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

Focusing on the end result: outcomes based commissioning in health and social care

In March 2016, the government announced that it was pairing up with the Blavatnik School of Government at the University of Oxford to create the Government Outcomes Lab (GOL). The aim of this partnership was to create a centre for excellence in commissioning research and practice – to find new and innovative ways for the public sector to commission projects, provide on the ground support to local commissioning teams and become a world class research centre on effective models of commissioning.

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Payment by service vs payment by results

Traditionally, governments contract third-party service providers on a ‘fee for service’ basis – so commissioners prescribe and pay for a particular service that they believe will lead to a desired outcome. More recently however, commissioning teams have started to introduce elements of ‘payment by results’ or ‘pay for success’ when commissioning services – so providers only get paid in full if they deliver the desired outcomes.

Social impact bonds

Social impact bonds (SIBs) are a tool to help outcomes-driven providers deliver on their projects, by giving them access to financing and management support from “socially-minded investors”. The idea being that this will broaden the pool of skilled providers, encourage smaller more locally based providers to tender for projects (who may have been reluctant to previously because of cost and lack of support) and, potentially, increase the chances of the service being successful.

One of the primary aims of the Government Outcomes Lab is to consolidate and promote as far as possible the use of social impact bonds to align social value based commissioning with commissioning for measurable outcomes – to promote a social value as well as an economic value in the way providers deliver on contracts. There are now 32 Social Impact Bonds across the UK, supporting beneficiaries in areas like youth unemployment, mental health and homelessness.

Gear

Benefits and challenges to outcome based commissioning

While to many people it may seem almost impossible to question the principle of outcomes based commissioning (to move from a system focused on process measures and targets to a system that is focused on improving the outcomes that matters to citizens and patients) the reality for commissioning teams, providers and service users is, in some cases, very far removed from this ideal.

In April 2012, the Audit Commission published its guidance on Payment by Results (PbR). This generated fairly positive messages around PbR but also advised commissioners to be aware of the risks:

“At its best, PbR can deliver savings and bring in new resources at a time when budgets are under great pressure. It also defers costs to commissioners to allow time to realise the benefits of change and preventative work….. However, PbR carries extra risks to securing value for money and requires higher level commissioning skills than more traditional approaches”- Audit Commission (2012)

Much of the literature on outcomes based commissioning models emphasises the importance of:

  • transparency;
  • agreed objectives;
  • agreed measurable outcomes;
  • communication and clear definitions of accountability between commissioners;
  • any social investors or third sector bodies with input;
  • providers;
  • and any secondary providers who may be awarded subsequent sub contracts

A more comprehensive list of pros and cons to outcomes based commissioning can be found here.

One high-profile intitiative which has faced more challenges than it has produced benefits is the “troubled families” programme. which aimed to support families with long-standing problems. The programme was heavily criticised for its payment by number (number of clients processed) rather than payment by specific outcome. The issue here appeared to be the lack of definition of outcomes and what was going to be expected of the provider in terms of service before they could be paid.

In this instance the organisations delivering the “troubled families” programme in some areas were being paid for the number of people who went through the service, rather than the number of people who completed the programme successfully, or saw notable improvement as a direct result of the input of the programme, and without taking note of the professional view of the quality of the service being provided (which was considered in some areas to be poor). This resulted in providers being paid for a service which, while many people used, did not actually achieve the expected outcomes. This is something which future commissioning bodies must take note of and act upon to ensure that any future agreements do not contain such massive loopholes with regards to payment.

Outcome Flow Chart

Outcome Flow Chart via Roma Learning Leaders

Outcomes based commissioning in health and social care

A number of different policy areas have begun to use outcomes based commissioning models with varied success (although as we have seen this can be as much to do with the quality of the provider and the transparency of the contract as it is about the implementation of an outcomes based model). Rather than focusing on inputs (e.g. number of doctors) or outputs (e.g. number of operations conducted, or amount of drugs administered), these commissioning models are based on achieving specific, predefined and measurable ‘outcomes’ (e.g. improved health).

In a specific health and social care context, outcomes based commissioning can, if done well, form a key part of a wider prevention agenda, as well as helping to improve personalisation of services. In Wiltshire for example, the council has employed outcomes based commissioning techniques in relation to its domiciliary social care teams. This example shows that when the right providers are selected and clear outcome measures are defined, the impact for service users can be significant, in a positive way: there is a strong focus on getting the best possible result for the customer in the way that suits them; with every visit having a clear purpose and a focus on achieving greater independence for the older person wherever that is possible (which is the overall wider outcome the commissioning teams were hoping to achieve – greater independence of service users and less reliance on the social care teams in the long term).

Some specific challenges in a health and social care context include coordinating payment for outcomes with direct (or personal) payment schemes and agreeing on realistic and well defined outcomes and time frames with service users (which if done well can have a very positive impact on the personalisation agenda of services) Attributing outcomes specifically to one set of interventions in health and social care can also be difficult, particularly if a service user is in receipt of a number of different strands of care, for example, primary care and domiciliary social care as well as having access to some remote telehealth facilities.

Commissioning for long term outcomes

If the issue of defining or attributing outcomes is a challenge for outcomes based commissioners, then the issue of planning for long term outcomes is even more difficult. This approach requires commissioners to have a long term view of the strategic aims of a programme, as well as requiring them to consider any factors which may influence or change these aims, and additionally to consider the scope of need in the future if other preventative measures are successful.

Advice for councils

The LGiU and academics at Oxford Brookes University, as well as many others, have published guidance for local authority commissioning teams, giving them some direction in relation to best practice in outcomes based commissioning. Some of the key “pointers” for councillors include:

  • Take time to get the right set of providers in place to deliver the new model and collaborate with them to get the best possible system in place – be thorough in research and consideration of tenders.
  • Be very clear what the likely outcomes are that any specific service is being asked to deliver.
  • Make the payment mechanism as simple as possible. Consider whether any rewards will be paid for good performance in delivering outcomes. Consider if payments should be made on each individual outcome achieved or for outcomes for sub-sets of the population e.g. hospital discharges.
  • Make use of the public, their opinions and data collected about them to assess the needs of the population and reflect this in the agreed outcomes.
  • Try to implement outcomes based commissioning as part of wider transformation within the organisation – in order to improve quality, reduce costs and improve efficiency (particularly in health and social care) other infrastructure and practices (such as IT systems and skills development in staff) need to be addressed in addition to commissioning models in order to bring about change.

Further reading about health and social care on our blog

Co-production in social care … a need for systems change

Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help

What’s happening to make big data use a reality in health and social care?

Assistive digital technology and older people: technology “bricolage” in dementia care

A key focus of social care teams today is helping people to grow old at home, safely, with dignity and with appropriate levels of care if needed, without breaking the budget. Increasingly, local authorities are looking to advances in technology to facilitate this “growing old in place”.

Telecare packages and assistive technologies are often the preferred way for care teams to deliver social care in a home setting. And in situations where care is required around the clock (for example, support for people with dementia and other life limiting degenerative diseases), families and carers are adapting everyday technology and integrating it into their care-giving in order to supplement the telecare provided by local authorities.

Notruf und Hilfe für Rentner und Kranke

 

Bricolage in dementia and elderly care

Bricolage means adapting an object to allow it to carry out a function which was not necessarily its original intended function. Relatives who care for loved ones with dementia, often adapt everyday objects to help them with their day-to-day caring. They find new, innovative and often non-conventional ways to use technology in diverse ways.

dementia post it

One example from dementia care was a man who bought a chicken ornament with a sensor which “crowed” whenever anyone walked past it. He placed it beside the front door so that if his wife, who suffered from dementia, walked up to the door to go out, he would hear and be able to go to her.

Other examples of technology being adapted include: setting alarms and reminders on mobile devices to remind people to take medication, or using webcams to act as personal CCTV so familly carers can monitor loved ones when they go out, or go into the next room.

These examples show that objects don’t have to be digital in order to be effective. The rise in capability of digital technologies and the relative decrease in cost, however, means it is often quicker and easier for families to invest in additional technologies themselves, rather than waiting for an assessment and an allocation of additional technology from their council.

Image by Buddi

Image by Buddi

Ethical challenges

Although there may be practical motivations, some charities have expressed concern about the ethics of some of the practices regarding adaptation of digital technology to form part of an assistive care package. While they recognise the strain of caring is significant for many people, rigging up a webcam in each room to allow you to “monitor” a loved one, or attaching a GPS tracking bracelet, for example, while often done with the best of intentions, could be interpreted as a breach of human rights.

Active assistive technology (technology which requires an active call for assistance) rather than passive technology (which is constantly monitoring) may be a better way of using technology ethically. It may also be used as an additional stimulant or interactive tool to allow patients to communicate. Apps and interactive devices, such as tablet computers, can inform a carer or loved one that someone had been using the app (providing a type of reassurance and monitoring) and the activities the app promotes might also be a visual stimulant and a communicative tool. The Dementia Citizens project has adopted this method and aims to help people with dementia and those who care for them, using apps on smartphones and tablets.

Dementia Citizens from Nesta UK on Vimeo.

Final thoughts

If we are mindful of the ethical challenges of integrating more technology into care, it might be possible for families and carers to work with social care and assistive technology development teams to adapt the tools available in a more empowering way. It might also mean that the onus is not on carers and their loved ones to build what they can from the standardised telecare provided by local authorities.

Bricolage in assistive care has, for many families, become the norm without them realising it. By adapting and supplementing assistive technology, like telecare packages, with non-assistive technologies or adapted additional digital technologies, families and carers can create a bespoke and personalised care package.

In future, understanding the extent to which families and carers adapt the technology given to them, could help creat more flexible care packages which can be more easily adapted to suit individual needs.

Digital technology in social work practice

Using social media in social work practice was the topic of conversation at a recent conference, held at the University of Stirling. With a delegate list including academics, researchers, practitioners and representatives from the public and private sectors the conversation topics were broad and wide ranging from how to use social media, what to avoid doing and how to integrate digital technologies and systems into everyday practice for social workers.

social media infographic photoPartnerships to deliver digital solutions

In March last year we told you about the partnership between a local authority and Idox who teamed up to deliver a digital case management tool to support the council social workers in their day to day practice. The ideas that were promoted during the conference not only emphasises the innovative nature of that partnership when it was developed, but also the continuing possibilities to pursue innovative digital solutions within local government to allow Idox to continue deliver efficient and positive outcomes for service users.

Avoiding social media pitfalls

Aside from poor infrastructure, like a lack of wifi, and seemingly impenetrable work computer firewalls, both of which came up regularly in discussions, one of the main reasons social workers did not use social media was fear, uncertainty and worry of the repercussions should something be posted or liked which was deemed inappropriate.

Rachel Wardell, the director of Services at Warwickshire council gave a talk on utilising Twitter in an appropriate way and outlined the “7 stages of Twitter” for new and advanced users. She suggested that Twitter was actually a great way for social workers, teams and managers to make connections and share best practice across the profession. She discussed how links initially forged on twitter by a follow or the sharing of an article developed into partnerships and trips to visit areas of best practice to observe and learn from fellow professionals.picjumbo.com_HNCK1814

However for many social workers, and their management teams, social media use can still be problematic, with the BBC reporting earlier in the year that there had been a rise in the number of council workers being punished for misconduct relating to social media. For social work teams the pressures and implications are even more significant. In discussion with Birmingham University’s Dr Tarsem Singh Cooner some of the delegates highlighted examples of colleagues who had been accused of bringing the profession into disrepute and some extreme instances where they had been removed from cases at the request of service users who had seen a post on their social media account which was not secured with privacy settings.

While most were keen to stress that these were individual mistakes and misjudgements there was still anxiety about the increasingly blurred boundaries between public and private, the importance of relationship building and personal experience for social workers interacting with service users, but the necessity to remain professional. The phrase ‘social workers are human too’ was used regularly by those advocating the use of social media and that councils should use a level of common sense and discretion when dealing with incidents involving staff and social media. However, the general consensus appeared to be that social media should be treated with caution:

  • use a separate work and personal account
  • use an alias
  • employ maximum privacy settings
  • don’t post anything that could potentially bring the profession or your conduct into disrepute
An example (from my own Twitter) of how Twitter can be used to document conferences and interact with professionals

An example (from my own Twitter) of how Twitter can be used to document conferences and interact with professionals

Making social work ‘appier

One of the big developments which has become increasingly popular as a tool to engage social work in digital technology is the creation of apps. Many of the conference discussions were on the benefits of using an app, how they can be utilised fully in their roles as training tools and information providers or how they can be used to encourage participation and communication in aspects such as feedback.

Anne Campbell from Queens University Belfast discussed the development of a series of information-based apps which focused on child development. Another app covered the knowledge of social workers and social care teams of drug and alcohol in substance misuse cases, including symptoms, street names for abused substances and the studies which use examples of substance misuse in social work and adult and child protection cases. She discussed the importance of using practitioners and service users to develop the app, to ensure it was fit for purpose and easy to use. She also highlighted the potential for her apps, which currently operate in a Northern Irish context, to be developed and diversified to account for differences in policy in Scotland, the Republic of Ireland and England and Wales.

Screenshot images of the apps

Screenshot images of the apps

There is a potential for software development in the future which would see more secure data files more easily accessible via personalised secure apps and document drop apps, which could be shared across a number of sectors, including health, social care and education. Delivering the digital infrastructure platforms to develop and successfully run integrated systems and sharing platforms such as these would require huge investment from local authorities, and would potentially provide the opportunity to work in conjunction with specialists, such as Idox, to develop software which is supportive, flexible and fit for purpose.

Apps

Iphone apps. Image by Daniel Go via Creative Commons

Using social media to create connections

The final part of the afternoon was characterised by case study style discussions, where speakers presented their own experiences, both positive and negative of using social media and stressed the importance of social media as a way to create connections. The connections spoken about included connections between practitioners, to create a more extensive community of best practice within the social work profession, connections between service users and social workers, many of whom feel more comfortable communicating via social media, and finally creating connections between service users to help them provide support to each other. This was something specifically highlighted by the team from Lothian Villas in East Lothian.

Lothian Villas have been using a closed, invite only Facebook group as a forum to interact with young people staying with them during a period in residential care. Members can post on the page, while others respond giving advice and reminiscing, much like a traditional family would do. That, according to Ewan McKay, is vital for allowing children who have come from care to build and maintain relationships and have happy memories of their childhood which can go on to shape how they behave as adults in the future. They can also then pass their memories and advice onto the children who are coming through the system after them.

Other groups spoke about the use of document sharing sites, digital presentation sites and networking sites like LinkedIn to create and document continuing professional development (CPD), a core part of social workers’ continuing improvement and the maintenance of standards.

 

The conference highlighted the massive steps forward which have been taken and the desire for drive and innovation in digital infrastructure to take public services, and their delivery onto digital platforms. This would allow for greater connectivity between professions such as social work and other service providers in health and education resulting in more efficient services, producing better outcomes for service users. Using digital platforms well, including apps, sharing websites and personal social networking sites such as Twitter will allow practitioners and local authorities to ‘join up’ services to promote more holistic, person-centred care at a local level while allowing professionals to build a network of best practice and document their own CPD. Digital media in social work practice could potentially be a key enabler in improving practice and generating positive outcomes for service users.


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.

Health Champions – “unlocking the power of communities”

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By Heather Cameron

“On the societal level, we must understand that health is not an individual outcome, but arises from social cohesion, community ties, and mutual support.” Dr Gabor Maté

Health inequalities have long been an issue in the UK and despite continuous government commitment to tackling them, they continue to persist.

It is estimated that avoidable illness costs around £60 billion and that 1 in 4 deaths are preventable with the adoption of healthier lifestyles. Calls have therefore been made for radical changes in the approach to public health by improving health and wellbeing outside of the core public health workforce.

This is just the approach of the Community Health Champion model, developed by Altogether Better, which has demonstrated not only the positive impact on health but the social value of such an approach.

What are health champions?

Health Champions are volunteers from all walks of life who are provided with accredited training and support so they can undertake health promotion activities within their communities to reduce health inequalities and improve the health of the local population.

The Community Health Champion role began as a five year Big Lottery Funded programme (Wellbeing 1) in 2008. Over 18,000 Health Champions were recruited, trained and supported between 2008 and 2012, reaching over 105,000 people.

Through a combination of their training and own personal experiences, these volunteers empower and encourage people within their families, communities and workplaces to take up healthy activities, create groups to meet local needs and can signpost people to relevant support and services.

Challenges

While Wellbeing 1 succeeded in reaching many people in need, the programme also raised two specific challenges: in almost all cases, the work being done was invisible to the NHS; and securing ongoing funding to continue the support was difficult.

Peer support was later identified as the most appropriate way of trying to connect communities with health services.

Following this recognition and the success of the original model, further lottery funding was awarded to develop the Champion model and use it to engage champions, communities and health services (Wellbeing 2).

Co-production of health and wellbeing outcomes

The model was applied to health services specifically with the aim of addressing the apparent disconnect between the NHS and community-based services. It helps connect both patients with support in their communities and professional practices with those communities.

Many citizens have volunteered in different ways and in different settings. These include:

  • Practice Health Champions working closely with their General Practice to create new ways for patients to access non-clinical support
  • Youth Health Champions where children and young people are recruited, trained and supported to help young people more actively engage with and influence their own and their community’s health
  • Pregnancy and early years Health Champions who are interested in giving children a better start
  • Health Champions working within a specialist, hospital-based NHS service
  • Senior Health Champions who engage with older people, offering a complimentary approach to more formal programmes

Community-based health improvement initiatives such as this could help to strengthen community-professional partnerships and cross-collaboration among health, social and other services. And this in turn could lead to a reduction in health inequalities.

Positive outcomes

According to a recent evaluation of the Health Champions programme, Wellbeing 2 has resulted in a range of benefits:

  • 86% of champions and 94% of participants in the programme reported increased levels of confidence and well-being;
  • 87% of champions and 94% of participants in the programme acquired significant new knowledge related to health and well-being;
  • 98% of champions and 99% of participants in the programme reported increased involvement in social activities and social groups;
  • 95% of practice staff involved with the programme would recommend it and wish to continue.

Other benefits included reduced social isolation, increased levels of exercise/healthy eating and feeling physically better. One champion reported “this has helped me more than any medication might.”

Success stories  include the work of a cycle champion who has improved her own health and wellbeing, encouraged over 70 other people to improve theirs through taking up cycling, provided cycle training to over 50 people in 6 community groups and provided specific detailed help to 5 people.

Other successes have involved volunteers setting up football training, providing support to women with mental health issues, providing advice and support to ethnic minorities and providing advice on healthy eating.

In terms of monetary value, an  analysis of the social return on investment (SROI) of a series of Altogether Better project beneficiaries found a positive SROI of between £0.79 and £112.42 for every pound invested, highlighting the potential value of these initiatives to funders.

Final thoughts

At a time of increasing demands on health services and with the relentless squeeze on public sector resources, perhaps the move towards greater community empowerment and collaboration across sectors is the right one. After all, as I’m sure we’d all agree, prevention is better than cure.


If you liked this blog post, you might also want to read Heather’s earlier post on social prescribing

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

 

 

Social prescribing – just what the doctor ordered?

blue toned, focus point on metal part of stethoscope

By Heather Cameron

It is widely acknowledged that wider social, economic and environmental factors have a significant influence on health and wellbeing. According to recent research only 20% of health outcomes are attributable to clinical care and the quality of care while socioeconomic factors account for 40%.

With increasing pressures on GPs and lengthy waiting times a real issue for many, particularly those with mental health conditions, social prescribing could represent a real way forward.

The government clearly recognised the importance of social prescribing in its new deal for GPs announced earlier this year, which made a commitment to make social prescribing a normal part of the job.

In response to a recent Ask-a-Researcher request for information on different approaches in social prescribing and evidence of what works in the UK, it was interesting to find that despite the recognition of potential value, there has been little evaluation of social prescribing schemes to date.

Much of the material found focused on specific interventions and small-scale pilots and discussion around implementation. A new review of community referral schemes published by University College London (UCL) is therefore a welcome addition to the evidence base as it provides definitions, models and notable examples of social prescribing schemes and assesses the means by which and the extent to which these schemes have been evaluated.

So what is social prescribing?

Social prescribing means linking patients with non-medical treatment, whether it is social or physical, within their community.

A number of schemes already exist and have included a variety of prescribed activities such as arts and creative activities, physical activity, learning and volunteering opportunities, self-care and support with finance, benefits, housing and employment.

Often these schemes are delivered by voluntary, community and faith sector organisations with detailed knowledge of local communities and how best to meet the needs of certain groups.

Social and economic benefits

Despite a lack of robust evidence, our investigation uncovered a number of documents looking at the social prescribing model and the outcomes it can lead to. Positive outcomes repeatedly highlighted include:

  • improved health and wellbeing;
  • reduced demand on hospital resources;
  • cost savings; and
  • reduced social isolation.

According to the UCL report, the benefits have been particularly pronounced for marginalised groups such as mental health service-users and older adults at risk of social isolation.

A recent evaluation of the social and economic impact of the Rotherham Social Prescribing Pilot found that after 3-4 months, 83% of patients had experienced positive change in at least one outcome area. These outcomes included improved mental and physical health, feeling less lonely and socially isolated, becoming more independent, and accessing a wider range of welfare benefit entitlements.

The evaluation also reported that there were reductions in patients’ use of hospital services, including reductions of up to a fifth in the number of outpatient stays, accident and emergency attendances and outpatient appointments. The return on investment for the NHS was 50 pence for each pound invested.

Similarly, the Institute for Public Policy Research (IPPR) has recently argued that empowering patients improves their health outcomes and could save money by supporting them to manage their condition themselves.

IPPR suggests that if empowering care models such as social prescribing were adopted much more widely throughout the NHS we would have a system that focused on the social determinants of health not just the symptoms, providing people with personalised and integrated care, that focused on capabilities not just needs, and that strengthened people’s relationships with one another.

Partnership working

With a continued policy focus on integrated services and increased personalisation, social prescribing would seem to make sense. In addition to providing a means to alternative support, it could also be instrumental in strengthening community-professional partnerships and cross-collaboration among health, social and other services.

The New Local Government Network (NLGN) recently examined good practice in collaboration between local authorities, housing associations and the health sector, with Doncaster Social Prescribing highlighted as an example of successful partnership working. Of the 200 referrals made through this project, only 3 were known to local authority and health and wellbeing officers, showing that the work of social prescribing identified individuals who had otherwise slipped through the net.

And with the prospect of an ageing population and the health challenges this brings, a growing number of people could benefit from community-based support.

As Chair of Arts Council England, Sir Peter Bazalgette, notes “social prescribing is an idea whose time has come”.

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

Further reading: if you liked this blog post, you might also want to read Heather’s earlier post on the health and wellbeing benefits of investing in public art.

Why UK-sourced evidence matters … and why it is so often ignored

By Morwen Johnson

If you follow our blog, you’ll know that we care passionately about promoting the uptake of evidence and research by policymakers and practitioners. It’s easy to be complacent and assume that when public money is at stake, decisions are made on the basis of evaluations and reviews. Unfortunately, this is still not always the case.

The current evidence-based policy agenda in the UK encompasses initiatives such as the What Works network, the Local Government Knowledge Navigators and independent organisations such as the Alliance for Useful Evidence. They are working on fostering demand for evidence, as well as linking up academics with those in the public sector to ensure that the research community is responsive to the needs of those making decisions and designing/delivering services.

A recent article in Health Information and Libraries Journal highlights another challenge in evidence-based policy however. A mapping exercise has found that literature reviews often ignore specialist databases, in favour of the large, well-known databases produced by major commercial publishers. Within the health and social care field (the focus of the article), literature reviews tend to use databases such as Medline, Embase and Cinahl – and overlook independent UK-produced databases, even when they are more relevant to the research question.

Why does it matter?

Research has shown that how (and why) databases are chosen for literature searching can “dramatically influence the research upon which reviews, and, in particular, systematic review, rely upon to create their evidence base”.

To generate useful evidence for the UK context (relating to UK policy issues or populations), researchers need to understand the most appropriate database to search – but unfortunately our own experience of looking at the detail of methodologies in evidence reviews, suggests that in many cases the only databases searched are those produced by American or international publishers.

Grey literature is a valuable source in evidence reviews – and again this is often overlooked in the major databases which tend to focus only on peer-reviewed journal content. A recent Australian report ‘Where is the evidence?‘ argued that grey literature is a key part of the evidence base and is valuable for public policy, because it addresses the perspectives of different stakeholder groups, tracks changes in policy and implementation, and supports knowledge exchange between sectors (academic, government and third sector).

Another benefit of UK-produced databases is that they will make use of UK terminology in abstracts and keywords.

Social Policy and Practice – a unique resource

At this point I should declare a vested interest – The Knowledge Exchange is a member of a UK consortium which produces the Social Policy and Practice (SPP) database. The SPP database was created in 2005 after five UK organisations, each with a library focused on sharing knowledge in community health and social care, agreed to merge their individual content in order to make it available to the widest possible audience.

The current members of the SPP consortium – the National Children’s Bureau, the Idox Knowledge Exchange, the Centre for Policy on Ageing and the Social Care Institute for Excellence – have just been joined by the National Society for the Prevention of Cruelty to Children. Inclusion of the NSPCC’s bibliographic data greatly enhances the coverage of child protection research in the database. SPP has been identified by NICE, the National Institute for Health and Care Excellence, as a key resource for those involved in research into health and social care.

We want the UK research community to understand what SPP offers, and to use it when undertaking literature reviews or evidence searches. This process of awareness raising should start with students – librarians in universities and the UK doctoral training centres have a key role in this as it ties in with the development of information literacy and critical appraisal skills. Ignoring specialist sources such as SPP risks introducing bias – at a time when initiatives are attempting to embed research and analytics in local government and the wider public sector.


Information on the coverage of Social Policy and Practice is available here and the distributor Ovid is offering a free 30-day trial.

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:

Child obesity – public health or child protection issue?

By Heather Cameron

The issue of childhood obesity is in the spotlight again. Just weeks after the Channel 4 series Junk food kids: who’s to blame? highlighted shocking stories of children having gained several stones in weight and children as young as four with rotten teeth, a new study reveals that parents rarely spot obesity in their children.

The results of the survey, given to nearly 3,000 families, showed that nearly a third, 31%, of parents underestimated the weight of their child. It would therefore be fair to say, as highlighted by one of the researchers, that “if parents don’t recognise a child is obese then they’re very unlikely to do anything to help their child move to a more healthy weight. Then it’s a potential major public health crisis being stored up.”

Obesity experts have called for stricter rules on the advertising of unhealthy foods and drinks in a bid to help address this public health issue. And the public would seem to support this, according to a recent poll, which revealed that almost two-thirds of Britons surveyed want a ban on junk food TV ads until after the watershed.

But is the childhood obesity epidemic just a public health issue?

There has been a high degree of contention for some time over whether obesity should also be considered a child protection concern. Numerous news reports have questioned whether children should be taken into care if they are considered obese and potentially at risk of harm.

Just last year it was reported that up to 74 morbidly obese children in the UK were estimated to have been taken into care over the previous five years, according to figures obtained under Freedom of Information laws.

Prior to this, an article from Protecting Children Update that looked at physical abuse in children highlighted obesity as a form of abuse, suggesting that many professionals see obesity as a form of neglect.

Similarly, the researchers of a much cited paper published in The BMJ in 2010 – When does childhood obesity become a child protection issue?argue that parents who refuse to help their overweight children to lose weight are neglectful. They say that whilst obesity alone is not a child protection issue:

consistent failure to change lifestyle and engage with outside support indicates neglect… childhood obesity becomes a child protection concern when parents behave in a way that actively promotes treatment failure in a child who is at serious risk from obesity.”

The report raises questions over how obesity should be addressed in terms of child protection, however, noting that there is evidence that families of obese children were being unfairly accused of abuse where rare genetic conditions were involved. It also suggests that removing obese children from their parents may in fact make matters worse.

With a lack of published evidence and guidelines for professionals, the report therefore suggests the following framework for action:

  • Childhood obesity alone is not a child protection issue
  • Failure to reduce overweight alone is not a child protection concern
  • Consistent failure to change lifestyle and engage with outside support indicates neglect, particularly in younger children
  • Obesity may be part of wider concerns about neglect or emotional abuse
  • Assessment should include systemic (family and environmental) factors

There is certainly no room for complacency, considering the knock-on effect the failure to recognise obesity could have on the nation’s health, not to mention health and social care services.


 

The Idox Information Service can give you access to a wealth of further information on public health and social care topics, to find out more on how to become a member, contact us.

Further reading

Some resources may only be available to Idox Information Service members.

Overcoming obesity: changing hearts and minds, IN Community Practitioner, Vol 87 No 3 Mar 2014, pp16-18

Process evaluation outcomes from a global child obesity prevention intervention, IN BMC Public Health, Vol 14 No 757 2014

The inactivity time bomb: the economic cost of physical inactivity in young people (CEBR, 2014)

Preventing child obesity: a long-term evaluation of the HENRY approach, IN Community Practitioner, Vol 83 No 7 Jul 2013, pp23-27

Is obesity a child protection issue?, IN Community Care, No 1833 2 Sep 2010, pp16-17

What technology brings to health and social care: a case study of Calderdale and Idox

 

By Steven McGinty

In the second of our articles on health and social care and technology, we‘re going to look at the advantages of using technology, as well as a case study of an innovative partnership between Calderdale Council and Idox.

The ‘Digital working, learning and information sharing’ strategy, developed in partnership with the adult social care sector, identifies three areas where technology would bring a number of benefits:

  • working directly with those who need care and their carers;
  • supporting the learning and professional development of staff;
  • organisational business support and information management systems.

The use of electronic notes, for instance, would be a simple step that would have a significant impact on homecare workers (highlighted in section 5 of the Burstow Commission report on the future of the home care workforce).  At the moment, care workers usually make handwritten notes and leave them in a book in someone’s home.  However, if care workers moved from handwritten notes to electronic notes, information could be shared more easily. This would mean that care managers and families would be able to monitor an individual’s care and conditions remotely.

Organisations have also seen the advantage of incorporating e-learning into staff development.  The Skills for Care ‘Digital capabilities in social care’ report found that 95% of organisations used e-learning courses to support staff development, particularly in administration-related areas, such as health and safety and fire training. For instance, instead of sending staff on full day training sessions, e-learning courses can be completed by staff in an hour, offering greater efficiency and flexibility.

However, the report also highlighted that social care related e-learning courses, which looked at issues such as dignity and respect, were of ‘variable quality’ and not able to compete with the experience of face-to-face and group learning. Therefore, it’s possible that an opportunity is being missed by education and training providers, as technology should be able to provide better solutions than the simple tick box exercises described in the report.

Interestingly, the report also suggests this might not be too far off, as one of the organisations revealed that they were looking at more interactive options and were currently working on a research project with a university in Greece, which focused on the idea of ‘gamification’.

One local authority that’s certainly tried to capitalise on the benefits of technology is 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. Parveen Akhtar, Early Intervention Service Manager, at Calderdale Council explains that:

“The Child Social Care solution was created in partnership with schools, health and police. Providing an intuitive system to meet the requirements of front line social care practitioners, it enhances our ability to provide better services to families within our community.”

The Child Social Care solution creates a single view of a child through combining information from several sources into one record. This means that practitioners are able to create, access and share information easily and securely, supporting informed decisions and putting in place appropriate support for children and their families.

The system has a number of benefits and features, including:

  • improving multi-agency communication and response;
  • reducing the amount of time taken by practitioners to locate another agency involved in a child’s case;
  • enabling practitioners to access information remotely;
  • offering comprehensive performance and reporting tools for providing vital statistics;
  • providing the ability to monitor and track the progress that children and families are making.

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.

Over the coming years, health and social care will be facing ever greater demands with tighter budgets. For this reason, technology is going to be essential to support better outcomes and more efficient services.  It is therefore important that a strategic approach is taken concerning information technology, and that organisations look at its long term benefits, rather than the short term savings from cuts to investment.

The first article on health and social care and technology, “What’s preventing health and social care from going digital?”, can be found here.

Further reading: