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Objectives: Ancillary staff – cleaning, catering, housekeeping and laundry workers – play a crucial role in care homes, by promoting infection control, food preparation and hygiene, and contributing to the care home environment. This study sought to understand the experiences of ancillary staff working in English care homes during the COVID-19 pandemic. The results will inform policy makers, employers, care home managers and others, both in England and overseas, as how to best support the ancillary workforce. Methods: Between March and August 2021, video and telephone interviews were conducted with those working or living in care homes in England. Participants comprised ancillary staff (n = 38), care home managers (n = 8), care home residents' family members and friends (n = 7), human resource managers (n = 5) and care home residents (n = 5). Results: Ancillary staff often had increased responsibilities and contributed to pandemic efforts by changing working practices, routines and job roles with the aim of supporting residents and other staff. Teamwork, underpinned by strong leadership, helped ancillary staff feel supported. Conclusions: Ancillary staff should be better recognised as being central to care home care. They are essential workers helping to keep residents safe and well. [ABSTRACT FROM AUTHOR]

Context: In England, Personal Assistants (PAs) are part of an international trend towards state funded but client-hired or directly employed care workers. The Covid-19 pandemic highlighted and exacerbated pre-existing risks and advantages of this arrangement for both PAs and people with care and support needs. Objectives: We aim to report PAs' reflections on their experiences of working since the pandemic started in 2020 and highlight the longer-term implications for health and care services. Methods: We undertook a large-scale, qualitative study in 2016–17 involving interviews with 104 PAs about their working lives. We re-interviewed PAs from this group twice to ask how the pandemic had affected them, once at the start of the pandemic in Spring 2020 and again in December 2021 –April 2022. This article reports findings from the last set of interviews undertaken with 38 PAs. Thematic analysis was conducted of interviews in which PAs discussed changes in tasks and responsibilities, pay and conditions, training, relationships and plans. Findings: This article focuses on the following themes: PAs' perceptions of their outsider status; support and training needs; job security; and whether PAs have an appetite for regulation to provide greater professional standing and connections. Limitations: Interviews in this study were carried out during the Covid-19 pandemic over the telephone or virtually rather than in person so may have missed certain body language or informal relationship building. The sample may be under-representative of non-British PAs. We were unable to triangulate participants' accounts with others'. Implications: This study highlights the importance of national and local government including the PA workforce in planning for national emergencies. Consideration should be given by policy makers and local health and care systems to how PAs can be better supported than currently. [ABSTRACT FROM AUTHOR]

Gambling harms are disproportionately experienced among disadvantaged groups and as such, adult social care (ASC) practitioners are well-placed to identify and support affected individuals. There exists no evidence-based 'introductory' question for practitioners to identify those at risk of gambling harms, which includes family and friends ('affected others'). To develop an 'introductory' question for use in English ASC, we conducted a scoping review that identified fifteen potential questions. Questions were refined through expert panel review groups (n  = 13), cognitive interviewing (n  = 18), test–retest reliability checks (n  = 20) and validity testing (n  = 2,100) against gold-standard measures of problem gambling behaviour. The question development process produced two questions suitable for testing in local authority (LA) ASC departments. These were (i) 'Do you feel you are affected by any gambling, either your own or someone else's?' and (ii) 'If you or someone close to you gambles, do you feel it is causing you any worries?' Each had good face validity, strong test–retest reliability, correlated highly with well-being measures and performed reasonably against validated measures of problem gambling. These two questions are currently being piloted by ASC practitioners in three English LAs to assess their feasibility for adoption in practice. [ABSTRACT FROM AUTHOR]

Gambling‐related harms are increasingly recognised as public health concerns internationally. One response is to improve identification of and support for those affected by gambling‐related harms, including individuals who gamble and those close to them, 'affected others'. Adult social care services have been identified as a setting in which screening for gambling‐related harms is suitable and desirable. To achieve this, a tool is required which can identify gambling‐related harms experienced by individuals and affected others. This scoping review aimed to identify whether any brief (i.e. three questions or less) screening tools are being used and, if so, how brief screening for gambling‐related harm is being implemented in health and social care‐related contexts. An international English language scoping review of research and grey literature was undertaken between April and July 2021. The search included single‐item and brief screening tools which have been developed to identify gambling‐related harms for individuals and affected others across a range of health and social care‐related contexts. Findings show that screening tools for gambling‐related harms have been developed for use in health settings rather than in social care contexts. For example within gambling, mental health or substance misuse support services. We found no evidence of a brief or single‐item screening tool for identifying harms to individuals and affected others which is of adequate quality to strongly recommend for use in an adult social care setting. Development of a validated brief or single‐item screening tool is recommended to assist adult social care practitioners to effectively screen, identify, support and signpost people affected by gambling‐related harms. [ABSTRACT FROM AUTHOR]

Personal Assistants (PA) or client‐hired workers are directly employed by people needing care and support, often making use of government funding. In the context of Covid‐19, questions emerged about how this workforce is supported to practice safely. This paper reports PAs' understanding and views of infection control during the early months of the Covid‐19 pandemic in England. Telephone interviews were undertaken with 41 PAs between 16th April and 21st May 2020. PAs were recruited from a sample that had participated in a previous study in 2014–16. Interview questions focused on changes arising from the pandemic. Data were transcribed and analysed using Framework analysis. This paper focuses on PAs' perceptions of their role and responsibilities in preventing and managing infection. Arising themes were identified about barriers and facilitators affecting infection control in five areas: accessing information, social isolation, handwashing, hygiene, personal protective equipment and potential attitude to vaccines. Infection prevention and control are under‐researched in the home care sector generally and efforts are needed to develop knowledge of how to manage infection risks in home settings by non‐clinically trained staff such as PAs and how to engage home care users with these efforts, especially when they are the direct employers. [ABSTRACT FROM AUTHOR]

Purpose: The involvement of patients or members of the public within public health, health and social care and addictions services is growing in the UK and internationally but is less common in gambling support services. The purpose of this study was to explore Patient and Public Involvement (PPI) infrastructures and engagement channels used in health and care services and debate their transferability to the gambling support sector (including research, education and treatment). Design/methodology/approach: A narrative review examined data from six English language electronic databases, NHS evidence and grey literature covering the period 2007–2019. We identified 130 relevant items from UK literature. A workshop was held in London, England, with people with lived experience of gambling harm to seek their views on and applicability of the review findings to gambling services. Findings: Synthesis of literature and workshop data was undertaken. Main themes addressed "What works" in relation to: building infrastructures and organising involvement of people with lived experience; what people want to be involved in; widening participation and sustaining involvement and respecting people with lived experience. Practical implications: Examination of the literature about involvement and engagement of patients, service users and the public in public health, health and social care and addiction services provides potentially useful examples of good practice which may be adopted by gambling services. Originality/value: The involvement of people with lived experience of gambling harms in gambling support services is under-explored, with little published evidence of what constitutes good practice amongst self-organising groups/networks/grassroots organisations or rights-based/empowerment-based approaches. [ABSTRACT FROM AUTHOR]

There is a shortage of Approved Mental Health Professionals (AMHPs), who are responsible for compulsory admission decisions under the Mental Health Act (MHA), 1983. Only 5% of AMHPs are health professionals, over a decade after the role was opened to them. The research aimed to identify factors motivating and discouraging health professionals from becoming and working as AMHPs. Semi-structured interviews (n = 52) with professionals enabled to become AMHPs by the MHA, 2007, including AMHPs; those that had not become AMHPs; and AMHP managers. Additionally, a survey of AMHP senior managers. Interviews and open-ended survey questions were analysed thematically. Motivating and discouraging factors were grouped as intrinsic and extrinsic. Intrinsic motivations were: altruism; the dynamic and contained nature of the work; and fit with experience. Intrinsic discouraging factors were: damage to therapeutic relationships; the perceived clash between AMHP work and professional values. Extrinsic motivations were: career progression; and professional esteem. Extrinsic discouraging factors were: profile and reputation of the service; organisational commitment; management support; and level of remuneration. The research suggests that changes in organisational responsibility for running AMHP services and raising the profile of the role might help increase recruitment and retention of health professionals. [ABSTRACT FROM AUTHOR]

Social work has long-standing, well-recognized problems of recruitment and retention in England and many other jurisdictions. Policymakers and employers are exploring if there are untapped sources of potential employees. We conducted a scoping review in 2018 to explore current practices and the potential to employ people with criminal records in the social work profession in England. Eighteen studies were located and two themes were identified within these: 1) the potential for people with criminal records to gain qualifications in social work and 2) the potential for people with criminal records to gain employment within social work. More research is needed to establish evidence about current responses to applications from people with criminal records seeking to access training and employment. More evidence is also needed about current practices in decision-making by all parties, together with exploration of people with criminal records' experiences of gaining qualifications in social work and then seeking employment, changing employers and pursuing career progression. [ABSTRACT FROM AUTHOR]

Social care policy-making seeks to address longstanding staff recruitment and retention problems but also to protect vulnerable clients from harm. Internationally many states have policies requiring disclosure of conviction histories by applicants seeking work with vulnerable populations. Policies also seek to encourage rehabilitation of people with offending histories, particularly in countries with high employment. This article presents and discusses the policy implications of a scoping review conducted in 2019 to explore evidence of current practice in employing people with criminal records as care workers in social care and the potential to recruit new staff from this group. The literature contains limited evidence about the effectiveness of policies inhibiting or facilitating social care work by people with criminal records. Further research should clarify policy contradictions, identify barriers and facilitators in different parts of the care sector to employment and protection, while holistic evaluation of initiatives in this area is needed. [ABSTRACT FROM AUTHOR]

Background: It is widely acknowledged that inadequate handovers are associated with putting patients at risk in clinical settings; however, handover practices have received little attention in other 24‐hr settings such as long‐stay residential care facilities. Aim: This study aimed to explore the perceived purpose and organisational processes involved in the handover of information between shifts of staff caring for older residents in five care homes in England. Methods: The study took an ethnographic approach to fieldwork, undertaken between February and June 2016. It consisted of observations of handovers (n = 12) and interviews with managers, Registered Nurses (RNs) and care assistants (n = 27) working day and night shifts. Interview transcripts and observation notes were analysed within NVivo using a matrix approach. Results: Handovers were highly variable in all five care homes in relation to their timings, locations, content and participants. Managers and RNs highlighted handovers as an opportunity for risk assurance, supervision, team building, staff education and monitoring of residents' clinical status. In comparison, care assistants considered the purpose of handovers to be prepared for the responsibilities of working a shift. The discussion addresses implications of these findings, particularly consideration of how best use can be made of RN skills and knowledge in handovers. Conclusion: Research is needed to identify whether care home resident safety can be linked to handover practices and how the presence of RNs in handovers in care homes affects this. Implications for practice: Care home managers, RNs and care workers may find this research useful in practice when considering how best to organise handovers and deploy staff in care homes for older people. [ABSTRACT FROM AUTHOR]

Personal health budgets (PHBs) are being promoted in England as expanding the benefits of choice and control to individuals with healthcare needs. National Health Service (NHS) money is provided to eligible people to use as set out in approved care plans, including direct employment of personal assistants (PAs). The government plans to increase NHS‐funded PHBs and to further introduce integrated personal budgets (IPBs). This potentially creates more demand for directly employed or self‐employed PAs with health‐related skills. The objective of this paper is to report findings from interviews with PAs (n = 105) and key informants (n = 26) from across England, undertaken between October 2016 and August 2017, about the potential for the PA workforce to undertake 'health‐related' tasks as facilitated by the introduction of PHBs. PAs were purposefully recruited to ensure the sample included participants from different geographical locations. Key informants were purposefully selected based on their knowledge of policy and community services. Data were analysed quantitatively and qualitatively. This paper focuses on reporting qualitative findings, which are set within the theoretical framework of normalisation process theory to explore implementation challenges of PHBs. The majority (64%) of PAs confirmed that they saw their current roles as congruent with PHBs, were willing to engage with PHBs and undertake health‐related tasks. However, 74% of PAs said they would need additional training if enacting such roles. Key informant interviews appraised the development of PHBs as complex, noting incongruences arising from NHS and social care‐funded PAs carrying out similar roles within different organisational systems. We conclude the current PA workforce is willing to take on PHB work and is likely to interweave this with work funded by PBs and self‐funding care users. Implications include the need for careful consideration of training requirements and delivery for PHB‐funded PAs. [ABSTRACT FROM AUTHOR]

Summary: This paper explores arguments for and against increasing social workers' legal powers in adult protection (safeguarding) in England, where there is no direct power of entry. It draws on a research study conducted in 2016–17 involving an international literature review, interviews with social workers (n = 22), managers (n = 15), older and disabled people (n = 6) and carers (n = 5) and a survey of adult safeguarding managers (n = 27). The paper contextualises findings by exploring concepts of vulnerability and autonomy. Findings: Most participants were in favour of increased powers for social workers undertaking safeguarding enquiries. A power of entry was seen to strengthen the legal basis of safeguarding and provide legitimacy for social workers to act. However, many participants expressed reservations, arguing that cases could generally be resolved with good social work, there would be a risk of negative impact on adults at risk and their families, the power of entry conflicted with social work practice and values and it could negatively affect social work relationships. Such arguments indicate a nuanced view of autonomy and vulnerability, which allow for doubt about the autonomy of people with capacity in certain circumstances. Applications: The paper suggests the need for investment in the processes of implementation of risk management if increased legal powers are introduced. There could be a value in encouraging social workers to make explicit their assumptions about the definitions of vulnerability and its impact on autonomy and to explore the subjective experience of vulnerability in their judgements about intervening in these kinds of situations. [ABSTRACT FROM AUTHOR]

Objectives To investigate residents’ and relatives’ views and experiences of handovers in care homes. This paper reports residents’ and relatives’ awareness of handovers, knowledge of and views on handover practices and purpose, and views on handover effectiveness. Outcomes, safety and satisfaction in clinical settings are influenced by shift handovers. Despite this link with quality, residents’ increasing support needs and the provision of 24 hours care in care homes for older people, little is known about handovers in these settings from a resident and visiting relative perspective. Setting Five purposively sampled care homes for older people in South East England. Participants Home managers (n=5), residents (n=16) relatives of residents (n=10) were interviewed; residents (n=15) and their interactions with staff were observed during handover periods. Participation was voluntary and subject to consent. Residents were identified by managers as having mental capacity to take a decision about participation which was then assessed. An ethnographic approach to data collection was taken, preceded by an evidence review. Results Shift handovers were largely invisible processes to participating residents and relatives, many of whom had given little thought to handover practice, logistics or effectiveness prior to study participation. Their awareness and understanding of handovers, handover practices, and handover purpose and effectiveness varied. There appeared to be an underlying assumption that administrative procedures in care homes would operate without input from residents or relatives. A small number of residents, however, were highly aware of the routine of handovers and the implications of this for the timing of and response to their requests for care or support. Conclusions The care home setting and perspectives of the effectiveness of handovers may influence awareness of, knowledge of and levels of interest in involvement in handovers. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe the employment conditions of social care personal assistants (PAs) in England. In England, disabled adults have been able to directly employ people to meet their care or support needs for a number of years, little is known about the employment conditions of people who are directly employed. Design/methodology/approach: PAs were recruited mainly through third sector and user led organisations. A total of 105 social care PAs took part in a semi-structured telephone interview, which on average was an hour long. Interviews were fully transcribed. Quantitative data were analysed using SPSS (v.24) and qualitative data by NVIVO software. Findings: The paper focuses on employment conditions: contracts, pay, pensions, national insurance, overtime, holiday and sick pay, etc. Access to training and support are also described. Though PAs enjoyed considerable job satisfaction, many did not enjoy good employment conditions. Though employer abuse was uncommon, many PAs could arguably be described as exploited. Occupational isolation and lack of support to resolve disputes was striking. Research limitations/implications: Though this may be currently the largest qualitative study of PAs in the UK, it is nonetheless relatively small and no claims for generalisability are made, though the geographical spread of the sample was wide and recruited from multiple sites. Practical implications: PAs are an effective way of establishing relationship-based care, and confer direct control to disabled employers. Many PAs experienced high job satisfaction. However, lack of regulation and oversight creates considerable potential for exploitation or abuse. This may make the role less attractive to potential PAs in the medium term. Social implications: Social care PAs may be a very effective means of achieving genuinely person-centred care or support for many people. However, PAs do not always appear to enjoy satisfactory conditions of employment and their role is largely unregulated. Growth and long-term sustainability of this emergent role may be jeopardised by these employment conditions. Originality/value: Little is known about PA working conditions. This study suggests that much more needs to be done to improve these. [ABSTRACT FROM AUTHOR]

Gambling is increasingly seen as a public health rather than an individual problem. Opportunities to gamble have grown in England in the last decade since the liberalisation of the gambling industry. This exploratory study investigated the experiences of 21 practitioners about gambling among adults with social care needs. Practitioners were interviewed about their understanding of the risks to their clients arising from their own or others' gambling participation, how they support clients in such circumstances and their views of how practice could be developed to better support clients experiencing gambling-related harm. Analysis revealed themes covering: (1) concerns about the pervasiveness and appeal of gambling; (2) lack of knowledge of the complexities surrounding gambling and gambling-related harm; (3) uncertainties about how to support adults with care and support needs at risk of gambling-related harm; (4) desire for professional development activities. This study highlights practitioners' concern about gambling-related harm and their wish for guidance about good practice in this area. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to investigate the content, purpose and effectiveness of the handover of information between care home staff beginning and completing a shift. Design/methodology/approach: This was an exploratory study drawing on ethnographic methods. A total of 27 interviews with a range of care home staff, including managers, registered nurses, senior care workers and care workers were undertaken in five care homes selected to give a good contrast in terms of size, ownership, shift patterns and type of handover. Findings: Most handovers were short – lasting 15 min or so – and were held in the office or secluded area in which staff could talk privately. They lasted longer in one home in which the incoming and outgoing shifts physically visited each resident's room and the communal spaces. Staff felt that handovers were important for the efficient running of the home as well as to alert everyone to changes in a resident's health or important events, such as a hospital appointment. In one home, handheld devices enabled staff to follow a resident's care plan and update what was happening in real time. Research limitations/implications: This was a small scale study based on data from a limited number of care homes. Practical implications: The increasing popularity of 12 h shifts means that many homes only hold two short handovers early in the morning and in the evening when the night staff arrive. There appears to be a trend to reduce the number of staff paid to attend handover. Despite this, handovers remain an important component of the routine of a care home. The information contained in handover relates to the running of the care home, as well as residents' wellbeing, suggesting that, while their content overlaps with written records in the home, they are not superfluous. Originality/value: Although the literature on handovers in hospitals is extensive, this appears to be the first published study of handover practices in care homes. [ABSTRACT FROM AUTHOR]

There is a considerable body of literature on the importance of effective shift handovers in hospitals and other health-care settings but less is known about the transfer of information between staff starting and completing stints of paid work in care homes. In the first of two articles considering this under-explored topic, we report findings from a scoping review examining what is known about shift-to-shift handovers in care homes for older people and their equivalents. It is based on systematic searches of electronic databases of English-language journals on ageing and internet searches for material published between January 2005 and October 2016. Guidance from the regulatory body for health and social care in England, the Care Quality Commission, highlights the importance of handovers in care homes but the degree to which they are embedded into care home routines appears to be variable, influenced by factors such as workplace culture, shift patterns and the extent to which they involve all those on duty or just those with professional qualifications. Staffing shortages and whether or not members of staff are paid for their time attending handovers appear to be further constraints on their use. We conclude that there is considerable scope for further research in this field to identify and develop good practice. [ABSTRACT FROM AUTHOR]

Social workers have a long history of working with clients with alcohol and drugs problems and collaborating with specialist addictions services. In England, while gambling participation has soared since 2007, the impact on social work is largely unknown. This article investigates what is known about social work practice in working with adults who have care and support needs and may be at risk of gambling-related harm. The scoping review included studies and commentaries covering the risks of gambling-related harm as reported in social work practice and education. The scoping review revealed limited evidence specific to social work, and therefore, we developed an arching theme for the analysis of ‘invisibility’ in relation to three areas: the near ‘invisible’ social worker in gambling research; the ‘invisibility’ of gambling in most professional qualifying social work programmes; and the near ‘invisibility’ of the impact of gambling on social work clients. Implications for policy and practice are that the social work profession could take steps to ensure it is better informed about identifying, minimising risks and providing support. Professional qualifying social work programmes may wish to consider including resources addressing the prevalence of gambling-related harms. Consideration should be given to whether screening for gambling-related harm should be introduced if social workers are to be better informed about gambling risks. [ABSTRACT FROM AUTHOR]

This paper reports on a study that examined social workers’ and service-user representatives’ perspectives on current options for accessing older people living at home when entry is being obstructed by a third party, there are concerns about possible abuse or neglect and legal approaches are not considered appropriate. In-depth interviews were conducted with social workers (n  = 37) and service-user representatives (n  = 11) from three English local authorities. Professional interviews focused on current practices in dealing with such cases. Service-user representatives were asked to discuss a fictitious obstructive case and potential actions that could be taken by social workers. Participants described current practice in terms of options for negotiation with third parties obstructing access to older people, ranging from ‘softer’ styles aiming to develop rapport to ‘more assertive’ approaches. Making good decisions about case allocation, being creative in pursuing cases and fostering good multi-agency relationships were valued by practitioners. Some service-user representatives questioned the time and resources involved in managing these cases. Policy makers may wish to consider developing guidelines for multi-agency partners outlining their responsibilities in such cases; practitioners may wish to consider whether offering an obstructer the services of an independent advocate would be useful. [ABSTRACT FROM AUTHOR]

Purpose People experiencing homelessness are being identified as a potentially vulnerable group in relation to gambling-related harm. The purpose of this paper is to explore the links between gambling-related harm and homelessness.Design/methodology/approach A scoping review of the English-language literature was conducted in 2016-2017 using a wide range of international sources. Qualitative content analysis was employed to code and identify key themes within the literature.Findings Five themes were identified: emerging knowledge about why people experiencing homelessness may participate in gambling; emerging knowledge about the prevalence of gambling within the homeless population; the likelihood that gambling-related harm is under-reported within the homeless population; emerging knowledge about the extent that people experiencing homelessness access gambling support services; and limited awareness about the potential impact of gambling participation among people experiencing homelessness.Originality/value The paper reviews research concerning the links between gambling, gambling-related harm and homelessness, which may be relevant to those working with people experiencing homelessness. [ABSTRACT FROM AUTHOR]

Purpose Being able to speak in private to an adult about whom there is a safeguarding concern is central to English local authorities’ duty under the Care Act 2014 to make enquiries in such cases. While there has been an on-going debate about whether social workers or others should have new powers to effect these enquiries, it has been unclear how common obstructive behaviour by third parties is and how often this causes serious problems or is unresolved. The purpose of this paper is to address this knowledge gap.Design/methodology/approach A survey of local authority adult safeguarding managers was conducted in 2016 and interviews were undertaken with managers and social workers in three local authorities. Data were analysed descriptively.Findings Estimates of numbers and frequency of cases of obstruction varied widely. Most survey respondents and interview participants described situations where there had been some problems in accessing an adult at risk. Those that were serious and long-standing problems of access were few in number, but were time consuming and often distressing for the professionals involved.Research limitations/implications Further survey research on the prevalence of obstructive behaviour of third parties may not command greater response rates unless there is a specific policy proposal or a case that has “hit the headlines”. Other forms of data collection and reporting may be worth considering. Interview data likewise potentially suffer from problems of recall and definition.Practical implications At times professionals will hear of, or encounter, difficulties in accessing an adult at risk about whom there is concern. Support from supervisors and managers is needed by practitioners as such cases can be distressing. Localities may wish to collect and reflect upon such cases so that there is learning from practice about possible resolution and outcomes.Social implications There is no evidence of large numbers of cases where access is denied or very difficult. Those cases where there are problems are memorable to practitioners. Small numbers of cases, however, do not necessarily mean that the problem of gaining access is insignificant.Originality/value This study addressed a question which is topical in England and provides evidence about the frequency of the problem of gaining access to adults at risk. There has been no comparable study in England. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore debates about the powers social workers may need to undertake safeguarding enquiries where access to the adult is denied.Design/methodology/approach The paper takes as a starting point a scoping review of the literature undertaken as part of a study exploring social work responses to situations where they are prevented from speaking to an adult at risk by a third party.Findings A power of entry might be one solution to situations where social workers are prevented from accessing an adult at risk. The paper focuses on the Scottish approach to legal powers in adult safeguarding, established by the Adult Support and Protection Act (Scotland) 2007 and draws out messages for adult safeguarding in England and elsewhere. The literature review identified that debates over the Scottish approach are underpinned by differing conceptualisations of vulnerability, autonomy and privacy, and the paper relates these conceptualisations to different theoretical stances.Social implications The paper concludes that the literature suggests that a more socially mediated rather than an essentialist understanding of the concepts of vulnerability, autonomy and privacy allows for more nuanced approaches to social work practice in respect of using powers of entry and intervention with adults at risk who have capacity to make decisions.Originality/value This paper provides a novel perspective on debates over how to overcome challenges to accessing adults at risk in adult safeguarding through an exploration of understandings of vulnerability, privacy and autonomy. [ABSTRACT FROM AUTHOR]

Purpose Opportunities to gamble have boomed in the UK in recent years, since the passing of the Gambling Act 2005. The implications of this for adults with care and support needs and for safeguarding services have not been greatly investigated. The purpose of this paper is to address the interface of how gambling affects adults with care and support needs in England and adult safeguarding.Design/methodology/approach This paper reports on the scoping review which focussed on adults with care and support needs and gambling-related harm. It also included literature on perpetrators who exploit adults with care and support needs to fund their own or others’ gambling. The overall aims of this scoping review were to explore what is known about gambling-related harm affecting adults with care and support needs, the gaps in the evidence base, and specifically to refine the interview questions for the wider study.Findings There is some evidence that adults with care and support needs experience or are at risk of gambling-related harm. There is, however, lack of data from safeguarding services about this affecting adults at risk and safeguarding practice and systems. A public health approach to gambling is advocated by some, as well as effective regulation and support for people who have problems with their own or others’ gambling.Originality/value Industry operators, practitioners, and policymakers are increasingly paying attention to gambling-related harm but there is a lack of focus on adults with care and support needs or implications for adult safeguarding. [ABSTRACT FROM AUTHOR]

Adult safeguarding is the subject of increasing attention in England and internationally. This article draws on research which developed a typology of 'models of safeguarding'. 'Models' refer to different ways local authorities in England organise adult safeguarding (about which there is little evidence) rather than 'model' approaches to be emulated. The four models identified were: Dispersed-Generic (safeguarding work undertaken by operational teams); Dispersed-Specialist (safeguarding work undertaken partly by specialist social workers located in operational teams); Partially Centralised-Specialist (some safeguarding work undertaken by a central specialist safeguarding team); and Fully-Centralised-Specialist (all safeguarding work undertaken by a specialist safeguarding team). We explored associations between these models and other important variables (numbers of referrals, kinds of alleged abuse and characteristics of adults at risk) and outcomes. The article reports secondary analysis of English local authority safeguarding referral data and on the possible different costs of different models. Dispersed-Specialist sites appeared to have a higher rate of substantiating alleged abuse compared with other models. Statistical correlations were found with types of victim profiles and the perpetrator/victim relationship. It may be that decisions about local organisation of safe-guarding are more affected by local organisational contexts than local authority model. [ABSTRACT FROM AUTHOR]

Professionals express divergent views about whether adults at risk are best served by safeguarding work being incorporated into social workers' casework or being undertaken by specialist workers within local area or centralised teams. This paper draws on findings from the final two phases of a three-phase study which aimed to identify a typology of different models of organising adult safeguarding and compare the advantages and disadvantages of these. We used mixed-methods to investigate four different models of organising adult safeguarding which we termed: A) Dispersed-Generic, B) Dispersed-Specialist, C) Partly-Centralised-Specialist and D) Fully-Centralised-Specialist. In each model, we analysed staff interviews (n = 38), staff survey responses (n = 206), feedback interviews (with care home managers, solicitors and Independent Mental Capacity Advocates) (n = 28), Abuse of Vulnerable Adults (AVA) Returns, Adult Social Care User Survey Returns (ASCS) and service costs. This paper focuses on qualitative data from staff and feedback interviews and the staff survey. Our findings focus on safeguarding as a specialism, safeguarding practice (including multi-agency working, prioritisation, tensions, handover, staff confidence and deskilling) and managing safeguarding. Local authority (LA) participants described and commented on the advantages and disadvantages of their organisational model. Feedback interviews offered different perspectives on safeguarding services and implications of different models. [ABSTRACT FROM AUTHOR]

Summary Greater priority is now being given to improving responses to concerns that adults may be at risk of abuse or neglect in England and internationally. In England, the Care Act 2014 placed ‘adult safeguarding’ on a firmer statutory footing. Although local authorities were given the lead responsibility for adult safeguarding over a decade ago, little is known about how they organised their responses. This article reports one element of a national study in which semi-structured interviews with 23 local authority adult safeguarding managers in 2013–14 were conducted. The interviews sought to understand how local authorities arrange their responses to adult safeguarding concerns. Findings Several models of practice were identified. Confirming a central theme reported in the literature, the extent and nature of specialism within safeguarding practice varied. Safeguarding specialists were reported to be based in centralised teams or were located as specialists in locality social work teams. In some areas, the role of specialist safeguarding practitioners was linked to an analysis of risk severity or location of concern. Other areas emphasised the importance of safeguarding work as the core of mainstream social work practice. Applications These findings offer a basis for analysis and managerial considerations about the implications of different organisational models of adult safeguarding. These may be relevant to option appraisals and decision-making about future organisational planning. [ABSTRACT FROM AUTHOR]

Purpose Opinion is divided on whether a new power of entry should be introduced for social workers in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk in England who have decision-making capacity. The purpose of this paper is to investigate the prevalence and circumstances of situations where access to an adult at risk is denied or difficult and what helps those in practice. The study consists of a literature review, a survey of adult safeguarding managers and interviews with social care staff in three case studies of local authorities. As part of the contextual literature review, during 2014 the authors located parliamentary debates on the subject and this paper reports on their analysis.Design/methodology/approach Following approaches were used in historical research, documentary analysis was carried out on transcripts of parliamentary debates available online from Hansard, supplemented by other materials that were referenced in speeches and set in the theoretical context of the representations of social problems.Findings The authors describe the content of debates on the risks and benefits of a new right to access for social workers and the role of parliamentary champions who determinedly pursued this policy, putting forward three unsuccessful amendments in efforts to insert such a new power into the Care Act 2014.Research limitations/implications There are limits to a focus on parliamentary reports and the limits of Hansard reporting are small but need to be acknowledged. However, adult safeguarding research has surprisingly not undertaken substantial analyses of political rhetoric despite the public theatre of the debate and the importance of legislative initiatives and monitoring.Originality/value This paper adds to the history of adult safeguarding in England. It also offers insight into politicians’ views on what is known/unknown about the prevalence and circumstances of the problems with gaining access to adults with capacity where there are safeguarding concerns and politicians’ views on the merits or hazards of a power of access. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present an analysis of media reactions to the BBC Television Panorama programme, Behind Closed Doors’ and to set this in the context of interviews with care staff about their reflections on publicity about poor practice in the care sector.Design/methodology/approach This paper reports on an analysis of media reactions to recent exposé of abuse in social care in England and data from an interview-based study of care workers. The interviews were analysed to consider the impact of such media reports on staff and to explore their views of action that might be need to be taken about care failings.Findings There are mixed reactions to exposé of poor care on television and to the debates that precede and follow their broadcast. Debates occur in print and on television, but also in social media. The particular exposé of care home practices by the Panorama programme, Behind Closed Doors, led to debate in England about the potential role of covert cameras in care homes. The interviews revealed that while care staff are affected by scandals in the media about social care, they do not necessarily focus on themes that the media stories subsequently highlight. Overall some are disenchanted while others have ideas of what needs to change to improve practice. Care staff consider that there remain problems in raising concerns about practices and some staff feel unable to stay in workplaces where they have made complaints.Research limitations/implications The care workers interviewed may not be representative of the sector and they may have wished to provide socially acceptable answers to the researchers. Practice was not observed.Practical implications Local Safeguarding Adult Boards may wish to develop a communications strategy to deal with requests for reactions to media reports locally and nationally. Safeguarding practitioners may wish to prepare for increased referrals following media coverage of poor care in their areas. They may later be able to use media reports to discuss any local differences of interpretation over matters such as prosecutions for abuse. Trainers and educationalists may wish to clarify the importance given by care providers to raising concerns, the ways in which difficult conversations can be held, and the protections available to whistle-blowers or those raising concerns – with local examples to provide assurance that this is not mere rhetoric.Originality/value Television reports of problems with social care attract wide media interest but the authors know very little about how care workers respond to depictions of their work and their occupational grouping. This paper links media and expert commentator reactions to television exposé with data acquired from interviews with those on the frontline of care. [ABSTRACT FROM AUTHOR]

Purpose Whether social workers should have a power of entry in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk is a topical question in England. The purpose of this paper is to present the findings of a re-examination of relevant sections of the 2012 Government Safeguarding Power of Entry Consultation.Design/methodology/approach Re-analysis of responses to question three of the 2012 Government’s Safeguarding Power of Entry Consultation was undertaken in late 2015-early 2016. The consultation submissions were located and searched for information on views of the prevalence of the situations where access to an adult at risk (with decision-making capacity) is being hindered by a third party and the nature of examples where a new power of entry might be considered appropriate by consultation respondents.Findings The majority of respondents to the consultation generally reported that situations when a new power of entry would be required were not encountered regularly; however a minority of respondents stated these situations occurred more frequently. Examples of situations where third parties appeared to be hindering access were given across the different categories of adults at risk and types of abuse and current practices were described. Respondents observed that the risks of excessive or inappropriate use of any new powers needed to be considered carefully.Originality/value This re-analysis sheds light on the prevalence and circumstances of the problems encountered about access to adults at risk. The legal framework of adult safeguarding continues to be of interest to policy makers, researchers and practitioners. [ABSTRACT FROM AUTHOR]

Background: There are currently no national measures in England reporting the experiences of people who have been involved with adult safeguarding services following concerns that they may be at risk of abuse or neglect. The Health and Social Care Information Centre (HSCIC) aimed to develop a new adult safeguarding outcome measure (survey) for local authorities (LAs) that could be added to the Adult Social Care Outcomes Framework (ASCOF). The ASCOF is a national collection of social care outcomes performance indicators collected from the perspective of people receiving partial or total funding from a LA for care services.Methods: An outcome measure (a face-to-face interview based survey consisting of 7 questions) was piloted in 40 LAs with 382 adults at risk (or their representative) who had been the subject of a safeguarding investigation. The aim was to investigate the feasibility of the survey in three domains: i) if a statistically representative sample of adults at risk (or their family, friend, carer or advocate) could be recruited; ii) analysis of survey responses and its acceptability to participants iii) feedback from LAs about the survey's administration.Results and Discussion: Overall the survey results met statistical confidence; however the individual results for adults at risk did not, due to the high proportion of representatives who responded because adults at risk were unable. Responses to the survey were generally positive; 72 % of participants felt that the help received during the safeguarding investigation had made them or the adult at risk (if reporting as a proxy) feel 'quite a bit' or 'a lot safer'. These results are the most robust data collected in England on the perspectives of adults at risk and their representatives on safeguarding services. Participants reported they appreciated being asked for feedback. LAs suggested survey administration improvements.Conclusions: This survey is one way LAs can meet their new legal requirement under the Care Act 2014 to 'seek feedback' from adults at risk about adult safeguarding services. The survey findings provide the first robust evidence that safeguarding services in the main meet their goals of promoting feelings of safety among adults at risk. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report and discuss the findings of an evaluation of the drama performance and reception of Let’s Talk in the context of interprofessional practice. Design/methodology/approach – This first stage evaluation addresses the initial development stage of the Let’s Talk drama initiative from the perspectives of health and social care participants. Recent policy and research are drawn upon in the presentation of the background to the drama and service integration imperatives. Findings – Most research on the subject of interprofessional education comes from professional training programmes. The development of the drama Let’s Talk provides evidence of how such a narrative can engage with local professionals working in different agencies but with the same patient or user groups. The development of such an initiative takes time and testing of it at early stages appears to be valuable in providing it with greater clarity and authenticity. Research limitations/implications – The paper addresses the developmental stages of an interprofessional drama initiative in one part of England in a locality where there is relative professional stability and reasonable communication across agencies and local support for workforce development. Practical implications – The evaluation may prompt reflection in practice and policy development on the potential for participation in role play and drama to be useful in changing cultures and in increasing interprofessional understanding. Originality/value – The paper contributes to understanding of the need for interprofessional and interagency debates to be informed by cultural change and active engagement with busy professionals. It recommends attention to careful development of such initiatives and to debate about what might be meaningful and long-term impacts. [ABSTRACT FROM AUTHOR]

Purpose – The Health and Social Care Information Centre undertook the development and piloting of a new adult safeguarding outcome measure (a face-to-face survey) for local authorities (LAs) that could be added to the adult social care outcomes framework (ASCOF). The ASCOF is a national collection of social care outcomes performance indicators collected from the perspective of people receiving partial or total funding from a LA for care services. The projected costs of introducing the survey as a new statutory measure in England were assessed. The paper aims to discuss these issues. Design/methodology/approach – An outcome measure (a face-to-face interview based survey consisting of seven questions) was piloted during 2014 in 40 LAs with 20 adults at risk (or other informant) in each site who had been the subject of a safeguarding investigation (n=382). LAs were asked to estimate the cost to their LA of conducting the survey for two years, interviewing at least 15 per cent of their completed safeguarding cases each year. Findings – Extrapolating cost findings to the full 152 LAs in England would give an estimated total cost of implementing the survey of approximately £3 million in Year 1 and £2.1 million in Year 2. Set-up costs for the survey can therefore be estimated at around £900,000. Wide variations were identified in the costs per interview between LAs and reasons for this are discussed. Originality/value – The benefits of this unique survey are it enables LAs to measure how they are undertaking their adult safeguarding work from the perspective of adults at risk and others with a close interest. It also enables LAs to meet their new obligations under the Care Act 2014 Guidance to “understand what adults at risk think of adult safeguarding”. [ABSTRACT FROM AUTHOR]

Summary This article presents the findings of a narrative synthesis of literature published between January 2000 and September 2013 exploring the organisation of adult safeguarding services in England. The review sought to identify the characteristics of safeguarding practice, which may be important for local authorities to consider when choosing between models of organisation. Findings The findings suggest that the development of adult safeguarding policy and practice has prompted local authorities to develop specialist safeguarding roles. The implications of specialism have not been extensively explored. However, several important characteristics of safeguarding practice are identifiable from the literature including specialism within the organisation of adult safeguarding; decision-making and thresholds for safeguarding response; and multi-agency working. Applications The review found limited evidence relating to the organisation of adult safeguarding, which suggests that further empirical research is needed. The critical features of safeguarding practice identified here comprise a useful starting point from which to explore the implications of different ‘models’ of safeguarding organisation. [ABSTRACT FROM AUTHOR]

Purpose – There are currently no national adult safeguarding outcome measures that focus on people who have been through an adult safeguarding investigation in England. There is a need for local authorities (LAs) and their partners to be able to measure whether the services provided to adults at risk of abuse and neglect are effective. The paper aims to discuss these issues. Design/methodology/approach – This paper describes the cognitive testing phase of a study to develop and implement a standardised adult at risk outcome measure in adult safeguarding for use by LAs in England. An outcome measure (a set of seven survey questions administered in a face to face interview) was cognitively tested in three LAs with adults at risk (or their carers/advocates) for whom an investigation of abuse had been concluded (n=40), with the aim of assessing whether it was commonly understood. A set of guidance notes was designed and LA staff (n=12) who assisted with the survey were interviewed about its usability and the feasibility of administering the survey. Findings – The survey questions required modifications to improve their reliability, validity and comparability. LA staff also suggested improvements were needed in the guidance document and survey. LA managers, adults at risk (and their relatives/carers/advocates) were willing to be involved in the survey and it was considered feasible to proceed with piloting the measure. Originality/value – The development of this unique survey is of interest to those working in adult safeguarding, user involvement, survey management and outcome measurement in LAs. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the methodology being used in a study exploring the organisation of adult safeguarding. Design/methodology/approach -- A mixed-methods study is presented which describes how the research team is seeking to identify models of adult safeguarding and then compare them using a quasi-experimental study design. Findings -- Close examination of this study's methodology highlights the potential value of mixed-method research approaches. Research limitations/implications -- Anticipated study challenges include difficulties with gaining agreement from study sites and recruitment of people who have been the subject of a safeguarding referral. Originality/value -- This will be the first study in England to identify and compare different models of adult safeguarding in depth. Outlining and discussing current methodology is likely to be of interest to practitioners, managers and other researchers and policy makers. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in 2011. Design/methodology/approach -- Jenny Weinstein is a Hon Senior Lecturer at Kingston University, Professor Ray Jones and Rick Hood are based at the Joint Faculty of Health and Social Care, St George's, University of London and Kingston University, London, UK.A qualitative study is described in which structured interviews were carried out with participants belonging to each service user group. The study aimed to explore the following issues: first, service users' experiences of the assessment process, second, whether service users wanted full control of their budgets and third, if personal budgets make a difference to quality of life. Findings -- xService users (n = 7 older people and carers; n = 7 people with mental health problems) found the personal budgets system and assessment process difficult to understand and its administration complex. Older people in particular were reluctant to assume full control and responsibility for managing their own personal budget in the form of a Direct Payment. Participants in both groups reported their continued reliance on traditional home care or day care services. These findings were reported back to the LA to help staff review the implementation of personal budgets for these two user groups. Research limitations/implications -- Study participant numbers are low due to difficulties recruiting. Several potential participants were not interviewed due to their frailty. Practical implications -- Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care. Originality/value -- Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care. [ABSTRACT FROM AUTHOR]

Interprofessional education (IPE) in health and social care has been well documented regarding student outcomes. Less has been written from the perspective of those who actually developed IPE. This study explores IPE within the context of a university partnership working with service providers in Southwest London (UK). We focused on the experiences and perspectives of 19 key players who were interviewed about the inception, implementation and development of IPE over 15 years. Our aim was to understand their views of IPE and its evolution over time. Interviewees provided different understandings of IPE, as well as contrasting views regarding its purpose and optimum delivery. Problems such as lack of central planning and the logistics of implementation were also discussed. Paradoxically, however, the participants highlighted positive outcomes and conveyed optimistic messages for the future. Despite various challenges and setbacks, a strong belief in the importance of IPE and a commitment to carrying it through were strong motivators contributing to finding solutions, as were building trust and positive relationships across professional and disciplinary boundaries. [ABSTRACT FROM AUTHOR]

Aim and objectives. To establish whether the problems and issues experienced by people with dementia living at home and their carers were addressed in the clinical guidance for continence management for community nursing services in England. Background. Internationally, the numbers of people with dementia are rising. Managing incontinence is a significant issue as the presence of incontinence is one of the triggers for people with dementia to move their residence to a care home. People with dementia living at home and their family carers report difficulties in accessing knowledgeable professionals and acceptable continence products. Design. A review by documentary analysis of clinical policies and guidance from a sample of community nursing services in all Strategic Health Authority regions of England. Methods. A sample of clinical policy and guidance documents for continence assessment and management from up to four community nursing services in each of the ten Strategic Health Authority regions in England was sought. Documentary analysis was undertaken on the relevance of the documents identified for people with dementia living at home. Findings. Ninety-eight documents from 38 local community nursing services spread across ten Strategic Health Authority areas were obtained and analysed. Only in the documents of three services were nurses offered detailed guidance about the management of incontinence for people with dementia at home. In the documentation of only one service were people with dementia identified as a special case which warranted the provision of additional continence products. Conclusion. Clinical guidance on continence assessment and management for community nurses in many parts of England does not address the specific needs of people with dementia living at home or their carers. Relevance for clinical practice. Nurses working in community settings and those providing clinical leadership in continence care should review their clinical guidance and policies to ensure relevance for people with dementia living at home and their family carers. [ABSTRACT FROM AUTHOR]

Reflective approaches have been increasingly adopted in health and social care education. However, how reflective practice is taught in and between professional courses differs extensively. This review of literature identified and categorised literature available on teaching reflective practice in health and social care and compared this with what was available interprofessionally and multiprofessionally. Limited examples comparing how reflective practice is taught in different professions were found. This lack of empirical data has implications for both the teaching and researching of professional practice. [ABSTRACT FROM PUBLISHER]

This article explores the restructuring of education in England and Spain. Against a presumably homogeneous global streamlining of educational systems according to competition-driven goals, the comparison of teachers' work-lives and professional knowledge evidences a variety of experiences under-represented in discourses on global restructuring. Our argument highlights how in England political reforms have worked their way deep into the working lives of professionals, giving rise to a 'managerial' model of professionalism, whereas in Spain reforms are more loosely coupled with teachers' work, favoring a 'social service'-oriented model. However, despite the different professional ideals, teachers uniformly stressed the challenges they face were predominantly due to broader social transformations for which policy reforms provided few if any remedies. Our study emphasizes the variety of educational reforms and teachers' experiences in the European context and argues further educational change should be bound to the historical trajectory and the concrete needs of the professionals in question. [ABSTRACT FROM AUTHOR]

This short report describes a study which aimed to explore the experiences of newly qualified assistant practitioners (APs) from an interprofessional foundation degree in long-term conditions. Interviews were carried out with one cohort of newly qualified APs and their employee mentors, 6-9 months after the APs had re-entered full-time practice. Three major themes were identified after analysis of the interview transcripts: widened AP horizons, poor AP pay and conditions and friction between APs and their colleagues. The course was highly praised by the APs and their workplace mentors. Unfortunately, the workplace infrastructure needed to support the APs was reported to be inadequate. [ABSTRACT FROM AUTHOR]