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Background: Meals on Wheels (MoWs) could help adults with care and support needs continue living independently. However, many people are not aware that the service still exists in England, or that it could provide benefits beyond nutrition. Objective: Working with an existing advisory group of six people with lived experience of MoWs (an adult who uses MoWs and people who have referred a family member to MoWs), this work aimed to co‐produce knowledge translation resources (two infographics and a film) to raise awareness of MoWs and their benefits. Methods: Four participatory online workshops were held in May–July 2023, to establish perceived high‐priority themes from recent qualitative research that should be included in the resources, and preferences about message content, language, design, and how the resources should be disseminated. Findings: The most important perceived MoWs benefits that the group agreed should be included in the resources were: the importance of a nutritious meal that requires no preparation; the service's reliability/consistency; the importance of interactions in reducing social isolation, and; the ease to commence the service. The group highlighted the need for language to be nontechnical and invitational, and for images to relate to respective messages, and be inclusive of anyone who could benefit from MoWs. Several routes for dissemination were proposed, highlighting the need to disseminate to the NHS, social care organisations and community groups. Conclusion: These co‐produced resources could enhance adult social care delivery in England, as raising awareness of MoWs and their benefits could increase referral rates, so that more adults with care and support needs can benefit from the service. Patient or Public Contribution: An advisory group of people with lived experience of MoWs (users of the service and family referrers) participated in the workshops, extensively discussed the findings of earlier research, co‐produced the knowledge translation resources, and advised on the implications and future dissemination steps. The group also provided informal feedback on a draft of this manuscript. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore the perceptions of Meals on Wheels (MoWs) service users (SUs), and people who refer them to MoWs ('referrers'), with accessing and commencing the service in England, the barriers that might hinder service uptake, and what information would be valued when considering accessing the service. Methods: Semistructured interviews were conducted in May–July 2022 with seven SUs and 21 referrers, recruited from four MoWs providers across England. Data were analysed using inductive thematic analysis. Results: Participants indicated various pathways into the service, but referrers (family members) were more likely to be the ones enquiring about, and commencing, MoWs for SUs. Once an enquiry about MoWs had been made, the service was perceived as straightforward to set up. However, existing preconceptions and stereotypes were perceived to act as barriers to accessing MoWs. Information that participants deemed important to have available when deciding on whether to access MoWs related to the meals, the specific services provided, the reliability and flexibility of delivery and the cost of services. Conclusion: These findings could inform MoWs service providers' public awareness strategies about MoWs, to facilitate referrals to the service for adults with care and support needs. Patient or Public Contribution: An advisory group of people with lived experience of MoWs (users of the service and their family referrers) extensively discussed the findings of the research and advised on the implications and future dissemination steps. [ABSTRACT FROM AUTHOR]

Meals on Wheels (MoWs) is a social care service providing daily meals and social contact to adults who need support to live in the community. Considering the rising number of adults who need help with shopping for food and preparing meals in England, MoWs could be essential for these individuals; yet little is known about the experiences of MoWs service users and people who refer them to MoWs ("referrers"), with the service. The aim of this study was to explore different dimensions of the MoWs service from the perspectives of MoWs service users and referrers. Semistructured interviews were conducted in May–July 2022 with seven service users and 21 referrers, recruited from four MoWs providers across England, and analysed thematically. Participants indicated that benefits of the service encompassed the daily provision of a hot, nutritious meal, an informal welfare check, the service's efficiency and reliability in promoting independent living and reducing pressures on families and carers, and the daily friendly interactions in reducing social isolation. The pandemic was not perceived to have affected participants' experiences with MoWs but longer interactions between drivers who deliver the meals and service users would be welcomed to reduce isolation further. Despite the cost-of-living crisis and an increase in MoWs prices, participants perceived that MoWs are value-for-money due to the social care benefits derived from the service. The wide range of benefits exerted by MoWs suggests that the service should be recognised as a crucial preventative resource in maintaining the wellbeing and independence of adults with care and support needs and suggests that MoWs forms an essential part of the care package that people with care and support needs receive in England. [ABSTRACT FROM AUTHOR]

Objectives: The use of external consultants from private and not-for-profit providers in the National Health Service (NHS) is intended to improve the quality of commissioning. The aim of this study was to learn about the support offered to healthcare commissioners, how external consultants and their clients work together and the perceived impact on the quality of commissioning. Setting: NHS commissioning organisations and private and not-for-profit providers. Design: Mixed methods case study of eight cases. Data collection: 92 interviews with external consultants (n=36), their clients (n=47) and others (n=9). Observation of 25 training events and meetings. Documentation, for example, meeting minutes and reports. Analysis: Constant comparison. Data were coded, summarised and analysed by the research team with a coding framework to facilitate cross-case comparison. Results: In the four contracts presented here, external providers offered technical solutions (eg, software tools), outsourcing and expertise including project management, data interpretation and brokering relationships with experts. In assessing perceived impact on quality of commissioning, two contracts had limited value, one had short-term benefits and one provided short and longer term benefits. Contracts with commissioners actively learning, embedding and applying new skills were more valued. Other elements of success were: (1) addressing clearly agreed problems of relevance to managerial and operational staff (2) solutions co-produced at all organisational levels (3) external consultants working directly with clients to interpret data outputs to inform locally contextualised commissioning strategies. Without explicit knowledge exchange strategies, outsourcing commissioning to external providers resulted in the NHS clients becoming dependent. Conclusions: NHS commissioning will be disadvantaged if commissioners both fail to learn in the short term from the knowledge of external providers and in the longer term lose local skills. Knowledge exchange mechanisms are a vital component of commissioning and should be embedded in external provider contracts. [ABSTRACT FROM AUTHOR]

Introduction : (comprising background and problem statement) In Singapore, as in other parts of the world, the healthcare system is undergoing reform. The thrust towards this is motivated by the global shared experience of a rapidly ageing population, an increasing burden of chronic diseases, decreasing old-age support across the nation, increasing healthcare costs, and a rising demand for healthcare. In response to these changes, and amongst many integrated policies and approaches, the government has looked to global partners, and has explored different approaches to integrated care that have been adopted by countries with similar experiences. This lesson-drawing from other countries, known as policy transfer, provides a framework to understand how integrated care is being developed in Singapore to address the problems that it faces. It refers to the notion of improving policy making by looking abroad and adopting policies from elsewhere as a stock response to addressing policy issues. In Singapore, where this Project is based, the Regional Health Systems (RHSs) were created in 2010, and they are tasked with implementing the integrated care policy through innovative methods of care coordination. Within this, there is an expectation that the RHSs will demonstrate public sector entrepreneurism and lead in the development of health systems to enhance the quality of care at reduced costs. This same leadership is expected of the other policy agents, such as the Voluntary Welfare Organisations and General Practitioners in the RHSs, which provide services at the community level. However, it is unclear how integrated care is being developed at the RHS level in Singapore, and the extent to which policy transfer in integrated care has taken place. This is likely to be due to the fact that policy transfer of integrated care is largely undocumented, which makes evaluating the policy problematic. The associated challenges in the development of integrated care are also unknown. Some of these challenges may include the influence of the political economy of integrated care, which is often not explicitly considered. The role of constructivism in the micro-political environment of the organisation is also yet to be explored in the local context. Such local political, cultural, social, economic and administrative contexts are however central to the thesis on policy transfer and for appropriate policy adoptions. The aim of the research is thus to understand how integrated care is being developed specifically at the Outram RHS in Singapore, the extent to which this reflects processes of policy transfer, and the associated challenges involved. Theory/Methods: This study adopts a qualitative approach as the primary theoretical methodological approach to address the research questions. The qualitative approach could help unravel micro-macro interactions between individuals and social structures and institutions, and connect generic and abstract questions with the individuals' specific experiences. As policy actors, state, and non-state actors are involved in developing policy ideas on integrated care, the study will adopt an actor-based approach, utilising a two-pronged method to answer the research question. It will involve semi-structured interviews with these policy agents, which constitute an elite group, and document reviews of the existing materials internal to their organisation in relation to integrated care development. The prospective respondents will be purposively sampled with maximum variation from five distinct clusters of policy agents. They include government officials, Singapore Health Services, service providers (Outram RHS), professional associations, and academic institutions/think-tanks. The data will be analysed using interpretative phenomenological analysis and documentary analysis. The documentary analysis component consists of a two-fold analytic approach: content and textual analyses. Results :(or 'progress report' where results not yet available) Fieldwork will begin in December 2015. Preliminary ideas from the findings will be shared at the conference. Discussion: Policy transfer as a theoretical framework facilitates the examination of barriers and enablers in the study of integrated care development in Singapore. It goes beyond the institutional-structural concerns, to understanding the global and systemic influences, and their roles and limitations. It furthers the exploration and understanding of the nation-state's interests and history, socio-cultural values, and politico-administrative structure on integrated care development. Conclusion: (key findings to date, lessons learned, limitations, suggestions for future research). This paper, which is part of a PhD work, advances policy transfer as an arguably novel approach to explaining integrated care development; this is distinct from the existing approaches in integrated care theories and frameworks. It seeks to make useful contributions to the debate over the development of integrated care, with specific reference to Singapore, and to wider arguments on integrated care development in other parts of the world. [ABSTRACT FROM AUTHOR]