Oh, to be in Finland now that spring is here

James Fuller reports on the ‘Housing First: Ending homelessness across Finland and the UK’ seminar at the Finnish Ambassador’s residence in London, 6 March 2019. The event was organised in co-operation with the Finnish Institute in London and Crisis UK. (1,070 words)

Kensington Palace Gardens, or Ambassadors Avenue as it might as well be called, is a private, heavily guarded boulevard nestled behind the sedate royal dwelling from which it takes its name that is packed with official residences. Not an obvious venue for a series of presentations, organised by the Finnish Institute, about how to house some of the most marginalised and multiply excluded members of society, even if the Finnish building is typically modest.

After a brief word from the Ambassador and the same from Jon Sparkes, Chief Executive of Crisis, we heard from Anita Birchall, Head of the Threshold Housing Project, a specialist housing first, five-year pilot project working with female homeless ex-offenders. As is generally the case for such pilots, Anita reeled off a succession of impressive outcomes for the fifty or so residents THP is helping, although she was clearly anxious about the renewal of her funding, as the end of term is fast approaching. She also revealed that whilst it had been possible to house people within about four weeks during the early stages of the pilot, at present it takes some 71 days on average. This is frustrating for her team, she said and is causing some distress to users of the service, who imagine an application will lead almost directly to accommodation. The idea that this is a ‘from the prison gate’ operation is way short of the mark. Continue reading

2019 – a year of change for gambling in the UK?

Stephanie Bramley is a Research Associate at the NIHR Health and Social Care Workforce Research Unit, King’s College London. (801 words)

It is only the middle of March and the Unit has submitted responses to three consultations about gambling.

This month we submitted a response to the All-Party Parliamentary Group (APPG) on gambling-related harm (Bramley, Manthorpe & Norrie, 2019a). This Group was previously the APPG on fixed-odds betting terminals (FOBTs) and following the success that it had with reducing the stake on FOBTs from £100 to £2 per spin, the Group has decided to conduct an inquiry into the impacts of online gambling (Gambling-related harm APPG, no date). Continue reading

Older People’s Health and Social Care: LIVING WITH CHOICE & CONTROL?

Dr Joan RapaportVisiting Research Fellow at the NIHR Health and Social Care Workforce Research Unit, Dr Joan Rapaport, reports from the 11th Annual Joint Conference from Age UK London and NIHR HSCWRU and Making Research Count (MRC) at King’s College London. It was held on 7 March 2019 at the Guy’s campus of King’s. On Twitter: #olderpeople11 (3,328 words)

Welcome

Joint chairs Professor Jill Manthorpe, Director of HSCWRU, and Paul Goulden, CEO of Age UK London welcomed nearly 100 people to the 11th Annual Joint Conference. The packed room included social workers, health care workers, researchers, and a diverse cross-section of ageing activists, users of services and their family carers, drawn from London’s older population.

Paul was pleased to report that since the last conference that London had signed up to the World Health Organization’s ‘Global Network of Age-friendly Cities and Communities’. Network members are committed to promoting healthy and active ageing and a good quality of life for older people. Many of the presentations and debates during the day addressed aspects of this theme. Continue reading

Promoting the importance of human relationships: hospital social work

Jo Moriarty, Senior Research Fellow at the NIHR Health & Social Care Workforce Research Unit, King’s College London introduces the new hospital social work report, which she wrote with Dr Nicole Steils and Prof Jill Manthorpe. World Social Work Day is on 19 March 2019 #WSWD2019 is the official hashtag. (602 words)

Mapping Hospital Social WorkThe theme for next week’s World Social Work Day is ‘promoting the importance of human relationships.’  In preparation for this we are launching our report into hospital social work, which was funded by the National Institute for Health Research Policy Research Programme at the request of the Chief Social Worker for Adults, Lyn Romeo.  Lyn has also kindly written the report’s foreword.

The origins of hospital social work lie in the decision made by the Royal Free Hospital in 1895 to appoint Mary Stewart as the first ‘lady almoner’. Her role was to interview people to decide who would be eligible for the free medical treatment that the hospital provided.  Other hospitals soon followed this example and by 1948, the Institute of Almoners had over 1000 active members.[1]  Written in the style of the time, Flora Beck’s textbook for almoners noted that their two key tasks were:

… to determine whether social problems are likely to have a bearing on the patient’s illness. The second is to make the patient feel that here is a person with whom he could, if necessary, discuss his personal difficulties; someone to whom he need not mind admitting any trivial misunderstanding which had been bothering him, and to whom he could reveal serious and confidential problems without embarrassment.[2, cited in 3] Continue reading

Viva Las Vegas! Observations about gambling from Las Vegas…

Stephanie Bramley is a Research Associate at the NIHR Health and Social Care Workforce Research Unit, King’s College London. (702 words)

Earlier this year I visited Las Vegas with two of my friends.  It was my first trip to Las Vegas and as a researcher who explores the impact of gambling for vulnerable people I was somewhat apprehensive about what I may see in Las Vegas.  However, the trip provided a good opportunity to explore gambling in ‘Sin City’.

The first thing that struck me was that gambling is synonymous with visiting hotels.  The majority of hotels in Las Vegas are ‘gaming hotels’ meaning that they have gambling facilities inside, typically a casino.  Indeed the casino is often central to hotel life – meaning that you often have to walk through a casino in order to visit any other part of the hotel.  For example, we stayed at the Paris Las Vegas whose check-in desks were situated off to the right-hand side of the casino floor. Furthermore, because of the location of the check-in desks it may be that children and young people may be exposed to gambling activities.  We did see a few families in the hotel who were visiting the hotel’s restaurants.  Although the official visitor statistics state that fewer children (classified as individuals under 21 years of age) visited Las Vegas in 2017 compared to 2016 (GLS Research, no date). Continue reading

Complexity, Homelessness and Addiction

Alan Kilmister (Peer Researcher and Expert by Experience with the Policy Institute’s Homeless Hospital Discharge Project) describes proceedings at recent conference organised by the London Drug and Alcohol Forum. (534 words)

Michelle Cornes with Alan Kilmister

I had the pleasure of attending the ‘Addressing Complexity: Homelessness and Addiction’ conference on Friday 18 January 2019 at the Guildhall in London. I arrived at this beautiful venue a little tired after my early start. My first train was at 06:24. However, a few cups of coffee soon warmed me up. It was an excellent event with a wide range of subjects and very good speakers. I was most impressed by the talk by Kevin Dooley (Recovery Programme Consultant) who at one time had been an armed robber, alcoholic and heroin addict with extensive experience of the ‘criminal justice system’! He spoke very truthfully and emotionally about his time on the streets and how when he was in prison his son had died, he received little in the way of compassion and understanding from the system. Some of the other people at the conference with lived experience commented how they were able to fully connect with what Kevin was saying especially with regard to the shame and stigma that goes hand in hand with homelessness and addiction. Kevin made the point that coming to events like these and talking about ‘our’ experiences takes that shame away. I am a firm believer in involving people with lived experience (“nothing about us without us”) and Kevin made the point that we were are still too few in numbers at events like these. The keynote address by Professor Alex Stevens also made this point, highlighting how, a structurally advantaged social group can dominate the cultural, intellectual landscape, while the people most affected by drug deaths have little say (or in the jargon “corporate agency”). I asked the expert panel in the morning session about this topic and there was consensus about the importance of involvement and engagement, and us all doing more to enable this.

I found the talk by Dr Steve Sharman who presented case studies of people’s experiences of homelessness and gambling very interesting. It reminded me of my time in a Hostel in Wolverhampton. A few of the clients living there were addicted to gambling and just around the corner from the Hostel was a big Casino. This made me wonder if they were addicted to gambling before becoming homeless or took to gambling after becoming homeless.

I found the street drinking in East London talk by Dr Allan Tyler interesting too and wondered about boundaries – would the researchers have learned more had they participated in the actual drinking? There was also a very good talk by our very own Dr Michelle Cornes ably assisted by Darren O’Shea and Jo Coombes.

Michelle presented a case study called the Gutter Frame challenge which tells of the barriers people have to overcome if they want to access services following discharge to the street.  Finally, I must also offer my compliments on the superb buffet provided at lunch time, and of course the chance for some networking too. This is really important for us, and I was thrilled to be approached by a research manager from a leading charity who invited me to join a new advisory group being set up on peer research. All in all, a very worthwhile and enjoyable day.

Alan Kilmister is a Peer Researcher and Expert by Experience with the Policy Institute’s Homeless Hospital Discharge Project

Getting the message about assistive technology and telecare: new guidance

John Woolham is Senior Research Fellow at the Social Care Workforce Research Unit, King’s College London. (592 words)

Last week I was invited to speak at the launch of ‘Help at Home – use of assistive technology got older people’ a review of current research evidence published by the National Institute for Health Research Dissemination Centre. My presentation discussed some of the findings from research I’d done last year as part of the NIHR School for Social Care Research funded UTOPIA project, which gets a mention in the review.

This review is timely and welcome. There has been considerable investment by local authorities in assistive technology and telecare at a time of unrelenting austerity. The research evidence to support this investment offers mixed messages, and local authority commissioners don’t have access to research findings, or even if they did, the time to read them. Worse, at least some of the information about telecare’s impact that is accessible is misleading. Local authorities are also under pressure: increasing demand for care and support, particularly from growing numbers of older people, and cuts to adult social care budgets that are unprecedented in their scale.

Is assistive technology and telecare the solution? Local authorities are keen to use it to promote independence, keep people living safely in their own homes and to reduce burdens facing family carers, which will, of course, also save money. These are all worthy objectives, but as the review suggests, more likely to be achieved by local authorities that pay good attention to the infrastructure within which assistive technology is used, rather than just the devices themselves.

The review makes the important point that much research in this field to-date appears to have focused on ‘high end digital technology’ rather than evaluating the impact of more basic technologies to help with everyday life; and more focus on the development of prototype technologies than real world testing. There are also some real challenges laid out for local authorities or other organisations that provide telecare services. For example, it reflects concerns by older people, highlighted in one international study that technology will be used as a substitute for hands on care. This is precisely what is happening in many local authorities in England at the present time. Another challenge from research is the suggestion that assessment and installation are seen as sequential one-off events (‘plug and play’) when getting the best out of it means seeing these as on-going processes, and that even simple technologies should be seen as a ‘complex intervention’. How does this compare with practices in hard pressed local authority adult social care departments at the present time?

Anyone working in this field or who is using, or thinking of using, technology, should find this report contains valuable insights, even if some of them are challenging. Research reviews can be dry-as-dust, of interest only to the scholarly or the assiduous and with little of value to care professionals. This review is readable and relevant. It offers clear summaries of current research evidence and there are also clear messages about what needs to happen for telecare to make an effective, optimal contribution towards the care and support of older people. It deserves to be widely read and for key messages to be addressed in practice.

John Woolham is Senior Research Fellow at the Social Care Workforce Research Unit, King’s College London. John’s presentation from the day.

The author’s own work, cited here, is independent research funded by the National Institute for Health Research School for Social Care Research. The views expressed in this blog post are those of the author and not necessarily those of the NIHR/SSCR, NHS, the National Institute for Health Research or the Department of Health and Social Care.

 

Resilience II: Older People and Social Care

Joan RapaportDr Joan Rapaport was inspired at a conference organized by the Social Care Workforce Research Unit at King’s College with London Age UK London and Making Research Count, that was also supported by the British Society of Gerontology. She provides her views of the event. Presentations are available on the conference website. (1,282 words)

In his welcome, Paul Goulden, Director of Age UK London explained that the conference was the second half of the Annual Joint Conference which had been held in March but was curtailed because of snow storms. This was indeed an event that had tested everyone’s resilience and explained why this conference was being held again thanks to the speakers and to the overall organizer, Jess Harris.

Paul Goulden, Daniel Webster, Lynne Phair and Dave Martin at the conference in Bloomsbury

Paul Goulden, Daniel Webster, Lynne Phair and Dave Martin at the conference held at Age UK London’s offices in Bloomsbury on 29 October

Using the Sit&See Tool to capture and celebrate Care and Compassion for Older People: Lynne Phair, Independent Consultant Nurse and Expert Witness

When investigating an allegation of hospital neglect, a manager had asked Lynne: ‘How do I know if staff are caring and compassionate?’ This started her on the road that ultimately led to the development of the Sit&See Tool, designed to capture care and compassion. Continue reading

‘Carelessness does more harm than a want of knowledge’ —Benjamin Franklin

Dr Mary BaginskyMary Baginsky is Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. (1,005 words)

I have been conducting research for more years than I am prepared to admit – sometimes to myself. Much of it has been qualitative in nature, although often as part of a mixed approach methodology. So quantitative data have helped to define the issues to be explored in more depth through interviews and focus groups, for example, or qualitative work has been used to help identify the issues that should be explored through a survey. I am used to weighing concepts such as reliability, validity and generalisability when designing and carrying out projects and reporting their findings, whatever their provenance. I am also as fallible as anyone in not seeing an inherent flaw – that is where the wisdom of colleagues and, however imperfect, the peer review process can be invaluable. However, my experiences of the past few years have given me cause for concern. In conducting a review of evidence on an area where I have been working I have been shocked by some of the things I have found. It has led me to wonder if I would find the same level of errors if I looked long enough in other papers, books and articles. Continue reading

Cameos of Care Homes: stories from social care Vanguards

Jess Harris is Research Fellow at the Social Care Workforce Research Unit, King’s College London. She led the Cameos of Care Homes project. (616 words)

Six ‘Vanguard’ areas across England have been developing approaches to enable care homes to better support the increasingly complex health needs of their residents. These six, focusing on ‘Enhanced Health in Care Homes’, were among 50 Vanguard pilot areas (2015 to 2018) tasked with developing models of care that can be sustained and replicated across England, helping the health and social care system tackle financial pressures and rising demands.

A recent National Audit Office (NAO) report has examined the Vanguards’ impact so far, in terms of value for money, and concluded: ‘there are early signs of a positive impact on emergency admissions’. However, at this early stage it cautions that ‘the longterm impact and sustainability of Vanguards is still not proven’. (page 47)

Staff members taking part in ‘Cameos of Care Homes’

Continue reading