What happens in English generalist day centres for older people? Findings from case study research

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Katharine Orellana is Research Fellow and Jill Manthorpe is Director at the NIHR Policy Research Unit in Health and Social Care Workforce at King’s. (420 words)

Cover of a research report with a photo of two people conversingA new report aims to improve the understanding of day centre services for older people among social care and health professionals and potential collaborators.

The Covid-19 pandemic led to a greater appreciation of everyone’s need for in-person, face-to-face contact and the difficulties facing some older people when they could no longer meet other people in their day centre when these closed temporarily. Now is the time for professionals to re-examine the value and broader use of these services, and their buildings and activities. Rather than continue to view day centres to be resource-heavy or expensive services, the focus could shift to what they do, and could offer – to individuals, their staff and volunteers, the social care sector, the wider community, local councils, the NHS, and the education sector.  They have great potential to make preventive and early intervention approaches promoted by policy a local reality.

This report provides a rich, pre-Covid pandemic account of four very different English day centres for older people. It sets out their main characteristics, aims, approach, locality, interiors, formal and informal care provided, opening hours, available ‘extras’, charges made to attenders and, finally, ‘typical days’ at each. Continue reading →

COVID-19’s Third Anniversary: Their Story of Wellbeing and Coping from the Health and Social Care Workforce

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The Health and Social Care Workforce Wellbeing and Coping Study has published its Phase 6 Report and Executive Summary. Researchers found the workforce faces continuing substantial pressure, staff shortages and is finding it difficult to cope. In this post, we summarise our findings.

Prof Jill Manthorpe, Director of the NIHR Policy Research Unit in Health and Social Care Workforce at King’s, is a co-investigator on this collaborative research project, involving also researchers from Queen’s University Belfast and Bath Spa University. The study is led from Ulster University (Dr Paula McFadden is Principal Investigator).(1604 words)

Report coverThe 6th Phase of this UK-wide multi-disciplinary study explored the impact of providing health and social care in the post-pandemic era from November 2022 until January 2023. The analysis builds upon the findings from five earlier Phases, beginning during May 2020 following the first wave of the COVID-19 pandemic in the UK. We received 14,400 survey responses from social workers, social care workers, nurses, midwives, and allied health professionals. We conducted 18 focus groups with frontline workers, managers, and Human Resource professionals.

The study provides a unique opportunity to gain in-depth understanding of how the pre- and post-pandemic times have impacted on health and social care workers’ working life, as well as effects on their own health and well-being. Our Phase 6 report presents survey findings collected over the six-months from the end of 2022 and up to early 2023. They reflect a difficult time of unprecedented industrial action in the NHS and continuing pressures on health and social care services. During this Phase, life was returning to pre-pandemic norms for most people in society, there were few remaining public restrictions, the use of face masks had generally ceased, although still being recommended in health and social care encounters and settings. Health and social care services were therefore adapting themselves to a post-pandemic time at the same time as still caring directly for people with illnesses related to Covid-19, and delays in seeking healthcare. Other impacts of the pandemic have placed increasing pressures on health and care services, such as sickness absences, staff vacancies, and retention problems, with mental health problems and new conditions such as ‘Long-Covid’, now affecting workforce stability.

Multiple workplace factors are described as a ‘vicious cycle’. For example, increased job-related pressures, exacerbated by staffing shortages and vacancies (increased use of agency or locum staff) add to job stress and this affects staff’s mental health and well-being. Some respondents indicate lasting or new depression and anxiety, or long-standing distress or trauma because of working through the pandemic. While the survey found many staff had made use of employer’s support services, not everyone sees them as accessible or helpful. Investment is still needed here; the report’s authors recommend. Continue reading →

Supporting people who identify as LGBTQ+

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Victoria Grimwood

Victoria Grimwood

Victoria Grimwood is a Pre-Doctoral Local Authority Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (448 words)

Skills for Care, the strategic workforce development and planning body for adult social care in England, has undertaken to support key equality, diversity and inclusion priorities in the social care workforce. The organisation has been reaching out to those seeking equity change to ensure that the workforce is empowered to work alongside all those who draw on services in a person-centred way that focuses on what matters to them, and acknowledges their identities.

On 22 February, during LGBT+ History Month, Skills for Care hosted a well-attended virtual launch of its new learning framework for knowledge, skills and values for working affirmatively with LGBTQ+ people in later life.

The development of the framework was led by Professor Trish Hafford-Letchfield from the University of Strathclyde and Lawrence Roberts, the Pride in Ageing manager for the LGBT Foundation, a national charity delivering advice, support and information services to LGBT communities. Continue reading →

Going into the Care Closet?

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Dr Cat Forward is Research Associate at the NIHR Policy Research Unit in Health and Social Care Workforce, King’s College London. (420 words)

As part of LGBTQ+ History Month, Lambeth Libraries hosted an event organised by Lambeth Links, talking about the issues surrounding the needs of LGBTQ+ individuals in later life. A panel chaired by Robbie de Santos (Stonewall, Director of Communications and External Affairs) shared their experiences of contact with the health and care system.

Ted Brown has been an active member of GLF (Gay Liberation Front) since 1970. He is currently campaigning against LGBTQI+ elder abuse following the experiences of his partner in residential care. He shared the experiences they had following Noel’s diagnosis of dementia and his subsequent interactions with health and social care services. Ted spoke of the advice they were given to ‘de-gay’ their house prior to care staff’s arrival to minimise any potential homophobia, and of the lack of staff awareness of issues relating to LGBTQ+ couples. He is continuing to raise awareness of issues such as these and spoke of wanting to work with local organisations to improve staff training and awareness. Continue reading →

Working with fathers to protect vulnerable babies from harm

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Dr Mary Baginsky,Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce. (414 words)

Dr Mary Baginsky

Dr Mary Baginsky

The Child Safeguarding Practice Review Panel’s report The Myth of Invisible Men: Safeguarding children under 1 from non-accidental injury caused by male carers, published in late 2021, examined safeguarding of children under the age of one year from non-accidental injury caused by male carers.  In summary, the data showed that men are more likely to be perpetrators of physical abuse and harm to babies than women. It indicates that birth fathers are much more likely to be the perpetrator than other male figures. Importantly, whilst just over 50 per cent of families were involved with local authority children’s services (either through early help services or children’s social care), this means nearly 50 per cent of the cases considered as part of the review were only ever known to universal services. Continue reading →

‘Opening the door’ to employment in healthcare: People with lived experience of homelessness

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Cover of a reportThe NIHR Policy Research Unit in Health and Social Care Workforce has published an evaluation of an access to employment programme in the NHS targeted at those with lived experience of homelessness. The pilot programme involved the homelessness charities Pathway and Groundswell and five NHS Trusts in England. Report author, Ian Kessler, here outlines the programme and the main findings of his evaluation.

Ian Kessler is Deputy Director of the NIHR Policy Research Unit in Health and Social Care Workforce. He is also Professor of Public Policy and Management at King’s Business School. (1,016 words)

Widening participation in the healthcare workforce has long been an important policy objective in the NHS. This has been reflected in an equalities, diversity, and inclusion agenda traditionally centring on gender and race, and more recently on young people with disabilities with the introduction of supported employment programmes by NHS Trusts, such as Project Search and Choice. However, the pursuit of widening participation is a rich policy space, connecting to an increasing range of workforce and broader service priorities.

Framed as ‘anchor institutions’, playing a key role as local employers, NHS Trusts have been encouraged to develop workforces which reflect, in socio-economic and demographic terms, the communities they serve. This role overlaps with moves to bring into the NHS workforce people with lived experience of various health conditions as a means of delivering patient-centred services and more effectively addressing health inequalities. Such moves have been especially evident in the introduction of the peer support worker role in mental health (which our Unit evaluated many years ago). More prosaically, but perhaps most pressing, the search for workforce diversity and inclusion addresses the recruitment and retention challenges faced by healthcare employers, with those at the margins of employment representing a new and reliable source of labour. Continue reading →

Social Care, Legal Literacy, Homelessness and the Care Act

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Helena Kitto is a third-year PhD student at Keele University. (1,097 words)

Homelessness and law

Homelessness is complicated to talk about from a legislative perspective. The Housing (Homeless Persons) Act 1977 is the first piece of English legislation that specifically pertains to homeless people, but other laws have been applied to people who are homeless, most infamously the Vagrancy Act 1824. Following the Housing (Homeless Persons) Act, there is now the Homelessness Act 2002, and later the Homelessness Reduction Act 2017. Another piece of legislation that does not specifically apply to homeless people, but nevertheless has significantly impacted them, is the Care Act 2014, primarily due to the changes the Act made to adult safeguarding in England.

These laws span a number of legal domains, from criminal concerns to property to social care. This is where the complications of discussing homelessness from a legislative perspective arise, because they require a degree of contextual understanding of several different areas of legal concern. Concepts like responsibility, entitlement and safeguarding can be hard to define.

One way to view homelessness legislation could be as in a state of evolution. A chronological analysis of laws that pertain to homeless people (including those that are not specifically about them) shows a gradual move away from viewing homelessness in a punitive fashion, or one that is exclusively a concern of housing and entitlement to housing support, to one that acknowledges homelessness as bringing in adult safeguarding and public health. Continue reading →

The view from here

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Karl Womack is a disability activist and poet who lives in a care home. (544 words)

Karl about Karl

My name is Karl Jonathan Womack. I was born in 1966. I was born with acute paralysis, epilepsy and a learning disability. The day I was born I had a testicle removed because it was strangulated and 6 months later I had an abscess. I couldn’t walk until I was 4 years old.

I was in and out of GP surgeries. They told my parents I was lazy and retarded. Through my early childhood I had intense physiotherapy, throughout my life I’ve had psychiatry and psychology. I was bullied from the age of 8 – 40 by able bodied and disabled because I went to mainstream school despite my disabilities. I was transferred to a special school for disabled and was bullied by the disabled for looking able bodied. I have a file full of certificates. And use a pseudonym called Blaze Burnstar.

I’m 56 and from the age of 23 I lived in residential care. Continue reading →

‘…items and belongings…’ – a hoarding case at the Court of Protection

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Stephen Martineau summarizes a recent case at the Court of Protection involving hoarding behaviour: AC and GC (Capacity: Hoarding: Best Interests) [2022] EWCOP 39. With thanks to Neil Allen for alerting us to the judgment via this Tweet.

The NIHR Policy Research Unit in Health and Social Care Workforce, where Stephen is Research Fellow, recently completed a study of self-neglect and hoarding behaviour among older people and it has just commenced another study on the commissioning of decluttering services by local authorities (this study is recruiting participants). Both projects are funded by the NIHR School for Social Care Research.

We are holding an online seminar engaging legal and psychological perspectives on hoarding: Mon 28 Nov 2022, 10am-11.30am. (2,294 words)

Introduction

This case concerned AC, a 92-year-old woman. She had been sharing her home (which she owned) with her son, GC, since her husband’s death eleven years earlier. GC had given up his job and had become his mother’s main carer. In February 2022 she was taken to hospital by emergency services and in March was discharged from hospital to a care home as a result of a best interests decision. There had been concerns about the unsanitary conditions at her home and their potential impact on her health and welfare.

The question to be decided in summer 2022 was whether AC should now return home for a trial period, receiving a package of care there. It was her wish to return home, while the local authority thought she should remain at the care home. We learn from this judgment (August 2022) that both AC and her son were diagnosed by a clinical psychologist, Professor Salkovskis, as having a hoarding disorder (among other conditions), and also that both have their own social worker.

The judge, HHJ Clayton, had already been managing the case for two years: there had been earlier applications to the Court of Protection by the local authority (and the judgment alludes to yet earlier proceedings that had ended in 2018). In August 2020, the local authority had applied for AC to be moved to a respite placement while the poor conditions at her property were addressed. More recently, it had sought an order that her son leave the property for the same reason.

Much of the difficulty of the case arose because of concerns around GC’s mental health. If AC were to return home, it was proposed that he would be the ‘second carer’ (after the care agency). Continue reading →

Liberty, social care detention and the law of institutions

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Stephen Martineau, Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce at King’s College London, reviews Deprivation of Liberty in the Shadows of the Institution by Lucy Series (University of Bristol). Page numbers in brackets refer to the book, which was published in March 2022 (and is available for free). (2,642 words)

Introduction

One of the more familiar stories from recent UK history about the lives of people with longstanding serious mental illness or intellectual or cognitive disabilities is their move from large-scale institutional accommodation to living arrangements beyond the walls of such places. The extent of this ostensible deinstitutionalization is illustrated by the decline in hospital beds for ‘mental illness’, ‘geriatric’ patients and people with intellectual/learning disabilities—from over 200,000 in 1955 to under 20,000 in 2020 (Series, 2022: p.53). Much of this shift was to do with the closing of survivals of the Victorian era (which started out being called asylums, subsequently renamed mental hospitals) that took place through the second half of the twentieth century.

As Lucy Series describes in her book, Deprivation of Liberty in the Shadows of the Institution, these newer smaller-scale living arrangements may take the form of ‘quasi-institutions’ (residential care and nursing homes) or ‘quasi-domestic’ arrangements (‘supported living’, ‘independent living’, sheltered housing), or indeed ordinary homes.

Series describes this development as a passage from a ‘carceral’ to a ‘post-carceral’ era (after Unsworth, 1991). But in making the physical move away from institutions, to what degree have some less tangible aspects of the old institutional life been carried over to those new living arrangements, as far as these individuals are concerned? To what extent, Series asks, are they still living in ‘the shadows of the institution’?

This question was brought sharply into focus in the UK Supreme Court case of Cheshire West, the litigation that forms the dramatic fulcrum of this book. The court’s approach meant that its definition of deprivation of liberty applied to a much wider array of living arrangements than had hitherto been the case, extending to private homes, where family members were the carers (or custodians?) of the person concerned. It is the socio-legal ramifications of this move (which Series views as transgressive) that are the main concern of the book. To put it briefly and in human-rights terms, in its approach to concerns about liberty in the area of social care detention—under article 5 of the European Convention on Human Rights—the court seemed to set up a clash with a set of questions belonging more under article 8 (respect for private and family life), to do with the distinction between institutions and homes.

This review is split into five short sections: 1. Social care detention. 2. The acid test. 3. Liberty. 4. Home. 5. Out of the shadows? Continue reading →