Jessica Harris

Disclosing disability in the context of professional regulation: a qualitative UK study

In the UK, the ‘fitness to practice’ criteria that allow regulatory bodies to use health standards to restrict entry to the human professions have resulted in some disabled people being excluded from this workforce. Disclosure of disability is therefore a risky process for those aiming to practice or train in nursing, social work and teaching. This research, commissioned to inform the Disability Rights Commissions Formal Investigation into fitness standards in the professions, was undertaken in 2006–07 and explored experiences of disability disclosure amongst professionals. Interviews with 60 practitioners and students, most of whom had unseen disabilities, revealed considerable variations in the extent of disclosure. Disclosure was perceived as having the potential to exclude participants from their chosen profession. Two overlapping models of disability disclosure emerged from data analysis. The study concludes that abolishing health standards for the professions would increase disability disclosure and decrease the stigma associated with disability.

The association between MTHFR 677C>T genotype and folate status and genomic and gene-specific DNA methylation in the colon of individuals without colorectal neoplasia

Background: Decreased genomic and increased gene-specific DNA methylation predispose to colorectal cancer. Dietary folate intake and the methylenetetrahydrofolate reductase polymorphism (MTHFR 677C>T) may influence risk by modifying DNA methylation. Objective: We investigated the associations between MTHFR 677C>T genotype, folate status, and DNA methylation in the colon. Design: We conducted a cross-sectional study of 336 men and women (age 19–92 y) in the United Kingdom without colorectal neoplasia. We obtained blood samples for measurement of serum and red blood cell folate, plasma homocysteine, and MTHFR 677C>T genotype and colonic tissue biopsies for measurement of colonic tissue folate and DNA methylation (genomic- and gene-specific, estrogen receptor 1, ESR1; myoblast determination protein 1, MYOD1; insulin-like growth factor II, IGF2; tumor suppressor candidate 33, N33; adenomatous polyposis coli, APC; mut-L homolog 1, MLH1; and O6-methylguanine-DNA methyltransferase, MGMT) by liquid chromatography/electrospray ionization mass spectrometry and pyrosequencing, respectively. Results: Of the 336 subjects recruited, 185 (55%) carried the CC, 119 (35%) the CT, and 32 (10%) the TT alleles. No significant differences in systemic markers of folate status and colonic tissue folate between genotypes were found. The MTHFR TT genotype was not associated with genomic or gene-specific DNA methylation. Biomarkers of folate status were not associated with genomic DNA methylation. Relations between biomarkers of folate status and gene-specific methylation were inconsistent. However, low serum folate was associated with high MGMT methylation (P = 0.001). Conclusion: MTHFR 677C>T genotype and folate status were generally not associated with DNA methylation in the colon of a folate-replete population without neoplasia. This trial was registered at clinicaltrials.gov as ISRCTN43577261.

Media reactions to the Panorama programme “Behind Closed Doors: Social Care Exposed” and care staff reflections on publicity of poor practice in the care sector

Purpose n n n n nThe purpose of this paper is to present an analysis of media reactions to the BBC Television Panorama programme, Behind Closed Doors’ and to set this in the context of interviews with care staff about their reflections on publicity about poor practice in the care sector. n n n n nDesign/methodology/approach n n n n nThis paper reports on an analysis of media reactions to recent expose of abuse in social care in England and data from an interview-based study of care workers. The interviews were analysed to consider the impact of such media reports on staff and to explore their views of action that might be need to be taken about care failings. n n n n nFindings n n n n nThere are mixed reactions to expose of poor care on television and to the debates that precede and follow their broadcast. Debates occur in print and on television, but also in social media. The particular expose of care home practices by the Panorama programme, Behind Closed Doors, led to debate in England about the potential role of covert cameras in care homes. The interviews revealed that while care staff are affected by scandals in the media about social care, they do not necessarily focus on themes that the media stories subsequently highlight. Overall some are disenchanted while others have ideas of what needs to change to improve practice. Care staff consider that there remain problems in raising concerns about practices and some staff feel unable to stay in workplaces where they have made complaints. n n n n nResearch limitations/implications n n n n nThe care workers interviewed may not be representative of the sector and they may have wished to provide socially acceptable answers to the researchers. Practice was not observed. n n n n nPractical implications n n n n nLocal Safeguarding Adult Boards may wish to develop a communications strategy to deal with requests for reactions to media reports locally and nationally. Safeguarding practitioners may wish to prepare for increased referrals following media coverage of poor care in their areas. They may later be able to use media reports to discuss any local differences of interpretation over matters such as prosecutions for abuse. Trainers and educationalists may wish to clarify the importance given by care providers to raising concerns, the ways in which difficult conversations can be held, and the protections available to whistle-blowers or those raising concerns – with local examples to provide assurance that this is not mere rhetoric. n n n n nOriginality/value n n n n nTelevision reports of problems with social care attract wide media interest but the authors know very little about how care workers respond to depictions of their work and their occupational grouping. This paper links media and expert commentator reactions to television expose with data acquired from interviews with those on the frontline of care.

Social work support for employment of people with learning disabilities: Findings from the English Jobs First demonstration sites:

Summary This article brings together two key themes in recent public policy in England affecting social work practice: the value of having a paid job for social inclusion and increasing self-worth, and the personalisation of public services. The article draws on a mixed method evaluation of Jobs First, which was a government-funded demonstration site project that aimed to show how personal budgets (a key mechanism for personalisation) could be used by people with learning disabilities, often with their families, to purchase employment support. The evaluation involved secondary analysis of case record data and 142 semi-structured interviews with a wide range of participants (we mainly draw on 79 interviews with professionals for this article). Jobs First is placed within the frame of Active Labour Market Policy. Findings The attitudes of social workers to Jobs First were broadly positive, which was an important factor supporting employment outcomes. However, social workers’ involvement was often limited to a coordinating role, undertaking basic assessments linked to resource allocation and ensuring that support plans, which had often been developed by non-social work practitioners, were ‘signed off’ or agreed by the local authority. Applications The study points to important elements of the role of social workers in this new field of practice and explores potential tensions that might emerge. It highlights a continuing theme that social workers are playing more of a coordinating, managing role, rather than working directly with individuals to support their choices.

‘We’re effectively becoming immigration officers’: social care managers’ experiences of the risk work of employing migrant care workers

In the UK care sector, as much as other fields of work, managers need to check and monitor the immigration status of their staff. In this article, we examine accounts from care home and home care managers of making decisions about recruitment and employment practices placing these in the context of risk work. We use data from a secondary analysis of interviews with 121 social care managers that took place in four contrasting English local authority areas in two rounds over the period 2009–2014. In the interviews, we explored managers’ views and experiences of employing or deciding not to recruit migrant workers and the extra work this potentially entailed. We identified three major themes in these interviews: vigilance, being caught, and shifting resources. The Vigilance in recruitment and managing staff theme highlighted managers’ experiences of and concerns about implementing the regulations around employment permissions and indicated their feelings that it was essential to comply with new government regulations relating to migrant workers. The Being caught theme was based on managers’ fears about the risks of being in breach of the regulations and worry about the severity of the penalties. The Shifting sources theme highlighted managers’ continued work in reaching out to fresh sources of recruitment as a response to changes in immigration regulations. Our findings expose the potentially stressful nature of managers’ roles in implementing new regulations and managing the risks of non-compliance. This new aspect of risk work reveals the tensions of managers’ role in performing their obligations to scrutinise documentation and abide by changing regulations while still running their services. As the UK moves to Brexit (leaving the European Union), these tensions look set to increase in the context of further migrant working regulations and amendments to immigration permissions.

Older people’s forums in the United Kingdom: civic engagement and activism reviewed

Purpose n n n n nThe purpose of this paper is to review the literature on UK older people’s forums. Forums seek to influence statutory responses to ageing, and enable older people to speak up on matters important to them. The review examined three facets of forums: their membership, structures, and effectiveness. n n n n nDesign/methodology/approach n n n n nMethods included searching databases, internet, and specialist libraries for materials relating to older people’s forums. Key points were extracted and source material described but not subject to quality appraisal. Relevant non-UK studies are included to draw contrast and comparisons. n n n n nFindings n n n n nSeveral studies and reports have explored forum members’ socio-demographic profiles, motivations and triggers for joining and the two-way rewards of participation. However, membership remains a minority activity, with only a small percentage of members actively engaged and the review highlights gaps in the literature on widening participation. Both statutory and voluntary sectors have supported forum development and sustainability. There is little data on formal structures but some exploration of the informal communications and behaviours that sustain them has been undertaken. Forums are viewed as effective but resource intensive. The size and representativeness of the membership, strength of influence and deployment of members’ expertise are all identified as potential contributors to effectiveness. n n n n nResearch limitations/implications n n n n nSome material may not have been accessible and there is potential bias by greater inclusion of journal published materials than other possible sources. Material was not quality appraised, and research literature and self-reporting by forums are presented alongside each other. n n n n nPractical implications n n n n nPractitioners should familiarise themselves with current older people’s organisations locally to ensure that consultations are broad and reach different groups. While partnerships with voluntary sector health and care providers are encouraged some of these groups may not wish to represent all older people. Wider reach may provide multiple perspectives. Help in kind as well as financial resources may be welcomed by older people’s groups, such as meeting spaces, assistance with administration, and briefings that are accessible. Offering to meet with older people’s forums to discuss matters regularly may provide insight into experiences of services and changing needs earlier than professional feedback. Dismissing older people’s forums as made up of the “usual suspects” is likely to be unfair and unhelpful to building up positive relationships. n n n n nOriginality/value n n n n nThe review provides a preliminary assessment of the size and scope of research and grey literature on UK older people’s forums, synthesising points of similarity and difference and identifying clear gaps in the evidence.