John Woolham

Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial

BackgroundAssistive technology and telecare (ATT) are relatively new ways of delivering care and support to people with social care needs. It is claimed that ATT reduces the need for community care, prevents unnecessary hospital admission, and delays or prevents admission into residential or nursing care. The current economic situation in England has renewed interest in ATT instead of community care packages. However, at present, the evidence base to support claims about the impact and effectiveness of ATT is limited, despite its potential to mitigate the high financial cost of caring for people with dementia and the social and psychological cost to unpaid carers.Method/designATTILA (Assistive Technology and Telecare to maintain Independent Living At Home for People with Dementia) is a pragmatic, multi-centre, randomised controlled trial over 104 weeks that compares outcomes for people with dementia who receive ATT and those who receive equivalent community services but not ATT. The study hypothesis is that fewer people in the ATT group will go into institutional care over the 4-year period for which the study is funded. The study aims to recruit 500 participants, living in community settings, with dementia or significant cognitive impairment, who have recently been referred to social services.Primary outcome measures are time in days from randomisation to institutionalisation and cost effectiveness. Secondary outcomes are caregiver burden, health-related quality of life in carers, number and severity of serious adverse events, and data on acceptability, applicability and reliability of ATT intervention packages. Assessments will be undertaken in weeks 0 (baseline), 12, 24, 52 and 104 or until institutionalisation or withdrawal of the participant from the trial.DiscussionIn a time of financial austerity, CASSRs in England are increasingly turning to ATT in the belief that it will deliver good outcomes for less money. There is an absence of robust evidence for the cost-effectiveness and benefit of using assistive technology and telecare. The ATTILA trial meets a pressing need for robust, generalisable evidence to either justify continuing investment or reappraise the appropriate scale of ATT use.Trial registrationCurrent Controlled TrialsISRCTN86537017

Do direct payments improve outcomes for older people who receive social care? Differences in outcome between people aged 75+ who have a managed personal budget or a direct payment

ABSTRACT Direct payments – cash for people eligible for adult social care and spent by them on care and support – are claimed to enable care to better reflect user preferences and goals which improve outcomes. This paper compares outcomes of older direct payment users and those receiving care via a managed personal budget (where the budget is spent on the recipients behalf by a third party). The study adopted a retrospective, comparative design using a postal questionnaire in three English councils with adult social care responsibilities in 2012–13. Included in the study were 1,341 budget users aged 75+, living in ordinary community settings. The overall response rate was 27.1 per cent (339 respondents). Three validated scales measured outcomes: EQ-5D-3L (health status), the Sheldon–Cohen Perceived Stress Scale and the Adult Social Care Outcomes Toolkit (social care-related quality of life). The study found that direct payment users appreciated the control conferred by budget ownership, but in practice, for many it did not ‘translate’ into improved living arrangements. It also found no statistically significant difference in outcomes between direct payment and managed personal budget users. The paper argues that despite policy and other guidance and research evidence about effective implementation of direct payments for older people, the absence of evidence for better outcomes may at least in part be attributable to values underpinning policies relating to personalisation and personal budgets.

Implementing safeguarding and personalisation in social work: Findings from practice

Summary This paper reports on part of a research study carried out in three local authority adult social care departments in England, which explored links between adult safeguarding and personalisation. The study included statistical analysis of data on safeguarding referrals and the take up of personal budgets and qualitative interviews with managers, social workers, other staff working on safeguarding and with service users. The paper reports the findings from 16 interviews with managers and social workers, highlighting their perspectives and experiences. Findings Five main themes emerged from our analysis: contexts and risk factors; views about risks associated with Direct Payments, approaches to minimising risk; balancing risk and choice; and weaving safeguarding and personalisation practice. Social workers identified similar ranges and kinds of risks to those identified in the national evaluation of Individual Budgets. They described a tension between policy objectives and their exercise of discretion to assess and manage risks. For example, some described how they would discourage certain people from taking their personal budget as a Direct Payment or suggest they take only part of a personal budget as a Direct Payment. Application This exploratory study supports the continued need for skilled social workers to deliver outcomes related to both safeguarding and personalisation policies. Implementing these policies may entail a new form of ‘care and control’, which may require specific approaches in supervision in order to ensure good practice is fostered and positive outcomes attained.

Did anyone notice the transformation of adult social care? An analysis of Safeguarding Adult Board Annual Reports

Purpose – The purpose of this paper is to report on a part of a study examining the interrelationships between personalisation and safeguarding practice. Specifically the authors aimed to examine how safeguarding practice is affected by the roll out of personalisation in adult social care, particularly when the adult at risk has a personal budget or is considering this. Design/methodology/approach – A sample of annual reports from Adult Safeguarding Boards in England was accessed for content analysis covering the period 2009-2011. One part of this sample of local authorities was selected at random; the other authorities selected had been early adopters of personalisation. The reports were analysed using a pro forma to collect salient information on personalisation that was cross-referenced to identify common themes and differences. Findings – The authors found variable mentions of personalisation as part of the macro policy context reported in the annual reviews, some examples of system or process changes...

The evolution of person-centred care to personalised care, personal budgets and direct payments in england: some implications for older users of social care services

The Westminster Government in the UK has implemented a series of significant changes to the way social care is organised and provided in England, including the use of personal budgets and direct payments. Advocates of this approach claim it will deliver more personalised care to budget holders. This paper examines key English policies underpinning these changes, reviewing social policy analysis and research evidence of their impact to consider implications for older social care users. It suggests that personal budgets and direct payments have partly been a response to demands for greater control over care from younger adults with disabilities and that policies and guidance often reflect the interests of this constituency rather than older people. Current research evidence tends to suggest that older people achieve less satisfactory outcomes from personal budgets than younger people. The paper argues for the re-discovery of person-centred care, rather than personalisation, as a way of addressing this important policy issue.

Loneliness amongst older people: findings from a survey in Coventry, UK

Purpose – The purpose of this paper is to investigate factors associated with loneliness amongst people aged 55 and over living in Coventry, a medium-sized city in the Midlands, UK. Design/methodology/approach – Quantitative community survey of residents, involving postal and online questionnaire and distribution of questionnaire to local community resources used by older people and “ballot boxes” for completed questionnaires in these locations. Findings – Using multivariate regression analysis the study found that living alone, not enjoying life, needing help with personal care and not being in touch with people as often as liked all predicted loneliness. Research limitations/implications – Survey was commissioned by a range of local statutory and voluntary sector providers and had a wider focus than loneliness. Some evidence of under-representation of males, minority ethnic groups and possibly people from lower socio-economic groups is reported. Further qualitative research is needed to better understan...

Do Personal Budgets Increase the Risk of Abuse? Evidence from English National Data

With the continued implementation of the personalisation policy, Personal Budgets (PBs) have moved to the mainstream in adult social care in England. The relationship between the policy goals of personalisation and safeguarding is contentious. Some have argued that PBs have the potential to empower recipients, while others believe PBs, especially Direct Payments, might increase the risk of abuse. This paper provides empirical evidence about levels of uptake of PBs and safeguarding referrals in England based on in-depth analysis of national data at aggregate, local council level in England, covering 152 Councils. This is complemented by analysis of 2,209 individual referral records obtained from three purposively selected study sites. The aim is to explore whether available data could provide evidence of association between the uptake of PBs and safeguarding referrals. Analysis of the national dataset found no significant relationships between PB uptake and the level and type of alleged abuse. However, analysis of individual level referral data, from the three selected sites did find some significant associations particularly with financial abuse; and t the main perpetrators of the alleged abuse to be home care employees. The findings are discussed within the context of current policy and practice context.With the continued implementation of the personalisation policy, Personal Budgets (PBs) have moved to the mainstream in adult social care in England. The relationship between the policy goals of personalisation and safeguarding is contentious. Some have argued that PBs have the potential to empower recipients, while others believe PBs, especially Direct Payments, might increase the risk of abuse. This paper provides empirical evidence about levels of uptake of PBs and safeguarding referrals in England based on in-depth analysis of national data at aggregate, local council level in England, covering 152 Councils. This is complemented by analysis of 2,209 individual referral records obtained from three purposively selected study sites. The aim is to explore whether available data could provide evidence of association between the uptake of PBs and safeguarding referrals. Analysis of the national dataset found no significant relationships between PB uptake and the level and type of alleged abuse. However, analysis of individual level referral data, from the three selected sites did find some significant associations particularly with financial abuse; and t the main perpetrators of the alleged abuse to be home care employees. The findings are discussed within the context of current policy and practice context.

The impact of personal budgets on unpaid carers of older people

Summary This paper focuses on the impact of a personal budget – either in the form of a direct payment or managed personal budget – on the role of unpaid carers of older budget holders. Data were collected via postal survey of 1500 unpaid carers and semi-structured interviews with 31 carers. Findings Unpaid carers played a central role in supporting older budget holders irrespective of the type of budget received. The allocation of a personal budget may have decreased the amount of ‘hands-on’ care they provided, enabling them to do different things for and with the person cared for, but most did not relinquish direct involvement in care provision. Both kinds of personal budget provided greater flexibility to juggle caring tasks with other roles, such as childcare or paid employment. However, carers supporting direct payment users did experience higher levels of stress. This seemed linked to the additional responsibilities involved in administering the direct payment. Carers seemed relatively unsupported by their local Adult Social Care Department: the survey found that only one in five said they had ever received a carer assessment. Application The findings offer a detailed exploration of the impact of personal budgets on carers, suggesting that even in countries with relatively well-developed systems of support for carers such as England their impact remains overlooked. The paper may be of interest to social work practitioners, managers, academics and social work policy specialists working in countries that have, or are about to introduce, personal budgets or other forms of cash-for-care scheme.

The development of safer walking technology: a review

Purpose – The purpose of this paper is to gain a greater understanding of the development of safer walking technology for people with dementia through contemporary literature. Design/methodology/approach – A two stage systematic approach to searching the literature was adopted. Initially this involved searching the literature to gain a broad overview of the development of safer walking technology and the context in which it has been developed. Then, this literature was examined in detail to look at published evidence surrounding the use of safer walking technology by people with dementia. These articles were quality appraised and a meta ethnographic approach taken to synthesis of the findings. Findings – There is a small but growing body of literature within this field. Whilst there is only limited evidence to support the use of safer walking technologies for people with dementia, the evidence to date indicates great potential for its use. If provided with the right support and guidance, safer walking tec...

Care management: some issues of interprofessional practice in Northamptonshire

This paper is based on research carried out into a series of care management pilot projects established by Northamptonshire Social Services in 1992–3. Despite limitations arising from the ‘pilot’ status of the projects, including temporary status, absence of individual budgets for care managers and a lack of infrastructure to support cure management activity, evidence presented in the first part of this paper indicates that in most cases, care management was able to deliver a more effective service to clients and careers which was noticeable, appreciated and valued by them. Issues arising from practice are discussed in the second part of the paper, This contains an analysis of the relationship between pre-existing organisational structures and the care management processes followed by care managers operating within these structures—specifically, raising referrals, coordinating assessments, constructing and implementing care plans.