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Purpose: In care homes concerns about abuse have established a culture where all information pertaining to a person must be shared, and little attention is paid to privacy in its broader sense. The purpose of this paper is to take a human rights perspective and consider how information governance may impact on the health, well-being and quality of life of residents. It proposes a proactive approach and presents a template for a privacy impact assessment which services could use to improve their approach to privacy, protecting the human rights of those in their care, contributing to their independence and improving outcomes. Design/methodology/approach: A review of historical and current thinking about the value of privacy in human services and wider society leads to a series of challenges to the way in which privacy is upheld in residential care services. Findings: Recent preoccupations with data privacy have led to a myopic neglect of broader considerations of privacy. Whilst it continues to be important to protect the confidentiality of personal data and to ensure that residents are protected from abuse, human services that provide 24 hour care in congregated settings must not neglect broader components of privacy. Research limitations/implications: Privacy impact assessments have been widely used to check whether data privacy is being upheld. The broader concept that might be termed "Big Privacy" is introduced within which data privacy is but one section. It is suggested that big privacy is severely compromised in residential care settings, thus denying residents their human right to privacy. The extent of such violation of rights should be investigated. Practical implications: Having set out the potential reach of the human right to privacy, important work needs to be done to find out how privacy might be upheld in the real world of congregate residential care. Some service providers may have solutions to the organisational challenges, have addressed staff training needs and revised risk assessment strategies so that privacy is upheld alongside other rights. Social implications: Nearly half a million people live in congregate residential care settings in England, and deprivation of privacy is argued to be a significant deprivation of human rights. Occasional tragedies and scandals in congregate settings create pressure for increasing the level of surveillance, and the right to privacy is sacrificed. This paper offers a challenge to this process, arguing that competing rights need to be balanced and privacy is an essential component of a decent quality of life. Originality/value: Personal growth and development depends to some extent on choice and control over access to privacy. Recent changes in the law regarding data protection have narrowed our thinking about privacy until it is a small concept, largely concerned with data handling. This paper invites consideration of big privacy, and invites congregate residential care settings to consider how a deep and broad definition of privacy could transform these services. [ABSTRACT FROM AUTHOR]

Purpose - Building the Right Support, a national plan for people with intellectual disabilities (ID) in England aims to avoid lengthy stays in hospital for such people. Discharge planning is understood to be helpful in facilitating successful transition from hospital to community services, however, there is little guidance available to help those working with detained patients with ID and offending histories to consider how to affect safe and effective discharges. The paper aims to discuss these issues. Design/methodology/approach - In this paper, the development and implementation of a multi-faceted and systemic approach to discharge preparation and planning is described. The impact of this intervention on a range of outcomes was assessed and the views of stakeholders on the process were sought. Findings - Initial outcome data provide support for the effectiveness of this intervention in terms of increased rates of discharge, reduced lengths of stay and low readmission rates. Stakeholders viewed the intervention as positive and beneficial in achieving timely discharge and effective post-discharge support. Practical implications - People with ID are more likely to be detained in hospital and spend more time in hospital following admission. A planned, coordinated and well managed approach to discharge planning can be helpful in facilitating timely and successful discharges with low risks of readmission. Originality/value - This is the first attempt to describe and evaluate a discharge planning intervention for detained offenders with ID. The intervention described appears to be a promising approach but further evaluation across a range of service settings is required. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper was to establish the extent to which safeguarding procedures in North Somerset identified and reviewed outcomes for the alleged adult at risk. The project aimed to address whether outcomes could be achieved and what steps need to be taken to make the experience of safeguarding personal. Design/methodology/approach – Three social care teams with a responsibility for following up safeguarding referrals were asked to participate in the work and provide feedback on cases completed within the project timeframe. Data were gathered centrally on specific forms and through focus group discussions with social workers. Findings – The findings confirmed the need for a change in practice to ensure safeguarding procedures are personal. Research limitations/implications – The number of completed cases in the timeframe of the project was small and this limits the conclusions. Practical implications – The paper identifies change needed to training and recording systems and recognises that further work is needed to embed the learning from this work and explore the implementation of alternative approaches. Originality/value – The paper establishes the extent to which existing safeguarding practice is outcome focused. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to discuss whether the use of outcome-focused homecare improves the subjective well-being of the familial carers of older people with dementia. It also discusses familial carers’ perception of whether this intervention has improved the well-being of their relative. Design/methodology/approach – This qualitative study followed the familial carers of 20 service users suffering from dementia over a six-month period. Semi-structured interviews were undertaken at three intervals during the six months. The carers were asked to assess their subjective well-being at the start, middle and end of the study. Findings – The key findings were that all 20 familial carers expressed an improvement in their subjective well-being and that of their older family member, who appeared more settled as a result of this model of care. Practical implications – The need to consider the use of outcome-focused care as an intervention strategy for older people living alone in the community. The need to provide supportive environments for the carers of older people with dementia to limit their sense of isolation. The prioritising of outcome-focused care in the most complex and chaotic cases. Originality/value – This study provides an insight into the effectiveness of outcome-focused homecare with older people experiencing dementia as perceived by their familial carers. Previously, research has established that outcome-focused care increased the subjective well-being of non-dementia sufferers. This study dovetails neatly with this in demonstrating the same effect on dementia sufferers as perceived by their familial carers. Additionally, this study also demonstrated that this model of outcome-focused care also improved the subjective well-being of the familial carers themselves. These finding will help practitioners consider the use of this model of homecare as a potential alternative or a delaying strategy to residential care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report on findings from an evaluative research study which looked at a timed intervention model of practice comprising of up to 24 weeks of intensive meetings with adult service users set up by one local authority in England, to prevent and delay the need for care and support. A particular focus of this paper is on adults who hoard.Design/methodology/approach The study employed a mixed-methods design, consisting of interviews with service users (n=13), social workers (n=3), social work managers (n=2) and stakeholders from external services and agencies (n=6). It included a costing analysis of staff time and an analysis of goals of service users and “satisfaction with life” self-report questionnaires (n=20), completed at pre- and post-intervention stages.Findings There was evidence that social workers used strengths, relationship-based and outcome-based focused approaches in their work. The techniques used by social workers to engage, achieve change and assess effectiveness with service users varied. These techniques included the use of photographs to enable the service user to map and assess their own progress over time, encouraging hoarders to declutter and reclaim their living space. The service users valued the time the social workers spent with them and the way that they were treated with sensitivity and respect.Research limitations/implications The study focused on one local authority in England; there was no comparison group. This, and the small sample size, means that statistical generalisations cannot be made and only limited conclusions can be drawn from the quantitative data.Originality/value The paper provides insights into the work undertaken by social workers with adults who hoard. It contributes to the body of knowledge on effective social work interventions with adults who hoard. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to share the challenges of, and learning gained by a voluntary sector organisation, Coventry Rape and Sexual Abuse Centre (CRASAC) in providing integrated care to victims of sexual violence. Design/methodology/approach – The paper first considers the big picture, focusing on the current UK public sector commissioning environment, the policy commitment to integrated care, and challenges a current focus on definitions of integration that do not consider wider determinants of health and well-being. As an example of client groups who may not meet narrow criteria, but require person centred coordinated care, the needs of victims of sexual violence are explored, illustrated by a case study within CRASAC. Findings – Challenges faced by CRASAC include identifying responsibility for specialist commissioning, maintaining strategic partnerships and a lack of cross-sector understanding of the needs of victims of sexual violence. Key learning points are the need to form strategic alliances and partnerships, to lobby and influence decision makers, to develop monitoring tools that demonstrate impact on long-term client outcomes and to constantly raise awareness of the needs of victims of sexual violence. Final reflections focus on the questions these issues raise for the future of specialised integrated care in the voluntary sector. Originality/value – The paper is of value to commissioners in health, social care and the criminal justice system, in addition to providers of services that are in contact with victims of sexual abuse. These include health, criminal justice, education, police and social care, alongside other voluntary and community sector organisations. [ABSTRACT FROM AUTHOR]

Purpose This paper reports research undertaken into the practices, processes and outcomes of joint commissioning at five English localities. This paper reflects on the implications of this study for the practice of joint commissioning. Design/methodology/approach A case study approach to the research was adopted where the assumptions about what joint commissioning should deliver in five "best practice" sites. These hypothesised relationships about organisational processes, services and outcomes were then tested through the collection of primary and secondary data. Methods of data collection included an online tool based on Q methodology, documentary analysis, interviews and focus groups. Findings - Very little of what we found seemed to relate directly to issues of joint commissioning. Respondents often spoke of joint commissioning conflating it with issues of commissioning or joint working more generally. We found a variety of different definitions and meanings of joint commissioning in practice suggesting that this is not a coherent model but varies across localities. Little evidence of improved outcomes was found, due to practical and technical difficulties. Research limitations/implications -Joint commissioning is not a coherent model and is applied in different ways across different contexts. As such we may need to ask very different questions of joint commissioning to those typically asked. Practical implications - It is important that local sites are clear about what they are trying to deliver through joint commissioning or else risk that it becomes an end in itself. Some of the current reforms taking place in health and social care risk pulling apart existing relationships that have taken significant time and resource to develop. Originality/value - This is one of the first large-scale studies of joint commissioning conducted in England. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care coordination. The paper illustrates the potential for integration through the experience of the personal health budgets pilot programme. Design/methodology/approach - This paper is based on a review of the experience of personal health budget pilot sites, drawing on the national evaluation of the pilot programme and the author's experience of working with pilot sites between 2010 and 2013. It also draws on the experience of similar programmes in the USA. Findings Personal health budgets support integration in two distinct ways. First, they can support the delivery of more holistic, whole-person care in line with the principles of shared decision making. Second, by bringing personal budgets in social care and personal health budgets together, they can provide a vehicle for integration across health and social care systems. If integration starts from, and responds to, what matters most to individuals rather than with the development of joint structures and processes, the result is more likely to be integrated care. Originality/value - This is one of only a small number of papers that discusses the scope for personal health budgets to improve the integration of care. Integration between the NHS and social care, in particular, has been identified as a central priority for the NHS. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to report on a study of outcome-focused care for older people in one English local authority. The aim of the research is to examine whether altering the delivery of care to an outcome-focused model would improve the individual participant's subjective well-being and save money for the local authority. Design/methodology/approach – In order for the aim of the research to be established, a pilot study was devised. This was a longitudinal study over 18 months, using a quantitative design. The sample was of 40 service users aged 65 and over whom all had critical and substantial care needs. Half of the sample of service users was receiving the new form of outcome-focused care and the other half were a comparison group who were receiving care packages according to the traditional form of delivery that could be characterised as a "task-focused" model. The service users were administered the Measure Yourself Concerns and Wellbeing Questionnaire (MYCAW). This questionnaire involves respondents identifying quality of life issues; where they are seeking improvement; and measures change over time in relation to these. Findings – The research established that there was a greater improvement in subjective well-being in the group receiving outcome-focused care, when compared with the comparison group receiving the traditional task-focused model. Practical implications – This paper will assist managers in their decision making to implement a more outcome-focused model of home care with older people. Originality/value – To use MYCAW in a social care context is an innovative aspect of this study as it has previously been used only in mainstream and complementary medicine. The focus of this paper is to examine the impact of two models of home care delivery for older people, and how these two models impact on the older persons' self-reported well-being. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to share the key findings of the Wandering in the Woods action research project conducted by Dementia Adventure. Practical implications for changing practices in the dementia care and health and well-being sectors are highlighted. Design/methodology/approach – Qualitative and quantitative data were gathered using the participatory appraisal method in small groups both before and after "woodland adventure" days out. Findings – There was a 41 per cent increase in participants rating "exercise" as a factor which is "very important" to them. A number of potential physical, emotional, and social benefits of activity out in woodlands, for people with dementia, were identified. Research limitations/implications – The research is conducted with three relatively small groups, which vary in composition across the study, for practical reasons associated with care and capability of participants. Practical implications – Suggestions are shared and questions posed for individuals wanting to practically embed the learning from this project. Originality/value – Research looking at the benefits of green exercise and experiences of people living with dementia in care taking activity out in nature is very limited, this paper significantly contributes to this growing body of knowledge. [ABSTRACT FROM AUTHOR]

Purpose - This paper identifies ways in which community action can enhance the quality of life of older residents and reports specifically on four community gardening initiatives developed with older people living in disadvantaged communities in Manchester.Design/methodology/approach - The Community Action in Later Life - Manchester Engagement (CALL_ME) project used an action research approach to engage older people. Older people and other stakeholders were actively involved in designing, planning and implementing the projects.Findings - Drawing on a range of qualitative data, the paper provides evidence of how older people can be actively engaged in community projects, and explores the benefits of involvement including: enhanced well-being, and increased socialisation, learning and empowerment. The challenges faced by the older people are also reported which include maintaining interest, recruiting new members and needing external support.Research limitations/implications - The paper also reports the implications for practice, discussing how gardening initiatives can involve and benefit older people and the wider community and the value of an action oriented approach in disadvantaged communities. Recommendations are made regarding ensuring sustainability of such projects by providing education and training to enhance participants' skills and build their confidence.Originality/value - Whilst recognising the problems associated with living in disadvantaged communities, the CALL-ME project takes a new approach and moves the focus to ways in which older people can become engaged in and benefit from community action, and empowered to sustain the projects they develop. [ABSTRACT FROM AUTHOR]

Purpose - This is the second of two papers which aims to describe the development of a sex offender assessment and treatment service for men with intellectual disability (ID) within a community ID service. The first paper by McBrien et al. in 2010 described the mapping of need, the assessment methods and results.Design/methodology/approach - This paper describes how decisions were made about whether or not to enrol 20 assessed men on group treatment and outlines the treatment group and outcomes.Findings - None of the seven men who completed treatment had committed a further sexual offence at 12-24 months follow-up. Other outcomes are discussed including the outcomes for the men who did not start or complete treatment. The available measures are not sufficiently sophisticated to detect change in individuals.Originality/value - This paper contributes to the literature that describes the assessment and treatment of men with an ID who have committed sexually harmful behaviours. It describes one community service's response to the complex needs of this client group. [ABSTRACT FROM AUTHOR]

Purpose - The search for alternatives to inpatient mental health care in the UK and further a field has been going on over the last few decades of the previous century. Amongst the range of alternatives that have been developed are community-based mental health crisis houses that seek to work with people, who may otherwise have been admitted to hospital. Amethyst House is a four-bed mental health crisis house based in inner city Liverpool and works solely with the local Crisis Resolution Home Treatment Team (CRHTT) to work with people who require support that could not be delivered at home. The purpose of this paper is to report the findings of one element of a service evaluation: the effectiveness of the service in relation to the mental health needs of people admitted.Design/methodology/approach - The paper describes the service model, which integrates the crisis house and the CRHTT, with the latter acting as gatekeepers to the service.Findings - Findings showed improvements in mental health symptomatology and disabilities associated with the crisis between admission and discharge from the service.Originality/value - The paper describes the profile of the people who used the service over a six-month period in 2009, their care pathways through the service and their clinical outcomes between admission and discharge. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the association between multi-agency working and psychosocial characteristics of work, practitioner time-use and job satisfaction. Design/methodology/approach – A comparison of practitioners working in multi-agency (health and social care) and single-agency (social care-only) teams, using data from the 2008 evaluation of individual budgets pilots in England. Participants worked in care manager roles supporting adult social care service users, and comprised social workers and a smaller number of health professionals. Data were collected using a self-completed questionnaire. Findings – Data were returned from 249 respondents (a 29 per cent response rate), with two-thirds working in single-agency teams. No significant differences were found between team type and job satisfaction. Respondents in multi-agency teams reported greater decision authority but poorer supervisory support than those in single-agency teams. The latter finding was robust to further exploration using regression to control for confounding factors. Research limitations/implications – These data were not specifically collected for the study and response rates were relatively low due to organisational upheaval at the time of data collection, which may affect interpretation. Practical implications – Government policy is dedicated to extending integrated forms of working, including multi-agency teamwork. This research suggests that such structures need careful planning for them to work effectively, with particular attention to supervision arrangements. Originality/value – This research gives a systematic and objective exploration of the relationship between job characteristics, time-use and satisfaction of practitioners in single as compared to multi-agency teams. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present the findings of a small-scale evaluation of the Department of Health “Homeless Hospital Discharge Fund” (HHDF) in England. Design/methodology/approach – The paper is based on a mixed-method approach comprising 52 telephone interviews with project staff, 48 responses from an online survey with staff, outcomes data collected by projects, 30 semi-structured interviews with patients and nine in-depth telephone interviews with staff and commissioners. Findings – Overall the 52 pilots funded under the “HHDF” provided positive health and accommodation outcomes for homeless people admitted and discharged from hospital. In contrast to previous studies patients described not feeling judged during their stay, however the admission process was a more mixed experience due to communication breakdown by hospital staff. Integrating housing and clinical staff in the hospital discharge projects produced better outcomes for patients and the availability of accommodation as part of the model allowed improved and more stable housing outcomes. We recommend integrated commissioning takes place for future funding of any hospital discharge projects. Research limitations/implications – The study was small in scale and carried out before some of the projects had become fully established. The data were self-reported and the quality and completeness varied between projects. Originality/value – This is one of the few examples of hospital discharge outcomes for homeless people across a number of different localities and project models which examine the role of both health and housing professionals in the process. [ABSTRACT FROM AUTHOR]

Purpose: Applications for clinical psychology training far outstrip places and relevant work experience is key. Paid opportunities are limited and therefore many choose volunteering, with well-connected graduates faring best. To promote equal opportunities a coordinated psychology graduate voluntary internship programme was established in a National Health Service Trust in the South of England. The purpose of this paper is to evaluate intern and supervisor outcomes, equality of access and adherence to governance standards. Design/methodology/approach: Three cohorts of interns, unappointed applicants and supervisors were surveyed. Between 2013 and 2016, 270 psychology graduates applied, 119 were recruited and 151 either refused a place or were unsuccessful. In total, 91 supervisors provided service-level feedback. Findings: Interns and applicants were predominantly young, able-bodied white British heterosexual females. Demographic profiles were similar and broadly representative of psychology graduates nationally. While fewer were from Black and Ethnic Minority backgrounds, proportions were greater than the local population. Participants were more socioeconomically privileged than undergraduates nationally. The scheme was popular and well governed according to interns and supervisors. Post-internship employment prospects were improved, with most interns gaining paid mental health roles like assistant psychologist. Most supervisors commented on the positive contribution made by interns to service outcomes. Originality/value: This study makes a significant contribution to the literature on voluntary psychology graduate posts, an area under-researched until now. Our results suggest that a coordinated, transparent approach can benefit both interns and services by minimising exploitation and maximising developmental opportunities for the new graduate. The programme makes an important contribution to addressing inequalities experienced by psychology graduates attempting to enter mental health careers. [ABSTRACT FROM AUTHOR]

Purpose – There are currently no national adult safeguarding outcome measures that focus on people who have been through an adult safeguarding investigation in England. There is a need for local authorities (LAs) and their partners to be able to measure whether the services provided to adults at risk of abuse and neglect are effective. The paper aims to discuss these issues. Design/methodology/approach – This paper describes the cognitive testing phase of a study to develop and implement a standardised adult at risk outcome measure in adult safeguarding for use by LAs in England. An outcome measure (a set of seven survey questions administered in a face to face interview) was cognitively tested in three LAs with adults at risk (or their carers/advocates) for whom an investigation of abuse had been concluded (n=40), with the aim of assessing whether it was commonly understood. A set of guidance notes was designed and LA staff (n=12) who assisted with the survey were interviewed about its usability and the feasibility of administering the survey. Findings – The survey questions required modifications to improve their reliability, validity and comparability. LA staff also suggested improvements were needed in the guidance document and survey. LA managers, adults at risk (and their relatives/carers/advocates) were willing to be involved in the survey and it was considered feasible to proceed with piloting the measure. Originality/value – The development of this unique survey is of interest to those working in adult safeguarding, user involvement, survey management and outcome measurement in LAs. [ABSTRACT FROM AUTHOR]

Purpose – Positive Behaviour Support (PBS) is thought to be an important model for working with people with intellectual disabilities who display behaviours challenging to service. The purpose of this paper is to explore clinical and service user outcomes associated with the delivery of PBS by a Complex Behaviour Service (CBS). Design/methodology/approach – Clinical outcomes of 24 service users treated by the CBS team were assessed at baseline, six and 12 months and compared with those of 22 peers who received usual care. The main outcome was reduction in challenging behaviour measured by the Aberrant Behaviour Checklist (ABC). Secondary outcomes included measures of mental health needs, risk and social care supports. Findings – At six months improvements were seen across all ABC domains in both groups, with greater improvement in the CBS group, compared to usual care in irritability and stereotypy. Between group differences were maintained only for stereotypy at 12 months. No other differences were found. Originality/value – This paper suggests that PBS delivered by trained and dedicated staff may provide clinical benefits to individuals with challenging behaviours. However, there are issues around integration into existing services that need to be addressed in order to maximise efficiency. [ABSTRACT FROM AUTHOR]

Purpose National policy in England is now directed towards keeping patients with intellectual disability (ID) presenting with forensic problems for time-limited treatment. The result is that secure hospital services are expected to work much more proactively to discharge patients to community-based services. However, there is little evidence in recent years on the outcome of discharged patients with ID from secure hospitals. The purpose of this paper is to describe the outcomes of a patient group discharged from a specialist forensic ID service in London, England.Design/methodology/approach This is a descriptive retrospective case note study of patients with ID admitted to and discharged from a secure service with both low and medium secure wards, over a six-year period from 2009 to 2016. The study examined patient demographic, clinical and outcome variables, including length of stay, pharmacological treatment on admission and discharge, offending history and readmissions to hospital and reoffending following discharge.Findings The study identified 40 male patients, 29 of which were admitted to the medium secure ward. In all, 27 patients (67.5 per cent) were discharged into the community with 14 patients having sole support from the community ID services and 4 from the community forensic services. In total, 20 per cent of patients were readmitted within the study period and 22.2 per cent of patients received further convictions via the Criminal Justice System following discharge.Originality/value This was a complex group of patients with ID discharged into the community with a number at risk of requiring readmission and of reoffending. Community-based services providing for offenders with ID must have sufficient expertise and resourcing to manage the needs of such a patient group including the ongoing management of risks. The national drive is significantly to reduce the availability of specialist inpatient services for this group of patients but this must occur alongside an increase in both resources and expertise within community services. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper pertains to the implementation of an occupational therapy service within a newly-established medium secure service for 16 men with intellectual disabilities and additional diagnosis of personality disorder located in the North West of England. Design/methodology/approach – This is a general review, providing a descriptive account of the development and implementation of an occupational therapeutic provision for men residing in a medium secure unit with a dual diagnosis of intellectual disability and personality disorder and a service user account of its efficacy. Findings – The paper seeks to illustrate the efficacy of occupational therapy implemented by a specifically recruited and trained staff team, describing engagement in meaningful, bespoke programmes of occupation used to assist service users to address deficit areas via mutual engagement in activities, serving to facilitate the formation and development of positive and trusting relationships between service users and staff. The impact of the service is described from a service user's perspective. Originality/value – There is very little literature relating to those with intellectual disability also diagnosed with personality disorder. There appears to be no specific study of occupational therapy amongst those with dual diagnosis of intellectual disability and personality disorder. This paper is therefore unique in its approach and provides an overview of both the process and method used to implement occupational therapy, as well as a service user perspective and an illustration of its efficacy in a medium secure setting. [ABSTRACT FROM AUTHOR]

Purpose – Social work is integral to community learning disability teams (CLDTs), however there is little research on how social workers discharge their statutory duties within them. The purpose of this paper is to report a study designed to describe what social workers do within a CLDT (anonymised as Maples). The question addressed is: what is the social work role in CLDTs and how is this accomplished? Design/methodology/approach – Ethnographic fieldwork was conducted in a CLDT in London during 2011/2012. This involved interviews of professionals and observations of “everyday” social work practice. Data were analysed using constructivist grounded theory. Findings – Social work practice in Maples could be categorised along five domains of practice, namely: case management, safeguarding, assessments, mental health practice, and duty. The accompanying professional activities within these domains are described in Table I, with a subsequent focus on the less researched domains of case management, assessment, and duty. Originality/value – This research is one of the few to delineate the professional activities of social workers within CLDT. By showing what professionals do, it has important implications for policy – example personalisation – and role effectiveness. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report on the use of an innovative peer review approach to identifying and addressing the causes of inappropriate admissions from hospital to nursing homes in South Gloucestershire (SG). It explains the methodology that was developed, the findings of the peer review process and reflects on the effectiveness of the process. Design/methodology/approach – The peer review consisted of two stages. The first stage involved a panel of local stakeholders carrying out an audit of a random selection of cases where people had been assessed as needing permanent nursing or residential care. From this four cases of inappropriate admissions were identified. Stage two involved an externally facilitated process with two peer challenge panels; one of local stakeholders and the other external experts. The two panels analysed the cases of inappropriate admissions, identified the system causes and suggested actions to tackle the issues which were fed back to an audience of local stakeholders. Findings – The combination of case audit and peer review was successful in providing robust challenge to the processes in SG by identifying shortcomings in the system and suggesting actions to improve outcomes. Research limitations/implications – The approach was taken in one Council area and therefore may not be replicable in another area. Practical implications – The case study suggests that a peer review approach using both local and external peers, including providers, is an effective way to identify weaknesses in the health and social care processes. The insights offered by external peers and providers is helpful for councils in identifying where to focus resources and suggests that other areas should consider proactive adaptations to the peer review methodology that is offered as part of the LGA’s programme of sector-led improvement. Social implications – The case study suggests that a peer review approach could have a positive impact on the quality of care and quality of life for older people who are admitted to hospital. Originality/value – The case study offers an innovative and original use of the peer review approach in social care that can be shared with other councils and partners. The Southwest Improvement Board have identified it as of particular interest to other areas seeking to work with partners to identify and implement positive change. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report the preliminary evaluation findings of an integration programme in the children’s health care sector in the North West of England. The programme was led by the local Clinical Commissioning Group (CCG) utilising a semi-autonomous working group model. It comprised horizontal and vertical integration. The evaluation reflects the emerging policy context of CCG leadership in the field of health care planning and commissioning. Design/methodology/approach – The evaluation used a mixed method observational study design to obtain the views and opinions of stakeholders and measured their change over time. A series of initial semi-structured interviews was conducted with purposively selected key professionals in strategic positions to assist in designing a survey instrument. An online survey was launched at programme inception and repeated at five months. Respondents were members of five implementation working groups. Survey responses were subjected to a descriptive analysis and tests of correlation. Findings – The data showed high levels of commitment and perceptions of shared vision and goals amongst respondents which were relatively stable over time. Responses also indicated that the programme was perceived to have a considerable impact on collaborative work but that this initial effect decreased over time. There were no significant attitudinal differences across sectors or professional groups. Originality/value – The study demonstrates the strengths and weaknesses of the multi-agency working group model to implement change. Whilst confirming initial positive effects of integration programmes on collaborative work, over time this appears to wear off to be replaced by increased levels of skepticism amongst participants. The author findings have implications for service commissioners and service planners engaging in vertical or horizontal integration of children’s services. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the outcome of referrals made to one police force in England by three local authorities between March 2010 and April 2011, in order to identify and understand the barriers to prosecuting suspects of abuse or harm against vulnerable adults, and improve inter-agency co-operation. Design/methodology/approach – All referrals to this police force are given a crime number when they are recorded on the Criminal Justice System database together with a vulnerable adult flag and a status code which indicates the outcome following a police investigation. A search of the database using the vulnerable adult flag identifies the total number of referrals and outcomes for the selected period. This can then be imported into a Microsoft Excel spreadsheet to allow further analysis to take place. Findings – Over 87 per cent of all referrals of alleged abuse to vulnerable adults made to this police force did not establish that a crime had been committed. Of those that did only 1 per cent resulted in either a caution or court proceedings. Research limitations/implications – This is a small sample from one, predominantly rural, police force. Originality/value – The benefit of this research is that it contributes to a greater knowledge of the outcomes of adult safeguarding referrals made, primarily, by local authorities to the police and how police disclosures, on Disclosure and Barring Service checks, are being used as a means of providing employers of regulated activities with information on individuals who have been suspected of abusing vulnerable adults. [ABSTRACT FROM AUTHOR]

Purpose – The Health and Social Care Information Centre undertook the development and piloting of a new adult safeguarding outcome measure (a face-to-face survey) for local authorities (LAs) that could be added to the adult social care outcomes framework (ASCOF). The ASCOF is a national collection of social care outcomes performance indicators collected from the perspective of people receiving partial or total funding from a LA for care services. The projected costs of introducing the survey as a new statutory measure in England were assessed. The paper aims to discuss these issues. Design/methodology/approach – An outcome measure (a face-to-face interview based survey consisting of seven questions) was piloted during 2014 in 40 LAs with 20 adults at risk (or other informant) in each site who had been the subject of a safeguarding investigation (n=382). LAs were asked to estimate the cost to their LA of conducting the survey for two years, interviewing at least 15 per cent of their completed safeguarding cases each year. Findings – Extrapolating cost findings to the full 152 LAs in England would give an estimated total cost of implementing the survey of approximately £3 million in Year 1 and £2.1 million in Year 2. Set-up costs for the survey can therefore be estimated at around £900,000. Wide variations were identified in the costs per interview between LAs and reasons for this are discussed. Originality/value – The benefits of this unique survey are it enables LAs to measure how they are undertaking their adult safeguarding work from the perspective of adults at risk and others with a close interest. It also enables LAs to meet their new obligations under the Care Act 2014 Guidance to “understand what adults at risk think of adult safeguarding”. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the link between one aspect of primary care in England – the annual review by general practitioners for dementia patients – and length of hospital stay (LoS). The annual review should identify the needs of both patients and carers and co-ordinate services across health and social care to address those needs. If this is done well, timely discharge from hospital may be facilitated. Design/methodology/approach – The study uses linked national data from 2006/2007 to 2010/2011 on over 36,000 patients, employing sophisticated statistical techniques to isolate the effect of the annual dementia review on LoS. Findings – Hospital patients discharged to the community have significantly shorter stays if they are cared for by practices that reviewed a higher percentage of their patients with dementia. However, this effect is small and is not evident for patients discharged to care homes or who died in hospital. Longer LoS is associated with a range of co-morbidities, markers of low availability of social care and with intensive provision of informal care. Practical implications – Although the dementia review has only a modest effect on LoS, the components of the review could improve the health and well-being of those with dementia and their carers. Originality/value – The study is the first to employ a robust methodology to investigate the impact of the annual dementia review on hospital LoS, an important aspect of the interface between primary and secondary care. There are implications for clinical and financial aspects of health and social care policy. [ABSTRACT FROM AUTHOR]

Purpose – Despite an increasing policy focus, routine outcome monitoring (ROM) is not common practice in UK children's services. This paper aims to examine whether it is feasible and valid to use measures from ROM of evidence-based parenting programmes (EBPPs) to assess the impact of services and to drive service improvements through feedback mechanisms. Design/methodology/approach – This is a secondary analysis of ROM measures collected from a London clinic offering EBPPs over five years. Demographic information from referrals was compared for attendees and non-attendees. Changes in parent reported child behaviour were measured using the Strengths and Difficulties Questionnaire (SDQ), and a Visual Analogue Scale (VAS). Findings – No significant differences were found in socio-demographic characteristics of attendees and non-attendees. Statistically significant differences were found between pre- and post-scores on parent reported SDQ scores and VAS concerns, as well as the SDQ Added Value Score. The data collected did not allow for investigation of a dose-response relationship between the level of attendance and any improvement made. Originality/value – This study illustrates that ROM can provide useful information about the impact of EBPPs in a particular clinical context. Demographic data could support service managers to evaluate reach and uptake while evidence of improvements can be communicated back to parents and support future funding bids. Incomplete data limited the inferences that could be drawn, and collaborations between research centres and clinics may be a way to optimise the use of ROM to drive service improvement and innovation. [ABSTRACT FROM AUTHOR]

Purpose – The published evidence in support of a tonsillectomy is equivocal relying on historical studies using objective outcome measures. Based on this, NICE have suggested that tonsillectomy is a "low clinical value treatment" and its funding curtailed by PCTs. This paper aims to prospectively evaluate the effect of a tonsillectomy on quality of life (QOL) of children affected by recurrent infective tonsillitis using a qualitative patient reported outcome measure (PROM). Design/methodology/approach – Parents of children under the age of 16, undergoing a tonsillectomy, were enrolled. Parents completed a paediatric throat disorders outcome (PTDO) test prior to their child's surgery and then six months post-operatively. Results were analysed using the Mann-Whitney U test. The power of the study was 0.8 to detect a difference of 10 in a total score of 70. Findings – A total of 63 children participated and an 86 per cent response rate was received at six months. The mean total score improved from 31.29 pre-op to 7.41 post-op (p<0.001). The mean score for the first two subgroups remained static but for the remaining 12 sub-groups significantly improved post-op. Originality/value – The study demonstrates that performing tonsillectomies in a carefully selected cohort of children, significantly improves their QOL. It adds to a growing body of evidence that tonsillectomy is not a "low clinical value procedure" and has a substantial impact on the patients' symptoms. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to detail the Wellbeing Project that was developed by Manchester Mental Health and Social Care Trust, in partnership with Manchester City Council.Design/methodology/approach - A group-based cognitive behavioural therapy intervention ("Be Well, Age Well") was written specifically to help improve the mood and wellbeing of older adults.Findings - A preliminary evaluation showed promising results and in response to a significant increase in demand for continued delivery of the intervention, there are now plans to examine the feasibility of non mental health qualified staff facilitating the course. Funding is currently being sought for a more definitive study.Originality/value - The Wellbeing Project believes that if older adults are educated via the approach as adopted by the "Be Well, Age Well" course, the level of resilience will improve for those individuals who would otherwise have experienced compromised wellbeing. [ABSTRACT FROM AUTHOR]

Purpose -- The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations. Design/methodology/approach -- A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines. Findings -- A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate .5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission. Originality/value -- To the authors' knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this study is to evaluate the efficacy of providing health and well-being checks and six months support to unpaid carers. Changes in carer stress will be measured between baseline and final assessment. Design/methodology/approach -- This is a cross-sectional, correlational study of the 394 carers recruited and the sub-group of 348 carers who received support for six months. A T-test measured change in the carers' GHQ-12 scores between baseline and final assessment. A chi-squared test was used to measure movement in the GHQ-12 scoring quartiles between baseline and final assessment. Findings -- The 348 carets receiving support for six months reported a statistically significant small reduction in their baseline and final assessment scores. The carets identified by the GHQ as having less severe stress scores did better than those with more severe stress levels. Research limitations/implications -- As there was no control group, it was not possible to compare the outcomes of the intervention group with the outcomes of a group of carers receiving care as usual. It is therefore possible that there may be some other factors at play for the intervention group over the six-month period of support, other than the intervention itself, which have influenced the change in carer stress. Social implications -- Financial pressures on health and social care budgets can lead to carers' support services being under-resourced in some areas. However, the draft Care and Support Bill (July 2012) and the introduction of new mandatory duties may help to ensure that local authorities and health and wellbeing boards meet their obligations to provide services for carers. Originality/value -- There is limited research available on the outcomes of carers' interventions, particularly those which involve holisfic interventions, such as health and well-being checks being delivered by a multi-agency partnership. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this article is to advance knowledge concerning outcomes among the former residents of therapeutic children's homes, especially those located in England. Design/methodology/approach – In total, 16 young adults who had been resident in one of seven therapeutic homes took part in interviews. Findings – It appeared, from the information they gave in these interviews, that their outcomes were good in terms of their emotional and behavioural well-being, physical health, accommodation, and absence of early parenthood and substance use. Some of the young adults also had good outcomes in respect of their education and absence of criminal convictions. A small number of the young adults did less well on these latter two measures but few of them were particularly poor in either of these respects. The young adults had limited contact with their family members. Originality/value – The evidence from this research is that young adults who have been in therapeutic residential care can have good outcomes. [ABSTRACT FROM AUTHOR]

The National Health Service Breast Screening Programme set up 20 years ago in the UK has to evolve continuously to meet changing needs as a result of fundamental transformations in the age and ethnic profile of the population. This article draws on evidence generated as part of the Healthcare Commission's national study aimed at identifying issues that may contribute to different groups not having equal access to, experience of, or outcomes from services relating to breast screening and breast cancer treatment. Findings indicate that ethnicity has an effect on the awareness of services and of breast cancer. Access to screening and the experience of screening and treatment are influenced by the interaction of ethnicity with age. Younger women from certain black and minority ethnic groups face particular barriers. There can be additional barriers experienced by those from linguistic minorities. Equality of access, experience and outcomes does not mean treating everyone the same way. [ABSTRACT FROM AUTHOR]

The article reports on the early findings from a research aiming to map arts and mental health projects in England and explore what makes them effective. 33% of the overall health service funding sources provided the total funding for 100 of the 102 projects in the region. There are 13 art projects that evaluate the outcomes related to health. A number of in-depth case studies based on the theories of change workshops with art projects are included in the third phase of the study.