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

 

Creating sustainability in health and social care

The question of the sustainability of funding for health and social care services has been in the spotlight recently. The Conservative Party manifesto contained proposals around making individuals pay for more of their social care costs, to deal with the “challenges of an ageing society”. Meanwhile, figures suggest that NHS Trusts in England overspent by £770m last year despite a focus on efficiency savings.

However, creating and maintaining sustainability in health and social care is much broader than financial sustainability. It means considering other factors, including environmental, training and project management issues. This takes planning, commitment and an understanding of the aims and expectations of staff and senior management.

A research symposium earlier this year (hosted by Healthcare Improvement Scotland and partners) explored these issues further, looking at the evidence underpinning ways to create sustainable health and care systems.

Environmental sustainability

Environmental sustainability is something which all organisations are being asked to address and improve. The issue of climate change has led to a focus on behaviour change and a more sustainable use of resources.

  • Buildings – This includes the planning of new healthcare buildings, as well as adaptations to existing structures to make them more energy-efficient. Alternative building materials and designs have been used in new projects to improve energy efficiency, with some buildings even incorporating wind turbines, solar panels and geothermal capture centres. Reducing waste water and improving temperature regulation through heat capture and insulation techniques are also being adopted. While these may be costly initial spends for many, the long-term cost savings are also significant, as well as ensuring that the buildings meet minimum national requirements for energy efficiency and contribute to emissions reduction targets.
  • Resource, waste and recycling management – In many offices and clinical centres, individuals are encouraged to be personally responsible for their own reduction in waste and improved use of recycling facilities; however, this must also be facilitated at an organisational level. Clearly labelled recycling bins, promoting reduction in of the use of disposable water and coffee cups, and encouraging employees to use less paper when report writing (printing double sided for example, or going paperless where possible) are all simple ways in which environmental sustainability can be promoted in health and social care settings. Innovative techniques such as reusing water in internal plumbing, or creating bespoke recycling facilities to help reduce the amount of clinical waste incinerated, are being developed.
  • Remote monitoring and the use of technology – There have been major advances in the use of remote technology to host meetings, video-conferences, follow up appointments and assessments for those in receipt of reablement care via tele-health. Remote monitoring of patients, as well as the use of tele-health and other digital platforms can allow consultations and routine check-ups to take place without either party having to leave the house or office, thereby reducing vehicle emissions used in transport. In social care, remote meetings and cloud-based reporting can allow front-line social workers to remain out on visits instead of having to return to the office to fill out reports, again reducing vehicle emissions.

Sustainable resource management

In the face of more limited funding, joint working between health and social care is being heralded as a new way of cost saving, making the most of ever-depleting resources in the face of ever-greater demands. Being efficient with resources, through effective planning and management is one of the key ways to ensure resource sustainability in the long term, especially for the NHS and local authority social care teams.

Approaches include:

  • Making full use of the entire health and care ecosystem – This means using the entirety of the health and social care ecosystem, its capacity, expertise, resources and the end-to-end care it can provide. It means engaging carers, GPs, nurses, and pharmacists to improve efficiency, make better use of resources, spread the workload and improve satisfaction levels and outcomes for service users.
  • Using careful and well-managed commissioning models  This means making good decisions about commissioning and outsourcing to make best use of funding and other available resources. It also means allocating to appropriate projects, being mindful of the possible consequences of payment by result frameworks, and getting the best value possible.

Sustainability in practice

The final level of sustainability in relation to health and social care practice involves the sustainable implementation of programmes. This means finding ways to ensure that implementation is carried out in ways that ensure long term success and positive outcomes. It involves understanding context, and the culture of the organisation and makes reference to something discussed previously in our blog on implementation science.

Ensuring sustainability in practice requires multiple efforts including:

  • Making sure that practice becomes embedded into everyday work
  • Sharing best practice
  • Maintaining motivation among your workforce
  • Using robust, local evidence in a way that is clear and concise.

Understanding what kind of evidence leads to sustainable programme implementation is also important: economists prefer cost-based strategies, chief executives want one-page summaries, professionals want examples of other organisational based programmes and what was required to implement effectively, and councillors want case studies based around the positive impact on services users. Case studies can at times actually be the least helpful because even in a failing programme there is usually one example you can use to find positives.

Another issue with evidence is the reluctance to report on issues or challenges, or failed projects, when actually some of the greatest insight can be gained from this. All of the learning that can be gained from failures could be useful when trying to make programmes more resilient so they can be more sustainable.



Final thoughts

The concept of sustainability in health and social care cuts across many areas of organisational management and personal practice and behaviour. Encouraging and participating in sustainable practice can mean anything from being more environmentally friendly by digitising reports, recycling paper or changing to energy saving lightbulbs to promoting sustainability of resources through efficient and effective management, utilising the skills, expertise and resources of the entire health and social care ecosystem.

These approaches to sustainability should not only help health and social care as a profession to be less impactful on the environment but will also allow organisations to save money, improve efficiency and ultimately improve outcomes for patients and service users as a result.


* The 5th Annual Research Symposium: Evidence for sustainability – exploring the current evidence underpinning ways to create sustainable health and care systems was held on 16 March 2017. It was jointly hosted by Healthcare Improvement Scotland, Health Services Research Unit and the Health Economics Research Unit at the University of Aberdeen, and the Nursing, Midwifery and Allied Health Professions Research Unit at the Chief Scientist Office.

If you enjoyed this blog, you may also be interested in other articles on implementation theory and commissioning in health and social care.

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From data to intelligence and improvement – what cutting edge councils are doing in the UK

Group of workers having a meeting

By Steven McGinty

Data has the potential to revolutionise the delivery of local services. Just like the private sector – where organisations such as Amazon and Facebook have leveraged user data – local councils have the opportunity to reap significant benefits from analysing their vast silos of data. Improving efficiencies, increasing levels of transparency, and providing services which better meet people’s needs, are just some of the potential benefits.

Although many councils are still at the early stages of utilising their data, some are innovating and introducing successful data initiatives.

Wise Councils

In November 2016, the charity NESTA published a report highlighting the most ‘pioneering’ uses of data in local government. The report emphasised that most local services would benefit from data analysis and that a ‘problem-oriented’ approach is required to generate insights that have an impact on services. The case studies included:

Kent County Council

Kent County Council (KCC), alongside Kent’s seven Clinical Commissioning Groups (CCGs), have created the Kent Integrated Dataset (KID) – one of the largest health and care databases in the UK, covering the records of 1.5 million people. The core requirement of the dataset was to link data from multiple sources to a particular individual, i.e. that information held about a person in hospital, should also be linked to records held by other public bodies such as GPs or the police.

This integrated dataset has enabled the council to run sophisticated data analysis, helping them to evaluate the effectiveness of services and to inform decisions on where to locate services. For example, Kent’s Public Health team investigated the impact of home safety visits by Kent Fire and Rescue Service (KFRS) on attendances at accident and emergency services (A&E). The data suggested that home safety visits did not have a significant impact on an individual’s attendance at A&E.

Leeds City Council

Leeds City Council have focused their efforts on supporting open innovation – the concept that good ideas may come from outside an organisation. This involved the initiatives:

  • Data Mill North (DMN) – this collaborative project between the city council and private sector is the city’s open data portal (growing from 50 datasets in 2014 to over 300 data sets, in over 40 different organisations). To encourage a culture change, Leeds City Council introduced an ‘open by default’ policy in November 2015, requiring all employees to make data available to the public. A number of products have been developed from data published on DMN, including StreetWise.life, which provides local information online, such as hospital locations, road accidents, and incidents of crime.
  • Innovation Labs – the city has introduced a series of events that bring together local developers and ‘civic enthusiasts’ to tackle public policy problems. Leeds City Council has also provided funding, allowing some ideas to be developed into prototypes. For example, the waste innovation lab created the app, Leeds Bins, which informs residents which days their bins should be put out for collection.

Newcastle City Council

Newcastle City Council have taken a data-led approach to the redesign of their children’s services. The Family Insights Programme (FIP) used data analysis to better understand the demand and expenditure patterns in the children’s social care system. Its aim was to use this insight to support the redesign of services and to reduce the city’s high re-referrals and the number of children becoming looked-after.

The FIP uses data in three different ways:

  • Grouping families by need – The council have undertaken cluster analysis to identify common grouping of concerning behaviours, such as a child’s challenging behaviour or risk of physical abuse. When a child is referred to long term social work, senior social workers analyse the concerning behaviours of the case, and then make a referral to a specialist social work unit. Since introducing this data-led approach, social work units have been organised based on needs and concerning behaviours. This has resulted in social workers becoming specialists in supporting particular needs and behaviours, providing greater expertise in the management of cases.
  • Embedding data analysts – Each social work unit has an embedded data analyst, who works alongside social workers. Their role is to test what works, as well as providing insights into common patterns for families.
  • Enabling intelligent case management – Social workers have access to ChildSat, a tool which social workers use to help manage their cases. It also has the capability to monitor the performance of individual social work units.

Investing in data

Tom Symons, principal researcher in government innovation at Nesta, has suggested that councils need support from central government if they are to accelerate their use of data. He’s suggested that £4 million – just £1% of the Government Digital Service (GDS) budget – is spent on pilot schemes to embed data specialists into councils.

Mr Symons has also proposed that all combined authorities should develop Offices of Data Analytics, to support data analysis across counties. Over the past few months, Nesta has been working on this idea with the Greater London Authority, and a number of London boroughs, to tackle the problem of unlicensed HMOs (Houses in Multiple Occupation). Early insights highlight that data analytics could be used to show that new services would provide value for money.

Final thoughts  

After successive years of cuts, there has never been a greater need for adopting a data-led approach. Although there are undoubtedly challenges in using council data – including changing a culture where data sharing is not the norm, and data protection – the above examples highlight that overcoming these challenges is achievable, and that data analysis can be used to bring benefits to local councils.


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

Grandparents – the ‘hidden army’ of kinship carers

mamy and the little boy

By Heather Cameron

Tomorrow is the International Day of Older Persons, designated by the United Nations in order to recognise the important contributions made by older people, while raising awareness of the issues of ageing.

Today there are around 600 million people aged 60 years and over world-wide. A number that is set to double by 2025 and reach 2 billion by 2050.

With people living longer and healthier lives, it is not surprising older people are playing a considerably more active and increasingly important role in society. Not least when it comes to contributing to the care of their grandchildren.

Extent of kinship care

Kinship care – when children are brought up by relatives or family friends in the absence of their parents – has grown markedly in recent years.

It is estimated that between 200,000 and 300,000 grandparents and other relatives are raising children who are unable to live with their parents. Common reasons cited for this include abuse and neglect, parental illness or disability, parental substance misuse, domestic violence or death of a parent.

In examining the prevalence of kinship care, drawing on census data, a recent University of Bristol study found that there has been a 7% increase in the kinship child population in England since 2001 – more than three times that of the population growth rate of all children in England, which was 2% over the same time period.

The study also found that one in two (51%) children were growing up in households headed by grandparents.

Positive outcomes

With regard to the children in kinship care, research suggests that they do ‘significantly better than children in care’, both emotionally and academically.

Indeed, a recent study on the educational outcomes of looked after children found that children in long-term foster or kinship care made better progress than children in other care settings.

The largest kinship carer survey in the UK, conducted by Family Rights Group, also highlights the effectiveness of kinship care in preventing children entering or remaining within the care system, to the benefit of both the child and the public purse. The data found that 56% of children had come to live with the kinship carer straight from the parents’ home, with 27% having been in unrelated foster care.

The caring contribution of grandparents has also been shown to have made a material difference to maternal rates of employment.

And as 95% of children being raised in kinship care are not officially ‘looked after’, billions of pounds are saved each year on care costs.

But while benefiting the public purse, and despite evidence that kinship children have better outcomes, many kinship families face a financial burden. The University of Bristol study found that 40% of all children in kinship care in England were living in households located in the 20% of the poorest areas in England (an improvement of only 4% since 2001), and three quarters (76%) of kinship children were living in a deprived household.

Impact on grandparents

As there is no statutory requirement for local authorities to make provision for kinship carers and no automatic right to child benefit, many receive no formal support; leading to financial hardship, and the stress that comes with it.

Many kinship carers have had to give up work or reduce their working hours, either permanently or temporarily. And this is often their main source of income.

A study from Grandparents Plus on discrimination against kinship carers found that of the 77% of grandparents that have asked for professional help, only 33% received the help they needed. And 30% said they didn’t receive any support at all.

The study also found that, overall, kinship carers score ‘significantly below average’ when it comes to their wellbeing.

Other recent research has suggested that regular and occasional care for grandchildren can impact on the mental health of grandparents. The findings indicated that ten additional hours of childcare per month increases the probability of developing depressive symptoms by 3.0 and 3.2 percentage point for grandmothers and 5.4 to 5.9 percentage points for grandfathers.

Policies that substitute informal with formal childcare, it argued, could improve the mental wellbeing of grandparents.

Of course there are positive impacts on grandparents too, many of whom find caring for grandchildren rewarding and who enjoy closer relationships with them, which can in turn have a positive effect on their health. As the research suggests:

the effect of grandchild care provision on grandparents’ health seems to depend on its intensity, the cultural context, as well as on its stability and change.”

Final thoughts

It is clear that grandparents play an increasingly vital role in family life. But it seems this role is in need of greater recognition and support, if society is to continue to benefit from this ‘hidden army’ of kinship carers.


If you enjoyed reading this, you may also be interested in our previous blog on the economic opportunities of an ageing society, published on last year’s International Day of Older Persons.

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

The power of personal budgets

Image by Tristan Martin via Creative Commons

Image by Tristan Martin via Creative Commons

Described by supporters as having revolutionised the way the social care system in England is organised, personal budgets have developed to become the norm in social care commissioning in England.

One of the ideas underpinning personal budgets is the development of a new relationship between people who use care services and the organisations who provide them. The new approach was designed to move away from previous prescriptive services towards more bespoke, personalised models of care, where service users are directly involved in planning and deciding what care they receive, and how they receive it.

Within the personal budgets model an allocation of money is given to a specific person from their local authority, following an assessment of need. Money is allocated to the individual, who then works with a professional to work out the most appropriate support. The idea is based on the ideas of transparency, empowerment and personalisation of care.

There are 4 options for service delivery which recipients can chose from to best suit their care needs:

  1. Managed council budgets – where councils arrange the care that is needed following an assessment and an agreed set of outcomes to go alongside a pre-agreed care plan;
  2. Individual service funds – marketed as a more flexible option than local authority led management, this allows recipients to select an alternate organisation to manage an individual’s care budget, and deliver the required services;
  3. Direct payments – this option sees the money paid directly into the account of the person in need of support and allows them to buy care services from an agency or to employ their own carer, or a mixture of both;
  4. Mixed package – a combination of any of the options above, where recipients of support may give some of their budgets to a care provider (either a charity or local authority) but may get a portion of the budget paid directly to them so they can pay, for example, for additional carers to visit during the night.

Seniorin mit Pflegerin

Those in favour of personal budgets point out that the model promotes the personalisation agenda within health and social care in a way that no other policy does. It gives control of spending directly to the person in receipt of the support and has been heralded as a new age for transparency, increasing choice and control, reducing bureaucracy and cutting costs. Personal budgets have also become a key part of the health and social care integration agenda, as well as being highlighted within the recent reform of SEND (special educational needs and disability) care and provision.

Supporters also argue that one of the best and biggest changes between personal budgets and the original direct payment pilots are that personal budgets are designed to produce outcomes, not pay for a service. They are co-produced with the person in receipt of care, as well as professionals from a number of sectors, care providers and family, if appropriate, to ensure that care plans and agreed outcomes are established when the budget is allocated and that the payments achieve those outcomes.

pregnant carer giving pills and medication to her elderly pacient

However, studies have shown that there are big variations in service provision, choice can be limited and poor practice and processes can have a big impact on personal budget delivery and effectiveness. There has also been criticism of the high level of support within government for the model, despite the limited number of pilot roll outs and reviews into outcomes.

In 2016 a National Audit Office report was critical of the way that public services have monitored the impact of personalisation through personal budgets, as very little evaluation of their long term benefits and efficacy have been completed. The report stated that the Department of Health needed to “gain a better understanding of the different ways to commission personalised services for users and how these lead to improvements in user outcomes.” It is clear that there is a lack of evidence as monitoring does not allow service providers to understand how personal budgets improve outcomes.

Critics also argue that personal budgets are ineffective and cannot provide suitable care for everyone in need. They argue that there has never been, and never will be adequate funding to implement personal budgets properly. The principle is only effective, they argue, if there is an unlimited supply of both funds to pay for services and service providers delivering high quality service, which under current conditions of austerity there is not. Supporters counter however, that the concept of “self-directed support” is fundamentally a good one, but admit that poor delivery can deter some people.

Conclusion

Personal budgets can empower people in receipt of care, allowing them to take control of how their care is delivered. This recognition that care should be individualised is a big step forward for people who rely on care services on a daily basis.

However, reduced budgets, inconsistent service provision, and a lack of information for recipients has meant that some people have missed out on the benefits of personal budgets. In practice, services are patchy and evidence of actual benefits, in terms of improved outcomes, is lacking due to the limited number of research studies.

In order to fully realise the power of personal budgets for everyone in receipt of care, the provision, implementation and understanding of the model must be improved. Support for people to help them make the most informed decisions about planning their care packages should also be increased.

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

SPP screenshot2016 has been described as “make or break time for the NHS”, and with pressures on finances increasing, social care and public health are in the spotlight. Around £1 in every £5 of NHS spending is estimated to be the result of ill health attributable to the big five risk factors of smoking, alcohol, poor diet, obesity and inactivity. Investing in prevention, and understanding the complex wider community and social factors that lead to poor health, is therefore important. In cash-strapped local authorities however, investment in preventative projects can be sidelined in the face of tackling acute issues.

Prevention and behaviour change are linked

Recent health policy has included an expectation that individuals should take greater responsibility for their own health. But where we are talking about behaviour change, there is no quick fix. Glib use of the term ‘nudge’ to promote change can suggest that laziness is the only issue. However, research such as that by the King’s Fund has highlighted that motivation and confidence are essential if people are to successfully modify their health behaviours.

Practitioners within the field of both public health and social care need help understanding what works – but as two great recent blogs from the Alliance for Useful Evidence noted, change can be achieved in multiple ways and evidence shouldn’t be used to prove a service works but as part of a journey of improvement and learning.

We talk about the “caring professions”, but it seems that it can be difficult to maintain a focus on the ‘person not the patient’ when budgets are being cut. Well-reported issues such as the rise in the use of 15-minute home care appointments are just one symptom of this. More generally, making time to consider alternative approaches or learn from good practice elsewhere can be hard. That is where having access to a trusted database can help.

Trusted source of research and ideas

The Alliance for Useful Evidence, most recently in its practice guide to using research evidence, has highlighted the importance of using trusted sources rather than “haphazard online searches”. One of these resources is Social Policy and Practice, a database which we have contributed to for twelve years.

“SPP is useful for any professional working in the field of social care or social work who can’t get easy access to a university library.” Alliance for Useful Evidence, 2016

The partners who contribute to the database – Centre for Policy on Ageing, Idox Information Service, National Children’s Bureau, the NSPCC and the Social Care Institute for Excellence – are all committed to sharing their focused collections with the wider world of researchers and to influence policy and practice.

Social Policy and Practice is the UK’s only national social science database embracing social care, social policy, social services, and public policy. It boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature.

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports the ability to take a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.


Find out more about the development of the Social Policy and Practice database in this article from CILIP Update. Update is the leading publication for the library, information and knowledge management community and they’ve given us permission to share this article.

If you are interested in using the Social Policy and Practice (SPP) database for evidence and research in health and social care, please visit www.spandp.net for more information and to request a free trial.

Read some of our other blogs on evidence use in public policy:

Secure care in Scotland: measuring outcomes and sharing practice

By Rebecca Jackson

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

 

National Secure Care Project

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

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

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

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

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

Outcomes in secure care

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

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

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

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

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

Sharing best practice and using staff as “knowledge brokers”

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

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

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

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

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

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


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Evidence use in health and social care – introducing Social Policy and Practice

SPP screenshotWith public sector austerity and the integration of health and social care, it seems as though the need for access to evidence-based policy and practice has never been stronger. Initiatives such as those from the Alliance for Useful Evidence, most recently its practice guide to using research evidence, have highlighted the importance of using trusted sources rather than “haphazard online searches”. One of these resources is Social Policy and Practice, a database which we have contributed to for twelve years.

“SPP is useful for any professional working in the field of social care or social work who can’t get easy access to a university library.” Alliance for Useful Evidence, 2016

The journey to a new resource

A recent article in CILIP Update has explored the background to the Social Policy and Practice database, and its contribution to ensuring the inclusion of grey literature and a UK-perspective within systematic reviews. Update is the leading publication for the library, information and knowledge management community and they’ve given us permission to share this article with our blog readers.

We’ve written before about the value of UK-produced databases within a global publishing context. The CILIP Update article makes the point that when conducting any search for evidence, it’s important to look beyond the major databases to more specialist collections, to source grey literature and to look beyond geographical borders.

This was one of the major drivers in 2003, when the heads of the Centre for Policy on Ageing, the Greater London Authority, Idox Information Service, National Children’s Bureau and Social Care Institute for Excellence agreed to pool their resources and create the first national social science database embracing social care, social policy, social services, and public policy.

The proposal was met with great enthusiasm by the sector which recognised a gap in provision. The new Social Policy and Practice database was launched in November 2004.

The strengths of consortium working

Bringing together these organisations was relatively simple. They were all striving to provide evidence and information to their staff, members or customers. They all also had a professional drive to share their focused collections with the wider world of researchers and to influence policy and practice.

Through developing best practice and troubleshooting problems together, we have improved not only the Social Policy and Practice database for users but also improved our own individual collections. All whilst remaining independent and focused on our individual specialities.

Continuing to evolve

The NSPCC joined the database consortium in 2015, bringing its collection of resources focused on child abuse, child neglect and child protection. The NSPCC library is Europe’s largest collection of publications dedicated to safeguarding children. It includes journal articles, books, academic papers, leaflets, reports, audio-visual material, websites and digital media on all subjects that help researchers, policy makes and practitioners protect children from abuse and neglect.

Social Policy and Practice now boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature. Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care.

We’re proud to be contributing to the knowledge base for social research, policy and practice!


To find out more about Social Policy and Practice (SPP) database for evidence and research in health and social care, or to get a free trial, please visit www.spandp.net

Read some of our other blogs on evidence use in public policy:

Telecare in the UK: lessons from Barcelona

By Rebecca Jackson

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

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

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

Lessons from Barcelona

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

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

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

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

Digital healthcare as an enabler

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

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

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

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

Local solutions

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

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

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


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