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Evaluating the Connecting People Intervention

7 August 2015

Social networks can be enhanced by social and health care workers to improve outcomes for service users. When the Connecting People Intervention (CPI) model is fully implemented it improves social outcomes for service users at no greater cost than when it is only partially implemented - a key finding from piloting the CPI model in a study led by Dr Martin Webber at the University of York.

The CPI model was developed in an earlier SSCR-funded study where Dr Webber's team explored good practice in six health and social care agencies, and illustrated the processes involved in connecting people through the model. The CPI was piloted in fourteen social and health care agencies in England from both the third and statutory sectors to evaluate its effectiveness and cost-effectiveness in enhancing the social participation of people with mental health problems or a learning disability.

The study team found that people in agencies where the CPI model was implemented more fully had better social outcomes over a nine-month period. Service use and the costs associated with this decreased for all participants receiving some level of CPI. Those who were in agencies where the CPI model was implemented more fully had lower costs throughout the study period. These participants also had higher ‘quality-adjusted life-years’.

In the agencies observed to be implementing the model more fully, there was a greater focus on the partnership between workers and service users. This enabled people to form new relationships and support existing relationships with friends and families.

The study team note that all but one of the agencies which implemented the CPI model more fully were in the third sector, where service costs are lower and individuals’ needs are also likely to be different. Implementation in the local authority and NHS sites was hampered by the lack of work capacity among staff to engage with the model. The findings of this study suggest that policy makers, commissioners and senior managers in provider services need to re-orientate social and health care services to be more focused on the communities in which they are located.

Read the full summary findings.

People with dementia benefit from participatory film-making

22 July 2015

Participating in film-making may enhance wellbeing and social participation for people with dementia, according to a study led by Dr Andrea Capstick from the University of Bradford.

The study explored the impact of participant-led film-making on engagement in meaningful activity, wellbeing and social participation for ten people with an average age of 87 living in long-term social care. Known as participatory video (PV), it involves helping people with dementia create slideshows on a PC.

Each participant had six one-hour sessions with the researchers to choose a subject for their films, identify images, develop a storyboard, create a slideshow and add a sound track. All themes related to early personal life history and the majority focused on a specific location.

Signs of wellbeing increased during the film-making activity, and did not significantly decrease when participants were watching their films after the intervention had ended. Viewing the completed slideshows encouraged social interaction and showed potential for breaking down barriers between residents with dementia and those without.

There was consistent evidence that the people who took part in PV had capacity for higher levels of social participation than were routinely offered. Although frequent, varied activities were on offer at the study site, participants were not always fully engaged. During the course of the study at the research site, there was some evidence of a general shift toward the provision of more meaningful activities.

Stakeholders considered PV a powerful medium for enabling the voices of people with dementia to be heard more widely. Costs of implementing PV were low, requiring only an internet-connected PC and free software. Wider implementation of the participatory film-making approach, however, might require changes in the current deployment of staff.

The project has shown that it is possible to adapt PV for people with dementia across a wide age-range and level of abilities. A step-by-step guide to PV has been produced for wider dissemination.

Read the full summary findings.
Watch Dr Capstick discussing the project at an LSE event.

Housing with care can offer older people a better quality of life

10 July 2015

Housing with care can support residents with widely different abilities, needs and care packages and offers some older people a better quality of life than mainstream housing, according to a study conducted by researchers at the Universities of Worcester, Bristol and Kent, the Housing Learning and Improvement Network and Housing 21.

Led by Dr Simon Evans (Worcester), the study - Adult Social Care Environments and Settings (ASSET) – explored experiences of extra care housing and retirement villages, collectively known as housing with care. The study is the first to measure social care-related quality of life in these settings and found significantly improved outcomes, including greater independence, when compared with remaining in mainstream housing.

The evidence suggested housing with care effectively reduced the need for services, and that these settings can be cost-effective compared with mainstream community housing. The data confirms previous findings that housing with care residents are on average less dependent, both physically and cognitively, than those living in care homes.

There were large differences in care and support needs across the sample of residents who took part in the mixed methods study, with a substantial proportion receiving no planned care; outcomes were also good for these residents.

While retirement villages and extra care housing share some characteristics they are very different forms of provision. Housing with care is often complex, both in terms of funding streams and the provision of care and support. Local authority approaches to commissioning adult social care vary considerably. In retirement villages, the commissioning of adult social care appears to be extremely uncommon.

The study concludes that although housing with care is increasingly popular, there is an urgent need to provide better financial information to current and prospective residents and their families. This could include information on personal budgets, direct payments and charging arrangements.

Read the full summary findings.

Domestic violence and women with learning disabilities

1 July 2015

It is essential that social care practitioners involved in the lives of women with learning disabilities become more aware of the problem of domestic violence, and more training is required for the police in responding to those women who report domestic violence, according to research led by Dr Michelle McCarthy from the University of Kent's Tizard Centre.

The study conducted interviews with 15 women with mild and moderate learning disabilities about the domestic violence they had experienced, alongside an online nationwide survey of care practitioners and police to explore their views, attitudes and responses.

The women interviewed reported that the domestic violence they experienced was often severe (including the use of weapons, and violence during pregnancy), frequent and over long periods of time, and typically women would experience multiple forms of abuse (physical, sexual, emotional, psychological, financial, coercive control) at the same time.

Only 20% of police respondents felt they had had a lot or enough training in learning disability issues, compared to 58% of other practitioners. Only 12% of police said they had had a lot or enough training in communicating with people with learning disabilities, compared to 57% of practitioners.

The study suggests that women with learning disabilities are additionally vulnerable to abuse as the majority of local authorities in England no longer offer social care to people whose needs are ranked low or moderate – those at the most able end of the learning disability spectrum are effectively moved outside the social care system.

Suggestions from the study include a greater remit for social care practitioners to work with those with mild learning disabilities and utilising opportunities for colleagues in adult social care services to train police and work jointly with them.

Read the full summary findings.

View the video from the study.

Can whole family approaches help people with mental health difficulties?

12 June 2015

Whole family approaches can contribute to the reablement of people with mental health difficulties, according to research led by Dr Jerry Tew from the University of Birmingham. Although rarely embedded as a core service option available to all mental health service users, some family inclusive practice activity is taking place in many areas in England; these were accessed typically only by specialist referral.

The study explored how more inclusive service approaches that engage with families might enable people with mental health difficulties to lead fuller lives. It found that no one whole family approach worked for everybody in all situations but reablement outcomes as a result of these approaches were closely associated with reported improvements in wellbeing.

Different mechanisms of change both between models and for different families receiving the same service model were observed in the study's 22 family case studies. Bringing families together helped to mobilise activity to support the family member with mental health difficulties. It suggests that improving inter-personal relationships and communication could be a key step towards creating a ‘safe base’ (physically and/or emotionally) from which the service user could start to engage with their wider world.

Good outcomes could be achieved when family work was started when the service user was quite unwell and in hospital. Practitioners willing to support family members in wider activities achieved some of the best outcomes. Barriers to progress included the family service being offered later, where family relationship difficulties pre-dated the onset of a person’s mental distress, and where individuals failed to engage with family meetings in the early stages of the therapy.

Read the full summary findings

People with sight loss and dementia need joined-up support

5 June 2015

People living with the double burden of sight loss and dementia (some 123,000 people) often only have their needs in one area addressed, according to findings from an SSCR study focused on home settings led by Dr Karen Croucher from the University of York. Those who have to cope with both conditions are at greater risk of losing their independence, of falling, and of being socially isolated.

Many people with dementia and sight loss would benefit from joined-up working by practitioners in the two fields, but until now, little has been known about the complex challenges of providing support for people with both dementia and sight loss.

Only about half the people with dementia and sight loss in the study were receiving any formal support and, usually, that amounted to just a few hours of care a week. Most people who were not receiving services said that they wanted support but did not know who to ask or what was available.

The study suggests that assessments of care and support needs must draw on the expertise of both dementia and sensory impairment practitioners. Early diagnosis of both conditions helps enormously, as does post-diagnosis support. Any interventions and adaptations need to take into account an individual’s capacity to cope with change.

Familiarity of both people and place is crucial for people with the two conditions. Services should aim to provide more social and cognitive stimulation and enjoyable activities.

Other key findings include:

  • Problems with eyesight are often considered secondary to cognition problems but people with dementia and sight loss need regular eye tests. Routine interventions for eyesight problems can dramatically improve levels of independence and quality of life.
  • Lighting and the use of contrasting colours are key changes in homes that assist people to make the most of the vision they have and they can help to reduce disorientation.
  • Extra care housing schemes could benefit people living with dementia and sight loss, particularly those who live alone.
Read the full summary findings.

Children and young people with intellectual disabilities still placed in residential schools

26 May 2015

Despite the drive towards the provision of local, specialised support, hundreds of children and young people with intellectual disabilities are still placed in out-of-area residential schools. Behaviour that challenges is cited as one of the main reasons why they are moved out of mainstream schools.

A scoping review, led by Dr Nick Gore of the Tizard Centre, University of Kent, surveyed research into the use of residential schools for children and young people with intellectual disabilities. The review found a paucity of evidence about both the use of residential schooling for children and young people with intellectual disabilities in the UK and the transition to adult placements.

There is a lack of evidence on the quality of support these placements provide and on whether they produce positive outcomes. And there is concern that a high proportion of young people in residential schools may be transferred to out-of-area residential placements on reaching adulthood.

Out-of-area residential placements are associated with a range of poor outcomes for adults with intellectual disabilities and behaviours that challenge. After Winterbourne View, there is increased concern that out-of-area placements make people of all ages more vulnerable to poor care and abuse.

In recent years there has been an increased drive to reduce such placements. The review surveys examples of alternative forms of support for children, young people and adults with intellectual disabilities.

Read the full scoping review.

Managing change in social care

14 May 2015

There is little empirical evidence to guide how change can be successfully achieved within social care organisations. An 18-month study by the Health Services Management Centre (University of Birmingham) and Middlesex University London explored research evidence and the practice experience of those who have led and participated in change initiatives.

The study suggests that successful change management in adult social care should be:

  • co-produced with users and carers and facilitate positive engagement with staff and other stakeholders;
  • based on a clear purpose with defined timescales, outcomes and indicators;
  • well planned and co-ordinated with flexibility to adapt to other changes that emerge;
  • sensitive to local governance and political processes to ensure initial agreement and long-term support; and
  • an opportunity to promote learning and development, and develop trust and partnerships between stakeholders.
The study identified four approaches which are potentially relevant to manage change within adult social care services: Action research, Appreciative Inquiry, Lean and Soft-systems Methodology. It has led to the production of a compendium for organisational change which includes a directory of change approaches and change management tools, and fictional case studies to illustrate how these four key approaches could be deployed within adult social care.

The compendium was launched at Community Care Live 2015 on Tuesday.

Read the full summary findings.

Read the full change compendium.

Physically disabled young adults and their care and support arrangements

8 May 2015

While welcoming the opportunities afforded by personalised approaches within adult social care, young adults can feel daunted by the associated responsibilities. This study, led by Wendy Mitchell from the Social Policy Research Unit at the University of York, explored physically disabled young adults’ experiences of taking greater control and responsibility for their care and support arrangements.

The study found that many of the young adults interviewed expressed a desire to gain more control over their support arrangements. They had clear views about the types of personal assistants (PAs)/carers they preferred to use, but identified managing them as the most difficult aspect of having a personal budget or direct payment. Most young adults felt ill-equipped to deal with issues such as poor performance, and establishing employer/employee boundaries.

Some felt their carers did not have the proper training or experience to help them establish further independence, and those used to working with other age groups could be inflexible in what they were prepared to do. They wanted their PAs/carers to recognise and respect their interests, preferences and priorities.

Key sources of practical, informational and emotional support were parents and other personal budget users, especially those using direct payments, those at the same life stage and/or those with the same or similar condition. Social networking sites could be useful in making contact with peers. Young adults found information from statutory services was typically targeted at other audiences, for example older people.

Social workers with more experience of working with young adults identified specific issues that need to be accommodated including: young adults’ relative lack of life skills and experience; young adults’ preferences regarding parental involvement; and addressing parents’ support needs.

Read the full summary findings.

Watch the project video for practitioners.

Relocation, portability and social care practice

24 April 2015

Moving locality can be a difficult and stressful time for anyone. For people with local authority funded social care support, the challenges may be magnified. This study led by Dave Marsland at the University of Hull explored the experiences of disabled people who have moved and relocated their social care support to a new local authority. The study also examined what social care practitioners do in helping people to relocate.

The study interviewed 12 participants and found a number of challenges such as delays and gaps in the provision of support and a lack of continuity as a result of a move. For some, these gaps occurred even when they felt they had given ‘sufficient’ notice of their plans to move. It found differences in the kinds of support services between local authorities - as well as interpretation of legislation and guidance - meant people might receive better or worse support than previously or may even become ineligible for support. This could lead to additional anxiety and experiencing a loss of control over their support.

Several participants described support systems and services as inflexible and somewhat unresponsive when they were in the process of moving. Some participants indicated that they had not felt sufficiently involved in decisions and tasks during the relocation process.

The study found that many social care practitioners in local authorities have little or no experience of supporting a disabled person to move to another area, but appear to have good insights into the complex and challenging situation of moving. Practitioners noted the importance of getting information and referrals about people moving as soon as possible so that they have as much time as possible to make plans and arrangements.

Read the full summary findings
View further information on the project

Satisfaction with social care among people with physical disabilities from Chinese backgrounds

10 April 2015

People from Chinese backgrounds who have disabilities often struggle to access social care and some only receive the support to which they are entitled after undergoing a crisis and being admitted to hospital, according to findings from a study led by Professor Fiona Irvine at the University of Birmingham. Expectations of social care services are low and, as a result, they do not always access services that could improve their wellbeing.

The research into experiences of social care revealed issues with language barriers, poor understanding of social care terminology and a lack of knowledge and information about available services. Satisfaction with services seemed particularly shaped by experiences of accessing services, the attitudes of care workers, the cultural and linguistic sensitivity of services and the ease of access to information. The study highlights the importance of social care that values the individual and respects cultural diversity.

Although participants in the study did not generally have high expectations of social care services, some who did receive support reported high levels of satisfaction. Others, though, chose to forgo publicly funded care, opting instead for self-funded care or to muddle through with limited help from family members.

Some participants described a complicated process in trying to access social care. The crucial role that Chinese welfare organisations played in supporting access to services was emphasised.

Read the full summary findings.

SSCR Call for Research Proposals live – deadline 27 May 2015 (16.30)

24 March 2015

The NIHR School for Social Care Research (SSCR) invites full proposals for research studies addressing the big questions for adult social care for the next 5-10 years in line with our mission to improve the evidence base for adult social care in England. We are seeking innovative, high-quality proposals using robust methods and with integrated and well-planned involvement and knowledge exchange approaches. Funding of up to £2.6 million is available for studies funded under this call, with a maximum of £1 million for any one proposal.

Call documentation:

Research brief (PDF)

Guidance notes (PDF)

Application form (Word)

Finances form (Excel)

The call is now open on the LSE Bravo System for applications to be submitted (see Current Opportunities in the left hand menu).

Assessing Improvements in Dementia Care and Support

17 March 2015

The Department of Health (DH) commissioned a team from the London School of Economics and Political Science and the London School of Hygiene and Tropical Medicine (as part of the Policy Innovation Research Unit (PIRU) and with support from the NIHR School for Social Care Research) to conduct a review to map data available and to summarise key research evidence on trends in dementia care in England over recent years, particularly since 2009.

The report "Independent assessment of improvements in dementia care and support since 2009" is now available - click here.

How are 'indirect payments' for people who lack capacity working?

9 March 2015

Confusion remains over assessments and some aspects of best interests decision-making processes, according to findings from an SSCR-funded study carried out by the Mental Health Foundation.

The study aimed to explore how direct payments (DPs) are operating for people who lack capacity to consent (termed 'indirect payments') and are living with learning disabilities or dementia.

It found that - for the purposes of receiving indirect payments - identifying a suitable person to act on behalf of the person who lacked capacity to consent was usually done informally, often because they were a family member and already involved in managing their relative's services.

People in the study had chosen indirect payments for several reasons. A suitable person had often chosen an indirect payment to avoid inadequate alternative services and/or to ensure meaningful activity for the disabled person.

There were differences in processes between people with learning disabilities and those living with dementia. The latter were often 'given' a plan which assumed minimum care needs and was not aspirational in nature. It was more common for people with learning disabilities to have some form of person-centred planning.

The study also found limited on-going support for suitable people, and lack of clarity among practitioners on the application of the Mental Capacity Act (2005).

The study recommends more information, training and support to help suitable people become fully engaged in the whole DP process, as well as more support and training for practitioners. It also suggests some of the person-centred practices common among people with learning disabilities could be adopted for people with dementia.

View the full summary findings.

SIgN: Self-funders and information needs

23 February 2015

This study, led by Dr Kate Baxter at the Social Policy Research Unit, University of York, aims to explore the information needs of adults and older people in England who pay for their own social care.

New research findings video

23 February 2015

Dr Michelle McCarthy and colleagues from the Tizard Centre at the University of Kent recently launched a video from their SSCR-funded study. Don't Put Up With It! Domestic Violence and Women with Learning Disabilities can be viewed here.

Taking a social care package as a direct payment does not guarantee choice and control for older people

4 February 2015

25% of older people needing help with basic tasks still cannot choose when they eat, when to take a bath or shower or what time to go to bed according to a recent study by researchers from the Centre for Communities and Social Justice at Coventry University. This is true for those who take their entitlement as a direct payment; for those with traditional, Council-managed care packages the choice is even less.

‘Although personal budgets give more control than Council-run care, the idea they will put the user in control often falls short of expectations,’ according to principal investigator, Dr John Woolham. ‘People like the idea of personal budgets, but having the cash to spend directly doesn't always give people more control – and we think many older people may be less interested in choice than in reliability and continuity of care.’

The study explored whether the social care needs of older people were best served by taking their personal budget as a direct payment, and compared staff, user and carer experiences of social care between those with a direct payment and those with a managed personal budget. It found that while personal budgets had the potential to give more choice, control and independence for older people, take up was limited due to lack of suitable services and information, low expectations, the stress of arranging care at a time of crisis and having someone willing and able to take on the administrative burden.

The timing of taking a bath or a shower was a compromise between what people would like and what was possible, or in over a third of direct payment cases people were given no choice at all. 27% could not choose what time they went to bed and 26% and 36% had to compromise over the timing of meals and bathing or showering respectively. The figures for Council run services were higher, with 41% having to compromise over timing of meals and bedtimes and 43% over when they could have a bath or shower.

Services were often also far from ‘personalised’ with carers changing often and without notice. As one unpaid carer put it ‘It would be nice if they didn’t send new people a lot because you need to get to know your carers and trust them. And when they’re doing personal care for you, I think it should be somebody you know, not a complete stranger giving you a bath.’

Amounts allocated for older people’s care packages were low at around £188 a week. This meant that once basic daily living activities were paid for there was little if anything left over to meet social needs, despite strong evidence of the negative impact of loneliness on older people.

Overall the study found little difference between people with direct payments and those with traditional managed budgets in relation to health, stress and social care related quality of life (QOL) outcomes. Unpaid carers of older people with direct payments reported higher stress levels, possibly due to the additional responsibilities of arranging, managing and accounting for care services.

Councils were working to make direct payments more useful and easier to administer by working with local service providers, streamlining administration and improving information but managers acknowledged there was a long way to go. The study found that older people were more interested in receiving services that were reliable and offered continuity, enabling them to develop friendly and trusting relationships with their carers. This suggests that local authorities should focus more on the quality of care offered to older people and less on promoting autonomy and choice.

The full summary findings is available here.

REF results confirm SSCR core members as world-class centres of adult social care research

23 January 2015

Since the NIHR School for Social Care Research was established in 2009, we have placed considerable importance on commissioning and conducting "world-class" research with the potential to improve adult social care practice in England.

Last month's announcement of the results from the Research Excellence Framework 2014 reconfirmed our Core Members as world-class centres of adult social care research. Our Director (London School of Economics and Political Science) and Associate Directors (Universities of Bristol, Kent, Manchester and York) all contributed to excellent results for their Universities.

View their individual press releases:

Relevant impact case studies (drawing on non-SSCR research carried out by Core Members) include:

“The combined results reflect the continued strength of the NIHR School for Social Care Research as a leader in the field of adult social care research. We look forward to a number of impact case studies for the next REF from SSCR-funded research" Professor Martin Knapp, NIHR SSCR Director.

Big gaps in information persist on the growing number of people privately funding residential and home care

23 January 2015

Many adults in England purchase their own social care services and support, both residential and within their own homes. This number is increasing but few studies to date have focused specifically on their experiences.

Kate Baxter and Caroline Glendinning from the Social Policy Research Unit (University of York) reviewed the evidence available but found no definitive figures for the number or percentage of people funding their own home care in England. Estimates suggest it is in the region of 20% to 25% of the home care market. For residential care home places, recent studies estimate more than 40% of residents fund the entire cost of their care. There is very little information on the characteristics of self-funders, although some evidence shows that people who fund their own care home places may be less disabled than those who are publicly-funded.

The number of self-funders is likely to increase in coming years as higher eligibility thresholds make it harder to qualify for state-funded care. The importance of self-funders is also likely to increase with the introduction in 2016 of care accounts as part of the Care Act 2014; all self-funders will be able to ask for an assessment of their needs to establish which of their care costs are eligible to be included in their care account and so count towards their care-cost cap.

Self-funders need sufficient information and advice to be able to make suitable choices about the level and type of care they need, and to know the financial implications, especially under the Care Act reforms. Yet the scoping study found evidence of shortcomings in the current provision of information and advice to them. Studies suggest that relevant information for self-funders exists, but it is often not well signposted, not obviously aimed at them, and not always easy to understand. This is the case particularly for financial information, the topic on which they say they want assistance. In relation to advice, the research evidence shows that advice is more difficult to obtain than information, especially financial advice for people moving into a care home. Self-funders who approach local authorities for advice are often signposted elsewhere and not followed up. In addition, there is a lack of evidence on the roles of NHS or social care practitioners in giving information to self-funders about the options available at the time of discharge from hospital.

Overall, the review identifies many large gaps in the research evidence base on self-funders. This includes a lack of accurate information on: the number and characteristics of self-funders; the factors that influence the level of demand; the levels of support needed ; how tasks carried out for self-funders might differ from local authority-funded clients; and the experiences and outcomes for self-funders.

There is similarly very little known from the perspective of the experiences of home care agencies or care homes in providing care to self-funders, although home care agencies are beginning to see the potential of the market for self-funders. Among managers of residential care homes, there are some concerns that self-funders and local authority-funded residents are not treated equitably in relation to assessments and reviews. There is no evidence about the impact of these inequities on self-funders.

The scoping review makes a number of recommendations on key areas for potential future research on self-funders that would be specifically relevant to adult social care practice. These range from compiling robust estimates of numbers and information on self-funders’ characteristics, to research on the experiences of self-funders in obtaining care and of the domiciliary and residential care providers in delivering care to self-funders. Findings would be important in helping social care practitioners to plan and deliver care, and to provide information and advice, for the self-funding population.

The review focused on publications since 2000, and identified 71 as fitting its remit. These used a wide range of research methods; some were based on national or multi-regional samples, while others were local studies. Details of the scoping review’s findings can be found here.

For further information, please contact Kate Baxter.

Next Call for Research Proposals launches 24 March 2015

15 January 2015

Our mission is to conduct and commission high-quality research to improve the evidence base for adult social care practice in England, and thus contribute to the improvement of care and support. Our first external Call for Research Proposals closed at the end of September with final decisions due to be made this month.

We will be launching our next Call for Research Proposals on 24 March 2015 at our annual conference with an expected deadline of 27 May 2015. The School will be looking for innovative and high-quality research proposals addressing the big questions for adult social care practice for the next 5 to 10 years.

The Call will be published on our website and through the LSE eTendering Service (you can sign up for alerts at any time).

Care home managers - a review of the evidence

23 December 2014

Very little is known about the practice, experiences and skills of care home managers and the challenges they face.

This scoping review, by Katharine Orellana, explored the evidence on care home managers themselves, yet identified only ten UK and seven US studies directly with or about them since 2000, most of which related to homes for older people. Most of the research that took place in or about care homes focused on residents, care workers, specific practices or local relationships rather than on their managers.

This review suggests that there remain many unanswered questions about care home managers. They are an often overlooked group when it comes to research, although many are involved in research about other aspects of life or work in care homes. The manager of the home is often a hidden or ‘shadowy’ figure, although there is frequent allusion to their impact on the culture of care.

The review recommends further research is needed to explore (among other areas): the requirements of the care home manager role; the contribution of care home managers to quality of care; mental health, stress and burnout; the role of the care home owner or provider; support for care home owners and providing organisations; and the views of people already working in social care/health, or studying with a view to working in social care/health, on being or becoming a care home manager.

Read the full scoping review.

Practitioner-led research - a review and recommendations

Little attention has been given to understanding practitioner research in social care as a distinct form of research practice, or to related good practice principles and procedures.

This methods review, by Ian Shaw, Neil Lunt and Fiona Mitchell, explored practitioner research in social care, adopting a flexible definition of ‘practitioner research’ in doing so.

72 practitioner research studies of adult social care were identified for inclusion. The majority were undertaken within a health service context, often informed by an established culture of audit and accountability, while others stemmed primarily from work delivered in community-based social care agencies.

The main strengths of practitioner research identified included detailed attention to ethics and use of a wide range of methods. Topics for research were also seen to be those that were important to frontline practice and the priorities of social care professionals.

The review highlighted that more support for practitioner research is needed. The authors recommended that: practitioner social care research should be implemented as an approach in its own right and not only perceived as a simpler version of academic research; good practitioner research should address issues of both local application and general interest, and the choice of study types should be widened; and greater support for practitioners involved or interested in research should include training workshops in the application of research methods, the development of supporting material around the experience of doing practitioner research, access to good libraries, and assistance with writing and publication.

Read the full methods review.

How local authorities allocate resources to carers through carer's personal budgets

19 December 2014

Most local authorities in the two regions studied allocate resources directly to carers but allocation processes differ between authorities and transparency was often not apparent among the resource allocation systems reported, indicate results from a study by the Social Policy Research Unit, University of York.

Support to carers should be allocated to carers in their own right as a personal budget (PB), with the preferred option of receiving the PB as a cash direct payment (DP). This study aimed to: explore the approaches local authorities in England were using to determine eligibility for, and levels of, carer PBs; why these approaches were used; and anticipated changes to these approaches following implementation of the Care Act.

The study found different practices exist across authorities for establishing the eligibility of carers for PBs, who conducts assessments of carer eligibility, establishing the levels of a carer PB, and how and when PBs are paid to carers. Outcomes for carers and carers’ experiences of resource allocation can differ both between and within local authorities.

Responses across the sample of local authorities indicate that an initial eligibility threshold – that carers must be providing ‘regular and substantial’ care – is often applied by authorities. Both standard, fixed sum and variable amount PBs were awarded; variable PBs were more common than standard, fixed sum amounts. A range of methods were reported: lump sum annual payments; lump sum payments less frequent than once a year; and regular monthly payments to carers. Over a half of the carer lead officers surveyed anticipated future changes to their authority’s system of assessing eligibility for, and allocating, PBs to carers.

Implementation of the Care Act in 2015 will strengthen carers’ rights and place a duty on local authorities to meet carers’ eligible support needs equitably and transparently. This study suggests that guidance may helpfully cover the following issues:

  • Minimum eligibility thresholds to qualify for a carer PB
  • Consistency in conducting assessments for carer PBs; training and appraisal may need to be offered where carer assessments are outsourced to voluntary organisations or NHS practitioners
  • The merits of different approaches to calculating levels of carer PBs and to paying PBs to carers.

Read the full summary findings.

Exploring differences in satisfaction with adult social care among Bangladeshi, Pakistani and white British populations

16 December 2014

There are common drivers of social care satisfaction regardless of ethnicity and religion between Pakistani, Bangladeshi and white British populations. Yet there are a number of factors specific to the Bangladeshi and Pakistani groups which affect awareness of social care services, and how social care is accessed and received, which could result in lower levels of satisfaction, suggest findings from a study by NatCen Social Research.

The study explored reasons for differences in reported levels of satisfaction between Pakistani, Bangladeshi and white British populations in social care service user experience surveys. The project found no clear inconsistencies in how social care survey questions are understood. Some issues with the survey design and questions emerged but there was no evidence that differences in satisfaction result from measurement inconsistency.

The study provides a number of recommendations:

  • Local authorities and providers could engage further with minority communities, through the media and community organisations, to raise awareness of available services and reduce the stigma associated with accessing services.
  • Service user characteristics and preferences should be taken into account when choosing a package of care to ensure that there is cultural and religious sensitivity.
  • Communication with those who do not speak English fluently could be improved through workforces that are representative of local populations, greater use of interpreters and better briefing and training of both interpreters and social workers.
  • A number of steps could be taken in collecting satisfaction data from surveys to improve accessibility for service users of all backgrounds, but particularly for those whose first language is not English or who receive a lot of help from carers in completing questionnaires, such as: verbal translations; involvement of community organisations in raising awareness of surveys and facilitating participation; and alternative methods for collecting feedback on satisfaction.
Read the full findings summary.

View other outputs from the study.

Risk, safeguarding and personal budgets

12 December 2014

There is no strong evidence to suggest there are higher levels of safeguarding referrals for those with Managed Personal Budgets (MPBs) or using Direct Payments (DPs) compared with all social care users finds a study by the Social Care Workforce Research Unit, King's College London.

The research explored safeguarding and personal budgets (PBs) data alongside an in-depth study of three councils. It found similar levels of safeguarding referrals for people with PBs and those using council-commissioned services. There was a statistically significant higher proportion of referrals for financial abuse and abuse by home care workers among people using PBs.

Key findings from the research included:

  • DP and MPB users reported a lack of information about managing risk and funding options, plus insufficient support for being an employer. Many said they did not know that the council had investigated a concern about their possible abuse. These experiences contrasted with professionals’ views that they provided information and support while they were investigating these concerns.
  • Helping people to balance risk and choice when they use DPs or MPBs is now one of the most important practice activities for social workers.
  • Monitoring (particularly financial) and review are important ways of identifying potential risks of abuse.
  • Processes for investigating safeguarding referrals are similar for PB users and other adults at risk.
  • Discrepancies between national data, summarised to the council level, and individual level local data, suggest the need for better national data – enabling more confidence that national summaries reflect the sum of individual cases.

Read the full summary.

Effective employment support for carers

28 November 2014

The most effective employment support services for carers provided through voluntary organisations are characterised by flexible skills provision and tailored support, as well as appropriately skilled staff and strong partnership working with other local organisations. Findings from a study by the Institute for Employment Studies found key challenges in providing employment support for carers have been public sector funding cuts to carer support services and low awareness among carers of the availability of tailored employment support services.

The study examined six voluntary organisations to explore effective employment support, the challenges and barriers around delivering this support and details of how these challenges can be overcome.

Carers often have complex needs: just under half of all survey respondents in this study said they were struggling financially and a similar number said they had a limiting long-term illness. The study found sustainable, long-term employment support for carers required a coordinated and proactive approach to partnership working from all relevant agencies and actors, including mainstream employment support providers, employers, and local authority statutory provision.

Organisations addressed financial challenges by diversifying their funding base or by utilising pump prime funding. Yet the lack of long-term funding resulted in an inability to plan ahead, retain key staff members, monitor long-term outcomes of employment support (including those around cost savings and effectiveness), and embed and sustain good practice.

The current emphasis on the role of the voluntary sector, ongoing trends in service provision towards personalisation and individual budgets, at the same time as spending restrictions in the public sector, suggest that there will be greater reliance on support provided through voluntary organisations in the future. This study suggests that grant makers and funders need to consider not just extending the length and amount of available funding for employment support services for carers, but also encouraging a partnership approach to funding between the public, private and voluntary sectors.

Read the full summary findings.

The role of adult social care services within MARACs needs clarity

21 November 2014

There is a major role for adult social care services within the MARAC (multi-agency risk assessment conference) process for domestic violence, but many adult social care managers were unclear what this role should be, according to a study led by Professor Hugh McLaughlin from Manchester Metropolitan University.

Domestic violence remains a significant risk in the lives of many in the UK. The MARAC system is under severe pressure and is struggling to cope with a growing number of referrals. Findings from the study found a 24% increase in referrals of MARACs in the Manchester case study area between 2010 and 2013. Nevertheless agency representatives attending MARACs showed high levels of commitment to the MARAC.

About half of the adults’ social workers interviewed knew little about MARACs and were apprehensive about their role in supporting people at risk of serious domestic violence. Adults at risk of domestic violence who have had their information shared at MARAC generally did not understand the process.

The study recommends that adult social care managers need to work with other agencies and staff to articulate and identify their role in the MARAC process, and further training in approaches to domestic violence is important. MARACs should consider different ways of ensuring the voice of the service user is heard. MARACs and other domestic violence services also need to ensure that services are available to service users beyond the crisis point when they are ready to access support. MARAC arrangements would benefit from being made statutory to enhance the profile of the work and ensure that key agencies attend.

Read the full summary findings.

Carers often still unaware of their rights despite new duties for local authorities under the Care Act 2014

12 November 2014

Only a small proportion of carers receive any type of social care support and just 1% of the social care workforce is estimated to be working exclusively with carers, according to a study carried out researchers within the Social Care Workforce Research Unit at King’s College London. The study also found many carers were still unaware of their rights to an assessment. The findings have implications for the implementation of the Care Act 2014, which has created new rights for carers in terms of rights to support and aims to place them on an equal footing with those for whom they care.

Researchers found that many people caring for family members or friends with disabilities still do not identify themselves as carers. Those that do sometimes think the process of applying for, and receiving, a carer’s assessment will be too cumbersome in relation to the amount of support that they can expect to receive. And feelings of stigma or guilt can still be barriers to asking for help.

The study investigated carers’ experiences of assessment; how carers access information about social care support; and what support is provided by carers’ workers whose tasks involve providing specific support to family carers. It found that few carers find out about their rights to an assessment themselves so carers’ centres and other carers’ organisations play a vital role in helping carers recognise their rights. When carer assessments do take place, they are mostly (excluding the self-assessments) incorporated into assessments of the person cared for and it is not always clear whether support is being provided on the basis of the needs of the carer or the person cared for. In many instances, this may not matter but carers whose own needs for support are greater than those of the person for whom they care may lose out under this system. It also disadvantages those caring for someone who is not eligible for, or who refuses, social care support from their local authority.

Under the new Act, the duties of local councils include assessing and meeting the needs of eligible carers and providing information and advice to carers about the available support. Many family carers described difficulties in accessing information but neither did they want ‘information overload’. They wanted information that is timely, relevant, and personalised to their specific circumstances. They did not want to be given too much irrelevant information at a time when they feel too stressed to absorb it. Carers’ workers drew a strong distinction between information delivery and information processing; they argued that carers are often given information in a scattergun way and that other professionals do not spend enough time going through it.

Carers were positive about the help provided by carers’ workers with a specific remit to provide them with support. Carers appreciated the range of support that carers’ workers offer, particularly the value of regular support from a ‘known’ person was emphasised strongly. Activities by carers’ workers are varied and include outreach work, information provision, counselling, advocacy and ongoing support.

As well as the 1% of social care workers working exclusively as carers’ workers, around 13% have subsidiary roles in supporting carers. These are mainly home care workers helping carers deliver personal care. Carers and carers’ organisations highlighted the importance of their work in giving carers a regular break or providing a ‘listening ear’.

There were mixed views on the impact of personalisation, particularly direct payments. On the plus side, these could provide carers with more tailored and practical support (driving lessons, bus passes and a day’s respite break at a spa were cited as examples). However, managing a personal budget could also represent an additional burden and those who were caring for someone very frail or with severe needs would prefer a regular and reliable break from caring instead of a direct payment.

Jo Moriarty and Jill Manthorpe, who led the study, identified a number of implications for practice from their findings, including the need for outreach information strategies to reach vulnerable groups of carers: individuals with literacy problems, people who do not use computers, carers who do not recognise themselves as carers, and those who feel unwilling to ask for help because of stigma or guilt. In addition, councils need to examine how effectively social care helplines and access teams are in providing preventive social care support to carers most at risk of experiencing difficulties in their caring role – and then offer acceptable and appropriate support. More attention should also be given to carers’ needs for emotional support.

The study, funded by the NIHR School for Social Care Research, drew on in-depth interviews with 24 family carers, 8 commissioners, 16 representatives of voluntary organisations and 38 carers’ workers in four parts of England; 80 responses to an email/postal survey sent to all local authorities with responsibilities for adult social care (50% response rate); a web audit of 50 local authority websites; and secondary analysis of the National Minimum Data Set for Social Care (NMDS-SC) data on carers’ workers. Further details of the findings are available here.

Misunderstanding persists over the power and conditions of Community Treatment Orders (CTOs)

6 November 2014

There is a “worrying” level of misunderstanding about the powers of CTOs but service users and their relatives nevertheless say that orders provide a “reassuring” legal recognition of a person’s need for care and improve their level of contact with services.

The findings come from from a recent SSCR-funded study of 199 CTOs, led by Dr Julia Stroud from the University of Brighton. The majority of the study participants were diagnosed with schizophrenia and had a history of non-compliance with medication.

The study points to a number of specific ways in which CTOs could be better aligned with ethical practice and ‘person centred’ care. It found CTOs were perceived as most appropriate for those service users who had previously been resistant to treatment and often lacked ‘insight’ into their mental health needs.

CTOs illustrate the tension between a policy of promoting choice among service users and their role in enforcing compulsion and control. The study recommended that assessments for CTOs should not be rushed and should involve the service user in decision making as much as possible.

Read the full summary findings.

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The School for Social Care Research (Phase II, 2014 - 2019) is a partnership between the London School of Economics and Political Science and the Universities of Bristol, Kent, Manchester and York, and is funded by the National Institute for Health Research (

Phase I (2009 - 2014) of SSCR involved the London School of Economics and Political Science, King’s College London and the Universities of Kent, Manchester and York.
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