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Purpose The paper reports on the findings of a survey of 115 (76 per cent) of English local authorities in 2016 which compared progress on the implementation of the Making Safeguarding Personal (MSP) approach in local authorities through their Adult Social Care departments and in relation to their area Safeguarding Adults Boards (SABs) and partner organisations. The purpose of this paper is to evaluate the survey in relation to personalised social care and its impact on organisations, their staff and service users, and conclude with wider implications and recommendations for further work.Design/methodology/approach A series of guided interviews were conducted with safeguarding leads from a sample comprising of 115 (76 per cent) of English local authorities during May and June 2016. The sample was randomly picked and balanced to give a fair representation of the different types of councils. The interviews were conducted by a team of five people. All interviewers had in-depth experience of adult safeguarding and were currently practicing independent chairs of SABs. The interviewers followed a prepared schedule consisting of a mixture of open and closed questions. All interviews were held over the phone and averaged one-hour duration.Findings The results pointed to the impression that the majority of local authorities had completed the first step of introducing MSP, i.e. they had trained their workers and modified their systems. Most local authorities were moving into the next phase of embedding user-focussed work into their practice and culture, and were at various points along that journey. However, most had still to engage partner organisations beyond a mere acceptance of MSP as “a good thing”.Research limitations/implications The research has wide ranging implications for organisations and their workers in the field of adult safeguarding based on its findings. Its limitations are that only organisational leaders and managers were interviewed, although reference is extensively made to initiatives that engage service users. The authors acknowledged the possible bias of interviewees when judging the performance of their own service and attempted to moderate their views in the final report.Practical implications The report references many practical implications to improve the practice of adult safeguarding in an attempt to make it more person-centred. Examples of good practice are given and recommendations are made to organisations.Social implications It is recognised that there are many people who may be at risk of harm through their environmental, personal, age or disability-related situations. In improving the way that services respond to their needs, they will be made to feel safer and their lives enhanced.Originality/value This original research follows up previous research in the preceding year. It is the widest ranging in its coverage of 76 per cent of English local authorities. Its value is that it measures progress towards full implementation of MSP; reports information and views from safeguarding leaders; and makes 20 recommendations to improve the implementation of MSP within local authorities, SABs and their partners. [ABSTRACT FROM AUTHOR]

Purpose This paper reports research undertaken into the practices, processes and outcomes of joint commissioning at five English localities. This paper reflects on the implications of this study for the practice of joint commissioning. Design/methodology/approach A case study approach to the research was adopted where the assumptions about what joint commissioning should deliver in five "best practice" sites. These hypothesised relationships about organisational processes, services and outcomes were then tested through the collection of primary and secondary data. Methods of data collection included an online tool based on Q methodology, documentary analysis, interviews and focus groups. Findings - Very little of what we found seemed to relate directly to issues of joint commissioning. Respondents often spoke of joint commissioning conflating it with issues of commissioning or joint working more generally. We found a variety of different definitions and meanings of joint commissioning in practice suggesting that this is not a coherent model but varies across localities. Little evidence of improved outcomes was found, due to practical and technical difficulties. Research limitations/implications -Joint commissioning is not a coherent model and is applied in different ways across different contexts. As such we may need to ask very different questions of joint commissioning to those typically asked. Practical implications - It is important that local sites are clear about what they are trying to deliver through joint commissioning or else risk that it becomes an end in itself. Some of the current reforms taking place in health and social care risk pulling apart existing relationships that have taken significant time and resource to develop. Originality/value - This is one of the first large-scale studies of joint commissioning conducted in England. [ABSTRACT FROM AUTHOR]

Purpose: All areas in England are expected by National Health Service (NHS) England to develop integrated care systems (ICSs) by April 2021. ICSs bring together primary, secondary and community health services, and involve local authorities and the voluntary sector. ICSs build on previous pilots, including the Integrated Care Pioneers in 25 areas from November 2013 to March 2018. This analysis tracks the Pioneers' self-reported progress, and the facilitators and barriers to improve service coordination over three years, longer than previous evaluations in England. The paper aims to discuss these issues. Design/methodology/approach: Annual online key informant (KI) surveys, 2016–2018, are used for this study. Findings: By the fourth year of the programme (2017), KIs had shifted from reporting plans to implementation of a wide range of initiatives. In 2018, informants reported fewer "significant" barriers to change than previously. While some progress in achieving local integration objectives was evident, it was also clear that progress can take considerable time. In parallel, there appears to have been a move away from aspects of personalised care associated with user control, perhaps in part because the emphasis of national objectives has shifted towards establishing large-scale ICSs with a particular focus on organisational fragmentation within the NHS. Research limitations/implications: Because these are self-reports of changes, they cannot be objectively verified. Later stages of the evaluation will look at changes in outcomes and user experiences. Originality/value: The current study shows clearly that the benefits of integrating health and social care are unlikely to be apparent for several years, and expectations of policy makers to see rapid improvements in care and outcomes are likely to be unrealistic. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to present the findings of a small-scale evaluation of the Department of Health “Homeless Hospital Discharge Fund” (HHDF) in England. Design/methodology/approach – The paper is based on a mixed-method approach comprising 52 telephone interviews with project staff, 48 responses from an online survey with staff, outcomes data collected by projects, 30 semi-structured interviews with patients and nine in-depth telephone interviews with staff and commissioners. Findings – Overall the 52 pilots funded under the “HHDF” provided positive health and accommodation outcomes for homeless people admitted and discharged from hospital. In contrast to previous studies patients described not feeling judged during their stay, however the admission process was a more mixed experience due to communication breakdown by hospital staff. Integrating housing and clinical staff in the hospital discharge projects produced better outcomes for patients and the availability of accommodation as part of the model allowed improved and more stable housing outcomes. We recommend integrated commissioning takes place for future funding of any hospital discharge projects. Research limitations/implications – The study was small in scale and carried out before some of the projects had become fully established. The data were self-reported and the quality and completeness varied between projects. Originality/value – This is one of the few examples of hospital discharge outcomes for homeless people across a number of different localities and project models which examine the role of both health and housing professionals in the process. [ABSTRACT FROM AUTHOR]

Purpose: Applications for clinical psychology training far outstrip places and relevant work experience is key. Paid opportunities are limited and therefore many choose volunteering, with well-connected graduates faring best. To promote equal opportunities a coordinated psychology graduate voluntary internship programme was established in a National Health Service Trust in the South of England. The purpose of this paper is to evaluate intern and supervisor outcomes, equality of access and adherence to governance standards. Design/methodology/approach: Three cohorts of interns, unappointed applicants and supervisors were surveyed. Between 2013 and 2016, 270 psychology graduates applied, 119 were recruited and 151 either refused a place or were unsuccessful. In total, 91 supervisors provided service-level feedback. Findings: Interns and applicants were predominantly young, able-bodied white British heterosexual females. Demographic profiles were similar and broadly representative of psychology graduates nationally. While fewer were from Black and Ethnic Minority backgrounds, proportions were greater than the local population. Participants were more socioeconomically privileged than undergraduates nationally. The scheme was popular and well governed according to interns and supervisors. Post-internship employment prospects were improved, with most interns gaining paid mental health roles like assistant psychologist. Most supervisors commented on the positive contribution made by interns to service outcomes. Originality/value: This study makes a significant contribution to the literature on voluntary psychology graduate posts, an area under-researched until now. Our results suggest that a coordinated, transparent approach can benefit both interns and services by minimising exploitation and maximising developmental opportunities for the new graduate. The programme makes an important contribution to addressing inequalities experienced by psychology graduates attempting to enter mental health careers. [ABSTRACT FROM AUTHOR]

Purpose: The Royal College of Surgeons recognises patient handover as the point at which patients are collectively at their most vulnerable. Concerns were raised in a London teaching hospital surgical department regarding an unstructured handover system, poor access to relevant clinical information, and inadequate weekend staffing. A quality improvement programme was designed and implemented to respond to these concerns and improve patient safety. The paper aims to discuss these issues.Design/methodology/approach: A structured questionnaire was distributed to staff and results used to construct a diagram outlining the main factors influencing weekend patient safety. This framework was used to design changes, including a new electronic handover tool, regular handover meetings and additional weekend staff. Regular staff training was provided, and success was assessed in a continuous audit cycle with the results fed back to team leaders.Findings: Over a three-month period, the handover meeting recorded an attendance rate consistently above 80 per cent. The electronic handover entries were scored according to seven criteria (correct layout; key information, i.e.: patient location, clinical priority, active issues, resuscitation status, test results and weekend plan), averaging between 42.2 and 92.9 per cent, with progressive improvement seen over the assessment period. Weekend staffing was increased by 50 per cent, allowing a dedicated team to care for stable inpatients and to oversee discharges.Originality/value: This improvement programme delivered lasting and significant change in response to staff concerns. It resulted in a more structured and reliable weekend system and established key mechanisms for dynamic performance feedback. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to understand how inspection team members work together to conduct surveys of hospitals, the challenges teams may face and how these might be addressed. Design/methodology/approach Data were gathered through an evaluation of a new regulatory model for acute hospitals in England, implemented by the Care Quality Commission (CQC) during 2013-2014. The authors interviewed key stakeholders, observed inspections and surveyed and interviewed inspection team members and hospital staff. Common characteristics of temporary teams provided an analytical framework. Findings The temporary nature of the inspection teams hindered the conduct of some inspection activities, despite the presence of organisational citizenship behaviours. In a minority of sub-teams, there were tensions between CQC employed inspectors, healthcare professionals, lay people and CQC data analysts. Membership changes were infrequent and did not appear to inhibit team functioning, with members displaying high commitment. Although there were leadership authority ambiguities, these were not problematic. Existing processes of recruitment and selection, training and preparation and to some extent leadership, did not particularly lend themselves to addressing the challenges arising from the temporary nature of the teams. Research limitations/implications Conducting the research during the piloting of the new regulatory approach may have accentuated some challenges. There is scope for further research on inspection team leadership. Practical implications Issues may arise if inspection and accreditation agencies deploy temporary, heterogeneous survey teams. Originality/value This research is the first to illuminate the functioning of inspection survey teams by applying a temporary teams perspective. [ABSTRACT FROM AUTHOR]