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COVID-19 lockdown and social distancing measures have restricted funerals and memorial events and have limited the face-to-face social networks that grieving people might normally be able to draw upon for emotional support. However, while there is considerable expert informed speculation about the impacts of grief and "COVID bereavement", detailed accounts of experiences of bereavement and bereavement support during the pandemic have the potential to enrich and provide nuance and subtlety to the evidence base. This paper draws on diary accounts of bereavement support volunteers in the UK, who have been providing support for the bereaved through these challenging times. These reveal layers of complexity to the experiences of loss, grief and bereavement during these extraordinary times. However, they also point to a number of additional themes that lend a more positive valence to the suspension of normal social expectations and memorial practices associated with the pandemic, which, we argue should be reflected upon for their potential to address the discontents of contemporary governance of end of life and bereavement. [ABSTRACT FROM AUTHOR]

Meals on Wheels (MoWs), a service offered by local authorities in England, deliver meals to older, housebound and/or vulnerable adults, who might otherwise not be able to acquire and prepare their own meals. Research suggests that MoWs provide benefits beyond nutrition. Little is known about the actual interactions between service providers and clients, particularly during the COVID‐19 pandemic. The aim of this small‐scale, formative study was to explore MoWs service providers' experiences and their perceptions around the benefits and challenges faced by the service, and understand how these experiences changed during the first UK national lockdown. Semi‐structured interviews were conducted in September 2020 with 18 service providers of MoWs (drivers who deliver the meals, service coordinators and managers) in two local authorities in England, and analysed thematically. Participants indicated that benefits of the service encompassed those to clients (e.g. welfare checks, encouraging independence and identifying and addressing isolation and loneliness), employees (e.g. sense of pride, rewarding relationships with clients) and the wider community (e.g. reducing pressures on families), and described MoWs as the 'fourth emergency service' (e.g. being the first responders to emergency situations). Participants identified several challenges faced by the MoWs service, including organisational challenges (e.g. funding cuts and closures, lack of appropriate publicity to raise awareness of the service) and restrictions on time spent with clients. The pandemic and lockdown resulted in increased demand on resources, concerns about client and staff wellbeing and uncertainty about how the service will cope if lockdowns continue. These findings provide important insights regarding the wide benefits of MoWs and the challenges the service faces, which can be used as the formative research base to guide future interventions and policies to protect vulnerable adults, not only during the COVID‐19 pandemic, but beyond. [ABSTRACT FROM AUTHOR]

Extra-care housing (ECH) has been hailed as a potential solution to some of the problems associated with traditional forms of social care, since it allows older people to live independently, while also having access to care and support if required. However, little longitudinal research has focused on the experiences of residents living in ECH, particularly in recent years. This paper reports on a longitudinal study of four ECH schemes in the United Kingdom. Older residents living in ECH were interviewed four times over a two-year period to examine how changes in their care needs were encountered and negotiated by care workers, managers and residents themselves. This paper focuses on how residents managed their own changing care needs within the context of ECH. Drawing upon theories of the third and fourth age, the paper makes two arguments. First, that transitions across the boundary between the third and fourth age are not always straightforward or irreversible and, moreover, can sometimes be resisted, planned-for and managed by older people. Second, that operational practices within ECH schemes can function to facilitate or impede residents' attempts to manage this boundary. [ABSTRACT FROM AUTHOR]

Extra care housing (ECH) has been lauded as an innovative model of housing with care for older people that promotes and supports independent living. The study used a qualitative design to explore how care is delivered in four extra care settings in England over 20 months during 2016–2017. This paper reports findings from semi‐structured interviews with 20 care workers and seven managers. The article argues that, despite being heralded as a new model, care workers in ECH face similar organisational pressures as those working in more conventional settings and, in turn, the care which they are able to provide to residents mimics traditional forms of care. [ABSTRACT FROM AUTHOR]

Increasing attention has focused on the role of joint commissioning in health and social care policy and practice in England. This paper provides an empirical examination of the three discourses of joint commissioning developed from an interpretative analysis of documents by Dickinson et al. (2013; BMC Health Services Research, 13) and applied to data from our study exploring the role of knowledge in commissioning in England. Based on interviews with 92 participants undertaken between 2011 and 2013, our analysis confirms that the three discourses of prevention or empowerment or efficiency are used by professionals from across health and social care organisations to frame their experiences of joint commissioning. However, contrary to Dickinson et al., we also demonstrate that commissioners and other stakeholders combine and trade off these different discourses in unexpected ways. Moreover, at sites where the service user experience was central to the commissioning process (joint commissioning as empowerment), a greater sense of agreement about commissioning decisions appeared to have been established even when the other discourses were also in play. [ABSTRACT FROM AUTHOR]

Accessible Summary When a vulnerable adult is in police custody, they should have someone with them to help them understand what is happening. This person is called an appropriate adult ( AA)., Previous research has shown that the role of the AA is not always well understood. This study compares the views of both professionals and vulnerable adults., Adults with learning disabilities and mental health problems said looking after them and helping them communicate were the most important things an AA should do., Like other studies have shown, not all adults who should be provided with an AA in custody have had one. This may be because no agency has a statutory duty to provide one., This study recommends that AA services should try and engage more effectively with vulnerable adults., Abstract Background Police custody sergeants have a duty to secure an AA to safeguard the rights and welfare of vulnerable people detained or questioned by the police. This study focuses on the role of the AA in supporting vulnerable adults and seeks to examine what stakeholders would expect from an effective AA service. Methods This was a qualitative study of four AA services in England. Interviews were undertaken with 25 professionals, and two focus groups were held with service-user groups (13 participants). Results There is disparity between the expectations of professionals, and service users, on what comprises an effective service. Professionals tend to prioritise the availability and response time of AAs, while service users prioritise their personal attributes and demeanour. Conclusions Professionals involved in commissioning and management of AA services should monitor whether the rights of vulnerable adults in custody are protected and better engage vulnerable adults beyond service delivery. [ABSTRACT FROM AUTHOR]

This paper reports findings from a longitudinal study of homeless women. Thirty-eight women were recruited with a retention rate of 58% over three rounds of interviews. Interviews explored specific events in women's lives, their current living arrangements and how their experiences and needs, including for social care, changed over time. Data were analysed thematically using a priori codes. Women reported a range of complex issues, consistent with experiences of deep social exclusion and received support from both statutory and voluntary agencies. Although women appreciated the support they received, many reported that services were fragmented and rarely personalised to their needs. [ABSTRACT FROM AUTHOR]

Joint working between local authorities and the National Health Service (NHS) has been an integral part of health and social care policy in the United Kingdom for many years. Using evidence from two literature reviews this paper argues that there is little indication that joint working delivers the outcomes envisaged in policy. While recent reforms may be beginning to influence improvements, they are undermined by constant reform and professional scepticism. [ABSTRACT FROM PUBLISHER]

Background: Policymakers such as English healthcare commissioners are encouraged to adopt 'evidence-based policy-making', with 'evidence' defined by researchers as academic research. To learn how academic research can influence policy, researchers need to know more about commissioning, commissioners' information seeking behaviour and the role of research in their decisions.Methods: In case studies of four commissioning organisations, we interviewed 52 people including clinical and managerial commissioners, observed 14 commissioning meetings and collected documentation e.g. meeting minutes and reports. Using constant comparison, data were coded, summarised and analysed to facilitate cross case comparison.Results: The 'art of commissioning' entails juggling competing agendas, priorities, power relationships, demands and personal inclinations to build a persuasive, compelling case. Policymakers sought information to identify options, navigate ways through, justify decisions and convince others to approve and/or follow the suggested course. 'Evidence-based policy-making' usually meant pragmatic selection of 'evidence' such as best practice guidance, clinicians' and users' views of services and innovations from elsewhere. Inconclusive or negative research was unhelpful in developing policymaking plans and did not inform disinvestment decisions. Information was exchanged through conversations and stories, which were fast, flexible and suited the rapidly changing world of policymaking. Local data often trumped national or research-based evidence. Local evaluations were more useful than academic research.Discussion: Commissioners are highly pragmatic and will only use information that helps them create a compelling case for action.Therefore, researchers need to start producing more useful information.Conclusions: To influence policymakers' decisions, researchers need to 1) learn more about local policymakers' priorities 2) develop relationships of mutual benefit 3) use verbal instead of writtencommunication 4) work with intermediaries such as public health consultants and 5) co-produce local evaluations. [ABSTRACT FROM AUTHOR]

Purpose -- Appropriate housing for the growing population of older adults is becoming an international concern. The purpose of this paper is to report on a review of UK and international literature carried out as part of a project exploring the commissioning and delivery of social care in housing with care settings. The paper also considers housing with care in the context of UK policy and practice. Design/methodology/approach -- The peer literature review process used a range of academic databases as well as government and third sector web sites, drawing on relevant material in English published from 1990 to 2012. Findings -- Findings are presented within three main themes: how care and support is provided; the role of the built environment; and the benefits for resident well-being. The review found a paucity of literature focusing specifically on care and support in housing with care settings, particularly in terms of how social care is delivered, but the evidence base suggests that housing with care is in a strong position to deliver on most if not all UK government aspirations. Practical implications -- Despite a growing literature both in the UK and internationally exploring the characteristics and benefits of housing with care for older people, substantial gaps remain in the research evidence. Originality/value -- This paper presents an up to date review of the housing with care literature in the context of current UK policy. [ABSTRACT FROM AUTHOR]

The impetus to work across boundaries is a longstanding theme in British public policy. Critical commentary has emerged from different perspectives, but has not provided empirically based analysis of joint working across different sectors and spheres of practice. In this article we present findings from an evaluation of joint working in the Supporting People Health Pilots. These raise questions about why some agencies -- primarily in the voluntary sector -- appeared to be more effective than others at working across boundaries. These questions and the broader implications of the findings for the voluntary sector are analysed. [ABSTRACT FROM AUTHOR]

The nature of the professional task in welfare services is constantly changing. These changes are not confined to Britain but are widespread across the developed world and include initiatives to develop new professional roles and redesign existing services. Central to these initiatives is an assumption that the professions, and the individual professionals involved, will be willing and able to adapt their professional practice. The challenges inevitably posed by these developments appear to have been played down, particularly in respect of the role played by the boundaries between professions. This article considers the nature of boundaries before exploring these service developments as a means to highlight the issues they raise. The article contends that for these developments to work we need to move beyond the current focus on the role of education, training and regulation which structure professional boundaries to appreciate the 'human and social aspects' of these changes in order to understand how individual professionals perceive and experience the boundaries between professional groups. [ABSTRACT FROM AUTHOR]

This paper reports on a small-scale study of British military spouses/partners. The findings from this study point to aspects of military policy and culture that are perceived to be lagging behind developments in the host society. While the organization continues to modernize various welfare and personnel policies, aspects of its total-institutional and gendered culture continue to be an issue for a number of the military community. [ABSTRACT FROM AUTHOR]

Introduction: Faced with rising numbers of older people in need of care and restrictions on public expenditure in the UK, extra care housing (ECH) has been hailed as an integrated model of housing with care that allows older people to live independently, while also having access to care and support if required. Despite the proposed benefits of ECH, however, little is known about how responsive it is to the needs of older people as their care needs change. Theory/Methods: This presentation reports on findings from the ECHO project, which explored the perspectives and experiences of those living and working in ECH settings. Longitudinal qualitative research was undertaken at 4 ECH settings (including one dementia-specialist scheme), based in 2 areas, over the course of 2 years. Residents were interviewed on 4 occasions to explore how their care needs and experiences of ECH changed over time. Managers were interviewed twice, at the beginning and end of the study, and care workers were interviewed on one occasion. Results: Residents appreciated the flexibility in the way that care was provided and felt that the ECH model allowed them some control over when and how their care was delivered. Some residents, care workers and managers reported an increase in care needs amongst people moving into ECH and amongst existing residents as they aged in place. Interviews with care workers revealed that their work was organised in a time/task manner. This resulted in frustration for some care workers who felt unable to provide care in a flexible and personalised way. Some care workers found ways to compensate for this approach by providing 'favours', doing tasks beyond their role. Discussions: The organisation of work in the 4 ECH schemes imitated patterns of work at some traditional care homes and it appeared that there was very little slack in the system. This is problematic given that there is an expectation of ECH to meet the changing care needs of residents in a timely and responsive manner. Such problems appear to be exacerbated by the changing context of ECH which means that the population whom it serves now has higher and more complex needs. Conclusions (including key findings): ECH's integrated model of housing and care has the potential to support quality of life for older people, including those living with dementia. However, while the ECH model promises to allow for increased flexibility and a more personalised approach to care delivery, cost saving forms of work organisation can undermine this approach. Lessons learned: Longitudinal research is a beneficial way to examine how older people's care needs are responded to in integrated housing and care environments. Limitations: Though a longitudinal approach allowed us to consider how participants' experiences altered over time, and in relation to contextual change, this approach was not as effective with residents living in a dementia-specialist ECH scheme. Suggestions for future research: Further research is required to establish whether ECH is the most appropriate form of integrated housing and care for older people living with dementia. [ABSTRACT FROM AUTHOR]

The article discusses a review on the evaluations of ten initiatives specifically promoted in the National Health Service (NHS) white paper "Our Health, Our Care, Our Say," published in January 2006. An extensive mapping exercise was made to identify evaluations of the specified initiatives being conducted in England. It indicates that the rhetorical commitment to evaluation was compromised and the investment in evaluation at national and local levels was not as productive.

Background: Healthcare policy-makers are expected to develop 'evidence-based' policies. Yet, studies have consistently shown that, like clinical practitioners, they need to combine many varied kinds of evidence and information derived from divergent sources. Working in the complex environment of healthcare decision-making, they have to rely on forms of (practical, contextual) knowledge quite different from that produced by researchers. It is therefore important to understand how and why they transform research-based evidence into the knowledge they ultimately use.Methods: We purposively selected four healthcare-commissioning organisations working with external agencies that provided research-based evidence to assist with commissioning; we interviewed a total of 52 people involved in that work. This entailed 92 interviews in total, each lasting 20-60 minutes, including 47 with policy-making commissioners, 36 with staff of external agencies, and 9 with freelance specialists, lay representatives and local-authority professionals. We observed 25 meetings (14 within the commissioning organisations) and reviewed relevant documents. We analysed the data thematically using a constant comparison method with a coding framework and developed structured summaries consisting of 20-50 pages for each case-study site. We iteratively discussed and refined emerging findings, including cross-case analyses, in regular research team meetings with facilitated analysis. Further details of the study and other results have been described elsewhere.Results: The commissioners' role was to assess the available care provision options, develop justifiable arguments for the preferred alternatives, and navigate them through a tortuous decision-making system with often-conflicting internal and external opinion. In a multi-transactional environment characterised by interactive, pressurised, under-determined decisions, this required repeated, contested sensemaking through negotiation of many sources of evidence. Commissioners therefore had to subject research-based knowledge to multiple 'knowledge behaviours'/manipulations as they repeatedly re-interpreted and recrafted the available evidence while carrying out their many roles. Two key 'incorporative processes' underpinned these activities, namely contextualisation of evidence and engagement of stakeholders. We describe five Active Channels of Knowledge Transformation - Interpersonal Relationships, People Placement, Product Deployment, Copy, Adapt and Paste, and Governance and Procedure - that provided the organisational spaces and the mechanisms for commissioners to constantly reshape research-based knowledge while incorporating it into the eventual policies that configured local health services.Conclusions: Our new insights into the ways in which policy-makers and practitioners inevitably transform research-based knowledge, rather than simply translate it, could foster more realistic and productive expectations for the conduct and evaluation of research-informed healthcare provision. [ABSTRACT FROM AUTHOR]

Introduction: Between 2012 and 2032 it is estimated that the populations of 65-84 years old and those over 85 in the United Kingdom will increase by 39 and 106% respectively (Kings Fund 2013). Recent figures suggest that people over the age of 65 account for almost 51% of gross local authority spending on adult social care (Oliver et al 2014). Current projections indicate that a growing proportion of older people will, in the future, be living on their own and will require formal care (King's Fund 2014). While these demographic changes have significant implications for adult social care policy they also draw attention to the pressing need for sufficient and appropriate housing that enables older people to live independently (Atkinson et al 2014). Practice: Not surprisingly the provision of appropriate housing is a key element of UK government policy (Garwood 2015). Various models of housing with care have emerged in recent years with Extra Care Housing (ECH) offering the potential to combine housing and social care in the same setting. Indeed the integration of personal housing alongside individualised care means that Extra Care Housing is viewed by many to be 'a viable alternative to and possible replacement for residential care' (Beach 2015:7). Extra Care Housing, compared to other models of housing, has several characteristics: it is primarily for older people; accommodation is almost always self-contained; social care can be delivered flexibly, usually by staff based on the premises; support staff are available on the premises 24 hours a day; domestic care is available; communal facilities and services are available; meals are usually available and charged for when taken; it aims to be a home for life and finally, it offers security of tenure (Laing and Buisson 2010). Key findings: Drawing on results from the Adult Social Services in Environmental Settings (ASSET) project (https://assetproject.wordpress.com/) and initial findings from our longitudinal study of Extra Care Housing (both funded by the National Institute for Health Research, School for Social Care Research) this paper will consider what potential the integration of housing and care has for older people living in the UK. It will consider the different models of integrating social care within housing and the advantages, as well as some of the challenges therein. The implications of integrating housing and care will be considered from the perspective of those managing schemes as well as from care workers and older people themselves. Conclusion: Despite the potential of Extra Care Housing to provide integrated care for older people the current economic context of the UK threatens to undermine the model. Reduced public spending and increased targeting of social care on those people thought most in need could weaken the preventive aims of Extra Care Housing. [ABSTRACT FROM AUTHOR]

Editorial. Focuses on the need to reshape the National Health Service (NHS) workforce in Britain. Impact of continuing fragmentation in the health service on the quality of patient care and on the well-being of health workers themselves; Staffing problems in the NHS; Mechanisms of workforce planning required to develop integrated strategies for the different occupational groups.

A letter to the editor is presented regarding the case of baby Jarden who was born with congenital rickets due to vitamin D deficit of his mother during pregnancy.

The COVID-19 pandemic and the lockdown measures imposed as a result affected the lives of people in all parts of society across the world. In 2020, during the first UK national lockdown, older adults (aged 70 years and over) were told to 'shield' within their homes, as they were regarded as being at higher risk of serious COVID-19 infection compared to other age groups. This paper explores older adults' experiences of COVID-19 lockdown measures whilst living in housing with care schemes for older people. The purpose is to examine the impact of the lockdown measures on scheme life including social connections amongst residents and their general everyday wellbeing during this time. We present qualitative findings based on interviews with 72 residents who took part in longitudinal and cross-sectional interviews across 26 housing with care schemes. Data were analysed using a thematic framework approach to examine specifically their experiences of living in housing with care schemes during the 2020 UK lockdown. The paper highlights that COVID-19 restrictions had a detrimental impact on the social connections and interactions of older residents living in housing with care schemes, as well as on their feelings of autonomy and independence. Despite this, residents adapted and coped with self-isolation restrictions and sought out positive ways to maintain social contact with others inside and outside to the scheme. We further highlight the tensions that providers of housing for older adults faced in promoting residents' autonomy and connectedness whilst also trying to provide a safe living environment and protect residents from risk of COVID-19 infection. Our findings apply not only to a pandemic situation but to the broader understanding of how housing with care for older adults must navigate between autonomy and support. • COVID-19 lockdowns challenged the independence and autonomy of older residents of housing with care in the UK. • Older adults in housing with care exercised autonomy through employing practices to maintain social connections. • Housing staff bolstered residents' autonomy, facilitated social interactions, and supported residents' wellbeing. • Housing staff faced challenges in maintaining the independent ethos of housing schemes whilst also protecting residents. [ABSTRACT FROM AUTHOR]