negatively by the media, who are on the one hand critical of social services for being too quick to intervene and break up family units by removing children from their parents’ care, but on the other are highly critical of their practices and their reluctance or delay in removing children from abusive or distressing situations. This negativity translates into how they are viewed by the public.

Perhaps adopting this model of partnership and change promotion can be a way forward for children and their parents and a way for social workers to reform their practices to create a more standardised transparent way of working where they can share ideas and practice, work in partnership, and be recognised for the good they do and the safeguarding role they play for vulnerable people, rather than the criticism of their inconsistent working or un-compassionate approach, as some make out.


Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Intimacy and sexuality in care homes

Talking about sexuality and intimacy can be an awkward and, for some, taboo subject, particularly when the people we are discussing are parents or elderly relatives.

However, in a care setting, where a relative has been moved into care, sexuality, sexual needs and questions around intimacy often remain un-talked about and un-catered for, and can create an awkward situation for residents, relatives and care staff.

For many people, intimacy is a ‘normal everyday’ part of life. But when moving into residential care, for many people, that is lost. They feel their privacy is taken away and their ability to conduct life as they had before needs to change as a result of moving from their home. The onset of conditions such as dementia in later life can also make other people uneasy about the idea of continuing with intimate relationships, or indeed starting new ones later in life. One of the aims of the research conducted by a team at Manchester University on older people’s understanding of sexuality (OPUS project) is to look at erotophobia, or a fear of older people’s sexuality (within the remit of feelings and beliefs on sexuality more generally).

The loss of identity through sexual expression can be even more explicitly felt by members of the LGBT community, many of whom, studies have found, have felt the need to ‘go back into the closet’ upon entering residential care.

In 2010 the World Health Organisation (WHO) published a set of sexual rights. In this the right of the individual to choice is key and something which care homes must still respect.

Sexual rights in older people was also the subject of a report by the Royal College of Nursing who commented that “when someone moves into a care home, to all intents and purposes the private space of their room is exactly that, their private space and provided any acts are consensual care homes should facilitate the wishes of residents to the fullest extent.” Within a human rights context, adults living in residential settings, unless they have had certain rights and freedoms curtailed or restricted by the law, generally have the same basic rights and freedoms as any citizen to live their lives as they wish. This includes possibly doing things that others might consider to be unwise or inappropriate.

In addition, although many decisions about care within a care home setting are taken in consultation with the family of the resident, carers and care home managers must also remember that they have a duty to their patient, and there is a level of patient-carer confidentiality which carers should be mindful of when discussing topics such as sex, sexuality or intimacy.

However, in that context it is also the case that care home workers have a duty of care, to protect vulnerable people from abuse, exploitation and situations which they might find distressing. The International Longevity Centre have produced a guide which contains advice around intimacy and sexuality in care homes, looks at intimacy in older people, (particularly older people with dementia) and the position of people within the LGBT community who move into residential care.

Many within the LGBT community have expressed a feeling of discrimination or anxiety about their sexuality on entering residential care and as a result there are suggestions of LGBT only residential care homes being created, with one proposed for either London or Brighton in the next few years.

The legality behind many of the decisions taken in care homes is set out in law, including definitions of consent, abuse, exploitation, violence. However, the individual practices of care homes regarding policy is often set out and implemented at the discretion of care home managers and staff and it is their responsibility to ensure that they have an effective and consistent policy in place when it comes to sexuality, intimacy and relationships more generally.

They also have a responsibility to ensure that staff are suitably trained to tackle any issues which may arise, answer any questions from residents or family members and recognise boundaries and levels of appropriateness while still delivering care to residents. Care workers must balance delivering effective care with promoting personal emotional and mental well being, allowing residents a level of freedom and personal choice while ensuring adequate safeguards are in place. This is not an easy task. However, more research is currently being conducted, and improved training for staff is also being increasingly offered as the norm.


Our popular Ask-a-Researcher enquiry service is one aspect of the Idox Information Service, which we provide to members in organisations across the UK to keep them informed on the latest research and evidence on public and social policy issues. To find out more on how to become a member, get in touch.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

 

Being a young carer shouldn’t be a struggle

Five teens hang out in a park and share a bible

By Stacey Dingwall

Last month the winner of the Apps for Good “People’s Choice Award” was revealed as a group of school pupils from Denbigh High School in Luton, with their idea for a mobile phone app to support isolated young carers. One of the team members revealed that “the problem that we are trying to solve is how can you help young carers get back into society, meet others like themselves and access the essential support services that they need – all in one place?

The question of how to support young carers also gained publicity earlier this year with the launch of a national campaign calling for policy changes to help young adult carers to participate in learning and work. NIACE, along with other members of the National Policy Forum for Young Adult Carers, is calling for three specific policy changes: young adult carers to be formally identified as a ‘vulnerable group’ giving them full entitlement to the 16-19 Bursary; young adult carers to be exempt from the 21 hour rule in the benefit system; and young adult carers to be able to access flexible hours Traineeships and Apprenticeships.

The extent of young carers in the UK

New measures introduced in April 2015 through the Care Act and the Children and Families Act place a responsibility on local authorities in England to take reasonable steps to identify young people who are caring for an ill or disabled family member, assess their needs and explicitly define what those needs are.

Our latest briefing for our members, many of whom work in children’s services or the voluntary sector, looks at the impact that caring can have on young people’s lives and how support can be improved.

2013 figures from the Office for National Statistics, based on the 2011 Census, placed the number of young carers (aged under 19) in England and Wales at 244,000. Of these, 23,000 young carers were aged under nine, and 10,000 were aged under seven. There were also 149,000 aged between 15 and 19, around twice the number aged between 10 and 14. Estimates from the Carers Trust suggest there are 36,821 carers in Scotland aged under 25, and around 30,000 child carers in Northern Ireland.

Hidden carers

In order to be identified in official statistics however, young carers need to be known to health, education and social care services. As acknowledged by the UK government’s 2010 Carers’ Strategy, many young carers actually remain hidden from services.

This is for two reasons: services need to do more to identify them; and some families actively conceal their need for a young person to undertake caring responsibilities, out of fear they will be taken into care. Another issue is that the young person or their family may not even recognise that they are classed as a young carer.

The practical, mental and emotional impacts of caring

With regards to the practical impact of caring, The Children’s Society has highlighted research by the Audit Commission which found that young carers between the ages of 16 and 18 had a much greater chance of being not in education, employment or training (NEET). In terms of the mental health of young carers, research by the Carers Trust found that 38% of those who participated indicated that they had a mental health problem. Additionally, the Longitudinal Survey of Young People in England (LSYPE) notes that young carers are 1.5 times more likely to have special educational needs, a disability or long-term illness themselves.

How to improve support for young carers?

The Carers Trust has made a series of recommendations for schools, GPs, health and social care services, and young carer and young adult carer support services, on actions they should take to improve the information and support available to young carers. These include that schools should establish a clear framework of support for young adult carers, which is embedded into the school’s policies and communicated to parents.

Our briefing also highlights examples of organisations who provide support and respite services for young carers, such as the Children’s Society’s Young Carers in Focus (YCiF) project. Part of the Include programme, this service includes the provision of a dedicated social networking site for young carers and those working with them, as well as specialist weekends, which offer young carers the chance to build skills and knowledge across a wide range of topics, including different potential future professions.


The Knowledge Exchange specialises in public and social policy. To gain an insight into the commentary it offers, please explore our publications pages on the Knowledge Exchange website.

Our members benefit from exclusive brieings, access to a dedicated team of researchers, and current awareness services. You can find out more about our unique service in this blog article and for more information on membership options, contact us.

How is health and social care integration being achieved in England?

By Steven McGinty

Since coming to power in 2010, the coalition government has introduced a series of major reforms to health and social care. They argue that these reforms are necessary for meeting the future needs of patients, as well as providing a more efficient public health service.  Central to these changes is the idea of integration, where services are delivered in a way that limits duplication, delivers more preventative care and targets resources more effectively. However, what has the government done to facilitate integration between health and social care?

In 2012, the Health and Social Care Bill was given royal assent and became an Act. The Act introduced a number of key changes to the way that healthcare is delivered, including:

  • the merging of a numbers of quangos, such as the Health Protection Agency and the National Treatment Agency for Substance Misuse, into one national body, Public Health England (PHE);
  • the abolition of Primary Care Trusts (PCTs), and the introduction of Clinical Commissioning Groups (CCGs), which are GP led bodies responsible for the commissioning of local health services, as well as a greater responsibility for local authorities;
  • the extension of the remit of bodies, such as Health and Wellbeing Boards, giving them extra responsibilities, including the development of strategies across health and social care to meet local public health issues;
  • the introduction of a new organisation, Healthwatch England, an independent body set up to promote the interests of patients in health and social care services.

In 2013, the government introduced a new funding mechanism known as the ‘Better Care Fund (BCF)’. This was a £3.8 billion pool of money to support health and social care bodies through the process of integration. Health and Wellbeing Boards (HWBs) are expected to provide plans to access the funding. These plans are assessed using criteria that includes:

  • how well data is shared between health and social care bodies;
  • how well plans protects social care services;
  • how it protects seven day a week services;
  • how well it reduces admissions to hospitals at weekends.

According to the County Councils Network, plans will have to show how services will be delivered in an innovative way that meets the local needs of people over the long term, in order to ensure funding.

In 2014, the government introduced the Care Act, a piece of legislation based on the 2011 Dilnot report into the funding of adult social care. The Act has been described as the biggest transformation in the care system since 1948, and introduces a number of significant changes, including:

  • that those who receive care from a regulated care provider or local council will be covered by the Human Rights Act, although those paying for care are not covered;
  • introducing a new cap of £72,000 on the cost of care for those eligible under the Act;
  • introducing duties for local authorities to offer prevention services, including the right to receive accessible information and advice, to try and reduce the numbers of people needing to go into hospitals.

The current Minister of State for Care and Support, Norman Lamb MP, has stated that the government is committed to integrating health and social care by 2018. However, it will be very interesting to see if the health care system can be fully integrated by that deadline and whether it can deliver the sort of outcomes expected.


Idox are involved in an innovative partnership with Calderdale Council. The council has developed an innovative case management tool to support their day-to-day work, in areas such as child protection, looked after children, and fostering and adopting.

Calderdale have teamed up with Idox, a specialist in providing technology, content and funding solutions to government, and are now offering their system to other local authorities. The partnership has already proven to be successful, with Calderdale and Idox providing their solution to councils in the Isles of Scilly and Leeds.

We blogged recently about the benefits of the system for integrated working. We have also looked at the barriers to the uptake of digital technologies in health and social care.

Further reading:

World Alzheimer’s Day: can we reduce dementia risk?

Older woman with Alzheimer's in a chair

Image courtesy of Flickr user Vince Alongi using a Creative Commons license

By Steven McGinty

On the 21st September, Alzheimer’s organisations across the world will be carrying out events to raise awareness about Alzheimer’s and dementia. The event, a key part of World Alzheimer’s Month, was launched by Alzheimer’s Disease International (ADI) in 1994, with the aim of highlighting the tremendous work carried out by Alzheimer’s organisations.

Each year, a new theme is selected for World Alzheimer’s Month, and this year the focus will be on how we can reduce the risks of developing Alzheimer’s and dementia. In support of this event, I’ve decided to look at some of the statistics on dementia, as well as review the latest evidence on reducing the risks.

Continue reading