A matter of life or death: A rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care

Caroline Emmer De Albuquerque Green, NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, introduces a new report on what Safeguarding Adult Reviews tell us about mental health social care services for adults in London. The report was co-authored with Unit Director Prof Jill Manthorpe and Research Fellow Stephen Martineau. (500 words)

Safeguarding Adult Reviews show that social care can be a matter of life or death when it comes to people experiencing mental health problems. In this new report we focus on a sample of Reviews that bear witness to the sad cases of people who may have been needing or using social care services to support them with mental health problems but who died or had been harmed and where multi-agency working was explored by the Review process. As with all such Reviews, they are designed to help learning and so improve individuals’ care and systems.

Our report ‘A matter of life or death: A rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care under a new Mental Health Act’ was commissioned by LondonADASS (Association of Directors of Adult Social Services). We amplified the learning from Safeguarding Adult Reviews published across all London Councils between 2017 and 2020 and also consulted Coroners’ Reports to Prevent Future Deaths. Our analysis is being used by LondonADASS to inform debates about the proposed new Mental Health Act, where, curiously safeguarding appears to be overlooked.

Our research suggests that there are specific groups of people who require particular attention when it comes to improving adult social care for people with mental health problems. There are also two major problem areas: first, professional knowledge and use of the Mental Capacity Act 2005 and second, inter-agency working and communication. These are really important now but also give some ideas for people working on training and implementation of mental health and mental capacity law and practice. We recommend other areas where local councils and other groups could be creative in taking forward professional practice. These include more attention to knowing the risks of pressure ulcers, looking at Coroners’ recommendations that are sent to mental health services, generally in the NHS, and taking the opportunity to discuss good practice as well as learning from when things did not go well. We also make suggestions for the authors and commissioners of Safeguarding Adult Reviews around collecting better information and keeping an eye on the implementation of recommendations.

Elaine Allegretti, Director of People & Resilience, London Borough of Barking and Dagenham, who is LondonADASS’ Mental Health lead provided the foreword to our report. She said: ‘This report is the first of its kind to use these two data sources together to identify recommendations to improve the wellbeing of those with mental health problems in London and to highlight that safeguarding must be part of social care support for people experiencing poor mental health. Any new mental health law must include safeguarding of the rights of people with mental health problems from neglect, abuse and exploitation’. We will be working with LondonADASS to track the response to our recommendations. This study is part of our programme of research that is responding to the priorities in South London through strong collaboration with local councils, providers, practitioners and people using social care services and carers (the NIHR Applied Research Collaboration).

Caroline Emmer De Albuquerque Green is NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce.

Emmer De Albuquerque Green, C, Manthorpe, J & Martineau, S (2021) A matter of life or death: a rapid review assessment of London’s safeguarding adults reviews to inform the future of mental health adult social care under a new Mental Health Act. NIHR Applied Research Collaboration South London; NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London, London.

Promoting the Health of Women Working in Home Care: towards an inclusive Women’s Health Strategy

Caroline Emmer De Albuquerque Green, NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, introduces a new report on the promotion of the health of women working in home care, which she co-authored with Unit Director Prof Jill Manthorpe.

Women make up the majority of the home care workforce. They provide essential support to people in the community with social care needs. But, the specific health needs of women working in home care have largely gone unrecognised and unmet. The health of home care workers is not just of interest at times of pandemic; it matters in addressing staff turnover, continuity of care for their clients, sickness absences but also the long-term impact on women’s later lives.

In our report, Submission of evidence on the specific health needs of women in the adult social care workforce in London with a focus on home care workers, we summarised what is known about the specific health needs of women working in home care. The report is co-produced with the assistance of the Proud to Care Board of the Association of Directors of Adult Social Services (ADASS) London which includes home care providers, London Boroughs and other stakeholders.

We submitted it as evidence to the Department of Health and Social Care’s consultation on a new Women’s Health strategy. From what is known, we concluded the following points to consider in such a new strategy:

  • Research is needed to see how home care occupations can be health-enhancing not health damaging. How can risks be minimised and positive aspects of the work amplified? Serious consideration should be given to the health of the social care workforce in any reform of adult social care and workforce health and wellbeing should be emphasised in this and in the proposed Women’s Health Strategy.
  • London’s home care workforce offers much learning for other places and sectors. The majority are not UK born and are from an ethnic minority; if we get women’s health right for them then we will have learned much about addressing inequalities and how to ‘level up’.
  • As well as addressing specific health problems, multiple problems or long-term conditions need to be recognised in any Strategy.
  • Coronavirus pandemic support will need to be long-term for people who are in work, need to change their work and who may contribute to society in other ways.
  • The Strategy needs to address why social care systems are so reliant on zero-hour contracts and acknowledge their health impacts so that it can support changes that are more health enhancing for women, and others.
  •  A Women’s Health Strategy could support dementia prevention but also needs to support the largely female dementia care workforce by acknowledging its skills and needs for recognition, reward and further work-related capacity building.
  • The pandemic highlights the urgency of answering questions around specific health needs and behaviours of women in adult social care from non-white ethnic backgrounds. Consultation on the ‘right’ questions and approaches should involve care workers, and managers.
  • More specific evidence is needed on the impacts of the pandemic on the health and wellbeing of women working in adult social care generally and in home care specifically to inform any future crisis but also recovery from the pandemic.
  • The impact of Long Covid on home care workers needs exploring so that effective support and readjustment can be offered. Data from Wales (linking individual health records and home care worker registration) are likely to be useful in the Covid-19 period but also subsequently for policy makers and employers.
  • The Strategy must build on the evidence to best support women working in the sector to receive the Covid-19 and other vaccinations for their protection against the on-going health threats of viruses and other infections.

The full report is available to download here.

Caroline Emmer De Albuquerque Green is NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce.

Workforce planning in the NHS – it is a kludge

Richard Griffin MBE is Professor of Healthcare Management, King’s Business School. (740 words)

Many years ago, I worked for an NHS Workforce Development Confederation (WDC), that had just been merged with a Strategic Health Authority (SHA). A few months into my role as Director of Education, a colleague asked me a question that has stuck with me ever since. “Who” she said, “owns workforce in the NHS?” A very good question. (1)

Consider the current situation. Is it the Department of Health and Social Care, or Health Education England, or NHS England and Improvement?  Where do Public Health England, Skills for Health or NHS Employers or the Social Partnership Forum fit in? They all have roles. What about regional People Boards? How about Integrated Care System (ICS) People Boards? Or the workforce leads in Primary Care Networks? In Trusts is it HR, or clinical leads like Directors of Nursing or the Learning and Development? It gets even more complex when you consider individual occupations like maternity, where you have Local Maternity Systems, or Allied Health Professions, where you have Councils and Faculties.

From pre-employment to careers information, apprenticeships and beyond, all these bodies are doing good things but not always together. Also, there is no single NHS workforce plan – it is spread across numerous policy documents from the People Plans to the latest Operating Guidance.

Frankly, it is all a bit of a “kludge”. Continue reading

At the Association for Professional Declutterers and Organisers annual conference

Jen OwenJen Owen is a Research Associate at the NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London. (482 words)

Unit researcher Jen Owen virtually attended the Association for Professional Declutterers and Organisers (APDO) annual conference on 20th May 2021. APDO represents the UK decluttering and organising industry. Founded in 2004, it now has a community of over 400 professionals across the UK.

Caroline Rogers started off the day with a presentation based on her recent paper ‘Home and the extended-self: Exploring associations between clutter and wellbeing’. As a Professional Organiser herself, Caroline was motivated to study for a MSc in Applied Positive Psychology and Coaching Psychology, to see if the positive wellbeing outcomes of being on top of clutter she noticed in her clients were universal. Her presentation outlined the current significant gap in literature on clutter, and how she went about exploring the associations between home self-extension variables (subjective clutter, objective clutter, home self-expression and declutter habit) and wellbeing (measured quantitively through the PERMA model). Her findings challenge existing theories of clutter as being maladaptive, instead drawing attention to its subjective nature, and offer a refined definition of clutter as “A subjective experience of possessions (material or other) that inhibits the curation of self-identity at home”.

Caroline is the founder of the UK Clutter Research Group – a cross-disciplinary group of academics in human geography, sociology, economics, social care, and psychology – of which Jen is a member. We meet quarterly to report on research developments and share findings. If you are interested in attending, please contact Caroline directly.

Amongst other presentations in the afternoon, Wendy Hanes and Angela Esnouf, of Hoarding Home Solutions in Australia, presented on ‘Managing Hoarding in COVID times’. Drawing on their experience of working with and providing training to, the Australian Department of Families, Fairness and Housing, during lockdown restrictions, they shared the things they learnt, and the strategies they used to help keep people engaged, motivated, safe, and on track during this difficult time.

They outlined specific practical examples for building respectful trusting relationships, using assessment tools to identify risk and encourage targeted activities to improve safety in the home, and providing avenues for people to seek support that may help them stay motivated and accountable.

Jen is a part of a team in the Unit working on the NIHR School for Social Care Research funded project ‘Social care responses to self-neglect and hoarding among older people: what works in practice?’. Working in six sites in England, we will be conducting interviews with safeguarding managers, practitioners, service users and family members. As part of this we intend to examine local referral pathways, practice approaches, inter-professional/agency working, and the use of specialised agencies such as hoarding services. The insights gained from attending this conference reinforce the need for this research, and also avenues for future research on services supporting older people with clutter.

This was my first time attending the APDO Annual Conference, and given the Association’s strong links with research into clutter and hoarding I will certainly attend again next year.

Jen Owen is a Research Associate at the NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London.

How Discharge to Assess (D2A) Can Work for Homeless Patients

Senior Research Fellow, Dr Michelle Cornes, has been working with NHS England and Improvement on the new Discharge to Assess (D2A) practice guidance, identifying good practice examples that illustrate how this new hospital discharge policy can work effectively for patients who are homeless. Here she provides one example from Cornwall Council. (302 words)

Specialist D2A Reablement for People who are Homeless  

Hospital Discharge Service Case Study – KA (Harbour Housing)

Cornwall Council working in partnership with Harbour Housing and Stay at Home have redesigned their out of hospital care services to increase the number of options available to homeless patients leaving hospital on D2A Pathways. For those patients who do not have a home and require more than just a sign-posting service, Harbour Housing provides access to six self-contained units of accessible step-down accommodation. This comes with onsite practical support such as helping people to get to their hospital appointments, as well as holistic ‘enrichment support’ for improved health and wellbeing including counselling and a range of strengths-based activities. Where people have care and support needs including self-neglect and issues linked to drug and alcohol use, a specialist reablement service is provided for up to six weeks. The Stay at Home service provides CQC regulated activities into the step-down accommodation and into the community. Specialist reablement workers are trained in the use trauma informed approaches and can for example, deliver Naloxone to prevent drug related deaths from overdose. During the reablement period, permanent housing is arranged and where necessary a Care Act 2014 assessment is carried out to identify needs for any longer-term care and support. Before these specialist D2A services were in place homeless patients would usually have stayed in hospital for long periods (sometimes up to six weeks) while waiting for various care and housing assessments to be completed.

Hospital Discharge Service Case Study – KA (Harbour Housing)

Dr Michelle Cornes is Senior Research Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London.

Caring in company: a pre-Covid snapshot of day centres in south London 

Dr Caroline Green and Dr Katharine Orellana are Post-Doctoral Fellows, National Institute for Health Research Applied Research Collaboration South London. (346 words)

Day centres can be a lifeline for some people. Day centres offer activities, meals and a place to connect with others. At the ARC South London, we wanted to find out more about what kinds of day centres are on offer in this part of London and how they operate. We searched the internet for day centres for older people, people living with dementia, people with disabilities and long-term conditions or palliative care needs and people experiencing homelessness across four boroughs of south London.

Our key findings were the following:

  • It was really difficult to find information on day centres even when online (e.g. Google) and in local directories and on social prescribing websites or databases. Information about day services for older people and people living with dementia seemed the hardest to find.
  • Some online information about day services is out of date (sometimes a day centre has closed), and important details are not always available. Fewer than half the websites we investigated specified day centre aims so readers are not able to see what they offer. Many websites did not explain what people would need to do to start using a centre, or provide information about how many people could attend, what charges would be made, or if the building is suitable for people with physical disabilities.
  • Information needs to be more accessible. Potential service users, their carers, and potential volunteers, need to be able to find and use information on day services. New funding is available to employ social prescribers, but they and other link workers need accurate information about local services fi they are to ‘prescribe’ social activities to the right people in the right places. Those supporting students (e.g. studying social work, social care and occupational therapy) looking for placements need accurate information about local services that may be able to help develop the skills of the next generations of health and social care workers

The full report of our mapping is here: Caring in company: a pre-Covid Snapshot of day centres in south London

See more about our work on the Social Care Theme in ARC South London

Please send any feedback or comments to: Katharine.Orellana@kcl.ac.uk.

This project is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Continuing to work through the COVID-19 pandemic and beyond: your views needed

As COVID-19 related restrictions begin to ease across the United Kingdom and vaccination is rolling out, it is important that our health and social care workforce is fully supported, contributes to new thinking about work practices, and is involved with planning for any future crises.


COVID-19 was a period of major changes in services, risk management and working practices. But it is not just one period – there were different waves and different pressures. We are exploring the health and wellbeing of frontline social care workers, social workers, nurses, midwives, and Allied Healthcare Professionals (AHPs) across the UK to formulate recommendations based on their experiences. The unique part of our study is that we are reaching a wide range of staff, in different settings, and have collected evidence from two previous surveys. In mid-May 2021 we launch our third survey – and need as many responses as possible.

Earlier findings

Our two previous surveys produced valuable findings from the 3,500 respondents to each. The first took place from May to July 2020 and the second from November 2020 to January 2021. We found that overall well-being and work-related quality of life decreased across the workforce when we compared the two survey results. People were using used more negative coping strategies (e.g. venting, self-blame) to deal with increased work-related stressors rather than positive coping strategies (active coping, planning, emotional support). Our second survey found three-quarters of our respondents were experiencing moderate to high levels of personal burnout (74.7%) and two-thirds work-related burnout (66.3.%).

From both surveys we developed a set of recommendations for employers and policy makers. We grouped them under Changing Conditions, Connections and Communication. The full reports from the first and second surveys, including the Summaries with Good Practice Guidance, are on our website www.hscworkforcestudy.co.uk.

Current study

We have now reached the time for the third survey (May-July 2021) when we are once again examining the quality of working life, mental well-being, burnout and coping of nurses, midwives, AHPs, social care workers and social workers. Some are working in a largely post-pandemic phase but many others are still working with the impact of the virus as it affects service users, residents and patients. Our aim is to further explore work changes over the last six months as restrictions begin to ease. The findings from this survey will help provide data which employers can use to make evidence informed, organisational level policy adjustments to support their workforce during COVID-19 and beyond.

If you are a social care worker, social worker, nurse, midwife or AHP, who is currently employed (this includes working as an agency/bank worker) or self-employed in the UK during the COVID-19 pandemic then please share your experiences with us by completing our short survey. Please click on the survey link below or scan the QR code for further information on the study and the questionnaire to complete. It just takes around 15 minutes to complete. We would be delighted to hear from you.


For more information about this research, please contact Paula McFadden on p.mcfadden@ulster.ac.uk or Patricia Gillen on p.gillen@ulster.ac.uk or Jill Manthorpe jill.manthorpe@kcl.ac.uk. Ethical approval has been given to the study and all responses are confidential.

The research team thanks everybody who responded to the two earlier surveys and all the many organisations across the UK that have promoted and contributed to this study. This research is partly funded by the National Institute for Health Research (NIHR) Policy Research Programme, through the Policy Research Unit in Health and Social Care Workforce, PR-PRU-1217-21202. The views expressed in the reports are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Towards a UN Convention on the Rights of Older Persons: 11th session of the Open-Ended Working Group on Ageing 29.03-01.04.2021 

Caroline Green is Post-Doctoral Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London. In December 2020, Caroline released a Human Rights toolkit as a means of reflecting on human rights in the context of social care. (218 words)

The COVID-19 pandemic has unleashed unprecedented concern over the treatment and rights of older people in societies globally. It has highlighted levels of structural and institutionalised ageism in addition to numerous issues that are in violation of the human rights and freedoms of individuals who are older. Calls have thus grown louder to adopt a UN Convention on the Rights of Older Persons. Its purpose could be to provide a legal human rights framework tailored to specific issues concerning older age groups as a powerful tool for change.

United Nations headquarters in New York, seen from the East River.

To discuss the possibility of such a Convention, delegates from around the world will meet between the 29.03 and the 01.04.2021 at the UN Headquarters in New York for the 11th session of the UN Open-Ended Working Group on Ageing. It will include a virtual element and will be accessible to follow on UN TV and open to all – no registration needed. The address to access this will be: webtv.un.org. More details about the hearing are available at: bit.ly/OEWG11_OlderPersonsRights. Additional info about this process is available via the UN website – specifically on the Open-Ended Working Group on Ageing part of the site. This is available via: https://social.un.org/ageing-working-group/ – then follow Eleventh Session tab for more info/documents relevant to the hearing.

Caroline Green is Post-Doctoral Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London. In December 2020, Caroline released a Human Rights toolkit as a means of reflecting on human rights in the context of social care.

HOPES 2 study launches! Helping older people with mental health needs to engage with social care

The HOPES 2 study commences this month. Led from the University of York by Dr Louise Newbould and Dr Mark Wilberforce, the project’s full title is ‘Helping older people with mental health needs to engage with social care: Enhancing support worker skills through a prototype learning and development intervention’. Dr Kritika Samsi, Research Fellow at this Unit, is also working on the study, which is funded by the NIHR School for Social Care Research. (542 words)

This project is about the care of older people living with dementia and complex mental health needs. Many studies show that outside help can be hard to accept for people living with poor mental health or memory difficulties. Understanding the purpose of care and communicating any worries can be hard. Sometimes people will reject the care verbally or physically, which can result in them being labelled as a ‘difficult person’. Providing care in these situations can be hard, when home care workers are under pressure to deliver care in often short timeframes. As a result, relationships between the individuals and service providers can sometimes fall apart. Our previous research suggests that “specialist support workers” within community mental health services may help older people living with dementia or with complex mental health needs to accept social care. However, these specialist support workers often say that they do not have the chance to learn or share knowledge, strategies and skills between themselves.

Our earlier research also found that the training available is often unsuitable for this group of workers because it is either too basic and does not account for their specialist knowledge from their experience in mental health work; or else too advanced as it expects them to have professional qualifications. The aim of this study is to develop a way of helping support workers to share and develop their knowledge of ways of reducing resistance to care. This will be based on what we are currently learning in the ‘Helping Older People Engage in Social care project’ (or ‘HOPES 1’).

The learning will be designed following three stages:

1) Describing what the new learning will include: We will examine what has already been written about developing learning for support workers, particularly what we know about its content and structure. We will also speak to practitioners in this area to ask them what should be included in the learning, how it should be delivered and what format it should take.

2) Co-producing the learning: We will combine the findings from (1), together with learning from the HOPES 1 study, to create a new learning resource. This will be achieved through a workshop with practitioners in support work, and through discussions with service users. Follow-up interviews will allow further detailed work on what we have learned.

3) Delivering the learning: The learning will be delivered in at least one site. This will allow us to see how this works in real situations. We will explore in more depth how people feel about delivering and receiving this intervention. This will allow us to develop the learning further. By the end of this short study we will have a prototype of this learning intervention which we can make available to the social care and mental health care sectors. If the initial delivery of the intervention and prototype are found to be suitable during this project we will then conduct a more in-depth evaluation.

The HOPES 2 Study, Helping older people with mental health needs to engage with social care: Enhancing support worker skills through a prototype learning and development intervention, is led by Dr Louise Newbould and Dr Mark Wilberforce (University of York) with Dr Kritika Samsi (HSCWRU), Gill Gregory, Ewan King, Wendy Mitchell, and David Niman.

It is funded by the NIHR School for Social Care Research.

Women’s activism across generations and the globe in the time of Covid

Dr Valerie Lipman is Honorary Research Fellow and Chair of the Patient and Public Involvement and Engagement Advisory Group at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London.[i] (1,198 words)

We celebrate International Women’s Day 2021 with a story of an intergenerational project between young girls and older women in West Bengal, India and their global links with European feminists. As a result of the extraordinary determination and struggle of a group of girls, over a hundred homeless older women living in cyclone flooded and Covid-affected villages in the Bay of Bengal region, India will be moving into homes which have been especially designed and built for them.

In May last year the Amphan Cyclone in the Sundarbans in West Bengal wrought destruction in this area not witnessed for about 50 years. Already reeling from the Covid pandemic, thousands of people lost their livelihoods, homes and lives. Families were destroyed and as a local worker said: ‘The old village tradition of living with each other together has now become a fairy tale’.  Older people were left isolated with no one to look after them and older women who have no rights to land ownership or their own housing in this area, were left particularly stranded. The commonly held view locally was to prioritise those struggling to support their younger families, rather than help people nearing the end of their lives. Continue reading