Towards a new national learning disability employment strategy

Posted on September 29, 2014 by

Stephen Martineau is a researcher at the Social Care Workforce Research Unit in the Policy Institute at King’s. (782 words)

There is a flurry of policy activity in the field of learning disabilities and employment at the moment. Last Wednesday’s Summit on the topic, hosted by the British Institute of Learning Disabilities (BILD) in Birmingham, followed close on the heels of a run of associated consultation events. Led by a Department for Work and Pensions (DWP) civil servant, with the Department of Health (DH) also in the room, the focus of the meeting was a new national learning disability employment strategy. This is to be in final draft form by November, with a set of four learning and sharing events to follow, and sign-off by Mark Harper, Minister for Disabled People, expected in January 2015. Other indications that the topic of learning disabilities is ‘hot’ in Whitehall and Westminster, as DWP’s Simon Francis asserted on the day, include: the recent appointment of a Special Educational Needs Tsar (Lee Scott MP); the revamp of the GOV.UK website for potential employers of people with learning disabilities; and, a commitment to put much more of the information in this domain into easy read format.

It is too early to say much about the new employment strategy for people with learning disabilities in detail. The talk is of opening up a new funding stream, but quite what shape this will take (and whether, for example, it will entail new pilots)—this isn’t being discussed openly yet. Continue reading →

The challenges of mental health for social science and policy

Posted on September 8, 2014 by Stephen Martineau

Guntars Ermansons, student in the Department of Social Science, Health and Medicine, introduces a report on a workshop held earlier this summer. See the full report of the workshop. (309 words)

On 19 June 2014, a workshop on “The Challenges of Mental Health for Social Science and Policy” was held at King’s College London, Waterloo Campus. Supported by the King’s Interdisciplinary Social Science Doctoral Training Centre’s Science & Society initiative and organized by the Department of Social Science, Health and Medicine, in collaboration with the Institute of Psychiatry and Social Care Workforce Research Unit, the workshop hosted a number of distinguished speakers and experts on mental health and involved postgraduate and early career researchers. Continue reading →

Sequeli welcomes the First Annual Report of the National Panel of Independent Experts on Serious Case Reviews

Posted on August 15, 2014 by

Sequeli is a social enterprise not-for-profit limited company which provides training for chairs of mental health investigations, domestic homicide reviews, children’s Serious Case Reviews (SCRs) and adult safeguarding SCRs. The First Annual Report of the National Panel of Independent Experts on Serious Case Reviews was published last month. Here, Gillian Downham, Sequeli‘s founder and Director, addresses the issue of the effectiveness of SCRs (and the training associated with them) that is raised in the Report. (652 words)

As Director of Sequeli, I have worked hard for over a year developing courses, seminars and training materials for the Department for Education’s (DfE) ‘Improving the Quality of Serious Case Reviews’ training programme. It has been a pleasure to work with experienced colleagues, among them members of the Social Care Workforce Research Unit at King’s College London, as well as the NSPCC and Action for Children. I have been steeped in the subject. So not surprisingly I have a few comments on the Panel’s first Annual Report.

Firstly, this is a very welcome Report. It is good to see the Expert Panel have been so assertive on the initiation of children’s SCRs (suspecting that alternatives to SCRs are on many occasions ‘proposed as a way of evading publication’) and publication of SCR reports. The need for independence, thoroughness, openness and proportionality has been the bedrock of the Sequeli approach and at the centre of the DfE training. It is heartening to see these mentioned throughout the Annual Report. Continue reading →

Looked after children and offending: reducing risk and promoting resilience

Posted on August 11, 2014 by

In this guest post, Gareth Crossman, Executive Director of Policy, Communications and Fundraising at TACT, a fostering and adoption charity, highlights research done with the University of East Anglia on the topic of looked after children and offending. (371 words)

In 2010, TACT and the University of East Anglia’s Centre for Research on the Child and Family were awarded a research grant by the Big Lottery Fund. This funded a major project examining the relationship between children in care and the criminal justice system. One hundred young people, along with local authorities across England and Wales, took part in a series of detailed interviews and surveys. The aim was to investigate the factors that caused young people in care to be at risk of entry into the criminal justice system. And, crucially, what were the factors that could promote resilience and help keep them away from criminalisation.

Young people in care are often stereotyped as likely to become criminals. There is no doubt that statistics about prison populations show disproportionate numbers of people who have experienced being in care. However, nine out of ten young people who go into care will never come into contact with the police. The research bore out what TACT’s own experience told us; that when the care system works well it can prove hugely effective in keeping young people out of the criminal justice system. However, negative experiences can lead to greatly enhanced prospects of criminalisation. Continue reading →

Risks and barriers to organisations conducting research

Posted on July 18, 2014 by

by Martin Stevens, Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. (2,114 words)

The Health Research Authority (HRA) is currently consulting on various aspects of research regulation in health and social care in preparation for replacing the Research Governance Framework (RGF). The Social Care Workforce Research Unit (SCWRU) has had a long involvement with the implementation of Research Governance in social care and has made a response to part of this consultation. The HRA is currently asking ‘What are the risks to research because of perceived risks of research? and has published a report explaining its proposed approach. There is much with which we agree in the consultation report, specifically:

the focus on clear and consistent definitions of terms;
the emphasis on collaboration;
the promotion of sound arrangements between the different organisations involved in research;
the promotion of a quality research culture, within research organisations and also in care organisations; and,
the need for more explicit support for a high quality research culture.

However, despite the focus on good collaboration and the need to involve all stakeholders, the document needs to better reflect the experiences of social care researchers, and those responsible for research governance in local authorities. Continue reading →

Making Safeguarding Personal (MSP) – the way forward for adult social care

Posted on July 16, 2014 by

by Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit at King’s College London. (952 words)

Professionals working in the adult social care field gathered at Friends House in Euston, London, on 30 June 2014 to share knowledge and experiences of Making Safeguarding Personal (MSP). MSP was initiated by the Association of Directors of Adult Social Services (ADASS) and the Local Government Association (LGA) as a sector-led response to concerns that adults at risk are not being involved in investigations and decisions when councils have concerns about abuse or neglect (adult safeguarding).

Supported by funding from Department of Health (DH) and the LGA, this improvement programme started in 2011/12 with the development of a toolkit. In 2012/13 five pilot councils signed up to the scheme and this year 53 councils participated. The programme has been given increased funding to continue next year across further English councils. Continue reading →

Where next for integration and funding?

Posted on July 7, 2014 by

John Woolham

Martin Stevens

It is estimated that the NHS faces a shortfall of at least £30 billion a year within a decade and possibly a deficit as high as £50 billion. Martin Stevens of King’s and John Woolham of Coventry University report on an event last month where experts debated funding and integration in health and social care. (1,369 words)

At a SSRG–SSCR event on Integration and Funding of Health and Social Care held at the LSE on 18 June José-Luis Fernandez of LSE opened with a statistical review of the decline of social care service provision since the 1980s, which had become especially marked since 2008-09 with the contraction in public spending—despite increases in the numbers of older people over this period. While this could in small part be due to better targeting and more effective services, his conclusion was that there was a great deal of unmet need in the community. Continue reading →

What can the city banks learn from social care?

Posted on July 1, 2014 by

The Registered Managers’ Programme from The National Skills Academy for Social Care aims to better equip Registered Social Care Managers to meet the challenges they face, to reduce their isolation by networking them at local and national level, and to enable them to recognise their leadership role. As part of the Programme, they are funding Local Networks to support Registered Managers on the ground, either where demand has been identified but no Network exists, or to strengthen and expand existing ones.

One such network has recently been established in Cumbria with support from the Social Care Workforce Research Unit at King’s College London, and it builds on earlier work around communities of practice. For more information contact michelle.cornes@kcl.ac.uk

This post was written by the members of the Cumbria Registered Social Care Managers’ Network following their meeting last month.

The focus of this meeting (4 June 2014) was celebrating the work of the huge number of social care workers who do a great job every day and make a really positive difference to the lives of people who need care and support. Inevitably though, the conversation moved to discussing the recent Panorama programme (Behind Closed Doors, 30 April 2014) on abusive care, and the impact programmes like this have on staff in the sector. That led to us thinking about what registered social care managers can do to raise the profile of care that is caring and compassionate?

The Cumbria Registered Social Care Managers’ Network at the June 2014 meeting

For the front-line care workers in attendance at this meeting, programmes like Behind Closed Doors are far removed from their day-to-day experiences of delivering care. A good day for some starts with crumpets, toast and jam and a chance to catch up with each other (called a ‘hand over’ in the jargon). There are enormous challenges in delivering good quality care—for example how to be personalised, compassionate and ‘quick’ (in your 15 minute time slot with each resident). Work is often stressful, physically demanding (12 hour shifts) and emotionally draining. Needless to say, the situation is not helped by the current climate of austerity and chronic underfunding. However, the job brings with it enormous rewards and a great sense of personal satisfaction. At the heart of the work is your team, like a family almost, and all the emotional benefits which flow from being collegiate.

Added to this, is the sense that you are making a very real and positive difference to people’s lives. In this business it is the ‘smiles and the thank yous’ that count for most… The six figure bonuses, pay rises, company cars and expenses said to be absolutely essential to recruit and retain the ‘best’ staff in the more compassionate(less) industries are seemingly not so important in social care. Maybe the city banks have something to learn from social care managers in this respect?

The Cumbria Registered Social Care Managers’ Network at the June 2014 meeting

Where programmes like Panorama can have a particularly detrimental impact is that they can work to undermine the confidence and integrity of some social care managers. The desire to ‘protect’ the public from abusive care often sees the inspectorates and commissioners of services imposing further layers of monitoring and regulation. However, unless carefully implemented as part of a wider culture of learning and improvement, this can quickly lead to a ‘them’ and ‘us’ scenario in which there is a lack of trust and authentic partnership working. While the ‘best managers’ will follow the rules and regulations, reporting ‘poor practices’ or any ‘safeguarding’ incidents as they are required to do, they can be left feeling demoralised and ‘brow beaten’ by the response. ‘Poor managers’ meanwhile will keep their heads down; they will not engage externally and will remain largely hidden from view, that is, until the television cameras go in.

How to engender trust and authentic relationships (the ‘smiles and the thank yous’) between commissioners and providers of social care services is a question we shall return to in future meetings. Celebrating the role of the social care worker and raising the profile of ‘good care’ has just been a first step.

For more information about this post please contact Michelle Cornes, Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. The Unit is part of The Policy Institute @ King’s.

Challenge the CQC

Posted on June 26, 2014 by

Caroline Norrie, Research Fellow at the Social Care Workforce Research Unit at KIng’s College London, and Esther Njoya, Research Intern at the Unit, report on a meeting held earlier this month at which the Care Quality Commission (CQC) was put on the spot by parliamentarians, professionals and the public.

The public had a chance to ‘challenge the CQC’ at an event held on 11 June at the House of Commons. This was an opportunity for the public, patients, and health and social care professionals to question representatives of the Care Quality Commission (CQC) about its work and especially the proposed changes to the regulation of primary and integrated care.

Held under the aegis of the All-Party Parliamentary Health Group, the meeting was chaired by Dr Sarah Wollaston MP with a panel made up of Chairman of the CQC, David Prior and Chief Inspector of General Practice, CQC, Prof Steve Field. Dr Sarah Wollaston opened the meeting with a brief description of the role of the CQC as independent of government and committed to transparency and the integration of health and social care.

Chairman of the CQC, David Prior

Following the Winterbourne View TV exposé and Serious Case Review the CQC has been making significant changes. These are summarised in its strategy, Raising standards, putting people first – Our strategy for 2013 to 2016, which it has been consulting on. As part of a new inspection regime, the five new key domains the CQC will be inspecting in all services are safety, effectiveness, caring, responsiveness to people’s needs and leadership. The new style inspections are being trialled in hospitals, mental health and community health services, and, since April 2014, in adult social care services and GP practices.

As has been widely reported, inspections are now being carried out by specialists (including experts by experience) within professional areas rather than generalists. Services will soon be graded as outstanding, good, requires improvement or inadequate. The CQC hopes this new grading system will encourage service improvement. The CQC has also undertaken a review of care homes and found about 3,000 care homes with no qualified registered managers; in some of these the owners have been penalised. Finally, a new aim of the CQC is to understand and measure service users’ experiences of integrated working. Final plans will be published in September 2014 and come into effect in October 2014. This meeting was part of CQC’s strategy to engage the public in this change process.

Professor Field outlined in more detail his vision for inspection in primary care, which includes improved access to care for vulnerable people (such as homeless people, people with learning disabilities, and sex workers, among others). The CQC will use ‘levers’ to improve integrated care and its commissioning. The aim is to ‘celebrate good practice as well as shining the light on poor practice.’ He outlined all the areas that are covered by CQC primary care inspection including GPs, dentistry, mobile doctors (e.g. the 111 service) medicine management, prisons and safeguarding.

The majority of this forum was taken up with discussion around a wide range of questions from the audience.

Baroness Hollins, a prominent Learning Disabilities (LD) campaigner, urged the panel to introduce levers to ensure GP practices fulfilled the regulation of noting when a patient has a learning disability. She asked whether the CQC had made any headway in implementing the recommendations set out in the Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD). She stated that 37% of the deaths of learning disabled people were preventable—making this a discriminated against group. Prof Steve Field replied he was taking notice of the comments and that such implementation might be possible using intelligent monitoring (a new system being developed to combine informal intelligence and formal performance management data).

Several service users and carers used this meeting to complain about lack of joined-up services and inequality between London boroughs in the provision of mental health services. Suggestions were made about providing crisis phone lines, which might reduce hospital admissions. The speakers took notice of these comments and also offered the audience information about making complaints to local Health and Well-being Boards (HWBs) and the CQC call centre in Newcastle.

A representative from Healthwatch asked about links with the CQC and how to make the most of their work (e.g. their role in being able to enter and view services) while avoiding duplication of roles. Prof Steve Field answered that the CQC was focused on ‘listening to people on the ground’ and the HWBs acted like the ‘eyes and ears of the CQC’ and so both organisations should be working together. It was not entirely clear how these mixed metaphors would work locally,

Concerns specifically relating to GPs were raised—for example, out-of-hours services, the trend for phone rather than face-to-face consultations, and regulation of single-doctor practices. Service users asked when electronic patient records were going to be introduced and whether patients would have permission to check and amend their own records. Questions were also asked about regulation of follow-up-care and post-discharge services and insurance for independent midwives.

Another representative from a Healthwatch organisation, who declared that they were willing to support individuals who wanted to expose acts of neglect and abuse in care homes as whistleblowers or witnesses, asked whether there were avenues that such organisations could use to effectively collaborate with the CQC. She observed that they could contribute to the CQC’s work in providing oversight roles for inspections, regulation and monitoring, as it was evident to her that the CQC had overlooked previous cases of abuse scandals—for example the case in The Old Deanery home, which was shown by Panorama at a time when CQC was actually carrying out an ongoing inspection. Professor Field replied by saying that it was unfortunate that such an incident had happened while still under their scrutiny, but that at the time they had relied on information from the management of the home. He reiterated that the CQC welcomes the contribution of Healthwatch organisations who are able to provide information.

In contrast, Paul Beresford MP noted his concern about over-regulation and suggested closer working together of the General Medical Council (GMC) inspections and the CQC. Professor Field replied that this was in the pipeline, and there were general murmurs of approbation to this news.

A representative from the care home sector then put forward the case for private providers. He said there was a danger that good quality operators offering services for people with long-term conditions would be driven out of the sector due to the growth of regulation. He called for increased funding and more training to be made available for care home managers. Prof Steve Field agreed, but noted that care homes should also take some responsibility for training and ensuring that their members of staff have care home management skills and professional qualifications.

One member of the audience questioned whether the CQC has capacity to undertake this more stringent inspection regime. Professor Field replied that the CQC was recruiting more staff and that it did have capacity to undertake the work. The best providers will only be regulated once every two years, rather than annually as is currently the case.

As researchers currently involved in projects about adult safeguarding, this meeting provided an interesting insight into the CQC’s vision for regulation. Plans for the CQC to carry out more stringent inspections of social care services and to use their powers to encourage more effective joined-up working across health and social care sounded highly positive aspirations—although the policy shift to more infrequent inspections of the ‘best homes’ needs to be tempered by an acknowledgement of the risks of such homes being quick to deteriorate.

Caroline Norrie is Research Fellow at the Social Care Workforce Research Unit at King’s College London. Esther Njoya is a Research Intern at the Unit.

Health & Social Care Workforce:

Welcome to the blog of the NIHR Policy Research Unit in Health and Social Care Workforce at King's College London