Search

Background: There is a lack of information on changes in hospital admission rates for childhood-onset schizophrenia (COS), or on patient characteristics, to inform clinical research and health service provision. Aims: To report age- and sex-specific incidence rates of hospital admissions and day patient care for schizophrenia (ICD-10 F20) and non-affective psychosis (ICD-10 F20-29), by year of occurrence and age, in childhood and adolescence. Methods: Population-based study using person-linked data for England (available 2001–2016); time-periods in single years and 4-year groups. Results: Hospitalised incidence for schizophrenia increased with increasing age, from 0.03 (95% confidence interval (CI) 0.02–0.05) and 0.01 (0–0.01) per 100,000 in, respectively, males and females aged 5–12 years, to 3.67 (3.44–3.91) in males and 1.58 (1.43–1.75) in females aged 13–17 years. There was no gender difference in hospitalised incidence rates in children aged 5–12, but in 13–17 years old, there was a male excess. Rates for schizophrenia were stable over time in 5–12 years old. In ages 13–17, rates for schizophrenia decreased between 2001–2004 and 2013–2016 in males, from 6.65 (6.04–7.31) down to 1.40 (1.13–1.73), and in females from 2.42 (2.05–2.83) to 1.18 (0.92–1.48). The hospitalisation rates for schizophrenia and non-affective psychosis, combined, in 13–17 years old decreased in males from 14.20 (13.30–15.14) in 2001–2004 to 10.77 (9.97–11.60) in 2013–2016, but increased in females from 7.49 (6.83–8.20) to 10.16 (9.38–11.00). Conclusions: The study confirms that childhood-onset schizophrenia is extremely rare, with only 32 cases identified over a 15-year period in the whole of England. The incidence of schizophrenia and non-affective psychosis increased substantially in adolescence; however, the marked reduction in the proportion of those diagnosed with schizophrenia in this age group suggests a possible change in diagnostic practice. [ABSTRACT FROM AUTHOR]

Accessible Summary: In the UK very few people with learning disability and/or autism and their family‐carers have a paid job although a lot of them may wish to work. National plans from the Government have not helped to change this.This article talks about a consultation we did on adults with learning disabilities and/or autism who attend day centres and their family‐carers. We asked about their current situation, their employment and the barriers to work.We found out that very few people with learning disabilities and/or autism or their family‐carers were employed. We found that there were lots of things stopping people with learning disabilities and/or autism and family‐carers from being able to work.We conclude that disability theories like the "social model of disability" need to go back to looking at inclusion, citizenship and independence, based on the real life experience of people with a learning disability. The government needs to provide strong plans to help people with learning disabilities and/or autism and family‐carers get into work. "Co‐production" networks should be set up between people with learning disabilities and families to support employment. Background: Only 5.9% of working adults with a learning disability are in paid employment and their family‐carers are similarly likely to be unemployed, as they continue to take on an extended caring and advocacy role as the welfare state retreats. Despite social policy efforts to stimulate employment for people with a learning disability, there has been little or no progress. Changes in the language of welfare benefit departments seek to use the words once heralded as success for the Disability rights activists and proponents of the social model: such as Inclusion, independence and citizenship. A new definition of the social model of disability utilising Hannah Arendt needs to redefine the "private" sphere of the lived experience of people with a learning disability to allow for a better understanding of the inter‐dependencies that exist between people with a learning disability, their family carers and a wider support network. Materials and Methods: Empirical data were collected in a mixed methods study while undertaking a consultation on the future of day services for people with a learning disability in a Local Authority in the north of England, UK. Results: The results reveal high levels of inter‐dependence between people with a learning disability and their carers, combined with the continued financial struggle as a lived experience of caring. The study found that barriers in providing care and support restrict the rights of people with a learning disability and their carers to secure employment. Conclusions: There is a need to reconceptualise the social model of disability to more closely resonate with the lived experiences of people with a learning disability and their carers. A newly revised theoretical approach should incorporate the "private" sphere of live acknowledging the inter‐dependent, co‐produced relationships, between people with a learning disability and their carers to support and enable employment for both people with a learning disability and their carers under the Care Act 2014 (Department of Health, 2014). [ABSTRACT FROM AUTHOR]

This short study looks at the use and benefit of the Vital 5 intervention, using a small cohort of 10 individuals in a London dermatology day centre. The Vital 5 is designed to address the biggest risk factors for ill health facing global populations, namely smoking, alcohol consumption, obesity, blood pressure and mental health. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify how the family care of people living with dementia could be supported to make reliance on family care sustainable in the long term despite the impact of stress. A Realist Evaluation (Pawson & Tilley, 1997) was conducted to investigate this aim. An initial review established 'coping' as a primary means of mediating stressors associated with caregiving. However, there was a need to specify which coping approaches/strategies are most effective. In‐depth interviews were conducted with a purposive sample of family carers (n = 18) in a suburb in North East England from 2016 to 2017. Analysis of the data revealed 'social coping' (SC) that included an emotional support component as a critical mediator of family carer stress. Several key hindrances to the utilisation of SC, including underpinning causal factors, are explicated. Ways in which these hindrances might be overcome are discussed and guidelines introduced for how family carers, formal providers and practitioners can facilitate SC as a critical coping strategy in sustaining the family care of people with dementia over the long term. [ABSTRACT FROM AUTHOR]

Background: Palliative care day services provide a safe environment for people with palliative care needs, enabling them to access a range of services while acting as a respite services for family caregivers. Viewed as marginal services, they are often under resourced and under researched. The aim of this study was to understand how palliative day care services contribute to client care from the perspective of management and hospice multidisciplinary teams. Methods: A descriptive qualitative study, using six focus groups conducted with staff at three United Kingdom hospices in England, Scotland and Northern Ireland. Thirty-five participants were recruited, including management and staff. Discussions were transcribed and analysed thematically. Results: Four key themes emerged: (1) variations of care, beyond heterogeneity of patients; (2) unclear referrals and inconsistent patient population; (3) recognising strengths and challenges and (4) an uncertain future. A major focus of group discussions was the model of care and the benefits of the service, however the importance of demonstrating services' effectiveness and value for money was highlighted. Conclusions: Management and hospice staff believed day-services to be a helpful introduction to palliative care, providing both social and medical support. Economic pressures and patient demand were influencing them to move from a social model to a hybrid model. Further research is needed to understand the effectiveness of the service. [ABSTRACT FROM AUTHOR]

Background: Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. Methods: People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). Results: Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121–£190 (excluding volunteer contribution) to £172–£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2: -£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: − 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: − 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: − 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis. Conclusions: This study highlights the contribution made by volunteers to PCDS provision. There is insufficient evidence on whether outcomes improved, or costs were reduced, in the three different service configurations for PCDS. We suggest how future research may overcome some of the challenges we encountered, to better address questions of cost-effectiveness in PCDS. [ABSTRACT FROM AUTHOR]

Background: There have been cases of suicide following the Work Capability Assessment (WCA), a questionnaire and interview for those claiming benefits due to ill health or disability in the United Kingdom. Aims: To examine whether experiencing problems with welfare benefits, including WCA, among people with pre-existing mental health conditions was associated with poorer mental health and wellbeing and increased health service use and costs. Methods: A prospective cohort study of an exposed group (n = 42) currently seeking help from a Benefits Advice Service in London and a control group (n = 45) who had recently received advice from the same service. Questionnaires at baseline and 3-, 6- and 12-month follow-ups. Results: The exposed group had higher mean scores for anxiety (p =.008) and depression (p =.016) at baseline and the control group higher mean scores for wellbeing at baseline (p =.034) and 12 months (p =.035). However, loss to follow-up makes overall results difficult to interpret. The control group had higher incomes throughout the study, particularly at the 12-month follow-up (p =.004), but the differences could have been accounted for by other factors. Health service costs were skewed by a few participants who used day-care services intensively or had inpatient stays. Over the study period the proportion of exposed participants engaged in benefits reassessment ranged from 50% to 88%, and 40% to 76% of controls. Conclusion: The hardship of living with financial insecurity and a mental health condition made it difficult for our participants to sustain involvement in a 12-month study and the frequency of benefit reviews meant that the experiences of our controls were similar to our exposed group. These limitations limit interpretation but confirm the relevance of our research. The control data raise the question of whether people with mental health conditions are being disproportionately reassessed. [ABSTRACT FROM AUTHOR]

Background: Ascites is an accumulation of serous fluid in the abdominal cavity. It can be caused by both malignant and non-malignant conditions and produces distressing symptoms. There have been no qualitative studies looking at the experiences of patients with non-malignant ascites. Aims: To explore the experiences of patients living with non-malignant ascites and its management. Also, to explore the views of these patients about services available to them. Method: Phenomenological qualitative research study using digitally recorded semi-structured interviews. Setting and participants: Six adult patients with non-malignant ascites who were receiving paracentesis to manage their symptoms in an acute hospital day unit. Results: Participants experienced a wide variety of physical symptoms. They discussed how the ascites impacted on their social lives. They had views on diuretics, low sodium diet and paracentesis as methods of symptom management. Participants' confidence in staff performing paracentesis was a common finding, particularly as ultrasound was rarely used. While only some were suitable for liver transplant, all discussed their future care needs. Conclusion: Participants' experiences of non-malignant ascites are that it has a considerable effect on their quality of life. Patients like the system of day case admission for drainage, but question whether this is sustainable. Advanced practitioners can successfully provide a paracentesis service for these patients in hospitals and potentially this is transferable to hospices. Patients seemed happy to consider the option of semi-permanent drains and pumps as methods of managing ascites. [ABSTRACT FROM AUTHOR]

This paper explores the effectiveness of paid services in supporting unpaid carers’ employment in England. There is currently a new emphasis in England on ‘replacement care’, or paid services for the cared-for person, as a means of supporting working carers. The international evidence on the effectiveness of paid services as a means of supporting carers’ employment is inconclusive and does not relate specifically to England. The study reported here explores this issue using the 2009/10 Personal Social Services Survey of Adult Carers in England. The study finds a positive association between carers’ employment and receipt of paid services by the cared-for person, controlling for covariates. It therefore gives support to the hypothesis that services for the cared-for person are effective in supporting carers’ employment. Use of home care and a personal assistant are associated on their own with the employment of both men and women carers, while use of day care and meals-on-wheels are associated specifically with women's employment. Use of short-term breaks are associated with carers’ employment when combined with other services. The paper supports the emphasis in English social policy on paid services as a means of supporting working carers, but questions the use of the term ‘replacement care’ and the emphasis on ‘the market’. [ABSTRACT FROM PUBLISHER]

Serious Case Reviews (SCRs) for adults are commissioned to examine the ways in which local professionals and agencies worked together to safeguard a vulnerable adult or take place following harm or death of a vulnerable adult where there are concerns about agencies' actions or engagement. There is no national system in England for their collation or analysis. This paper presents the results of a study investigating SCRs for vulnerable adults where the person who was at risk of harm, harmed or died had a learning disability. Eighteen SCRs were identified and a further three where there are grounds for considering that the victim may have had such a disability. Three themes are presented: staff relationships; family and carers; and biography and chronology to draw out material relevant to social work policy and practice. At a time when the English government has announced plans for SCRs for adults to move to a statutory basis, this paper draws attention to their potential as learning materials, but also the risks of seeing them as presenting a full picture of practice. The case for local flexibility is argued. [ABSTRACT FROM AUTHOR]

There are many drivers for change and innovation in adult social care and one of the most significant is the personalisation agenda; however, whilst resources are always limited, this does have its roots in a more relaxed financial climate than currently prevails. This article draws on findings from a scoping study which aimed to identify future areas for research to assist councils in developing and commissioning personalised services. Twenty local authorities were surveyed and in three case study areas, interviews and focus groups conducted with staff and service users to explore progress with personalisation and identify innovative practice. Although, at the time of the study, the impact of resource reductions had yet to be felt, budget cuts were seen as a potential impediment to future developments. The innovative practice identified demonstrated approaches to tackling some of the challenges of personalising social care and a commitment from practitioners and commissioners to find ways to do this. However, it remains to be seen whether the cold financial climate results in a top-down prescriptive approach to personalisation or leads to local innovation to enable people to make decisions about their needs. [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]

This paper is an exploration of a dilemma that is central to the place of day centres in tackling single homelessness and raises issues for social work more generally. On the one hand, day centres provide vital services to a vulnerable group in a safe, non-threatening and non-judgemental setting; on the other hand, in doing so, they are believed to impede opportunities for personal change. The paper draws on findings from a research study which compared and contrasted the priorities of single homeless people with multiple support needs with the priorities of support services, exploring the role of encounters between service users and agencies in either overcoming or reinforcing multiple exclusion homelessness. This paper focuses on evidence about the use of day centres. It seeks to draw on theological insights to explore day centres as ‘places of sanctuary’ whose largely unconditional accessibility enables them to serve as both a last refuge for the victims of multiple rejection and a safe place to confront the past. This paper will take the debate about conditionality in welfare provision beyond the field of homelessness to address one of the oldest dilemmas of social work: how to facilitate change while respecting people's free agency. [ABSTRACT FROM AUTHOR]

With anticipated greater demand for formal care services globally, this article examines the sociodemographic and health characteristics of frail older people in receipt of community support. Data were collected from audits of case files of older people receiving care management at two time points during which two government policy initiatives were implemented to promote greater standardization in health and social care provision for older people in England. Findings at Time 2 revealed that there were higher levels of physical and mental impairment and more health care assessments undertaken. There was a slight decrease in home care receipt but a marginal increase of more intensive home care provision. Service users living with a carer were less likely to receive home care but more likely to receive respite care or day care than those living alone. The policy goal of widening access to specialist health and social care services for older people with mental health problems was achieved. Guidance that focused eligibility criteria on the identification of older people with complex needs required the availability of appropriate support and services. Irrespective of policy initiatives, the sociodemographic characteristics of older people and the availability of informal support are principal determinants of service provision. [ABSTRACT FROM AUTHOR]

Purpose Policy has identified the need for integrated dementia services for older people. However, the role of the formal cater within an integrated framework of service delivery has not been well articulated in practice. The aim of this paper is to understand the experiences of formal carers working with the context of an integrated dementia service by exploring findings from a research-based evaluation. Design/methodology/approach - The evaluation captured the experiences of formal carers working within the service via observations, semi-structured interviews and focus groups. Findings - Working with an integrated service brings about individual, social and organisational challenges to the role of the formal carer, in terms of: delivering flexibility and responsiveness, providing continuity of care, ensuring cross-organisational working and acquiring skills, knowledge and expertise. Originality/value - To facilitate the successful delivery of integrated care, the emerging role of the formal carer needs to be more clearly articulated and supported within a service context. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this study is to describe the characteristics of severely psychiatrically impaired adolescents requiring day hospital management and the effectiveness of the service using standardised outcome measures. Design/methodology/approach – The data was collected on adolescents aged 13-17 years in two London boroughs, attending the day service over a period of one year. Outcome measures were HoNOSCA, CGAS, SDQ and qualitative data from feedback forms from adolescents and parents. Findings – The adolescents (n=22) had varied disorders, but mainly depression, (n=9) and psychosis (n=4). HoNOSCA score on admission was mean 18.14 (SD 3.78) but by discharge it had reduced to mean 15.39 (SD 7.31) (p=0.07), and CGAS reduced from initial mean score of 43.83 (SD 9.90) to 53.17 (SD 12.04) (p=0.003). Attendance for 19 (86 per cent) adolescents was for less than six months. Following discharge 14 (64 per cent) returned to education or employment. Adolescents and their carers reported high levels of satisfaction. The findings indicate substantial improvement and satisfaction with the service. The size of the improvement in outcome scores and the consistency across the HoNOSCA and CGAS associated with high service satisfaction also suggest that the data is reliable. Research limitations/implications – The small size of the sample and loss of data made it difficult to extrapolate from the results to other groups of impaired adolescents. There was no control group in the study and therefore it was not possible to demonstrate whether the improvement was due to spontaneous changes over time, Tier 3 CAMHS input or the attendance at the day service. It is difficult to demonstrate what proportion of adolescents who were admitted to the day service would have required a Tier 4 in patient admission had the service not been available. A larger study using a more robust design involving randomisation to the day-service or in-patient service would provide important comparative data regarding the service benefits. Originality/value – Currently there is little provision for severely psychiatrically impaired adolescents who require a day treatment programme. Day patient programmes appear to offer a useful and accessible treatment method. The service is much cheaper than an in-patient service, and may also reduce the demands for or duration of inpatient admission. Unfortunately the service did not obtain continuation funding in view of NHS funding cuts, rather than dissatisfaction by local commissioners, and so needed to close. The data presented here can hopefully be used to support the case for child and adolescent psychiatric day programmes. [ABSTRACT FROM AUTHOR]

Accessible summary [ABSTRACT FROM AUTHOR]

Purpose - This paper aims to look at lesser-known approaches to working with older people which challenge current assumptions about older people and approaches to providing care, suggesting that they lay on a continuum of support services, which stretches from traditional, paid-by-the-hour, professional/client transactions at one end, to unboundaried, unpaid family care at the other.Design/methodology/approach - The paper looks at Shared Lives, ASA Lincolnshire's At Home Day Resource for people with dementia, Homeshare, KeyRing and micro-enterprises.Findings - Through combining the value of real relationships with more formal support approaches, better outcomes can be achieved at lower costs.Originality/value - With the gap between the capacity of existing services and the needs of an ageing population growing daily, this paper provides additional research and development in this area of work. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to detail the Wellbeing Project that was developed by Manchester Mental Health and Social Care Trust, in partnership with Manchester City Council.Design/methodology/approach - A group-based cognitive behavioural therapy intervention ("Be Well, Age Well") was written specifically to help improve the mood and wellbeing of older adults.Findings - A preliminary evaluation showed promising results and in response to a significant increase in demand for continued delivery of the intervention, there are now plans to examine the feasibility of non mental health qualified staff facilitating the course. Funding is currently being sought for a more definitive study.Originality/value - The Wellbeing Project believes that if older adults are educated via the approach as adopted by the "Be Well, Age Well" course, the level of resilience will improve for those individuals who would otherwise have experienced compromised wellbeing. [ABSTRACT FROM AUTHOR]

The modernisation of mental health day services has been shaped by concerns about the social exclusion of people with enduring mental health problems. Initiatives have emphasised the use of mainstream facilities and an individualised approach. In contrast, service users have sought to safeguard opportunities for peer support in safe places. This participatory action research brought together service users, staff and others involved, to explore how these different views could be transformed into modernised services. The research took place in an outer London borough from 2003-2007, using varied methods to explore social networking, including a visual method, action research groups and individual interviews. The research was designed and adapted to enable the involvement of people with different capacities and interests. Each stage generated findings for local modernisation, pointing to the importance of a safe space, service user knowledge of social and recreational activities and how self-help groups develop and thrive. The final reconfiguration of local services reflected these research outcomes. Credible and useful outcomes can be achieved from collaborative research, allowing time and creating opportunities to shape interpretations of policy. Emerging initiatives are more likely to reflect service user perspectives and receive their support. [ABSTRACT FROM AUTHOR]

More people will receive personal budgets to pay for social care services in England. Such people may or may not continue using services such as adult day care centres. Many day centres are under threat of closure. These trends will affect those working in adult day care. This article examines the profile of this workforce, using recent NMDS-SC data and applying multinomial statistical modelling. We identified nearly 6000 adult day care workers, over half supporting adults with learning disability. The results of the analysis show significant variations between the adult day care, residential care and domiciliary workforces. At the personal level, day care workers are significantly older and less ethnically diverse than other workers. They tend to have been working in the sector for longer, and their work patterns are more stable. The findings are discussed within the context of policy changes affecting learning disabilities and social care workforce strategies. [ABSTRACT FROM PUBLISHER]

Aim: To explore experiences of health services and unmet care needs by people with late-stage Parkinson's in England. Method: Ten participants, at Hoehn and Yahr stage 4 or 5, were interviewed using semi-structured open-ended questions. Data were analysed using qualitative thematic analysis. Findings: Participants reported that whilst under the treatment of specialist hospitals, the majority of care provision had shifted into the community, often because hospital-based services were felt to be difficult to access and have limited benefit to them. When using health-care services, participants frequently experienced having to 'fit-in' to service structures that did not always accommodate their complex needs. Despite high levels of disability, participants expressed their desire to maintain their identity, normality of interests and activities in their lives, including remaining in their own homes. This was facilitated by bespoke care and equipment, and positive relationships with care providers. Knowledge on disease management was a key factor in their perceived ability to remain in control. Family caregivers had a central role in facilitating care at home. There was uncertainty about and little planning for the future, and moving to a residential nursing home was perceived an undesirable but potentially necessary option for future care. Conclusion: Unmet care needs identified by people with late stage Parkinson's in England include greater flexibility of healthcare structures and bespoke service provision, to accommodate their individual complex needs. Support in their own homes and positive relationships with healthcare providers help People with Parkinson's (PwP) to maintain a degree of normality and identity, and provision of information help them maintain some control. There is a need for more informed discussions on future care planning for this specific population. [ABSTRACT FROM AUTHOR]

Objective: Care homes are a common place of death for older adults, especially those with complex health needs or dementia. Representative, internationally comparable data on care home facilities and their residents is needed to monitor health and wellbeing in this population. Identification and collection of data from care homes can be challenging and often underreported. This paper draws on the experiences of the PACE study, a cross sectional mortality follow back study conducted in six European countries. Results: Multiple challenges were encountered in creating a sampling framework and contacting, recruiting and retaining care homes in the PACE study. Recruiting a randomly identified, representative cohort from a stratified sampling framework was problematic, as was engaging with care homes to ensure high response rates. Variation in the funding of care homes across the six countries involved in the study may explain the additional challenges encountered in England. Awareness of the challenges encountered in England in implementing an international study in care homes can inform the design and implementation of future studies within care homes. Further discussion is needed to determine the barriers and facilitators to conducting research in care homes, and how this is shaped by the focus of the study. [ABSTRACT FROM AUTHOR]

The article provides updates on several reports related to child care in Great Britain as of September 2018. The stillbirth rate for Great Britain in 2016 remained at 3.93 per 1,000 total births according to MBRRACE-UK. The number of people waiting more than 12 hours in accident and emergency departments in Northern Ireland has more than quadrupled in a year. Children in England are consuming twice the suggested amount of sugar according to Public Health England.

Ruth Stone, a final year student at the University of East Anglia, reflects on her placement in a day unit, where she saw patients receive a wide range of support and care, from blood transfusions to singing sessions [ABSTRACT FROM AUTHOR]