Kate Baxter

The imPaCT study: a randomised controlled trial to evaluate a hospital palliative care team

A randomised controlled trial was undertaken to assess the effectiveness of a hospital Palliative Care Team (PCT) on physical symptoms and health-related quality of life (HRQoL); patient, family carer and primary care professional reported satisfaction with care; and health service resource use. The full package of advice and support provided by a multidisciplinary specialist PCT (‘full-PCT’) was compared with limited telephone advice (‘telephone-PCT’, the control group) in the setting of a teaching hospital trust in the SW of England. The trial recruited 261 out of 684 new inpatient referrals; 175 were allocated to ‘full-PCT’, 86 to ‘telephone-PCT’ (2 : 1 randomisation); with 191 (73%) being assessed at 1 week. There were highly significant improvements in symptoms, HRQoL, mood and ‘emotional bother’ in ‘full-PCT’ at 1 week, maintained over the 4-week follow-up. A smaller effect was seen in ‘telephone-PCT’; there were no significant differences between the groups. Satisfaction with care in both groups was high and there was no significant difference between them. These data reflect a high standard of care of patients dying of cancer and other chronic diseases in an acute hospital environment, but do not demonstrate a difference between the two models of service delivery of specialist palliative care.

Making informed choices in social care: the importance of accessible information

The current policy trend is to encourage greater choice in the use of welfare services. To make informed choices, people need information. The process of finding and using information has costs for individuals in terms of effort, time and material resources. These costs are different for different people and impact on their use of information in different ways. Thus, the accessibility of information is important in ensuring those people who need to make choices can do so in an informed way. This paper discusses the importance of information in making informed choices about social support by drawing on the findings of a scoping review of government research and development activity on the accessibility of information about adult social care services. The scoping review was carried out in spring 2006. Details of recent, current and planned projects were obtained through discussions with staff in government departments, government agencies and other related organisations identified using a snowballing technique. Forty-two contacts were made. Eleven research and 36 development projects were identified that aimed to investigate or improve the accessibility of information about social care services. A limited literature search was undertaken on information needs in areas not already under investigation by government. Eighteen articles were identified. Information and helpline staff from six voluntary organisations gave their views on the accessibility of information about social care services. Our findings show that there is no government-related or other recent research evidence on the specific information access needs for some user groups and services, for example, people from ethnic minority groups. For other user groups, such as people with chaotic lifestyles, there is evidence on information needs but no current or planned development projects to address these needs. The implications for the costs of finding and processing information to aid informed choices are discussed.

Making choices about support services: disabled adults’ and older people’s use of information

This paper explores how disabled adults and older people find and use information to help make choices about services. It presents findings from a qualitative longitudinal study in England. Thirty participants had support needs that fluctuated, meaning that additional services might be needed on a temporary basis; and 20 had the sudden onset of support needs resulting from an accident or rapid deterioration in health. Each disabled adult or older person was interviewed three times between 2007 and 2009, using a semi-structured topic guide. They were asked to discuss a recent choice about services, focussing, amongst other things, on their use of information. Interviews were transcribed and coded, then charted according to emergent themes. A wide range of choices and sources of information were discussed. These were dominated by health and to some extent by social care. Key findings are that information was valuable not just in weighing up different service options, but as a precondition for such choices, and that disabled adults and older people with the gradual onset of support needs and no prior knowledge about services can be disadvantaged by their lack of access to relevant information at this pre-choice stage. Timely access to information was also important, especially for people without the support of emergency or crisis management teams. Healthcare professionals were trusted sources of information but direct payment advisers appeared less so. Ensuring that practitioners are confident in their knowledge of direct payments, and have the communication skills to impart that knowledge, is essential. There may be a role also for specialist information advocates or expert lay-advisers in enabling disabled adults and older people to access and consider information about choices at relevant times.

Personal budgets and the workforce implications for social care providers: expectations and early experiences

Drawing on two studies in England, this paper explores the workforce-related impacts that social care providers envisage, and have so far experienced, from an increase in the number of people using personal budgets. It presents findings in relation to financial and workforce planning, recruitment and retention, workforce training and service user/provider relations. The discussion considers the implications not only for providers but also care workers, service users and local authorities.

Managed personal budgets for older people: what are English local authorities doing to facilitate personalized and flexible care?

This paper explores how three local authorities in England have tried to facilitate personalized home care for older people through changes in commissioning and market development activities; and how these changes have been experienced by support planners and home care agency managers. Overall, it appears that changes are well intended, but the practicalities of implementing them raise some challenges that mean desired objectives may not always be achieved.

The implications of personal budgets for the home care market

This article uses an analytic framework based on the preconditions for effective markets to consider how the widespread introduction of personal budgets is likely to affect the market for social care. While there are some promising signs of changes that should result in a more responsive market, there are some structural features that may act as barriers. The roles of local authorities as facilitators will be essential. The research findings reported here have relevance for other countries that have introduced personal budgets or ‘cash for care’ schemes.

The Role of Emotions in the Process of Making Choices about Welfare Services: The Experiences of Disabled People in England

Choice is central to developments in many areas of welfare. Making choices, for example about health, social care, employment and housing, can be very emotional. This article draws on theories from experimental psychology and behavioural economics to analyse empirical evidence from a longitudinal, qualitative study of support-related choices. It argues that if people are expected to make emotion-laden choices, and to minimise negative aspects associated with the process of making a choice, they need to be supported in doing so. It contributes to the limited evidence and debate to date about the process costs to individuals of choice.

Efficiency, choice and control in social care commissioning

Publicly-funded social care providers are under significant pressure as a consequence of an ageing population, a tight financial climate, and demands for greater quality and dignity in care. Personal budgets have been advocated as a potential solution. However, the implications of personal budgets on commissioning and market development are largely unexplored. This article looks at new approaches being adopted by English local authorities to reconcile tensions between the efficiency and personalization agendas, and to counter new transaction costs.

Supporting choice: Support planning, older people and managed personal budgets

Summary English policy emphasises personalised and flexible social care support using ‘Personal Budgets’ (PB) – preferably as cash direct payments. However, most older people opt for their council to manage personal budgets on their behalf. It is not clear what benefits of personalisation are available to this group of older people. This article reports research into the choices available to older people using managed personal budgets to fund home care services in three councils. It focuses on the roles of support planners, in councils and service provider agencies, who are central to supporting choice on the part of service users. Data were collected from three focus groups with 19 council support planning practitioners and interviews with 15 managers of home care agencies. Findings The study suggests that new commissioning and brokerage arrangements have the potential to give older people using managed personal budgets greater choice and control over their support. However, new communication barriers have also been introduced and some staff report receiving inadequate training for their new roles. Above all, resource constraints were reported to impede council support planners in encouraging users to plan creatively how to use personal budgets. Resource constraints also meant councils placed constraints on how flexibly home care agencies could respond to changing needs and preferences of older users. Applications The paper concludes by highlighting the implications of new arrangements for social work practice and some of the barriers that need to be addressed if the potential benefits of personalisation for older people holding managed personal budgets are to be achieved.

Collaborative commissioning of secondary care services by Primary Care Trusts

This article examines collaborations between primary care trusts in the commissioning of secondary care services in England. It applies principal-agent theory qualitatively to two case studies. The theory suggests that collaboration should take place if organizations share relevant information and agree joint objectives. The study findings show that sharing information is not a major problem for these case studies, but that agreeing joint objectives is.