Michelle Cornes

‘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.

Review of Interprofessional Education in the United Kingdom (1997–2013)

Review of Interprofessional Education in the United Kingdom (1997–2013), By Hugh Barr, Marion Helme, and Lynda D’Avray, Fareham: CAIPE, 2014, 131 pages, ISBN: 978-0-9571382-2-3, http://caipe.org.uk/silo/files/iperg-review-15-4-14-with-links-pdf. pdf This research-based review charts the development of interprofessional education (IPE) in the UK between 1997 and 2013, and updates an earlier review by one of the authors. The aim of the research is to understand how prequalifying IPE had developed and what is needed to be done to improve its efficiency and effectiveness set against a changing and complex policy landscape in education, health and social care, and government. It draws on the literature, an on-line survey and reflective accounts of the history of the ‘‘implantation’’ of IPE across 11 universities. The survey established that IPE was included in pre-qualifying health and social care courses in at least two thirds of the relevant UK universities. However, the main focus of the report is on the considerable skill and effort that is required by university staff to weave IPE into the fabric of the institution. What is most insightful is how the cultural, hierarchical and institutional barriers to interprofessional working in the wider health and social care system also play out in education. There are insights into the competitiveness between professions within the same institution to own IPE and to consequently distance themselves from ‘‘others’’ IPE initiatives. This has led to fragmentation especially where ‘‘medicine’’ and ‘‘nursing’’ refuse to ‘‘toe the line’’. The report also charts the numerous practical and logistical nightmares which impact on IPE delivery such as misalignment between programmes, timetables, placements, faculties, regulators, validation and periodic review cycles and other factors which are subject to year on year adjustments. The authors describe how these barriers work to challenge even the most committed and experienced champions of IPE noting the potential for ‘‘burn out’’ which arises from working in ‘‘cultures that value professional above interprofessional priorities and protect established patterns of education with curricula that has no room for IPE’’ (p.17). The main body of the report comprises the detailed reflective accounts of those with first hand experience of leading the development of IPE across eleven purposively selected universities. These are ‘‘warts and all’’ rather than institutionally glossed accounts and will be of most interest to those in similar development roles. This section provides an insight into the common problems that are encountered and importantly practical suggestions as to how these might be overcome. For example, one IPE lead notes that, ‘‘Some students (and it has to be said some staff) [are] suspicious about the teaching and assessment by a member of ‘another’ profession. We have worked with this. . . by referring to all who contribute to teaching and assessment as ‘academics’ rather than ‘physiotherapy’ ‘social work’ lecturers.’’ (p95) Overall, there is a sense that to succeed IPE leads must act cautiously and strategically at all times: ‘‘Sustainability has been achieved in part because we have designed just enough (short IPE events) placed throughout the profession specific curriculum rather than large IPE modules.’’ (p73) Overall, the report paints a rather guarded picture of the state of IPE in the UK. Particular attention is drawn to the significant gains that were achieved through external (government led) drive and funding (before 2010) and the ease with which things step backwards once this is lost. Although the accounts and survey provided clear evidence of thriving IPE, the authors concluded that there was still a sense of IPE as a movement or campaign to be won rather than as an institutional imperative or requirement (p14). The main strength of the report is that it presents some very clear messages targeted at specific bodies which have the remit to take the required action to address the various challenges mapped out. In many respects, this report will be a litmus test for the government’s integration agenda as only on acting on these recommendations and effectively underpinning what appear to be very weak foundations will the problems of the wider health and social care system begin to be addressed.

Wise owls and professors: the role of older researchers in the review of the National Service Framework for Older People.

Aim  This article explores the involvement of older people in research and inspection, reflecting on the learning from the recent ‘joint review’ of the National Service Framework for Older People in England.

Working Together to Address Multiple Exclusion Homelessness

This article draws on preliminary findings from a two-year exploratory study to describe how different agencies and professionals work together to identify and manage the intersections between homelessness and other facets of deep social exclusion. We assess the extent to which current practice is informed by policy frameworks for ‘personalised and integrated care planning’ focusing in particular on the ‘coordinating’ and ‘sign-posting’ role of the housing support worker. We conclude with some initial thoughts as to how policy and practice might be strengthened in this area to ensure more ‘joined-up’ and continuous support for people with experience of multiple exclusion homelessness.

Developing wider workforce regulation in England: Lessons from education, social work and social care

This paper draws on the findings of a review of regulation of professionally qualified teachers, social workers and other staff in social care. It charts the process of developing and implementing both professional and wider workforce regulation in England, focusing on the implications for generic and integrated working and the development of cross-professional procedures for the protection of vulnerable adults and children from abuse. There are many uncertainties about how best to develop workforce regulation especially when integrated working is a policy goal. In light of the paucity of evidence of outcomes and benefits for improved practice and the protection of the public, there is a need for research to address this complex arena.

Implementing the Single Assessment Process: Driving Change or Expecting the Impossible?

This article considers the potential for single assessment to overcome longstanding difficulties with care management, looks at initial progress in one SHA area and identifies some key priorities for the next stages of local implementation. We conclude that, not only is much more work required in localities, but additional national guidance and resources may also be required.

When self‐directed support meets adult support and protection: findings from the evaluation of the SDS test sites in Scotland

Purpose – This paper aims to explore the possible connections between self‐directed support and adult support and protection, both of which are important policy developments in Scotland.Design/methodology/approach – The authors draw on findings from the national evaluation of the test sites or pilots of self‐directed support in Scotland and interviews at two time points with adult protection leads in the test sites. These interview data are set in the context of Scottish developments in adult support and protection.Findings – Self‐directed support and adult protection had not been joined up initially. In the three Scottish test sites those responsible for adult safeguarding had not been engaged with the changes. They were unclear about the new systems and were concerned about the implications of reduced monitoring of risks. Shared training between those implementing self‐directed support and those carrying out adult protection work was viewed as a way of bridging these different areas of practice through ...

Making partnership work

The Department of Health recently issued draft guidance that will require the NHS and the community and voluntary sectors to sign up to local compact agreements by 2004. The overall aim is to promote partnership working to support the voluntary and community sectors’ growing role in contributing to health service and social care delivery. This is seen to be complementary to their distinct roles in relation to promoting health and social inclusion, and in lobbying and advocacy (Department of Health, 2003). While there is considerable research on joint working between the twin peaks of the NHS and local council social services, there is limited evidence on the interplay with the voluntary and community sectors (Andrews et al, 2003). To redress the balance, this article draws on some of the lessons to emerge from the Help the Aged intermediate care programme for older people. Intermediate care lends itself well to analysis in this area because it depends on the integration of services to promote faster recovery from illness, prevent unnecessary acute hospital admissions, support timely discharge and maximise independent living (Department of Health, 2001). Although intermediate care is not specifically targeted at older people, this group forms the great majority of its users. Development of intermediate care was a key standard for the National Service Framework for Older People issued in 2001.

Intermediate Care: Older People's Involvement and Experiences

New service models such as intermediate care may find it difficult to involve older people in services that are time‐limited and unfamiliar. Their staff may perceive themselves as having little time to sustain or build relationships with voluntary and community‐based organisations engaged in intermediate care. This article shows how such challenges can be met by drawing on the experiences of voluntary sector projects involved in intermediate care services.

On-line information and registration with services: patterns of support for carers in England

Purpose – The paper aims to ascertain how local authorities and other services are responding to central government strategies to make support for family carers a priority. Design/methodology/approach – A web-based audit of local authority public information for carers was undertaken (n=50). The sample covered different parts of England and different local authority types. Findings – A small minority of local authority web sites mention that they operated Carers’ Registers. Overall local authorities offer different resources to carers, ranging from discounts in the local area to access to emergency card registration. Some use online information as a communication channel. Overall local authority online information for carers seems to be variable in quality, accessibility and purpose. We conclude that growth in the collection of information by primary care services in England risks duplicating some of the functions of, and problems with, local authority activities. Local commissioning should minimise confu...