Author Archives: Stephen Martineau

Complexity, Homelessness and Addiction

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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

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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

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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

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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

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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’

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Personalisation and older people – better outcomes?

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John Woolham is Senior Research Fellow at the Social Care Workforce Research Unit, King’s College London. (455 words)

On Friday 14 September I met with a small international delegation of Occupational Therapists who work in two hospitals in Hong Kong: Pamela Youde Nethersole Eastern Hospital, an Acute District General Hospital, and Kowloon Hospital, a slightly smaller institution which offers general care to people who have chronic health conditions. They were accompanied by Denise Forte, who works as a senior lecturer in gerontology at Kingston University and who had organised the itinerary of the group. I had been invited to talk to them about two topics about which they were keen to know more: personalisation for older people in England, and the role of social workers and social services in supporting older people. Though the group was small, which enabled the seminar to be very informal, I did prepare some slides which I used where necessary.

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Intergenerational event at Portcullis House

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Charlotte Bice (17 years) and Jessica Bice (16 years), with their grandmother, Joan Rapaport, PhD took part in an intergenerational workshop at Portcullis House, 24 August 2018. The afternoon involved discussing different approaches that the young and older generation may adopt to achieve a successful outcome in resolving community challenges. The event was presented by The Way Ahead Engagement Project in association with the City of London, City Bridge Trust and Age UK London. (400 words)

Reflections on the day

‘This has been an enjoyable event’. ‘Great day’. ‘Ninety-nine per cent of the population should have this’.

We were excited to be right by the Houses of Parliament, to be sitting in the room where Select Committees hear evidence and to be working in a group to consider how we might help to improve our local amenities. The presentation How Parliament holds Government to account gave us a clear understanding about the respective roles of Parliament and Government, the duties of our MP and the work undertaken by a range of parliamentary groups. We were also told that if our MP failed to respond to a particular concern we could attend the Houses of Parliament and register our query on a green card. Our MP would then be obliged to stop what they were doing to come to see us in person! Continue reading →

The Role of the AMHP: A Fool’s Errand?

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Caroline Norrie and Nicole Steils are researchers at the Social Care Workforce Research Unit (SCWRU), King’s College London. (618 words)

The identity of Approved Mental Health Professionals (AMHPs) was the subject of a joint SCWRU and Making Research Count seminar held on Thursday, 23 August 2018, at King’s College London (KCL) as part of the Contemporary Issues in Mental Health series.

Dr Caroline Leah

Dr Caroline Leah

The presenter, Dr Caroline Leah, Senior Lecturer at the Faculty of Health, Psychology and Social Care at Manchester Metropolitan University, discussed findings from her recently completed PhD about the role and identity of AMHPs, as well as enabling the audience, many being practising AMHPs, the chance to participate in lively discussions throughout the seminar.

An AMHP is a professional who is authorised to make certain legal decisions and applications under the Mental Health Act 1983; their powers include sectioning service users. This professional will usually be a social worker, who has undertaken additional training. In 2007, however, the law was amended to allow other mental health professionals to train for and to undertake this role. It is therefore now possible for psychiatric nurses, occupational therapists or psychologists to qualify as AMHPs, although this is still unusual. Continue reading →

Research reveals reasons for low take-up of Approved Mental Health Professional role

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Pay levels, poor awareness of the role, and a lack of associated career benefits all discourage health professionals from training and working as Approved Mental Health Professionals (AMHPs), according to new research by the NIHR Social Care Workforce Research Unit at King’s College London.

AMHP Final Report 2018Published today, Who wants to be an Approved Mental Health Professional?, finds that closer working between Mental Health Trusts and local authorities, higher remuneration and enhancing the reputation and profile of AMHP work would encourage more health professionals to take up such positions.

Greater engagement from the Royal Colleges of Nursing and Occupational Therapists, and the Nursing and Midwifery Council, may also make the AMHP role more attractive by helping to embed it in these health professionals’ career plans.

The research highlights how organisational barriers – such as difficulties in managing AMHPs across separate local authority and mental health trust teams – deter many health professionals from taking up the role.

The study consists of more than 50 interviews with individuals involved in AMHP services, as well as a survey of Local Authority AMHP Leads.

Unsurprisingly, health professionals interviewed for the research reported needing a high degree of motivation to become AMHPs, often having to overcome opposition from their managers. Some also feared being responsible for decisions to detain patients, which they thought would make it more difficult for them to establish and maintain therapeutic relationships. Continue reading →

At the 7th International Health Humanities Network Conference

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Dr Martin StevensMartin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit at King’s. (1,276 words)

I was pleased to be asked to chair a few sessions of this conference, on 2nd-4th August 2018, at St Mary’s Stadium, the home of Southampton Football Club. Overcoming the prejudice about all things Southampton inevitable in a Portsmouth resident, I have to admit it was a great venue.

This was the 7th International Health Humanities Network (IHHN) conference. The venue has alternated between the USA and Europe; this year the conference was run in collaboration with the Good Mental Health Cooperative and speakers and delegates came from the USA, Australia, Europe and Nigeria. The IHHN:

…provides a global platform for innovative humanities scholars, medical, health and social care professionals, voluntary sector workers and creative practitioners to join forces with informal and family carers, service-users and the wider self-caring public to explore, celebrate and develop new approaches in advancing health and wellbeing through the arts and humanities in hospitals, residential and community settings. (from the IHHN website)

St Mary's Stadium, Southampton

St Mary’s Stadium, Southampton

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