Remembering Jeremy Swain and his contribution to our work on homelessness

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

Jeremy Swain

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 21st 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

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.

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.

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

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!

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)

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)

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 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

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

Antonina SemkinaDr 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

The NIHR Policy Research Unit in Health and Social Care Workforce Programme of Work: The Next Five Years

Prof Ian Kessler of the NIHR Policy Research Unit in Health and Social Care Workforce introduces the Unit’s programme of work commencing this year under the 2024-28 award from the NIHR Policy Research Programme.

In the context of ongoing challenges to the recruitment, retention, and motivation of around three million staff employed in health and social care, the NIHR Policy Research Unit in Health and Social Care Workforce in the Policy Institute at King’s College London (KCL) has announced its programme of work as it sets out on its next five years (2024-28).

Developed in consultation with the Department of Health and Social Care, this programme is sensitive to the importance of workforce organisation and management to the delivery of high quality services as the health and care needs of the population change, and as technological and medical advances provide new opportunities to address such needs. The Programme has been framed by key policy initiatives, for example, the NHS England Long Term Workforce Plan (2023) and the DHSC White Paper People at the Heart of Care: Adult Social Care Reform (2021). It comprises the following seven related but discrete projects, with their Principal Investigators (PI):

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What are the experiences, motivations and plans of Health and Care Visa holders and their dependants?

Kalpa KharichaDr Kalpa Kharicha is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce in the Policy Institute at King’s College London. She leads the Unit’s work on the Health and Care Visa, the report from Phase of 1 of which was published in October 2023. (679 words)

Internationally recruited care workers made the biggest contribution to reducing vacancies in frontline adult social care in England during 2022-3; 70,000 people came to the UK to work in a direct social care role. During this time the number of domestic recruits to care work fell. Vacancies in social care are currently at 152,000.

The increase in international care workers follows changes to government immigration policy in recent years. In particular, the addition of ‘Senior care workers’ and ‘Care workers’ to the shortage occupation list (on 27 January 2021 and 15 February 2022, respectively) allows people from other countries to apply for these jobs, with a licensed UK employer and if eligible for a Health and Care Visa.

Recent announcements on immigration policy mean that from early 2024 (exact date to be confirmed at time of writing), Health and Care Visa holders arriving in the UK after that time will no longer be able to bring their dependants with them Health and Care Visa holders who are already in the UK can bring dependants whilst on their current visa.

As part of our recent research to understand the impact of the Health and Care visa system on the adult social care workforce in England, we spoke to 29 internationally recruited care workers and dependants, as well as 22 social care providers, 8 brokerage agencies and 15 sector skills experts, who shared their views and experiences with us. Continue reading