Joan Rapaport

‘We are not blaming anyone, but if we don't know about amenities, we cannot seek them out’: black and minority older people's views on the quality of local health and personal social services in England

ABSTRACT Improving access to culturally-appropriate services and enhancing responses to the needs of older people from black and minority ethnic backgrounds were among the aims of the National Service Framework for Older People (NSFOP) that was introduced in England in 2001. Progress in meeting the aims of the NSFOP was evaluated by a mid-term independent review led by the Healthcare Commission, the body responsible for regulating health-care services in England. This paper reports the consultation with older people that underpinned the evaluation. It focuses on the views and experiences of older people from black and minority ethnic (BME) groups and of the staff that work in BME voluntary organisations. A rapid appraisal approach was used in 10 purposively selected local councils, and plural methods were used, including public listening events, nominal groups and individual interviews. In total 1,839 older people participated in the consultations and 1,280 (70%) completed a monitoring form. Some 30 per cent defined themselves as of a minority ethnic background. The concerns were more about the low recognition of culturally-specific and language needs than for the development of services exclusively for BME older people.

Individual budgets and adult safeguarding: Parallel or converging tracks? Further findings from the evaluation of the Individual Budget pilots

• Summary: The transformation of adult social care in England is underway, with the aim of promoting greater control and choice among people eligible for publicly funded social care services. A key part of personalization is the policy move to promote personal budgets. This article aims to investigate the inter-relation of personal budgets with another policy goal, adult safeguarding. A pilot programme of the predecessors of personal budgets, individual budgets, took place 2005–2008 and was evaluated by an independent research team. This article presents findings from the team’s second round of interviews with adult safeguarding coordinators (ASCs) in the 13 pilot sites held early 2008 which are discussed in the context of proposed adult safeguarding reforms in England. • Findings: This second round of interviews with ASCs revealed greater engagement with social care transformation than previously. However, their detailed expertise in adult safeguarding and their local intelligence and experiences were not regularly accessed. This may constitute a missed opportunity to address some of the tensions of personalization in practice. • Application: The interviews reveal that the personalization of social care is often interpreted as relating to greater use of Direct Payments and has yet to consider other facets of this policy transformation that are central to social work practice, including safeguarding.

Responding to the financial abuse of people with dementia: a qualitative study of safeguarding experiences in England.

BACKGROUND The risks of financial exploitation and abuse of people with dementia remain under-researched. Little is known of the views of those responsible for local adult safeguarding systems about prevention and redress. We explore current repertoires of responses of such persons and consider barriers and facilitators to minimizing risks of financial abuse for people with dementia. METHODS Fifteen qualitative interviews were undertaken with a purposively sampled group of Adult Safeguarding Co-ordinators in England in 2011. Framework analysis delineated themes in the transcripts; these were included in an iteratively developed coding framework. RESULTS Five themes were explored: (1) incidence of financial abuse; (2) impact of dementia on safeguarding responses; (3) warning signs of financial abuse, including neglect, unpaid bills, limited money for provisions; (4) encouraging preventive measures like direct debit to pay for bills, advance care plans, appointing Lasting Power of Attorney; and (5) barriers and facilitators in safeguarding, including the practice of financial agencies, cultural barriers, other systemic failures and facilitators. Not all systems of financial proxies are viewed as optimally effective but provisions of the Mental Capacity Act 2005 were welcomed and seen as workable. CONCLUSIONS Healthcare professionals may need to be more alert to the signs and risks of financial abuse in patients with dementia both at early and later stages. Engaging with safeguarding practitioners may facilitate prevention of abuse and effective response to those with substantial assets, but the monitoring of people with dementia needs to be sustained. In addition, professionals need to be alert to new risks from electronic crime. Researchers should consider including financial abuse in studies of elder abuse and neglect.

The Mental Capacity Act 2005 and Its Influences on Social Work Practice: Debate and Synthesis

The newly implemented Mental Capacity Act 2005 in England and Wales enshrines much of the practice established under case law to safeguard people who lack ability to make specific decisions, enhances personal autonomy and enables people to make advance decisions to refuse treatment. It introduces new proxy-decision-making roles to address health, welfare and financial matters and specialist advocacy for people who do not have family or friends where major health and welfare decisions are to be made. This article outlines the scope of the Mental Capacity Act 2005, considers some of the implications of the Act for social work practitioners around the areas of planning and working with others in new roles, and clarifies some of their responsibilities. The article concludes that the potential for good practice will need to be supported by professional reflection and service monitoring.

Old Issues and New Directions: Perceptions of advocacy, its extent and effectiveness from a qualitative study of stakeholder views

This article describes and discusses 27 interviews that explored perceptions of the effectiveness of advocacy services for people with learning disabilities in the UK.The views of stakeholders on the current position of advocacy services, how services are evaluated and recommendations for change are central themes in the analysis of the interviews.The discussion suggests that although evaluation of effectiveness is increasingly important in the light of policy change and funding constraints, it is not universally in place and available tools are considered to be inadequate for the task.The explanation of this may lie in the continuing debates over the meaning and purpose of evaluation and fears that it is one-dimensional. Future investment and commitment to advocacy schemes will need to address these issues.

Advocacy and people with learning disabilities in the UK : How can local funders find value for money?

Advocacy schemes have been established throughout the United Kingdom (UK) but their evaluation by funders is varied. This article reviews the literature in respect of models of evaluation of advocacy schemes for people with learning disability. It discusses the six main models and the issues that arise in evaluation. The advantages and disadvantages of each model are analysed. The article concludes that whilst fears exist about the potential for evaluation to infringe advocacy schemes’ autonomy, funders need to undertake such a process for reasons of public accountability. Advocacy schemes may find it useful to consider which model of evaluation works best for them and will be appropriate and useful for their funders.

‘More of a leg to stand on’: Views and usage of the Mental Capacity Act 2005 among staff of local Alzheimer's Society and carer organisations

Objectives: The Mental Capacity Act (MCA) 2005 was implemented in 2007 in England and Wales. It offers new opportunities for people to plan for any future loss of capacity and provides a framework for decision-making on behalf of people lacking capacity. This article explores the challenges staff in local voluntary organisations focusing on dementia and carers face when they offer information and advice connected to possible loss of decision-making capacity to people with dementia and carers. Method: A set of 17 qualitative interviews were undertaken with a purposively sampled voluntary sector staff in London in 2008–09. Framework analysis was used to delineate themes in the transcripts and identified themes were included in the iteratively developed coding framework Results: Interviews revealed that voluntary sector staff generally perceived the Act as largely benefiting people with dementia in the exercise of their rights. They also thought that carers would benefit from the Acts provisions, whilst their own involvement in advice, information-giving and referral to other sources of expertise in relation to the MCA differed according to their role and confidence. Voluntary sector staffs capability and interest in using the MCA vary; there should be no presumption of detailed knowledge, and resources relevant to the MCA might be need to be coordinated more effectively by this sector. Conclusion: Ongoing training, local coordination and auditing seem warranted. These could encompass the new safeguarding provisions of the MCA which may need to be highlighted as part of the welcome extension of rights conferred by the MCA.

Mental Health and Mental Capacity Law: Some Mutual Concerns for Social Work Practice

The roots of mental incapacity and mental health legislation in England and Wales are deeply intertwined. Changes in healthcare policy, human rights principles, demographics and social attitudes have highlighted deficiencies in the law to protect the interests and rights of people considered to lack decision-making capacity. This led to calls for legal reform from social workers amongst other groups. The Mental Capacity Act 2005 took shape alongside the more controversial Mental Health Act 2007. Whilst mental capacity and mental health legislation are separate once again, both are concerned with the care and treatment of adults who are perceived as lacking capacity to make specific decisions. The Deprivation of Liberty Safeguards enacted as part of the Mental Health Act 2007 to amend the Mental Capacity Act 2005 will change practice for many social workers as they will give rise to new assessments and roles. Social workers will need to be aware of the potential interaction of the two Acts to ensure compliance with the laws and to promote positive practice. This article explores the interface between the Mental Capacity Act 2005 and Mental Health Act 2007 in England and Wales and examines and speculates on some of the possible implications for social work practitioners.

Paying the piper and calling the tune?: Commissioners’ evaluation of advocacy services for people with learning disabilities

Increases in funding of advocacy schemes are leading to their general expansion in the UK. Little is known of how their activities are evaluated by funders. This article examines how local authorities evaluate the outcomes of advocacy schemes. It reports on and discusses the findings of a survey of local authorities. Respondents identified the types of support they provided to advocacy schemes and their requirements for service reports. Data are presented on the length of time that schemes have been funded, geographical variations and whether schemes are generalist or specialist. This analysis is set in the context of discussion with stakeholders. The authors conclude that monitoring and review systems are not well known or extensively used, that while user involvement in evaluation is seen as appropriate this is not well developed, but that advocacy services themselves are interested in contributing to processes of improvement and accountability.

Gearing Up for Personalisation: Training Activities Commissioned in the English Pilot Individual Budgets Sites 2006-2008

The transformation of social care in England is taking place though changes affording greater choice and control for people using services. Individual budgets were one key element of these changes and were piloted in 13 local authorities in 2006–2008. This article reports on interviews with training leads in these local authorities that took place in 2008 as part of an independent evaluation of the individual budget pilots. The aims of the interviews were to explore the role of training as part of the processes of transformation, the use of resources and establishment of training strategies within the local authority. Participants revealed that the subject of training was acquiring higher profile within their authorities, although uncertainties remain about the extent of local authority responsibilities for training. Within local authorities, training resources were yet to be determined and models of training were not fully developed. The article concludes that training will remain a central issue when implementing personalised social care services and that models of training for such changes should be shared and evaluated over the long term.