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Norfolk Archaeology, 36 (3), 233-240

This research aimed to explore the experiences of individuals with mental health difficulties applying for disability benefits in the UK since 2014. Semi-structured interviews with nine individuals who had claimed PIP or ESA were analysed using an Interpretive Phenomenological Analysis approach. The findings show participants experienced the system as deliberately trying to trap them to make it as hard as possible for them to claim benefits. This placed dilemmas on participants; eliciting emotions of being an unvalued citizen, forcing them to work hard to prove their entitlement and exacerbating their symptoms of psychological distress. Participants drew strength from connecting with others applying for disability benefits and speaking about their difficulties negotiating the benefits system. The findings suggest the need for psychologists to address the negative impact applying for disability benefits may have on claimants’ mental health both in and outside the therapy room. a budget of up to £250 was provided by Plymouth University

Supplemental material, Supplementary_table_S1 for A worked example of initial theory-building: PARTNERS2 collaborative care for people who have experienced psychosis in England by Ruth Gwernan-Jones, Nicky Britten, Jon Allard, Elina Baker, Laura Gill, Helen Lloyd, Tim Rawcliffe, Ruth Sayers, Humera Plappert, John Gibson, Michael Clark, Maximillian Birchwood, Vanessa Pinfold, Siobhan Reilly, Linda Gask and Richard Byng in Evaluation

Background:\ud The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets.\ud \ud Objectives:\ud To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly.\ud \ud Design:\ud Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way.\ud \ud Data sources:\ud Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions.\ud \ud Results:\ud The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs.\ud \ud Limitations:\ud The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed.\ud \ud Conclusions:\ud Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience.

Supplemental Material, Appendix_1_Px for Codesigning a Measure of Person-Centred Coordinated Care to Capture the Experience of the Patient: The Development of the P3CEQ by Thavapriya Sugavanam, Ben Fosh, James Close, Richard Byng, Jane Horrell, and Helen Lloyd in Journal of Patient Experience

Introduction: Current National Health Service (NHS) policy towards care coordination in England, involving the introduction of Multi-Specialty Community Providers (MCPs), assumes that repeated unplanned admissions of older people with multiple morbidity make disproportionately heavy use of hospital bed-days, that a substantial number of these admissions are preventable, and that reducing these admissions would substantially reduce cost and access pressures on hospital services. 'Integrated' (better-coordinated) care, delivered by MCPs, is intended to reduce these admissions by partly replacing hospital care with non-hospital care, hence raising the quality and reducing the cost of care. Our study synthesised existing evidence about how to integrate care at the system-level, including management of complexity and whole system patient flow. Theory/Methods: Stage 1. From grey literature, MCPs’ published logic models, and a think tank (policy makers, health-workers, patients/public), we elicited policy-assumptions ('programme theory') about what structures, working practices and services ('mechanisms') the MCPs will contain, and how these mechanisms are expected to produce the outcomes above. Stage 2. Realist review: Evidence from other ‘integrated’ care projects which related to the programme theory identified in stage 1 was synthesised to produce a revised, more strongly evidence-based explanation of how complex, MCP-like ‘integrated’ care systems function in different contexts. 3. 'Critical Analysis': The policy-makers' initial programme theory (from stage 1) was compared with the evidence from stage 2. In that way the policy-makers’ initial programme theory was elaborated, qualified and revised, better to inform the development of health and social care co-ordination in England. Results: We present 1) the initial programme theory, built from NHS England policy-makers' assumptions as to what outcomes the MCP models of care integration will produce in England, and by what means, and 2) some main findingsof how different models of care co-ordination might contribute to achieving these outcomes and under what conditions. Discussions: We discuss 1) how realist review methods were used to elaborate, qualify or challenge policy-makers' assumptions about how care co-ordination by means of MCPs would achieve the desired outcomes, and 2) how these findings can inform better care co-ordination. Conclusions: We describe the main empirical strengths and weaknesses in the assumptions underlying the models of care and care coordination which inform current NHS policy, and indicate where existing evidence is weak or lacking. Lessons learned: We discuss how we met the challenge of focusing the scope of a project that encompasses complex system-level issues across health and social care, and how far the findings and lessons might apply to other, differently-structured health systems. Limitations: Policy-makers assumptions were complex and incompletely articulated, making our findings depend, at points, upon our interpretation of what policy makers specifically intended. The complexity constrained us to focus our review on the policy makers’ most central assumptions. Future research: 1) Understanding how the logic models informed practice by evaluating the usefulness, and any future policy application, of our findings by policy makers in England. 2) Testing our findings empirically through primary research (Realist evaluation) of MCPs in practice.

Lloyd et al., Treatment outcomes in schizophrenia: qualitative study of the views of family carers. Interview schedule. (DOCX 12 kb)