Signs of Safety: Findings from the second evaluation by King’s College London

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Dr Mary Baginsky

Dr Mary Baginsky is Senior Research Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce. (1,109 words)

The report on the second round of Children’s Social Care Innovation Programme funding for the 10 MTM (Munroe, Turnell and Murphy) Signs of Safety (SofS) pilots has just been published. The strengths-based approach to child protection and safety is widely used around the world, as well as in two-thirds of local authorities in England (Baginsky et al., 2020). The term ‘Signs of Safety’ refers to a model of practice that consists of:

  • principles that privilege relationships with children and their families
  • disciplines in relation to assessments, behaviours and language
  • tools for assessment and planning, as well as for use with children and families.[1]

It is not known to what extent a ‘pure model’ of SofS is in place in English local authorities. The survey that identified its use also showed the variations – and pick and mix approaches – that  were in place.

Back in 2014 when the 10 MTM pilots were recruited the idea was that they worked to the model above which was developed into a whole system design that MTM considered essential to support, monitor and build high-quality SofS practice based on a supportive organisational culture and the commitment of those in senior leadership positions. The first evaluation found that: Continue reading →

Cleaning, catering and housekeeping staff in care homes: shining a light on their contributions during Covid

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Kritika Samsi and Caroline Norrie, Research Fellows at the Policy Research Unit in Health and Social Care Workforce, introduce a new study at the Unit. (329 words)

Kritika Samsi

Kritika Samsi

Caroline Norrie

Caroline Norrie

Housekeeping staff in care homes – cleaners, those working in kitchens, laundries, maintenance – are often forgotten but are the backbone of many care homes. What happened to them during the coronavirus pandemic is the subject of a new research study. Researchers at the NIHR Health and Social Care Workforce Research Unit at King’s College London (KCL) have received NIHR Policy Research Programme funding to investigate the experiences and challenges of these care home workers during COVID-19.

Housekeeping and catering staff have been crucial during the coronavirus crisis given their role in infection control, food preparation, and help with social distancing. But they tend to be overlooked. What they have done and the challenges they faced during the crisis are often hidden. Many are women with families, work part-time, and on shifts, and often are from migrant or minority ethnic backgrounds. We know they are not well paid. Some sadly died from the virus. We want to find out whether and to what extent these workers were prepared and supported in their roles during the pandemic. This will help meet a gap in knowledge – how to better support this staff group work to prevent coronavirus, help those with it, and with service recovery. Continue reading →

Toolkit for reflection on human rights in the context of social care

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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. (709 words)

During the COVID-19 pandemic, the importance of human rights for people needing care and support in care homes or at home, their carers, families and friends became evident. Care home residents, especially people with dementia, were one of the groups who were and still are most severely affected by the virus, with thousands of deaths from a COVID-19 infection not only in England but many countries around the world. The need to protect people requiring care and support and to balance infection control – thus the basic rights to health and life – with the right to a private and family life and to social participation was but one of many examples of a human rights issue that we as a society had to face during this pandemic. Conversations around these topics are often difficult.

Human rights as enshrined in international and national law, notably the Human Rights Act, are directly relevant to people requiring care and support, service providers and care workers. Not only is every human being entitled to have his or her rights respected, protected and implemented but the English legal and regulatory system for care providers also makes them directly relevant in care settings. However, human rights are more than a legal concept. They are also a moral concept, which can help to build a social care system and determine the way care is provided. Human rights in social care is therefore a broad topic, with many different ways of approaching it in conversations, training and research. Continue reading →

Three early papers on self-neglect

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At the NIHR Policy Research Unit in Health and Social Care Workforce we are undertaking two studies examining self-neglect, both funded by the NIHR School for Social Care Research. In an article published in The Journal of Adult Protection, for the project examining Adult Safeguarding Responses to Homelessness and Self-neglect, Stephen Martineau goes back to three pioneering research papers on self-neglect to consider what, if anything, they can feed into current debates. (787 words)

Patricia Shaw's contribution in the 1957 paper on ‘social breakdown in the elderly’

Patricia Shaw’s contribution in the 1957 paper on ‘social breakdown in the elderly’

While conducting a review of the self-neglect literature during this year, references to two early papers on the topic have come up repeatedly. The first, published in the British Medical Journal in 1966, by Macmillan and Shaw, is often described as the seminal academic paper in this field and drew on cases in Nottingham. The other is the Diogenes Syndrome article, by Clark, Mankikar and Gray, published in The Lancet in 1975; it derived from a study conducted in a Brighton hospital. Our new Journal of Adult Protection article examines these two articles plus a third, again by Shaw and Macmillan. This one dates from 1957 and, though it did not use the term self-neglect (rather, social breakdown in the elderly), it is the most vivid and interesting of the three.

There is a good deal of research interest in self-neglect at present. Following consultation with, and a survey of, practitioners, carers and service users (suggested by our Unit), the James Lind Alliance (2018) Priority Setting Research Partnership on Adult Social Work recommended that the topic should be a research priority. As well as the Unit’s two studies (details below), the NIHR has a call out for a study of self-neglect in the community (closing 28 January 2021). The need for such research is reinforced by Michael Preston-Shoot and colleagues’ new national study of Safeguarding Adults Reviews that were conducted between April 2017 – March 2019. SARs are commissioned where questions are raised about the way agencies involved in safeguarding have worked together in individual cases: among the 231 reviews the authors analysed, self-neglect constituted the most common type of abuse/neglect (featuring in 45% of the reviews). Continue reading →

How to improve health and social care unregistered staff’s education and development

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Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School. (434 words)

I write a fair bit about the challenges and barriers support workers can face. Research by King’s College London and others has identified persistent issues such as poor job design, lack of funding for training, pay levels that too often do not reflect the extended nature of the roles and poor progression pathways. I thought though, particularly in the run up to the Royal College of Midwives’ annual Maternity Support Worker Week (23-27 November) and the Royal College of Nursing’s first Nursing Support Worker Day (23 November), I would set out my views of some of the ways these problems can be addressed in the NHS. Continue reading →

Understanding the impact of COVID-19 on ethnic inequalities in health and social care – Have your say!

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Introducing a King’s College London study examining inequalities experienced by people from racial and ethnic minority groups working in health and social care during COVID-19. (570 words)

Prof Stephani Hatch

Leading the study: Stephani Hatch, Professor of Sociology and Epidemiology in the Department of Psychological Medicine, King’s College London

We have launched a study to help improve working conditions and to tackle the inequalities experienced by people from racial and ethnic minority groups working in health and social care during the COVID-19 pandemic. Based at King’s College London, we are working in partnership with NHS England Workforce Race Equality Standard, NHS Confederation and the Royal College of Nursing. The study findings will be used to develop education and training materials (e.g. Virtual Reality training) available nationally to all staff, specifically to better support and improve the workplace experiences of NHS and social care staff from Black, Asian and minority ethnic groups.

COVID-19 pandemic

The pandemic has shone a light on existing inequalities that have a great impact on Black, Asian and minority ethnic communities. These communities are approximately 14% of the population in England and Wales, yet they have had greater exposure to the virus and are more likely to have poorer outcomes, including severe health complications and death. We have also seen that higher numbers of racial and ethnic minority health and social care workers have died from COVID-19. Despite making up 21% of the NHS workforce, 63% of those who died from COVID-19 were from racial and ethnic minority groups. What is less often known and discussed is that health and social care staff from racial and ethnic minority groups experience greater levels of workplace harassment and discrimination compared to other staff and these experiences have been compounded by the pandemic. This can have long-lasting effects on their health, wellbeing, and their ability to do their job. Continue reading →

Black History Month in Social Work and Social Care

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Jo Moriarty (Senior Research Fellow) and Prof Jill Manthorpe (Director) of the NIHR Health & Social Care Workforce Research Unit, King’s College London. (1246 words)

In the aftermath of the pulling down of the statue of the merchant and slave trader, Edward Colston, in the June of this year, discussions took place about how best to replace it. We were intrigued to read one suggestion that it should be replaced by a statue of Paul Stephenson. Who was he and what was the boycott we wondered?

Paul Stephenson leading the Bristol bus boycott in 1963 (Photo: ITV)

We soon found out that he was the first black social worker in Bristol (BBC Newsround 2018). The Bristol Bus Company refused to employ black people on bus crews and, inspired by the refusal of Rosa Parks to give up her seat on a bus and the ensuing Montgomery Bus Boycott, Stephenson was one of a group of people who led a bus boycott in Bristol in 1963.

The cause was taken up by the wider black community and white sympathisers in Bristol. Within a few months, the company succumbed to pressure and ended its ban. The following year Stephenson refused to leave a pub until he was served. He is now widely recognised as having played an important part in the passage of the 1965 Race Relations Act and was awarded an OBE in 2009. Continue reading →

Black History Month – a spotlight on Social Care in South London

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Prof Jill Manthorpe and Dr Katharine Orellana both work on the NIHR ARC South London Social Care Theme from within the NIHR Policy Research Unit in Health and Social Care Research, King’s College London. (1226 words)

Many stories are being told relating Black history in and about South London. Some of them are coming from people who staffed or volunteered in local social care services. These are largely unsung stories of efforts to meet the needs of London’s new migrant populations. In this blog we highlight some of the developments that were taking place in South London over 30 years ago in older people’s day services and others outside the statutory sector (although many were supported by local council grants). South London was for many years the location for Age Concern nationally (in Mitcham) and the pan-London body, Age Concern/Age UK London (in Camberwell then Elephant and Castle) as well as Black groups that had interests in social care such as the Afiya Trust (in Vauxhall). Where possible we provide links to the items we found.

South London is still the home of one of the leading national, even international, organisations that has proven the value of oral history and reminiscence among older people of different faiths, cultures and heritages. Founded in 1983 by Pam Schweitzer MBE, Age Exchange is based in Blackheath. Her ‘Mapping Memories’ collection remains a key resource for families, volunteers and care staff working with older people from different ethnic backgrounds. Continue reading →

Evaluating the Nursing Associate Role: Initial Findings

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Interim Report

Ian Kessler is Professor of International HRM at King’s Business School and Deputy Director of the Policy Research Unit in Health and Social Care Workforce (HSCWRU). Prof Kessler is lead author of the Interim Report and two case studies from the HSCWRU Nursing Associates study, published today. (1,624 words)

Film of webinar (23/11/20) where Prof Kessler discussed these findings.

We are conducting a survey of senior health and social managers on the use and management of the nursing associate role. The survey is open until 18 December 2020.

The introduction of the Nursing Associate (NA) role in England represents a decisive step towards changing the structure of the nursing workforce, with a view to improving the quality of health and social care. Originally proposed by the 2015 Willis report on nurse and care assistant education[1], as ‘a bridging role’ between the care assistant and the registered nurse, the NA has emerged in NHS England as a pay band 4 role, requiring a two-year level 5 qualification, registered with and regulated by the Nursing and Midwifery Council (NMC). The NA programme was launched in early 2017 in two waves 11 pilot and 14 ‘fast follower’ sites, respectively taking-on 1,000 Trainee Nursing Associates (TNA). There were subsequent waves, with 5,000 TNAs recruited in 2018 and 7,500 in 2019. It is a role which attracts interest given its capacity to address a variety of workforce and care management goals. However, as with the introduction of any new role, there are organisational challenges to be faced in ensuring that it becomes established at the workplace level and accepted by the various actors with a stake in it, including nurses, managers, healthcare assistants and service users. Continue reading →

Grow your own – an idea whose time has come (again)

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Richard Griffin MBE is Visiting Senior Research Fellow, King’s Business School. (869 words)

Back in 2010 I produced a paper for the Department of Health with the snappy title of Widening Participation Into Pre-registration Nursing Degree Programmes. Nursing was becoming an all degree profession and there was a concern at the time that this might narrow the pool of future recruits as vocational routes were closed. The document mapped pathways up to and into pre-registration degrees for existing support staff, including via the then current version of apprenticeships. It also set out the wider benefits of a “Grow Your Own” (GYO) approach to workforce development and recruitment. These included, not only securing future labour supply, but also helping ensure that the NHS workforce better reflected its local population, supporting diversity and reducing turnover.

Fast forward a decade and I’m having a conversation with an NHS Trust who had hoped to recruit from their existing support staff on to a degree apprenticeship. There is no shortage of candidates, but it appears the step up from support role to a pre-registration degree is too large for staff and the Trust is unable to recruit. The 2010 paper, which I repeated for Camilla Cavendish’s review three years later, made the point that GYO needs to be “end-to-end”, starting even before employment begins and delivering investment in the formal education of support staff at every level, creating clear pathways to mobilise what we called back then, the NHS “skills escalator”. GYO seeks to create progression steps creating horizontal and verticals career routes, avoiding the “gap” problem experienced by the Trust I was talking to. Continue reading →