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

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 Adult 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.

Our research suggests that there are specific groups of people who require particular attention when it comes to improving adult social care for people with mental health problems. There are also two major problem areas: first, professional knowledge and use of the Mental Capacity Act 2005 and second, inter-agency working and communication. These are really important now but also give some ideas for people working on training and implementation of mental health and mental capacity law and practice. We recommend other areas where local councils and other groups could be creative in taking forward professional practice. These include more attention to knowing the risks of pressure ulcers, looking at Coroners’ recommendations that are sent to mental health services, generally in the NHS, and taking the opportunity to discuss good practice as well as learning from when things did not go well. We also make suggestions for the authors and commissioners of Safeguarding Adult Reviews around collecting better information and keeping an eye on the implementation of recommendations.

Elaine Allegretti, Director of People & Resilience, London Borough of Barking and Dagenham, who is LondonADASS’ Mental Health lead provided the foreword to our report. She said: ‘This report is the first of its kind to use these two data sources together to identify recommendations to improve the wellbeing of those with mental health problems in London and to highlight that safeguarding must be part of social care support for people experiencing poor mental health. Any new mental health law must include safeguarding of the rights of people with mental health problems from neglect, abuse and exploitation’. We will be working with LondonADASS to track the response to our recommendations. This study is part of our programme of research that is responding to the priorities in South London through strong collaboration with local councils, providers, practitioners and people using social care services and carers (the NIHR Applied Research Collaboration).

Caroline Emmer De Albuquerque Green is NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce.

Emmer De Albuquerque Green, C, Manthorpe, J & Martineau, S (2021) 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. NIHR Applied Research Collaboration South London; NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London, London.

Promoting the Health of Women Working in Home Care: towards an inclusive Women’s Health Strategy

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:

  • Research is needed to see how home care occupations can be health-enhancing not health damaging. How can risks be minimised and positive aspects of the work amplified? Serious consideration should be given to the health of the social care workforce in any reform of adult social care and workforce health and wellbeing should be emphasised in this and in the proposed Women’s Health Strategy.
  • London’s home care workforce offers much learning for other places and sectors. The majority are not UK born and are from an ethnic minority; if we get women’s health right for them then we will have learned much about addressing inequalities and how to ‘level up’.
  • As well as addressing specific health problems, multiple problems or long-term conditions need to be recognised in any Strategy.
  • Coronavirus pandemic support will need to be long-term for people who are in work, need to change their work and who may contribute to society in other ways.
  • The Strategy needs to address why social care systems are so reliant on zero-hour contracts and acknowledge their health impacts so that it can support changes that are more health enhancing for women, and others.
  •  A Women’s Health Strategy could support dementia prevention but also needs to support the largely female dementia care workforce by acknowledging its skills and needs for recognition, reward and further work-related capacity building.
  • The pandemic highlights the urgency of answering questions around specific health needs and behaviours of women in adult social care from non-white ethnic backgrounds. Consultation on the ‘right’ questions and approaches should involve care workers, and managers.
  • More specific evidence is needed on the impacts of the pandemic on the health and wellbeing of women working in adult social care generally and in home care specifically to inform any future crisis but also recovery from the pandemic.
  • The impact of Long Covid on home care workers needs exploring so that effective support and readjustment can be offered. Data from Wales (linking individual health records and home care worker registration) are likely to be useful in the Covid-19 period but also subsequently for policy makers and employers.
  • The Strategy must build on the evidence to best support women working in the sector to receive the Covid-19 and other vaccinations for their protection against the on-going health threats of viruses and other infections.

The full report is available to download here.

Caroline Emmer De Albuquerque Green is NIHR ARC South London Post-Doctoral Fellow at the NIHR Policy Research Unit in Health and Social Care Workforce.

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 

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.

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

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

Resource for day centres – Guide for adult day centres to ‘unlock lockdown’ safely

Caroline Green and Katharine Orellana, Post-Doctoral Fellows, National Institute for Health Research Applied Research Collaboration South London. (721 words)

On 23 March 2020, most of England’s population was placed into ‘lockdown’ due to the novel Coronavirus or COVID-19 pandemic taking hold across the UK. This was an unprecedented move by the government and meant that social care services, including day centres for older people or those with social care needs mostly closed to regular users.

Several months later, the government is taking a step-by-step approach to ‘unlocking’ society, with social clubs and community centres allowed to open again from 4 July 2020. But, with the pandemic not yet subsided, day centres are faced with the task of making their services safe and reducing the risks of infections to service users and staff. This is particularly important for day centres, as they may serve groups of people at risk of being seriously affected by the virus, such as people with underlying health conditions. Continue reading

International Women’s Day, 8th March 2020: Remembering the achievements for health and social care of some great women in South London

Caroline Green, who is NIHR ARC South London Post-Doctoral Fellow, reflects on the lives of prominent women figures in the health and social care context in South London. (838 words)

International Women’s Day is an annual celebration of the achievements of women and a day to put special emphasis on raising awareness of gender bias and taking action for gender equality. Women contribute significantly to England’s health and adult social care. The adult social care workforce is dominated by women, with 83% of the workforce being female. In 2017, 77% of NHS health workers were women. However, beyond “holding up” England’s health and social care system, women have revolutionized it at many points in time. This blog post looks back at some significant female figures in South London, who have shaped health and social care either directly or indirectly. This list is of course not exhaustive. Countless women with a diversity of backgrounds are driving today’s health and social care provision in South London and have done so for many years. Yet, the stories of the women below offer an indication of the rich female history of health and social care in this part of London:

Florence Nightingale (1820-1910)

Florence Nightingale is widely considered the founder of modern nursing and a social reformer of health and social care. She first gained prominence as a manager and trainer of nurses during the Crimean War, looking after wounded soldiers. In 1860, she established the nursing school at St Thomas’ Hospital in London, the first secular nursing school in the world, and now part of King’s College London. Many say that Nightingale here laid the foundation of professional nursing, with the International Nurses Day celebrated annually on her birthday. Nightingale’s social justice work extended to the abolition of prostitution laws, advocating for hunger relief in India and expanding acceptable forms of female participation in the workforce. Continue reading

CQC emphasises the importance of human rights for high quality care home services

Caroline Green is a PhD student at King’s College London. (362 words)

The Care Quality Commission (CQC), England’s care service regulator and quality inspector, is emphasising the centrality of human rights and equality when providing high quality care in care homes and other care services. Human rights are the rights we all have because we are human beings. They are legally enshrined in the Human Rights Act 1998 and the Equality Act 2010.

Andrea Sutcliffe, CQC’s Inspector-in-Chief, recently explained at CQC’s Human Rights and Equality Conference in February 2018 what role human rights play for CQC’s regulation and inspection of care homes. She said, ‘Human rights thread through all our key-lines of enquiry. It informs the judgement that we make when inspecting care services and is one way that the CQC can emphasise the importance of human rights, raise the profile and make sure that the people are being treated the way that they should.’ Continue reading