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

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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

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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

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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 →

Workforce planning in the NHS – it is a kludge

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Richard Griffin MBE is Professor of Healthcare Management, King’s Business School. (740 words)

Many years ago, I worked for an NHS Workforce Development Confederation (WDC), that had just been merged with a Strategic Health Authority (SHA). A few months into my role as Director of Education, a colleague asked me a question that has stuck with me ever since. “Who” she said, “owns workforce in the NHS?” A very good question. (1)

Consider the current situation. Is it the Department of Health and Social Care, or Health Education England, or NHS England and Improvement?  Where do Public Health England, Skills for Health or NHS Employers or the Social Partnership Forum fit in? They all have roles. What about regional People Boards? How about Integrated Care System (ICS) People Boards? Or the workforce leads in Primary Care Networks? In Trusts is it HR, or clinical leads like Directors of Nursing or the Learning and Development? It gets even more complex when you consider individual occupations like maternity, where you have Local Maternity Systems, or Allied Health Professions, where you have Councils and Faculties.

From pre-employment to careers information, apprenticeships and beyond, all these bodies are doing good things but not always together. Also, there is no single NHS workforce plan – it is spread across numerous policy documents from the People Plans to the latest Operating Guidance.

Frankly, it is all a bit of a “kludge”. Continue reading →

At the Association for Professional Declutterers and Organisers annual conference

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Jen OwenJen Owen is a Research Associate at the NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London. (482 words)

Unit researcher Jen Owen virtually attended the Association for Professional Declutterers and Organisers (APDO) annual conference on 20th May 2021. APDO represents the UK decluttering and organising industry. Founded in 2004, it now has a community of over 400 professionals across the UK.

Caroline Rogers started off the day with a presentation based on her recent paper ‘Home and the extended-self: Exploring associations between clutter and wellbeing’. As a Professional Organiser herself, Caroline was motivated to study for a MSc in Applied Positive Psychology and Coaching Psychology, to see if the positive wellbeing outcomes of being on top of clutter she noticed in her clients were universal. Her presentation outlined the current significant gap in literature on clutter, and how she went about exploring the associations between home self-extension variables (subjective clutter, objective clutter, home self-expression and declutter habit) and wellbeing (measured quantitively through the PERMA model). Her findings challenge existing theories of clutter as being maladaptive, instead drawing attention to its subjective nature, and offer a refined definition of clutter as “A subjective experience of possessions (material or other) that inhibits the curation of self-identity at home”. Continue reading →

How Discharge to Assess (D2A) Can Work for Homeless Patients

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Senior Research Fellow, Dr Michelle Cornes, has been working with NHS England and Improvement on the new Discharge to Assess (D2A) practice guidance, identifying good practice examples that illustrate how this new hospital discharge policy can work effectively for patients who are homeless. Here she provides one example from Cornwall Council. (302 words)

Specialist D2A Reablement for People who are Homeless  

Hospital Discharge Service Case Study – KA (Harbour Housing)

Cornwall Council working in partnership with Harbour Housing and Stay at Home have redesigned their out of hospital care services to increase the number of options available to homeless patients leaving hospital on D2A Pathways. For those patients who do not have a home and require more than just a sign-posting service, Harbour Housing provides access to six self-contained units of accessible step-down accommodation. This comes with onsite practical support such as helping people to get to their hospital appointments, as well as holistic ‘enrichment support’ for improved health and wellbeing including counselling and a range of strengths-based activities. Where people have care and support needs including self-neglect and issues linked to drug and alcohol use, a specialist reablement service is provided for up to six weeks. The Stay at Home service provides CQC regulated activities into the step-down accommodation and into the community. Specialist reablement workers are trained in the use trauma informed approaches and can for example, deliver Naloxone to prevent drug related deaths from overdose. During the reablement period, permanent housing is arranged and where necessary a Care Act 2014 assessment is carried out to identify needs for any longer-term care and support. Before these specialist D2A services were in place homeless patients would usually have stayed in hospital for long periods (sometimes up to six weeks) while waiting for various care and housing assessments to be completed.

Hospital Discharge Service Case Study – KA (Harbour Housing)

Dr Michelle Cornes is Senior Research Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London.

Caring in company: a pre-Covid snapshot of day centres in south London 

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Dr Caroline Green and Dr Katharine Orellana are Post-Doctoral Fellows, National Institute for Health Research Applied Research Collaboration South London. (346 words)

Day centres can be a lifeline for some people. Day centres offer activities, meals and a place to connect with others. At the ARC South London, we wanted to find out more about what kinds of day centres are on offer in this part of London and how they operate. We searched the internet for day centres for older people, people living with dementia, people with disabilities and long-term conditions or palliative care needs and people experiencing homelessness across four boroughs of south London. Continue reading →

Towards a UN Convention on the Rights of Older Persons: 11th session of the Open-Ended Working Group on Ageing 29.03-01.04.2021 

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Caroline Green is Post-Doctoral Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London. In December 2020, Caroline released a Human Rights toolkit as a means of reflecting on human rights in the context of social care. (218 words)

The COVID-19 pandemic has unleashed unprecedented concern over the treatment and rights of older people in societies globally. It has highlighted levels of structural and institutionalised ageism in addition to numerous issues that are in violation of the human rights and freedoms of individuals who are older. Calls have thus grown louder to adopt a UN Convention on the Rights of Older Persons. Its purpose could be to provide a legal human rights framework tailored to specific issues concerning older age groups as a powerful tool for change.

United Nations headquarters in New York, seen from the East River.

To discuss the possibility of such a Convention, delegates from around the world will meet between the 29.03 and the 01.04.2021 at the UN Headquarters in New York for the 11th session of the UN Open-Ended Working Group on Ageing. It will include a virtual element and will be accessible to follow on UN TV and open to all – no registration needed. The address to access this will be: webtv.un.org. More details about the hearing are available at: bit.ly/OEWG11_OlderPersonsRights. Additional info about this process is available via the UN website – specifically on the Open-Ended Working Group on Ageing part of the site. This is available via: https://social.un.org/ageing-working-group/ – then follow Eleventh Session tab for more info/documents relevant to the hearing.

Caroline Green is Post-Doctoral Fellow at the Policy Research Unit in Health and Social Care Workforce, King’s College London. In December 2020, Caroline released a Human Rights toolkit as a means of reflecting on human rights in the context of social care.

HOPES 2 study launches! Helping older people with mental health needs to engage with social care

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The HOPES 2 study commences this month. Led from the University of York by Dr Louise Newbould and Dr Mark Wilberforce, the project’s full title is ‘Helping older people with mental health needs to engage with social care: Enhancing support worker skills through a prototype learning and development intervention’. Dr Kritika Samsi, Research Fellow at this Unit, is also working on the study, which is funded by the NIHR School for Social Care Research. (542 words)

This project is about the care of older people living with dementia and complex mental health needs. Many studies show that outside help can be hard to accept for people living with poor mental health or memory difficulties. Understanding the purpose of care and communicating any worries can be hard. Sometimes people will reject the care verbally or physically, which can result in them being labelled as a ‘difficult person’. Providing care in these situations can be hard, when home care workers are under pressure to deliver care in often short timeframes. As a result, relationships between the individuals and service providers can sometimes fall apart. Our previous research suggests that “specialist support workers” within community mental health services may help older people living with dementia or with complex mental health needs to accept social care. However, these specialist support workers often say that they do not have the chance to learn or share knowledge, strategies and skills between themselves.

Our earlier research also found that the training available is often unsuitable for this group of workers because it is either too basic and does not account for their specialist knowledge from their experience in mental health work; or else too advanced as it expects them to have professional qualifications. The aim of this study is to develop a way of helping support workers to share and develop their knowledge of ways of reducing resistance to care. This will be based on what we are currently learning in the ‘Helping Older People Engage in Social care project’ (or ‘HOPES 1’). Continue reading →