What makes extra care housing an appropriate setting for people with dementia? An exploration of staff decision-making.

Extra care housing facilities in the UK are intended to offer a community-based alternative to care home placement. However, little is known about staff’s views of the appropriateness of extra care housing for people with dementia. This paper describes a mixed-methods study which explored this issue using statistical modelling of frontline staff’s recommendations of the best care setting for care home entrants; thematic analysis of transcripts from a simulated Resource Allocation Management Panel meeting; and content analysis of care coordinators’ reasons for not considering extra care housing in actual care home applications. Frontline practitioners saw extra care housing as a valuable alternative for a significant minority of care home entrants. However, extra care housing was not recommended if people needed care at night. Social care managers expressed general support for the idea of extra care housing, but appeared overwhelmingly focused on maintaining people at home and unsure where in the care pathway extra care housing sat. More evidence is needed on whether extra care housing can be an alternative to care homes and how services should be arranged to meet the needs of people living in extra care housing

Identifying alternatives to old age psychiatry inpatient admission: an application of the balance of care approach to health and social care planning.

BACKGROUND: Mental health problems in older people are common and costly, posing multiple challenges for commissioners. Against this backdrop, a series of initiatives have sought to shift resources from institutional to community care in the belief that this will save money and concurs with user preferences. However, most of this work has focused on the use of care home beds and general hospital admissions, and relatively little attention has been given to reducing the use of mental health inpatient beds, despite their very high cost. METHODS: The study employed a 'Balance of Care approach' in three areas of North-West England. This long-standing strategic planning framework identifies people whose needs can be met in more than one setting, and compares the costs and consequences of the possible alternatives in a simulation modelling exercise. Information was collected about a six-month cohort of admissions in 2010/11 (n = 216). The sample was divided into groups of people with similar needs for care, and vignettes were formulated to represent the most prevalent groups. A range of key staff judged the appropriateness of these admissions and suggested alternative care for those considered least appropriate for hospital. A public sector costing approach was used to compare the estimated costs of the recommended care with that people currently receive. RESULTS: The findings suggest that more than a sixth of old age psychiatry inpatient admissions could be more appropriately supported in other settings if enhanced community services were available. Such restructuring could involve the provision of intensive support from Care Home Outreach and Community Mental Health Teams, rather than the development of crisis intervention and home treatment teams as currently advocated. Estimated savings were considerable, suggesting local agencies might release up to £1,300,000 per annum. No obvious trade-off between health and social care costs was predicted. CONCLUSIONS: There is considerable potential to change the mix of institutional and community services provided for older people with mental health problems. The conclusions would be strengthened by further studies and the incorporation of evidence about relative outcomes. However, the utility of the approach in challenging established patterns of resource allocation and building local ownership for change is apparent

Is integrated care associated with service costs and admission rates to institutional settings? An observational study of community mental health teams for older people in England.

OBJECTIVES: To evaluate the association between the degree of integration in community mental health teams (CMHTs) and: (i) the costs of service provision; (ii) rates of mental health inpatient and care home admission. METHODS: An observational study of service use and admissions to institutional care was undertaken for a prospectively-sampled cohort of patients from eight CMHTs in England. Teams were chosen to represent 'high' or 'low' levels of integrated working practice and patients were followed-up for seven months. General linear models were used to estimate service costs and the likelihood of institutional admission. RESULTS: Patients supported by high integration teams received services costing an estimated 44% more than comparable patients in low integration teams. However, after controlling for case mix, no significant differences were found in the likelihood of admission to mental health inpatient wards or care homes between team types. CONCLUSIONS: Integrated mental health and social care teams appeared to facilitate greater access to community care services, but no consequent association was found with community tenure. Further research is required to identify the necessary and sufficient components of integrated community mental health care, and its effect on a wider range of outcomes using patient-reported measures. © 2016 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd

Positive risk taking: debating the research agenda in the context of adult

The purpose of this paper is to present the case for examining the concept of Positive Risk Taking (PRT) in the context of adult protection. The paper argues there is a need for empirical research to understand the application of and attitudes to PRT to explore whether the concept has moved beyond a principle to make an identifiable difference to service users. By investigating evidence from policy, literature, and professional opinion, this paper presents the ethical tensions for professional practice in adult protection between respecting a service user’s freedom to make choices to enhance their independence whilst preserving safety for service users and society. This is considered in the context of risk in health and social care and the recent changes in society resulting from Covid-19. Inherent tensions are apparent in the evidence in health and social care between attitudes propounding safety first and those arguing for the benefits of risk taking. This indicates not only a need for a paradigm shift in attitudes but also a research agenda that promotes empirical studies of the implications of PRT from service user and professional perspectives. This paper draws attention to the relatively limited research into both professionals' and service user perspectives and experiences of PRT in practice

A history of the University of Manchester, 1973-90

This is the second volume of a history of the University of Manchester since 1951. It spans seventeen critical years in which public funding was contracting, student grants were diminishing, instructions from the government and the University Grants Commission were multiplying, and universities feared for their reputation in the public eye. It provides a frank account of the University's struggle against these difficulties and its efforts to prove the value of university education to society and the economy. This volume describes and analyses not only academic developments and changes in the structure and finances of the University, but the opinions and social and political lives of the staff and their students as well. It also examines the controversies of the 1970s and 1980s over such issues as feminism, free speech, ethical investment, academic freedom and the quest for efficient management. The author draws on official records, staff and student newspapers, and personal interviews with people who experienced the University in very different ways. With its wide range of academic interests and large student population, the University of Manchester was the biggest unitary university in the country, and its history illustrates the problems faced by almost all British universities. The books will appeal to past and present staff of the University and its alumni, and to anyone interested in the debates surrounding higher education in the late twentieth century. A history of the University of Manchester, 1951-73 by Brian Pullan is also available from Manchester University Press

National trends and local delivery in old age mental health services: towards an evidence base: a mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes

Background The rising number of older people with mental health problems makes the effective use of mental health resources imperative. Little is known about the clinical effectiveness and/or cost-effectiveness of different service models. Aims The programme aimed to (1) refine and apply an existing planning tool [‘balance of care’ (BoC)] to this client group; (2) identify whether, how and at what cost the mix of institutional and community services could be improved; (3) enable decision-makers to apply the BoC framework independently; (4) identify variation in the structure, organisation and processes of community mental health teams for older people (CMHTsOP); (5) examine whether or not different community mental health teams (CMHTs) models are associated with different costs/outcomes; (6) identify variation in mental health outreach services for older care home residents; (7) scope the evidence on the association between different outreach models and resident outcomes; and (8) disseminate the research findings to multiple stakeholder groups. Methods The programme employed a mixed-methods approach including three systematic literature reviews; a BoC study, which used a systematic framework for choosing between alternative patterns of support by identifying people whose needs could be met in more than one setting and comparing their costs/outcomes; a national survey of CMHTs’ organisation, structure and processes; a multiple case study of CMHTs exhibiting different levels of integration encompassing staff interviews, an observational study of user outcomes and a staff survey; national surveys of CMHTs’ outreach activities and care homes. A planned randomised trial of depression management in care homes was removed at the review stage by the National Institute for Health Research (NIHR) prior to funding award. Results BoC: Past studies exhibited several methodological limitations, and just two related to older people with mental health problems. The current study suggested that if enhanced community services were available, a substantial proportion of care home and inpatient admissions could be diverted, although only the latter would release significant monies. CMHTsOP: 60% of teams were considered multidisciplinary. Most were colocated, had a single point of access (SPA) and standardised assessment documentation. Evidence of the impact of particular CMHT features was limited. Although staff spoke positively about integration, no evidence was found that more integrated teams produced better user outcomes. Working in high-integration teams was associated with poor job outcomes, but other factors negated the statistical significance of this. Care home outreach: Typical services in the literature undertook some combination of screening (less common), assessment, medication review, behaviour management and training, and evidence suggested intervention can benefit depressed residents. Care home staff were perceived to lack necessary skills, but relatively few CMHTs provided formal training. Limitations Limitations include a necessary reliance on observational rather than experimental methods, which were not feasible given the nature of the services explored. Conclusions BoC: Shifting care towards the community would require the growth of support services; clarification of extra care housing’s (ECH) role; timely responses to people at risk of psychiatric admission; and improved hospital discharge planning. However, the promotion of care at home will not necessarily reduce public expenditure. CMHTsOP: Although practitioners favoured integration, its goals need clarification. Occupational therapists (OTs) and social workers faced difficulties identifying optimal roles, and support workers’ career structures needed delineating. Care home outreach: Further CMHT input to build care home staff skills and screen for depression may be beneficial. Priority areas for further study include the costs and benefits for older people of age inclusive mental healt

Support workers in community mental health teams for older people: exploring sources of satisfaction and stress

Context. Support workers play an essential role in multidisciplinary community mental health teams for older people (CMHTsOP) in England. However, little is known about how they perceive their role or the impact this has on their levels of stress, wellbeing and job satisfaction. Objectives: To compare CMHTsOP support workers’ perceptions of the psychosocial characteristics of their work with those of registered CMHTsOP practitioners. Methods: A postal survey of CMHTsOP staff in nine mental health trusts. Information was collected about job demands, controls and support using the Job Content Questionnaire. Additional data was collected on other psychosocial features of CMHTsOP working using job satisfaction and intention-to-quit measures and a set of bespoke statements which were supplemented by a subset from the Occupational Stress Indicator. Findings: Responses were received from 43 support workers and 166 registered practitioners. Support workers reported significantly lower job demands and better co-worker support than registered practitioners. They were also significantly more satisfied with their jobs and more likely to believe that their skills and strengths were used appropriately. The majority of both groups were positive about their team’s climate and their value and identity within it. Limitations: Although the study explored the psychosocial characteristics of work that contribute to wellbeing, it did not directly measure stress. Implications: Given the growing number of CMHTsOP support workers and their diverse roles, future research might usefully explore the specific tasks which contribute most to individual satisfaction and wellbeing

Identifying standards for care coordination in adult social care: a multinational perspective

© 2016, © the Author(s) 2016. Introduction: Standards for care coordination in adult social care can support the delivery of high-quality services. Methods: A content analysis of 20 guidance documents produced over the last 30 years was undertaken to consider their utility for current practice. a mix of convenience and purposive sampling was used. Data were extracted on document design and substance and were analysed in relation to a conceptual framework that articulated standards as principles of practice situated within elements of care coordination such as assessment. Results: A total of 24 standards were repeatedly found across the documents. the most frequently cited were user participation, a network approach and person-centred practice. Most documents contained ‘standards’ as identified by the framework above. Variation was found regarding how standards were operationalised in relation to elements of care coordination. Principles were most frequently linked to assessment and care/support planning and least often to referrals and case closures. User participation was the most cited principle, operationalised in relation to all elements of practice in seven documents. a total of 16 standards related to individual practice and eight to agency level responsibilities. Discussion: The findings indicate a set of core standards that have demonstrated utility over a 30-year period and to gaps in relation to both the operationalisation of certain principles and particular elements of care coordination. the application of the definition of a standard developed by this study could support the delivery of comprehensive high-quality services across the care coordination pathway. Further research is needed to validate its use in different settings

Care coordination for older people in England: Does context shape approach?

© The Author(s) 2018. Summary: Policy and practice developments in adult social care in England and elsewhere recognise the increasing role of the non-statutory sector. Care coordination services are central to the delivery of tailored support. This qualitative study focuses on support for older people and reports an analysis of 13 non-statutory sector services providing care coordination, grouped into four service types. Semi-structured interviews explored the influence of service context on the nature of practice. Findings: Particular elements of care coordination (e.g. assessment) were found to be shaped by the specific aims and purpose of each service type, such as extent to which they had a commissioning or provider role and the nature of their target group. Aspects of a range of case and care management approaches were in use throughout the sample, varying in relation to the distinct features of the service type. A set of overarching standards was found to be relevant to all services considered. Non-statutory sector services were found to provide innovative support which both complemented and sometimes substituted for the statutory sector. Applications: Findings point to the continued importance of social work values and methods to the work of non-statutory sector services providing care coordination and to current limitations in relation to what the sector can provide. These are issues which employers and service commissioners need to address to ensure that non-statutory sector services have the capacity and standards of practice to meet the demands made of them. Further areas of research are identified

Electronic Information Sharing Between Nursing and Adult Social Care Practitioners in Separate Locations: A Mixed-Methods Case Study

Context: A longstanding concern in both the UK and internationally is that multiple health and social care professionals undertake assessments of adults and older people with complex needs but information is not shared. Electronic information sharing within assessment and support planning has been identified as a means of promoting integrated care for adults with complex health and social care needs. Objective: To evaluate the implementation of a shared electronic record between nursing and adult social care practitioners in separate agencies and locations to inform the assessment of need for adults and older people with complex needs. Methods: The design of the study reflected the incremental implementation of the shared electronic record between 2010 and 2012 in one geographical area within England. It was a mixed-methods case study employing data from three sources: audit of patient case files; survey of nurse practitioners’ time use, well-being and job satisfaction; and manager interviews post-implementation providing further insights into the implementation process. Findings: Electronic information sharing facilitated greater involvement of adult social care practitioners in the continuing healthcare assessment process and contributed to a more streamlined service. No adverse effects of the intervention on the well-being and job satisfaction of nursing practitioners’ were reported. Limitations: This research was undertaken in a single setting. Implications: Continuing healthcare services are a universal service that uses a standardised assessment process offering the potential for this to be replicated elsewhere. Thus findings are of value to policy makers and practitioners and offer the potential to inform wider roll-out