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There is a growing emphasis on prevention to reconcile demographic pressures, resource scarcity and expectations of better quality care and support. The Care Act 2014 placed a statutory duty on English local authorities to prevent and delay the development of needs for care and support. However, evidence suggests that the prevention approach has secured less impact than intended. Given that existing approaches have achieved such limited results, new ways of addressing this apparently intractable challenge should be considered. We argue here that theory-based models that support the understanding of, and responses to, implementation barriers and facilitators can provide tools to support the development of more successful implementation. Drawing on in-depth interviews (n  = 20) in selected English councils and analyses of their policy documents, we explore the 'Ready, Willing and Able' (RWA) model, which posits that those three preconditions must be satisfied before new practices can be implemented sustainably. We argue that RWA can provide a straightforward and parsimonious framework for identifying implementation barriers and facilitators. Using the model to identify potential bottlenecks prior to the implementation can help local actors clarify baseline barriers to progress. RWA could help to inform opportunities to target identified problems, by reinforcing facilitators and moderating barriers. [ABSTRACT FROM AUTHOR]

While debate on how best to pay for social care in England continues, information about public attitudes on this issue is limited. We asked representative samples of the public whether care costs for older people should be met by the state, met by the service user or shared between state and user. We used an online survey of people aged 18–75 (n = 3,000) and interview survey of people aged 65 and over (n = 466). Respondents were given four vignettes (two home care, two residential care) and asked who should pay at different levels of user resources; and how much users should contribute when costs were shared. Fewer than one-fifth of the online sample and one-quarter of the interview sample considered that the state should meet the full costs whatever users' resources; considerably lower proportions believed that users should meet the full costs in all cases. Two-thirds of the online sample and half the interview sample thought costs should be shared. The proportion of costs that users should contribute was relatively low (20–50 per cent, varying by user resources). The study illustrates that public views elicited through vignettes can provide evidence to inform policy on social care funding. [ABSTRACT FROM AUTHOR]

Circles of Support aim to enable people with learning disabilities (and others) to live full lives as part of their communities. As part of a wider study of the economic case for community capacity building conducted from 2012 to 2014, we conducted a mixed methods study of five Circles in North West England. Members of these Circles were supporting adults with moderate to profound learning disabilities and provided accounts of success in enabling the core member to live more independent lives with improved social care outcomes within cost envelopes that appeared to be less than more traditional types of support. The Circles also reported success in harnessing community resources to promote social inclusion and improve well-being. This very small-scale study can only offer tentative evidence but does appear to justify more rigorous research into the potential of Circles to secure cost-effective means of providing support to people with learning disabilities than the alternative, which in most cases would have been a long-term residential care placement.

Advocacy can help service users both to understand their rights and choices and also to support them in resolving issues of great significance to their lives. We investigated some of the costs and outcomes of advocacy provided to parents with learning disabilities at risk of having their children taken into care. Through two workshops and a survey, we gathered information about service use and outcomes at case- and project-levels. We used evidence from previous studies to assign unit costs to service use and to value the economic consequences of outcomes. We combined data with simple decision-modelling techniques. The mean cost of the advocacy intervention was £3040; potential cost savings per case ranged from £720 if we only considered the impact on children's social services, to over £3130 if savings to other public services were considered. Estimated improvements in quality of life and earnings were worth an additional £550. The limitations of our study mean those findings should be interpreted cautiously. Nonetheless, they suggest there is scope for securing better value for money through introducing advocacy for parents with learning disabilities.

Discharge to Assess (D2A) models of care have been developed to expedite the process of discharging hospital patients as soon as they are medically fit to leave, thereby improving the efficiency and effectiveness of the healthcare system. This article focuses on the implementation of a D2A model in Kent, England, which formed a case study for a European research programme of improvements in integrated care for older people. It uses the Critical Systems Heuristics framework to examine the implementation process and focuses in particular on why this improvement project proved to be so difficult to implement and why the anticipated outcomes were so elusive. The analysis highlights the value in using critical systems thinking to better evaluate integrated care initiatives, in particular by identifying more explicitly different stakeholder perspectives and power relationships within the system and its decision environment. [ABSTRACT FROM AUTHOR]

Twelve synchronous online focus groups were conducted, each involving four to six members of the general public who had expressed in‐principle support for sharing the costs of social care for older people between service users and government. These explored participants' reasons for preferring a shared approach and their views on how costs should be shared, with particular attention given to the sociocultural frames employed. Four main sociocultural frames were identified, reflecting dominant discourses concerning (i) the financial burden of meeting social care need ('scarcity' frame) (ii) the core purpose of social care ('medicalised conception of care' frame) (iii) the role and perceived limitations of the private market ('consumer' frame), and (iv) fundamental concerns about safety, security and belonging ('loss and abandonment' frame). Of these four frames, the 'scarcity' frame was dominant, with views about how costs should be shared overwhelmingly formulated upon assumptions of insufficient resources. This was reflected in concerns about affordability and the consequent need for the financial burden to be shared between individuals and government, and resulted in a residual vision for care and anxieties about care quality, cliff‐edge costs and abandonment. The concept of shared funding was also employed rhetorically to suggest an equitable approach to managing financial burden, reflected in phrases such as 'splitting the difference'. Whilst out‐of‐pocket payments were sometimes seen as useful or necessary in the context of scarce public resources, the idea of shared funding was sometimes interpreted more flexibly to include individual contributions made in a range of ways, including tax, social insurance payments and wider social and economic contributions to society. Despite the dominance of the 'scarcity' frame, participants favoured greater government contribution than currently. These four frames and their associated discourses provide insight into how the public 'hear' and make sense of the debate about social care funding and, specifically, how apparent support for shared public–private funding is structured. Government and those hoping to influence the future of social care funding need to promote a vision of funding reform and win support for it by actively engaging with the sociocultural frames that the public recognise and engage with, with all of their apparent inconsistencies and contradictions. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2006.05.023 Byline: Gillian Callaghan, Gerald Wistow Keywords: Participation; Public involvement; Citizenship; Governance; Primary care trust; UK Abstract: The article considers the role of public involvement in the British National Health Service in the context of the wider shift from government to governance. Based on a comparative case study, it identifies different outcomes from a single policy initiative in two localities. It argues, following Jessop, that accounts of governance which rest on inter-organisational relationships are inadequate, and that we also need to look at inter-systemic and inter-personal levels for more complete explanations. Investigating the relationships between these levels, we derive an account of governance within which to situate the role of public involvement. It is against this background that we focus on why the methods of involvement deserve greater attention for their substantive contribution to its quality and effectiveness. Author Affiliation: University of Durham, Durham, UK Article Note: (footnote) [star] The research upon which the article is based was funded by the NHS Northern and Yorkshire Research and Development Portfolio Programme. It was completed when both authors were employed at the University of Leeds.

This perspective examines the challenge posed by COVID-19 for social care services in England and describes responses to this challenge. People with social care needs experience increased risks of death and deteriorating physical and mental health with COVID-19. Social isolation introduced to reduce COVID-19 transmission may adversely affect well-being. While the need for social care rises, the ability of families and social care staff to provide support is reduced by illness and quarantine, implying reductions in staffing levels. Consequently, COVID-19 could seriously threaten care availability and quality. The government has sought volunteers to work in health and social care to help address the threat posed by staff shortages at a time of rising need, and the call has achieved an excellent response. The government has also removed some barriers to effective coordination between health and social care, while introducing measures to promote the financial viability of care providers. The pandemic presents unprecedented challenges that require well-co-coordinated responses across central and local government, health services, and non-government sectors. [ABSTRACT FROM AUTHOR]

Introduction: Although person-centredness is a key principle of integrated care, successfully embedding and improving person-centred care for older people remains a challenge. In the context of a cross- European project on integrated care for older people living at home, the objective of this paper is to provide insight at an overarching level, into activities aimed at improving person-centredness within the participating integrated care sites. The paper describes experiences with these activities from the service providers' and service users' perspectives. Methods: A multiple embedded case study design was conducted that included thirteen integrated care sites for older people living at home. Results: Service providers were positive about the activities that aimed to promote person-centred care and thought that most activities (e.g. comprehensive needs assessment) positively influenced personcentredness. Experiences of service users were mixed. For some activities (e.g. enablement services), discrepancies were identified between the views of service providers and those of service users. Discussion and conclusion: Evaluating activities aimed at promoting person-centredness from both the service providers' and service users' perspectives showed that not all efforts were successful or had the intended consequences for older people. Involvement of older people in designing improvement activities could ensure that care and support reflect their needs and preferences, and build positive experiences of care and support. [ABSTRACT FROM AUTHOR]