Lisa Pinkney

Partnership means protection? Perceptions of the effectiveness of multi‐agency working and the regulatory framework within adult protection in England and Wales

This article examines the effectiveness of the multi‐agency approach in adult protection and draws on findings from research that examined the effectiveness of both partnership working and perceptions of the regulatory framework to protect vulnerable adults. The research findings were collected through the use of a survey of all local councils with social services responsibilities in England and Wales. Examples of good practice in partnership working were found. However, resource pressures, insufficient information sharing and a lack of clarity about roles and responsibilities were reported to hinder a multi‐agency approach.

Why do patients develop severe pressure ulcers? a retrospective case study.

Objectives This study focuses on the ways in which the organisational context can influence the development of severe pressure ulcers. Severe pressure ulcers are important indicators of failures in the organisation and delivery of treatment and care. We have a good understanding of patients’ risk factors, but a poor understanding of the role played by the organisational context in their development. Setting The study was undertaken in six sites in Yorkshire, England. The settings were sampled in order to maximise diversity, and included patients’ own homes, acute hospital medical and surgical wards, a community hospital and a nursing home during a period of respite care. Participants Data were collected about eight individuals who developed severe pressure ulcers, using a retrospective case study design. The data sources included interviews with individuals with severe pressure ulcers, and with staff who had treated and cared for them, and clinical notes. Results 4 accounts indicated that specific actions by clinicians contributed to the development of severe pressure ulcers. Seven of the 8 accounts indicated that they developed in organisational contexts where (1) clinicians failed to listen and respond to the patients’ or carers’ observations about their risks or the quality of their treatment and care, (2) clinicians failed to recognise and respond to clear signs that a patient had a pressure ulcer or was at risk of developing one and (3) services were not effectively coordinated. Conclusions Patient accounts could only be partially explained in terms of specific events or sequences of events. The findings support the conclusion that there was general acceptance of suboptimal clinical practices in 7 of the 8 contexts where patients developed severe pressure ulcers.

Select questions: considering the issues raised by a Parliamentary Select Committee Inquiry into elder abuse

This article updates a review submitted to the Department of Health (DH) in the light of the House of Commons Health Select Committee report on Elder Abuse. The review drew on recent research about elder abuse in the UK, including research published after the Select Committees hearings, that made specific recommendations for areas of development in research and policy. The aim of this paper is to address specific questions posed by the Select Committee in light of developments up to mid 2005.

Managing relations in adult protection: A qualitative study of the views of social services managers in england and wales

Collaboration or partnership between different agencies is seen as an important part of resolving problematic social issues. This article reports on findings from interviews with 32 managers working in 26 local authority social services departments that were undertaken as part of a larger study of interagency working in adult protection in England and Wales (2004–2007). Themes of managing relations, system development and prioritisation emerged from the analysis of the interviews. These findings are set in the context of developments in adult protection or safeguarding in England and Wales. The article concludes that managers perceive relationships as key in implementing aspirations for adult safeguarding, in the context of a lack of statutory obligations and sets this in the context of policy and practice.

Form and function: views from members of Adult Protection Committees in England and Wales

Little is known about the relationship between organisations charged with the protection of vulnerable adults in England and Wales. This paper investigates adult protection1 inter‐agency relationships in the context of an adult protection framework that gave local authorities the lead role and charged other agencies with working in partnership with them. The data reported are from focus groups undertaken with members of 26 Adult Protection Committees (APCs) from England and Wales during 2005‐2006. The APCs were selected using a stratified sampling frame and 271 professionals participated. Analysis revealed that participation in the local strategic decision‐making setting of the APC was influenced by the local history of partnership working, information‐sharing, affective relationships, understanding of respective roles and a shared acknowledgement of the importance of adult protection. The implications of these findings are discussed in the light of government reviews of local discretion around adult protection systems.

Modernising Adult Protection: An Inside or an Outside Job?

This article presents an analysis of modernisation as it affects adult protection in England. One of the key policy goals of modernisation has been to improve protection of service users. The article outlines some areas of good practice that are emerging and draws attention to some of the latent conflicts that are apparent.

Developing a framework for gathering and using service user experiences to improve integrated health and social care: the SUFFICE framework.

BackgroundMore people than ever receive care and support from health and social care services. Initiatives to integrate the work of health and social care staff have increased rapidly across the UK but relatively little has been done to chart and improve their impact on service users. Our aim was to develop a framework for gathering and using service user feedback to improve integrated health and social care in one locality in the North of England.MethodsWe used published literature and interviews with health and social care managers to determine the expected service user experiences of local community-based integrated teams and the ways in which team members were expected to work together. We used the results to devise qualitative data collection and analysis tools for gathering and analyzing service user feedback. We used developmental evaluation and service improvement methodologies to devise a procedure for developing service improvement plans.FindingsWe identified six expected service user experiences of integrated care and 15 activities that health and social care teams were expected to undertake. We used these to develop logic models and tools for collecting and analysing service user experiences. These include a narrative interview schedule, a plan for analyzing data, and a method for synthesizing the results into a composite ‘story’. We devised a structured service improvement procedure which involves teams of health and social care staff listening to a composite service user story, identifying how their actions as a team may have contributed to the story and developing a service improvement plan.ConclusionsThis framework aims to put service user experiences at the heart of efforts to improve integration. It has been developed in collaboration with National Health Service (NHS) and Social Care managers. We expect it to be useful for evaluating and improving integrated care initiatives elsewhere.