Gillian Parker

A response to Aldridge and Becker-'Disability rights and the denial of young carers: the dangers of zero-sum arguments'

that is generally presented with regard to outcomes (Aldridge and Becker, 1993b; Mahon and Higgins, 1995a). Moreover, we argue that ’young carers’ and ’young caring’ should be theorized in comparison with other children, and other childhoods. Our position is not that caring has no impact on children; rather, that without analysing ’young carers’ alongside other children in stressful situations, it is not possible to talk of ’young carers’ having lost their childhood (Aldridge and Becker, 1993c: 13, 1993d: 384; Dearden et al., 1994: 6; Siddall, 1994).

The effectiveness of personal budgets for people with mental health problems : a systematic review

Abstract Background: Personal budgets are a key policy priority in adult social care in England and are expected to become increasingly important in the care of adults with mental health problems. Aims: This article systematically reviews evidence for the effectiveness of personal budgets for people with mental health problems across diverse outcomes. Methods: The review, conducted in 2013, used the EPPI-Centre methodology for conducting a systematic review informed by Social Care Institute for Excellence guidelines. Data were extracted from studies and combined using meta-synthesis. Results: Fifteen studies were included in the review which found mostly positive outcomes in terms of choice and control, quality of life, service use and cost-effectiveness. However, methodological limitations make these findings rather unreliable and insufficient to inform personal budgets policy and practice for mental health service users. Conclusions: Further high quality studies are required to inform policy and practice for mental health service users, which lags behind other adult social care groups in the use of personal budgets.

Can general practitioner commissioning deliver equity and excellence? : Evidence from two studies of service improvement in the English NHS

Objectives To explore some of the key assumptions underpinning the continued development of general practitioner-led commissioning in health services. Methods Qualitative data from two studies of service improvement in the English NHS were considered against Englands plans for GP-led commissioning. These data were collected through in-depth interviews with a total of 187 professionals and 99 people affected by services in 10 different primary care trust areas across England between 2008 and 2009. Results Internationally, GPs are seen to have a central position in health systems. In keeping with this, the English policy places emphasis on the ‘pivotal role’ of general practitioners, considered to be ideally placed to commission in the best interests of their patients. However, our evidence suggests that general practitioners do not always have a pivotal role for all patients. Moreover, it is planned that the new commissioning groups in England will not be subject to top-down performance management and this raises the question of how agreed quality standards will be met under the proposed new system. Conclusions This paper questions the assumption that GPs are best placed to commission health services in a way that meets quality standards and leads to equitable outcomes. There is little evidence to suggest that GPs will succeed where others have failed and a risk that, without top-down performance management, service improvement will be patchy, leading to greater, not reduced, inequity.

Will You Still Need Me, Will You Still Feed Me?—Paying for Care in Old Age

A major issue for social policy in the twenty-first century will be providing good-quality support and care for older people. However, recent debate about this has been driven more by ideology than by evidence. This paper examines the socio-economic, demographic and policy changes that are influencing the debate, and outlines findings from current research on attitudes towards financial planning for care in old age. This shows that the majority of people feel that the state should provide or pay for care for older people, either through a means-tested system or one which provides some basic level of protection which people can choose to enhance through their own means. However, only a minority would be willing to pay themselves for this, either directly through increased taxation or indirectly through reduced prospects of inheritance of housing capital. The paper concludes with a discussion of the policy implications of these findings.

Confessions of a Jobbing Researcher

ABSTRACT The relationship between research and policy making is complex and not always direct. This paper describes disability-related research for policy makers which is carried out at the Social Policy Research Unit (SPRU), University of York. A distinction between the ways in which research is formed and the ways in which it is informed is made. The informing of research influences how it is carried out; the research questions themselves, the choice of design and methods, the form of analysis, and the pattern of dissemination. The seminar series has helped SPRU reappraise its disability-related research. Disabled people must be able to influence the framing and elaboration of research questions more directly; there must be an increased commitment to employing and to training disabled researchers; dissemination must be wider; ‘crucial gateways’ to policy makers and practitioners have to be identified; and the debate on informal care must be moved further on.

Service user engagement in health service reconfiguration: a rapid evidence synthesis

Objective To assess what is known about effective patient and public engagement in health service reconfiguration processes and identify implications for further research and health care practice. Methods Rapid systematic review of published and grey literature to identify methods or approaches to engagement in decisions about health service reconfiguration; and to examine how engagement has worked or not worked in specific examples of system change. Following a search for literature published in English from 2000 to March 2014, eight systematic reviews, seven primary studies and 24 case studies (of which 6 were exemplars) were included. We undertook a narrative synthesis to consider five aspects of engagement with health service reconfiguration. Results Engagement varied in nature and intensity, and efforts generally involved multiple methods. There was no evidence on the isolated impact of any particular engagement method or collection of methods. In general, engagement was most likely to be successful when started early, when led and supported by clinicians, and when it offered opportunities for genuine interaction. The impact of engagement was variably measured and demonstrated, and frequently defined as process measures rather than the outcomes of proposals for service reconfiguration. Little was reported on the potential negative impact of service user engagement. Conclusions Patients and the public can be engaged through various methods. Problems often arise because decision-makers paid insufficient attention to issues considered important by patients and the public. Guidance setting out the stages of reconfiguration and opportunities for service user input could be a helpful practical framework for future engagement activity. Future evaluation and explicit reporting of engagement and impact is needed.

Benchmarking integrated care for people with long‐term neurological conditions

Purpose – This paper aims to report results from a national survey of primary care trusts (PCTs) that explored the strategic, organisational and practice context of services for people with long‐term neurological conditions (LTNCs). It seeks to provide benchmarks for integrated service provision and to discuss possible reasons for the variability in progress.Design/methodology/approach – Earlier phases of the research identified three models of care that promoted continuity of care for people with LTNCs: community interdisciplinary neurological rehabilitation teams, nurse specialists and pro‐active day opportunities. Based on this evidence, a benchmarking questionnaire was developed and a telephone survey of PCTs in England undertaken in 2009.Findings – The survey found that the prevalence of models of good practice varied widely across and within PCT areas. Strategic support and commissioning arrangements were also variable. A little over half of responding PCTs had completed a joint strategic needs asse...

Care closer to home for children and young people who are ill: developing and testing a model of service delivery and organization

AIMS To report findings of a national survey of care closer to home services for children and young people and a typology based on these findings. BACKGROUND Providing care closer to home for children is a policy and practice aspiration internationally. While the main model of such services is childrens community nursing, other models have also developed. Past research has proposed a relatively static typology of services, determined by where they are based, whether they are generic or specialist and whether they provide short- or longer-term input. As services develop, however, this typology needs further elaboration. METHODS A two-stage national survey of all primary care and hospital trusts in England, in mid-2008. RESULTS In all, 67% of trusts responded to the screening questionnaire and 75% of relevant services to the main stage questionnaire. Thirteen distinct types of services were identified initially. Cluster analysis of delivery and organization characteristics then identified a three-model typology: hospital-based, condition-specific services (36%); childrens community nurses and other community services (45%) and other (mainly therapy-based) services (19%). The models differed in staffing, costs, functions, type of care provided and geographical coverage. Only a third of nurses in teams were paediatric-trained. CONCLUSION Care closer to home services are an established part of care for children and young people who are ill. They deal with complex and technical care and can prevent or reduce the length of acute hospital admission. Lack of readily available information about caseloads, case mix and costs may hamper their further development.

Paying for Long-Term Care in the UK: Policy, Theory and Evidence

Questions about who should provide and pay for long-term care for older people have moved up the policy agenda in the UK over the last 15 years. Concern is often justified, particularly by politicians, as a wise response to the ageing of the population. However, as this process of ageing has been taking place since the turn of the 20th century, why should concern manifest itself now? It can, perhaps, be understood by referring to other social, economic and political changes which have taken place over a shorter period but which, in combination, have opened up the space for a discussion about who ‘should’ provide and pay for care.

Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness : A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations

People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings. Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services. Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.