Social work, neglect and the renewal of ‘poverty aware practice’

Posted on November 14, 2024 by Stephen Martineau

Carl Purcell, of the Health and Social Care Workforce Research Unit, King’s College London, reflects on a recent meeting of the Social Work History Network (17 June 2024). (791 words)

At a recent seminar organised by the Social Work History Network Dr Michael Lambert, Professor June Thoburn and Professor Marian Brandon reflected on the history of the concept child ‘neglect’ and how this has been redefined and responded to by policymakers and social workers.

The evacuation of children from towns and cities during the second world war exposed the appalling suffering of many children living in desperate poverty. Lady Allen of Hartwood was spurred to write a letter to The Times that provoked a remarkable political response. Following the Curtis Report (1946), and subsequent inquiries, the Children Act 1948 established local authority Children’s Departments to make arrangements when children, including neglected children, needed to be received in to care. Subsequently, the Children and Young Persons (Amendment) Act 1952 provided powers to actively investigate neglect.

Many health and social work professionals working in this space located the underlying causes of neglect in the personal characteristics of parents. Jones wrote: “Their lives are characterised by dirt, disintegration and disorder. They are often shiftless, apathetic, irresponsible to an almost incredible degree”[1]. But some social policy writers were critical of this perspective. Barbara Wootton argued: “About the only common characteristics of these families, it seems, are the financial ones”[2]. Continue reading →

Remembering Jeremy Swain and his contribution to our work on homelessness

Posted on July 23, 2024 by Stephen Martineau

Maureen Crane, Visiting Senior Research Fellow, King’s College London.

Jeremy Swain

It was with deep sadness I heard about the death on 27 May 2024 of Jeremy Swain. He was a key figure in tackling homelessness and particularly rough sleeping for decades. Following a volunteering experience with the Cyrenians in London, Jeremy became a street outreach worker at Thames Reach in 1984 followed by periods as a resettlement worker and then a housing service manager within the organisation. He became Chief Executive of Thames Reach in 1999 and remained in the post until 2018, when he became Deputy Director for Homelessness and Rough Sleeping Delivery at the Ministry of Housing, Communities and Local Government. He was responsible for overseeing programmes developed through the Rough Sleeping Strategy, and later became a senior adviser for the Covid-19 Rough Sleeping Task Force. In 2017 he received a City Lit Lifetime Achievement Award for his contribution in helping people who had been homeless to develop the skills and confidence to gain employment.

I first met Jeremy in 1994 when starting fieldwork for my PhD. I was keen to interview older people who were homeless and he gave permission for me to visit Thames Reach’s hostels to see if any residents would be willing to take part. He showed great interest and enthusiasm in research on homelessness and understanding why people become homeless and what is needed to help them move on. He commissioned Tony Warnes (former Professor of Social Gerontology, University of Sheffield) and myself to undertake evaluations of programmes and services within Thames Reach, and he worked closely with many other homelessness sector service providers in London, including with Charles Fraser, former Chief Executive of St Mungo’s. Collectively these organisations commissioned us to undertake comprehensive studies of the needs of single people in London who were homeless and of the role of hostels in the early 21^st century.

Over the years Jeremy continued to be a great supporter of my research on homelessness, both at the University of Sheffield and at King’s College London. He was always keen for his organisation to participate in our government-funded research, and Thames Reach staff and service users played an active role in studies such as the Three-Nation Study of the causes of homelessness among older people, the FOR-HOME study and Rebuilding Lives. Through his knowledge, guidance and support over many years, he helped steer our Homelessness Research Programme to what it is today – from relatively small evaluations of services to large scale, multi-site studies concerning people who are homeless and services for them.

Using the Mental Capacity Act 2005 with those experiencing Multiple Exclusion Homelessness – Challenges, Debates & Resources

Posted on July 19, 2024 by Stephen Martineau

Stephen Martineau (KCL) reports from the latest webinar in the Homelessness series, part of the Homelessness Research Programme at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (855 words)

Over 220 people attended yesterday’s webinar in which Jess Harris presented early emerging findings from the NIHR HSDR-funded study, Use of the Mental Capacity Act 2005 (MCA) with people experiencing multiple exclusion homelessness in England. The findings were drawn from a set of scoping interviews with a range of senior professionals working with this population. The presentation focused on the professionals’ views of the challenges around use of the MCA in this space. These interviews have already informed the development of our national survey of health, social care and homelessness practitioners which is the next stage of the study, and which is currently live (and takes about 10 minutes). We plan to report on our analysis of findings from this survey later in 2024 at another webinar in the Homelessness series.

Please sign up if you would like to hear about future events in this series, or get in touch if you would like to present research: jess.harris@kcl.ac.uk
Presentation slides from the webinar
Please take part in the survey

The presentation provoked thoughts from attendees about various aspects of this topic, together with suggestions of some useful resources. We have collated some of these below. Among a lot of valuable contributions, two stood out as particularly interesting. One was about the ‘diagnostic test’. This has come up in practitioner interviews – specifically the question of how practitioners are approaching this element of the capacity assessment with people where substance use may feature in combination with (and possibly masking) mental illness. The other was the suggestion that the MCA is a poor fit when it comes to compulsive behaviours. It will be interesting to explore this further during the fieldwork part of this study (starting in autumn 2024) in light of London Borough of Tower Hamlets v PB [2020] EWCOP 34 (see Kane et al. (2023) Shades of grey: choice, control and capacity in alcohol-related brain damage).

General issues raised at the webinar by attendees

Problem of exclusion of rough sleepers from needs assessments under the Care Act 2014.
Dual diagnosis is a particular challenge because of the lack of services in many areas.
Lack of suitability of interventions available to social care – a commissioning issue, but also a systemic issue, across Health, Social Care, Housing.
It was suggested that early release schemes from prison are going to be a big issue for this population.

Using the MCA

It was suggested that the MCA is a poor fit for complexity within the MEH population, particularly around compulsive behaviours.
Executive function: importance of longitudinal capacity assessments was stressed by some. Also, Occupational Therapist and Speech and Language Therapist involvement in assessments.
On the ‘diagnostic test’ and this population. There was debate in the chat as to whether the Court of Protection requires a formal diagnosis. North Bristol was cited in support of the argument that a formal diagnosis is not required. (North Bristol NHS Trust v R [2023] EWCOP 5). (See August 2024 update below and the suggestion that a better term is ‘impairment test’)
Importance of recognizing the knowledge and potential input (to capacity assessments etc.) of non-statutory practitioners. Support workers’ and outreach workers’ knowledge of the person may be overlooked. A clinical psychologist in a third sector organisation made a similar point, speaking of a power imbalance.
There was mention in the chat of detox being provided under Deprivation of Liberty Safeguards, in at least one site in England, if there is a plan for Alcohol Related Brain Injury rehab.
It was suggested self-discharge from hospital and mental capacity is a key concern.

Continue reading →

A new online Resources Hub to support day centres for older people and professionals interested in these services

Posted on May 23, 2024 by Stephen Martineau

Katharine Orellana & Kritika Samsi (NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London; NIHR Applied Research Collaboration South London). (592 words)

Our unique new Day Centre Resources Hub was co-produced with day centres for older people and their broader professional stakeholders. We created the Hub to support day centre sustainability by improving knowledge about them, supporting their operation, and encouraging joint working.

The Hub provides useful information, practical tips, guides, case study examples and templates that can be downloaded and used to help inform your work. Topics covered include research, outcomes and impact, marketing, recruitment and local examples.

Day centres are often valued places for people with social care and support needs who want to remain living in their communities (Bennet et al 2023, Lunt el al 2021, Orellana et al 2020, Orellana et al 2024). Their providers would like these services to be more central to health and social care systems. Continue reading →

Dementia Community Research Network celebrates in style!

Posted on May 22, 2024 by Stephen Martineau

The Dementia Community Research Network (DCRN) turns one this year, and what better way to celebrate than to showcase the incredible work of Network members and start a conversation about better, more inclusive, dementia care? On Thursday 9 May 2024, the DCRN held its first community engagement event to do just that…

The DCRN is a network of public, community, and research partners from across South London. We are connected though our shared goal of better care for all people affected by dementia, by giving equitable opportunities to people of all backgrounds and ethnicities to be involved in dementia research.

With thanks to generous funding from the British Society of Gerontology, and hosting by King’s College Hospital, we welcomed well over 50 guests to our event, including people living with dementia and their relatives, community staff from the voluntary sector, clinical and managerial staff from the NHS and dementia care researchers. Continue reading →

In Search of Hidden Healthcare Workforces: NHS Therapists for Children and Young People with Special Educational Needs and Disabilities (Part 2)

Posted on May 19, 2024 by Stephen Martineau

Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Policy and Management at King’s Business School. He introduces a new report from the Unit, scoping the demand and supply of NHS therapists for Children and Young People with Special Educational Needs and Disabilities.

This, the second of two blogs, focuses on the supply of, while the first addressed the demand for, therapists for children and young people with Special Educational Needs and Disabilities.

The Supply Side

Commissioning. While the capacity to address this increased demand rests in large part on the scale, structure, and capabilities of the therapy and, as already implied, the wider health and care workforce, the commissioning process for CPY with SEND, is pivotal. Commissioning determines the services available and at what level of resource, inevitably feeding through to determine the workforce required to provide them: to put it crudely, if a service is not commissioned, a workforce is not required. The close connection between service design and the workforce is apparent from various ‘good practice’ commissioning models [1]. These typically distinguish different levels of services linked to the nature of need and support, with implications for the requisite workforce: for example, accessible universal services delivered by a wider workforce; targeted services provided by registered therapists and their support co-workers; and specialist services the exclusive preserve of the registered therapist. Continue reading →

In Search of Hidden Healthcare Workforces: NHS Therapists for Children and Young People with Special Educational Needs and Disabilities (Part 1)

Posted on May 19, 2024 by Stephen Martineau

This, the first of two blogs, focuses on the demand for, while the second discusses the supply of, therapists for Children and Young People with Special Educational Needs and Disabilities.

Context

The workforce delivering care and support for children and young people (CYP) with special educational needs and disabilities (SEND) is an elusive one. In part this elusiveness stems from the diffuse and fragmented nature of the workforce as CYP with SEND typically engage with a variety of services- education, health, social care and sometimes housing. Even drilling down into these discrete service segments, tying the SEND workforce down in terms of its size, skill mix, and capacity remains challenging. Take health as an example. CYP with SEND will have a range of developmental, physical, and mental health care needs, addressed by a variety of staff groups to be found in different clinical settings including: nursing in both community, acute and mental health settings, clinical consultants in a similar range of settings, GPs in primary care, and healthcare visitors in the community. Adding to the challenges is the fact that those in any one of these staff groups will have clients which include but are rarely limited to CYP with SEND. With policies often framed by and centred on ‘children and young people with SEND’ as the named client group [1], the hidden nature of the workforce caring for and supporting them becomes a real challenge in meaningfully delivering on the policy initiative. Continue reading →

In Pursuit of Ethically Sustainable Approaches to International Nurse Recruitment

Posted on May 6, 2024 by Stephen Martineau

Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce is Professor of Public Policy and Management at King’s Business School. He introduces a new evaluation from the Unit: International Nurse Recruitment and the Use of Memoranda of Understanding: The Kenya and Nepal Pilots. (1,447 words)

With rising health and care needs as national care systems seek to cope with aging populations, the growing incidence of chronic conditions, and the shock of the Covid pandemic, there has been increasing pressure on the global supply of healthcare workers. Traditionally drawing upon overseas staff, this raises new and important questions for the NHS about how such employees are accessed and managed. The recent NHS England’s Long Term Workplace Plan, 2023, for example, cautions against an over reliance on any specific source of labour. More profoundly, the pressure on the supply of overseas healthcare workers prompts renewed concerns about the ethics of international recruitment as a practice.

Earth seen from space

There has been longstanding debate on the ethics of overseas recruitment by the NHS and other high income countries. This is reflected in international attempts to regulate the practice through, for example, the World Health Organisation Global Code, 2010, designed to ‘establish the ethical international recruitment of health personnel, accounting for the rights, obligations and expectations of source countries, destination countries and migrant health personnel.’ Debate on the ethics of the process has deepened with the new labour supply side pressures, and in response, government-to-government, or bilateral, agreements, whether in the form of Memorandum of Understanding (MoU) or tighter, more formal treaties, have emerged as a potential vehicle for addressing ethical concerns. Continue reading →

Occupational Health and Wellbeing (OHWB) and the Health and Social Care Workforce

Posted on April 8, 2024 by Stephen Martineau

Dr Antonina Semkina is Research Associate at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (613 words)

Unit researchers Antonina Semkina and Caroline Norrie attended the annual Health and Wellbeing at Work Conference that took place in Birmingham National Exhibition Centre on 12-13 March, 2024. The conference featured 13 themes, including Future of Work; Equality, Diversity, and Inclusion; Health and Conditions; and Culture, Values and Engagement, among others. There were 100+ exhibitors representing Occupational Health providers, NHS and social care organisations, consultancies, training agencies, and charities.

Caroline and Antonina recently published the final report from their NIHR-funded study “Exploring the awareness and attractiveness of Occupational Health (OH) careers: perspectives of trainee doctors, nurses, OH trainees, OH career leavers” so they particularly enjoyed the opportunity to connect with and hear presentations from policy makers, researchers, practitioners, and providers in the field of OH. Continue reading →

Health & Social Care Workforce:

Welcome to the blog of the NIHR Policy Research Unit in Health and Social Care Workforce at King's College London