On best interests: values and participation in mental capacity law

Stephen Martineau is Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (1,115 words)

At the British Academy earlier this month, Dr Camillia Kong (Birkbeck College) and colleagues presented their end-of-project findings on the place of values and participation in mental capacity law. As well as contributions from the research team, the day featured a group of international experts, three Speak Out Leaders from VoiceAbility, and it culminated in a panel made up of four senior former judges: Baroness Hale of Richmond, Sir Mark Hedley, Senior Judge Denzil Lush, and District Judge Margaret Glentworth.

Participation and values

The event coincided with the launch of the second of two films produced by the project. The first, from 2021, had addressed the importance of good communication with the person at the centre of Court of Protection proceedings and discussed some of the ways of enabling their involvement (see particularly the ‘role-play’ at about 22 mins in). Three contributors in the film, Speak Out Leaders from VoiceAbility, took part in a panel at the event. The new film, Making Values Matter in the Court of Protection, includes a remarkable ‘demonstration’ of the exploration of a person’s values by a barrister engaging with the person and their father (from about 9 mins in). By modelling one way that requirements in the best interests checklist in s.4 Mental Capacity Act 2005 can be met, it provides a corrective to any notion that a finding of incapacity in respect of a decision amounts to an ‘off-switch’ for a person’s rights and freedoms.* Continue reading

New Roles at the Health, Housing and Social Care Interface – The Homeless Health Team Leader

The DHSC’s Out-of-Hospital Care Models Programme provided £16m of funding to 17 test sites across England to improve discharge arrangements for people experiencing homelessness. The programme affords opportunities to develop new services and workforce roles that aim to integrate health, housing and social care at key transition points. In this blog, Shevon Simon describes her work as a ‘Homeless Health Team Leader’ at the Princess Royal University Hospital in South East London. 

What is your job role?

In my new role as Homeless Health Team Leader, I am assigned to PRUH (Princess Royal University Hospital) in South East London to support the hospital with facilitating the discharge of homeless patients – primarily the discharge of single homeless people with complex needs. I am also responsible for developing discharge pathways and upskilling Discharge Teams to understand key homelessness legislation.

Can you tell us about why your role is needed?

My background is in local authority homelessness assessments and 14 years ago people rarely presented as homeless with more than one medical condition.

Today, many people have more than one condition – so they are multi-symptomatic and this in itself creates complexities around health management and means that they are sicker than in earlier times. In addition, chronic homelessness usually features at least three multiple long-term conditions – meaning people are more likely to suffer mental health problems, physical health problems and substance misuse and are not accessing the health services they need. COVID–19 and multiple lockdowns have not helped with healthcare accessibility, with many services not being as accessible as they were prior to the first lockdown in March 2020. Two years on and most local authority housing departments are still closed for face-to-face/office appointments, requiring patients to complete lengthy online forms or telephone assessments. As you can imagine, this is a huge barrier for someone who is homeless. Continue reading

Martin Stevens

Our colleague Martin Stevens, who has died aged 57, was Senior Research Fellow here at the NIHR Policy Research Unit in Health and Social Care Workforce. Martin joined our Unit’s predecessor at King’s, the Social Care Workforce Research Unit in 2004, and for 18 years he was a central figure within the team.

Martin’s first research post was at Hampshire Social Services Department, where he undertook work on community care, child protection and learning disability services, and completed his PhD (University of Portsmouth) on family group conferences. His BA had been in philosophy at the University of Southampton, following which he had worked for five years in a residential service for people with learning disabilities. He also gained an MSc in social research.

At King’s, Martin developed his research expertise in adult safeguarding, personalisation and learning disability services – and is widely published in these fields. His interest in learning disabilities services and their workforces led to his convening our popular seminar series on the topic – this has been running since 2014 and will continue, with three more webinars already planned for 2022.

During his research career he chaired the UK Social Services Research Group and led on social care for the Local Area Research and Intelligence Association. And since 2019 he had been advising other researchers, both new and old to research, in the setting up of studies at the NIHR Research Design Service.

He was, until recently, chair of the Health Research Authority Social Care Research Ethics Committee. As colleagues we benefited hugely from his expertise in this area. Whether seeking initial ethical approval for projects or dealing with problems as studies unfolded, Martin was always humane and empathic. One felt his interest in philosophy at these times. He was also a union member and encouraged others to value the union, as part of a wider commitment to social justice.

Latterly, Martin’s research had a focus on mental health, leading two projects on the professionals who work with the Mental Health Act, both commissioned by the Department of Health and Social Care. He remained the chair of the Good Mental Health Co-operative Committee up until his death.

We will all miss Martin greatly as a funny, talented and generous colleague.

Martin Stevens, 18 April 1964 – 21 March 2022

If you wish to share your memories of Martin, please add them below (comments are moderated, so will not publish immediately).

And, on Twitter, see the replies to tweets by: this Research Unit | NIHR School for Social Care Research | Prof Jill Manthorpe. See also: Other Lives (by John Woolham in The Guardian, 21 April 2022).

Exploring the effects of the rise of living costs on small to medium sized care home providers and care professionals

Head and shoulders of a person

Dr Caroline Emmer De Albuquerque Green, Post-Doctoral Fellow at the ARC South London, introduces a new study. Caroline works within the NIHR Applied Research Collaboration South London: Social Care Theme at HSCWRU.

 

Our work is to care for the most vulnerable in society and after the pandemic… [the costs of living crisis] is more reason why providers will be closing homes” (A small care home provider)

The United Kingdom (UK) is currently experiencing the steepest rise of inflation in the past 30 years. Consumer prices in February 2022 were 6.2% higher compared to the previous year. The Bank of England estimates that inflation may rise to 9% in 2022 (Francis-Devine et al. 2022 Rising cost of living in the UK – House of Commons Library (parliament.uk)). For people living in the UK, this means increased costs of living, including fuel, energy and food prices. This is also the case for care homes and people working in them, which next to the rise of living costs are still facing Covid-19 related restrictions, staff shortages as well as further rises in operational costs and taxes. Continue reading

Action not words: Race Equality Week 2022

Adele van Wyk, social worker and PhD student at University of Edinburgh, reports from Race Equality Week, which is run by London ADASS and supported by the ARC South London Social Care Theme (based at the NIHR Policy Research Unit in Health and Social Care Workforce). (985 words)

The London Association of Directors of Adult Social Services (London ADASS) presented a series of online luncheons as part of its Race Equality Week (7-13 February 2022). In this blog, I reflect on the Thursday lunchtime conversation (10 February), attended by 122 practitioners and managers from a wide range of social care services, which focused on cultural competence in adult social care. In the first section, I share some of my thoughts about the key points made about cultural competence, and in the second, some thoughts about spirituality in care homes.

# Culture is a strength and an asset. Fact: It might be, but it might not.

# All members of a culture subscribe to the same values. Fact: Not everybody is interested in having kosher food or going to the prayer room. Some people stay away from religious celebrations but enjoy the cultural associations with religion.

# People from Asian and black African backgrounds have big extended families supporting themFact: This might be true for some, but for many it is not. Continue reading

Is the legal tail wagging the social work dog?

Mary Baginsky, Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, introduces the paper given by Martha Cover recently at the Unit. Dr Baginsky convenes the seminar series where the paper was presented.

We were delighted that Martha Cover led our latest seminar in the Contemporary Issues & Debates in Social Work Education, Research and Practice on 18 January 2022.  Martha is a very experienced child law barrister who has considerable experience representing parents and children in cases of serious injury and death. Until recently she was joint head of Coram Chambers.

Martha writes on this subject, and regularly gives television and radio interviews and has given evidence to parliamentary select committees.

She was legal aid barrister of the year in 2019 and has recently been given an honorary doctorate in Law by Queen Mary University of London.—Mary Baginsky

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Is the legal tail wagging the social work dog?

Martha Cover

Martha Cover

Martha Cover

What I do not propose to do in this talk is to enter into the debate about whether the “right” number of children are in care, or whether there are too many or too few – or whether they are in fact the “right” children. To set the scene, as of March 2021, there were 80,850 children in care in England. The great majority were the subject of section 31 care orders rather than voluntarily accommodated under section 20 Children Act 1989.

I want to travel upstream from that and ask the question: with legal processes and court requirements becoming more dominant, is there an unintended consequence that social work is now focussed from the start on court requirements, and proving the section 31 threshold? If that is right, then is there any room in frontline social work for open and supportive relationships with children and their families?

The idea for this topic germinated when reading some government research following the institution of the 26-week time limit for care proceedings, introduced by the Children and Families Act 2014.  In August 2015, the Department for Education published “Impact of the Family Justice Reforms on Front-Line Practice: The Public Law Outline”. The research examined the impact of the changes in the PLO on front line practice. It quotes a social worker:

“As soon as we have a case that we know may meet threshold, straight away we start doing pre-proceedings work- family group conference, viability assessments, more comprehensive chronology, exploring extended family members,…. doing any assessments that need to be done……” Continue reading

The Gallery of Spiritualities – welcome to a new exhibition in a care home

olivia luijnenburgOlivia Luijnenburg is a Research Associate in King’s College London’s NIHR Policy Research Unit in Health and Social Care Workforce. (460 words)

What is ‘spirituality’ in care? How can care home staff attend to residents’ spiritual needs? For my PhD project, I had the task of finding answers to such questions. When thinking about spirituality and spiritual needs, many people’s minds immediately go to religion and religious needs. However, what about care home residents who do not practice a religion or are not part of a religious community? We know that spiritual wellbeing is found through a sense of community, connection, nature, or the arts, which can but does not have to be of a religious nature. Surprisingly, the spiritual needs of older people in residential care have often been overlooked.

To address the lack of knowledge around spirituality in care and illuminate the intangibility of what spiritual needs might look like, I collected ‘artefacts’ from care home residents before talking with them. These could be an object, a space, a song, a person, or anything else that represented a sense of joy, peace, safety, or fond memories for the person. The ‘artefacts’ functioned as a conversation starter, as well as a stimulant to the imagination of what ‘spirituality’ might mean to the participant. They were photographed and collected in a ‘Gallery of Spiritualities’. Continue reading

Improving professional decision-making in situations of risk and uncertainty: a pilot intervention

Dr Mary Baginsky

Mary Baginsky

Dr Mary Baginsky,Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, reflects on our seminar led, online, by Professor Cheryl Regehr on 28 September 2021. (763 words)

Professor Cheryl Regehr is Provost and Vice-President for the University of Toronto and former Dean of the Factor-Inwentash Faculty of Social Work. She is also a Visiting Professor at our Unit this term. We were delighted that she agreed to lead a seminar that focused on her recent work. In this she explained how the Social Sciences and Humanities Research Council (SSHRC) of Canada has supported a number of her recent research projects that have examined stress, trauma and decision-making in social work (see examples below). The aim is to develop a new model for improving decision-making in situations of high-risk to reach a better understanding of the factors that drive decision-making in these situations. Professor Regehr and her team piloted a new approach for improving professional decision-making. The researchers examined biological, emotional, cognitive and contextual influences and this involved measuring social workers’ heart rates and recording their reflections on the decisions they had taken at specific times. The participants were able to link their emotional responses to the points at which they had been under physical stress. By raising their awareness to the relationship between their physiological responses and their automatic responses to the decisions they made the intention was to help them move towards more deliberate decision-making. Continue reading

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 Adults 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. Continue reading

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: Continue reading