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Little is known of the experiences of directly employed care workers communicating with healthcare providers about the situations of their employers. We report findings from 30 in-depth semi-structured interviews with directly employed care workers in England undertaken in 2018–19. Findings relate to role content, communication with healthcare professionals and their own well-being. Directly employed care workers need to be flexible about the tasks they perform and the changing needs of those whom they support. Having to take on health liaison roles can be problematic, and the impact of care work on directly employed workers’ own health and well-being needs further investigation.

This review explores international practice in hospital social work with older people through the lens of four different aspects of professional identity (self-identity and reported practice; profe...

Signs of Safety (SoS) is a comprehensive assessment framework (AF) used in some form in most English children’s service departments as well as in many other countries. The Framework for the Assessment of Children in Need and their Families (AF) was introduced nearly twenty years ago to address identified failures to adopt a holistic approach to assessments of families where there were concerns that children were in need of protection or support. The AF is not only a statutory requirement in England but it has influenced the development of approaches to assessment globally. An evaluation of SoS in pilot local authorities in England provided opportunities to examine the extent to which the two frameworks were being used together. Findings from interviews, case record analysis and a survey indicate that while recording processes were aligned with the AF, it was not central to many of the assessments conducted and it proved difficult to detect its influence on their content. It appears timely to examine the extent to which the AF is used across England, to assess its relevance to current practice and the extent to which frameworks such as SoS have supplemented or replaced it.

The Care Act 2014 allows eligible people with care and support needs to access funding directly from local authorities in England. Such funds may be used to employ care workers. Others may employ care workers using their own or family resources. This study explores the working relationships, views and experiences of General Practitioner (GP) about older people's directly employed care workers (DECWs). Qualitative interviews were conducted with 20 GPs in England, identified by convenience sampling of research networks and snowballing methods. Data were analysed thematically. Three overarching themes were identified: (a) anxieties about the identity of the DECW, and their relationship to their employer; (b) experiences of relationship-based care, and; (c) tasks carried out by DECWs. Identity mattered because DECWs can appear as an unknown participant in consultations, raising questions about consent, and prompting thoughts about elder abuse. Uncertainty about identity made documentation of DECWs' details in electronic medical records and care plans problematic. Case examples of relational care illustrated the benefits of reciprocity between older person and their employee who sometimes provided continuity of care and care co-ordination for their employer. Participants were alert to the risks of exploitation and insecurity for DECWs whose tasks were thought to span household and personal care, transport assistance and health-related activities. The involvement of DECWs in maintaining older people's health raises questions about the support they receive from health professionals. In conclusion DECWs are well placed to monitor older people's health, provide continuity of care and undertake certain healthcare tasks. GPs envisaged such workers as potentially valuable assets in community-based care for an ageing population. They called for skills training for this workforce and the development of protocols for delegation of health tasks and safeguarding of vulnerable older people. Older people employing care workers and those advising or supporting them should address communications with health providers in employment contracts and job descriptions.

Purpose The purpose of this paper is to describe and discuss both the early implementation of a US mental health intervention for young children in the context of its introduction to a pilot site in a London borough and the progress made in establishing a randomised controlled trial (RCT). Design/methodology/approach This paper describes an evaluation of a new intervention and the learning that followed in terms of its implementation and future evaluation. Qualitative data were collected from a range of stakeholders and practitioners through interviews and small group discussions. These interviews focussed on both of these issues, with particular reference to the proposal to conduct an RCT. Findings The findings of this evaluation add to the evidence on how best to support new initiatives that have been introduced from other settings and countries to embed in a receiving site and the optimal timing and feasibility of conducting an RCT. At the end of the feasibility study, which took place within the year of the service being introduced and which was only open to clients for six months of this year the conclusion was that an RCT at that point was neither possible nor desirable. Over the following years, the commitment of the judiciary to examine if there was a way to make an RCT study in respect of this intervention meant that a template was established that may well have broader application. Research limitations/implications At a time when there is an increasing demand for evidence on effective interventions this paper makes a valuable contribution to the development of RCTs in general and specifically in the family court arena. It also recommends that attention must also be paid to the time, which is needed to implement and establish interventions and then to test them. Practical implications This paper highlights the need to establish realistic timescales not only around the implementation of initiatives but also for their evaluation. Originality/value This study breaks new ground in considering implementation challenges in the court and children’s services’ context. It brings to the fore the important role of the judiciary in approving new processes.

The Care Act 2014 imposed new statutory duties on English local authorities in relation to family or informal carers and it broadened carers’ statutory entitlements to assessment, care and support, irrespective of eligibility for local authority funding of the person they care for. Despite this legislative framework, local authorities appear to be translating the new legal obligation into practice in different ways. This paper draws on evidence from in-depth interviews held during 2017–2018 with key stakeholders in three English local authorities to investigate whether and how local efforts meet the Act's intention of supporting carers. We explored local goals associated with supporting carers, local authorities’ approaches to needs assessment and service provision as well as barriers and facilitators to adoption of the new legal obligations towards carers. The paper draws on Twigg, J., & Atkin, K. (1995). Journal of Social Policy, 24, 5–30, typology to explore perceptions of local stakeholders of the interaction between formal care system and carers post-Care Act. The findings indicate that despite a clear Care Act emphasis on meeting carers’ needs, when faced with financial constraints the formal care system approaches carers mainly as a resource and often supports carers to keep cared-for people away from health and social care systems. Although replacement care is a vital element in the Care Act's ambitions to support carers, in sampled authorities, it was often newly being subject to needs thresholds and financial assessment of people they care for, leading to reported conflicts of interests between carers’ needs and those of cared-for-people. The Care Act is nonetheless seen as having made progress in legitimising carers’ needs as clients. Social care professionals increasingly emphasise the importance of meeting carers’ needs and well-being as valued and desirable outcomes.

Purpose The purpose of this paper is to describe some of the changes to the content and delivery of care work in the context of developments in the wider labour market. Design/methodology/approach A total of 240 interviews with social care practitioners and managers were undertaken at Time 1 (T1) (2009–2012) and Time 2 (T2) (2011–2014) in four local council sites in England. A final round of interviews (T3) with managers (n=60) and staff (n=60) took place between 2015 and 2018. Findings The way in which many workers found meaning and satisfaction within their work was an important way by which many of them tempered dissatisfaction with pay, status and working conditions. Some workers used the concepts of ethical practice and vocation to differentiate themselves from other workers and organisations whom they considered lack these qualities and from what they saw as a wider societal perception that their work was unskilled and unfulfilling. Research limitations/implications The interview data may not be generalisable or totally representative of care staff. Those employers who agreed to participate may have been more committed to workforce development and valued their staff more highly. Nonetheless, data were sector wide and there were sizeable numbers of participants. Practical implications Pride and job satisfaction are important aspects of job satisfaction in care work and could be fostered in care services and by older people. Social implications Negative perceptions of care work within society may act as a barrier to recruitment and retention. Older people might help raise the positive profile of care work. Originality/value This is a unique data set from which to document long-term determinants of job satisfaction in care work.

Purpose The purpose of this paper is to investigate the content, purpose and effectiveness of the handover of information between care home staff beginning and completing a shift. Design/methodology/approach This was an exploratory study drawing on ethnographic methods. A total of 27 interviews with a range of care home staff, including managers, registered nurses, senior care workers and care workers were undertaken in five care homes selected to give a good contrast in terms of size, ownership, shift patterns and type of handover. Findings Most handovers were short – lasting 15 min or so – and were held in the office or secluded area in which staff could talk privately. They lasted longer in one home in which the incoming and outgoing shifts physically visited each resident’s room and the communal spaces. Staff felt that handovers were important for the efficient running of the home as well as to alert everyone to changes in a resident’s health or important events, such as a hospital appointment. In one home, handheld devices enabled staff to follow a resident’s care plan and update what was happening in real time. Research limitations/implications This was a small scale study based on data from a limited number of care homes. Practical implications The increasing popularity of 12 h shifts means that many homes only hold two short handovers early in the morning and in the evening when the night staff arrive. There appears to be a trend to reduce the number of staff paid to attend handover. Despite this, handovers remain an important component of the routine of a care home. The information contained in handover relates to the running of the care home, as well as residents’ wellbeing, suggesting that, while their content overlaps with written records in the home, they are not superfluous. Originality/value Although the literature on handovers in hospitals is extensive, this appears to be the first published study of handover practices in care homes.

The Care Act 2014 amended legislation relating to government responsibilities for adults with care needs. It set out new statutory responsibilities for the support of family or informal carers. As part of a study investigating the impact of the Care Act 2014 on family carers in England, we undertook a contextual literature review, focusing on parliamentary debates available online from Hansard. We describe the content of debates seeking to amend the law relating to carers and aspirations for the proposed reforms. We highlight the role of parliamentary carer champions, as well as carer-related themes and the lack of controversy over this subject.

Signs of Safety (SoS) is an approach used to work with families involved with children's services that was developed in Australia during the 1990s. Despite the fact that it has been adopted by countries across the globe, the evidence for its effectiveness in relation to improved outcomes for children has not been established. This study attempted to take an initial step in measuring the impact of SoS on families. In the course of evaluating SoS in 10 areas across England, the authors collected data from social workers using the approach and from families with whom they were working who also gave permission for their case records to be examined. Where social workers were more confident about using SoS and had consistently applied its elements, more families reported improvements in their lives. Families with social workers who had higher confidence in using SoS were also more likely to say that they had achieved more than expected against their earlier stated goals and were more likely to report positively against self-defined goals.

The article reports research aimed at identifying factors relating to retention in English intellectual disability services, drawing on a study of the social care workforce. The research involved two rounds of interviews with social care managers and staff between 2009 and 2014. The study uses social exchange theory, particularly the idea of ‘reciprocity’ and the mechanism of ‘hope’, as a conceptual framework to aid interpretation of the themes relating to retention identified in the interview analysis: ‘pay’, ‘support’, ‘morale’, and ‘training’ (related to reciprocity) and ‘improving quality of life’ and ‘supporting personal development’ (related to hope). Both groups of themes are identified as being particularly appropriate to intellectual disability services. The study concludes that reciprocity and hope seem to interact in factors related to staff retention, although the study suggests that reciprocity rather than hope is directly connected with retention.

Purpose Signs of Safety (SoS) is a strengths-based approach to child protection casework that has been widely adopted in countries across the world. The purpose of this paper is to report on a study that aimed to synthesise the many evaluations of SoS that have been conducted to assess their strengths and limitations. The intention is to identify the aspects which should be explored further and those that remain unexamined to inform future evaluations. Design/methodology/approach The study collated and then examined many of the evaluations that are in the public domain as well as some of those that were conducted within agencies and have not been made publicly available. Findings At the present time (early 2019), the evidence base for SoS is limited. Independent, robust research needs to be undertaken over time to build on the studies that have been conducted. New research must be designed to fill gaps and be capable of producing the evidence required and it must address its own limitations. Originality/value This study is the most comprehensive contemporary review of the evaluations of SoS that have been conducted to the best of the authors’ knowledge.

Recent years have seen a re-emergence of international interest in relationship-based social work. This article uses children’s accounts of their relationships with social workers to build on previous research to promote children’s safety and well-being. Interviews were undertaken with 111 children aged six- to eighteen-years old across ten different local authorities in England, as part of the evaluation of Munro, Turnell and Murphy’s Signs of Safety pilots within the Department for Education’s Children’s Social Care Innovation Programme. The interviews reveal four key findings: that children look for care and reciprocity in their relationships with social workers and this can be achieved through listening and small acts of kindness; that they are adept at recognising aspects of social workers’ verbal and non-verbal communications which indicate to the child whether they are listening and interested in them; that there are times in which children are particularly vulnerable especially if parents are resistant to engagement or children’s trust is broken; and that children actively use their agency to control their communication and engagement. The article concludes by highlighting children’s relational resilience and the importance of ensuring opportunities for children to develop new relationships with social workers when previous relationships have broken down.

Social care is the broad term for the support provided to people living at home and in care homes. Major changes have taken place to this sector in the past few years and this chapter describes the key policy developments that have impacted upon the kind of support provided to older people with mental health problems and how that support is funded. The policy of personalization is intended to increase choice and control, but as yet it is unclear whether this will lead to improved outcomes in terms of quality of life or independence. Some long-standing issues, such as the high prevalence of people with unidentified mental health problems in long-term care, continue to provide challenges for organizations providing social care support.

Scoping reviews, a type of knowledge synthesis, follow a systematic approach to map evidence on a topic and identify main concepts,theories, sources, and knowledge gaps. Although more scoping reviews are being done, their methodological and reporting quality need improvement. This document presents the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation. The checklist was developed by a 24-member expert panel and 2 research leads following published guidance from the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network. The final checklist contains 20 essential reporting items and 2 optional items. The authors provide a rationale and an example of good reporting for each item. The intent of the PRISMA-ScR is to help readers (including researchers,publishers, commissioners, policymakers, health care providers, guideline developers, and patients or consumers) develop a greater understanding of relevant terminology, core concepts, and key items to report for scoping reviews. Refereed/Peer-reviewed

Objective National and global dementia plans have focused on the research ambition to develop a cure or disease-modifying therapy by 2025, with the initial focus on investment in drug discovery approaches. We set out to develop complementary research ambitions in the areas of prevention, diagnosis, intervention, and care and strategies for achieving them. Methods Alzheimer's Society facilitated a taskforce of leading UK clinicians and researchers in dementia, UK funders of dementia research, people with dementia, and carer representatives to develop, using iterative consensus methodology, goals and recommendations to advance dementia research. Results The taskforce developed 5 goals and 30 recommendations. The goals focused on preventing future cases of dementia through risk reduction, maximising the benefit of a dementia diagnosis, improving quality of life, enabling the dementia workforce to improve practice, and optimising the quality and inclusivity of health and social care systems. Recommendations addressed gaps in knowledge and limitations in research methodology or infrastructure that would facilitate research in prioritised areas. A 10-point action plan provides strategies for delivering the proposed research agenda. Conclusions By creating complementary goals for research that mirror the need to find effective treatments, we provide a framework that enables a focus for new investment and initiatives. This will support a broader and more holistic approach to research on dementia, addressing prevention, surveillance of population changes in risk and expression of dementia, the diagnostic process, diagnosis itself, interventions, social support, and care for people with dementia and their families.

There is a considerable body of literature on the importance of effective shift handovers in hospitals and other health-care settings but less is known about the transfer of information between staff starting and completing stints of paid work in care homes. In the first of two articles considering this under-explored topic, we report findings from a scoping review examining what is known about shift-to-shift handovers in care homes for older people and their equivalents. It is based on systematic searches of electronic databases of English-language journals on ageing and internet searches for material published between January 2005 and October 2016. Guidance from the regulatory body for health and social care in England, the Care Quality Commission, highlights the importance of handovers in care homes but the degree to which they are embedded into care home routines appears to be variable, influenced by factors such as workplace culture, shift patterns and the extent to which they involve all those on duty or just those with professional qualifications. Staffing shortages and whether or not members of staff are paid for their time attending handovers appear to be further constraints on their use. We conclude that there is considerable scope for further research in this field to identify and develop good practice.

Purpose There is increasing interest in befriending services that aim to combat loneliness among older people. The purpose of this paper is to use the Equality Act 2010 as a framework for considering why older people might need these services and why some groups are over and under represented among service users. Design/methodology/approach Databases, websites and other resources were searched systematically for material on befriending. The final review consisted of 80 items, ranging from research articles, reports, and toolkits. Findings Individual face to face befriending has been the mainstay of the type of befriending support for older people. The increasing diversity of the older population and reductions in funding has led to adaptations of this model for different groups living in different circumstances. Research limitations/implications The resources and time available to conduct the review were limited. It is possible that some relevant material was not identified. Practical implications Practitioners working with older people need to know about befriending schemes available in their area and consider the reasons why some groups of older people might be reluctant to use them or require specialist schemes. Originality/value Existing research on befriending rarely reports the demographic characteristics of those using the service in detail or considers why some groups of older people might have greater needs for befriending services or be reluctant to use them. The Equality Act 2010 provides a structured framework for considering diversity in access to, and use of, services.

Purpose The purpose of this paper is to explore the equalities’ dimension of falls prevention services in light of the Equality Act 2010 and its protected characteristics. Research and policy are discussed in light of the Act and public services’ duties to be aware of their responsibilities. Design/methodology/approach An initial research review was undertaken in 2012 and updated in 2016. Findings The research on falls prevention services does not always collect data on users of the service and services do not always collect data about their users that would enable them to build a picture of their users in line with the Equality Act 2010. Practical implications Services and commissioners will need to be able to show that the services funded by the public purse are accessible, acceptable and appropriate to the UK’s increasingly diverse older population. This paper describes some of the existing resources and research papers that contain elements of attention to the protected characteristics of the Equality Act 2010. Originality/value This is an update on a research review undertaken in 2012.

Background It is widely acknowledged that inadequate handovers are associated with putting patients at risk in clinical settings; however, handover practices have received little attention in other 24-hr settings such as long-stay residential care facilities. Aim This study aimed to explore the perceived purpose and organisational processes involved in the handover of information between shifts of staff caring for older residents in five care homes in England. Methods The study took an ethnographic approach to fieldwork, undertaken between February and June 2016. It consisted of observations of handovers (n = 12) and interviews with managers, Registered Nurses (RNs) and care assistants (n = 27) working day and night shifts. Interview transcripts and observation notes were analysed within NVivo using a matrix approach. Results Handovers were highly variable in all five care homes in relation to their timings, locations, content and participants. Managers and RNs highlighted handovers as an opportunity for risk assurance, supervision, team building, staff education and monitoring of residents' clinical status. In comparison, care assistants considered the purpose of handovers to be prepared for the responsibilities of working a shift. The discussion addresses implications of these findings, particularly consideration of how best use can be made of RN skills and knowledge in handovers. Conclusion Research is needed to identify whether care home resident safety can be linked to handover practices and how the presence of RNs in handovers in care homes affects this. Implications for practice Care home managers, RNs and care workers may find this research useful in practice when considering how best to organise handovers and deploy staff in care homes for older people.

Purpose The purpose of this paper is to explore the impact of personalisation policy on the providers of social care services in England, mainly to older people, within the context of austerity and different conceptions of personalisation. Design/methodology/approach The paper draws on part of a longitudinal study of the care workforce, which involved 188 interviews with managers and staff, undertaken in two rounds. Findings Four themes were identified: changing understandings and awareness of personalisation; adapting services to fit new requirements; differences in contracting; and the impact on business viability. Research limitations/implications The paper reflects a second look at the data focussing on a particular theme, which was not the focus of the research study. Furthermore, the data were gathered from self-selecting participants working in services in four contrasting areas, rather than a representative sample. Practical implications The research raises questions about the impact of a commercial model of “personalised care”, involving personal budgets (PBs) and spot contracts, on the stability of social care markets. Without a pluralistic, well-funded and vibrant social care market, it is hard to increase the consumer choice of services from a range of possible providers and, therefore, fulfil the government’s purposes for personalisation, particularly in a context of falling revenues from local authorities. Originality/value The research presents an analysis of interviews with care providers and care workers mainly working with older people. Their views on personalisation have not often been considered in contrast to the sizeable literature on PBs recipients and social workers.

Purpose The purpose of this paper is to present an analysis of media reactions to the BBC Television Panorama programme, Behind Closed Doors’ and to set this in the context of interviews with care staff about their reflections on publicity about poor practice in the care sector. Design/methodology/approach This paper reports on an analysis of media reactions to recent exposé of abuse in social care in England and data from an interview-based study of care workers. The interviews were analysed to consider the impact of such media reports on staff and to explore their views of action that might be need to be taken about care failings. Findings There are mixed reactions to exposé of poor care on television and to the debates that precede and follow their broadcast. Debates occur in print and on television, but also in social media. The particular exposé of care home practices by the Panorama programme, Behind Closed Doors, led to debate in England about the potential role of covert cameras in care homes. The interviews revealed that while care staff are affected by scandals in the media about social care, they do not necessarily focus on themes that the media stories subsequently highlight. Overall some are disenchanted while others have ideas of what needs to change to improve practice. Care staff consider that there remain problems in raising concerns about practices and some staff feel unable to stay in workplaces where they have made complaints. Research limitations/implications The care workers interviewed may not be representative of the sector and they may have wished to provide socially acceptable answers to the researchers. Practice was not observed. Practical implications Local Safeguarding Adult Boards may wish to develop a communications strategy to deal with requests for reactions to media reports locally and nationally. Safeguarding practitioners may wish to prepare for increased referrals following media coverage of poor care in their areas. They may later be able to use media reports to discuss any local differences of interpretation over matters such as prosecutions for abuse. Trainers and educationalists may wish to clarify the importance given by care providers to raising concerns, the ways in which difficult conversations can be held, and the protections available to whistle-blowers or those raising concerns – with local examples to provide assurance that this is not mere rhetoric. Originality/value Television reports of problems with social care attract wide media interest but the authors know very little about how care workers respond to depictions of their work and their occupational grouping. This paper links media and expert commentator reactions to television exposé with data acquired from interviews with those on the frontline of care.

The care workforce in England is ethnically diverse yet little is known of how managers manage this aspect of human resources work. This article reports findings from a longitudinal study of the care workforce to offer insights into managers’ views of staff demographics, relationships and management challenges and strategies. Three themes emerged from the analysis: sources of conflict; reactive approaches to limiting conflict; and proactive approaches to preventing and limiting conflict. Findings have implications for human resource management and the creation of supportive staff relationships within care work in countries where ethnic diversity is characteristic of the care workforce.

Increasing numbers of older people directly employ care workers to help them live independently at home using cash for care schemes or pay for the services of a worker using their own money. Despite the longstanding nature of these arrangements, little is known about how these workers, their older employers or family carers employing these workers on behalf of an older person negotiate relationships with primary care professionals. For example, what happens if community nurses express concerns about the quality of a worker’s performance? Who undertakes responsibility for training and supervising directly employed workers in tasks such as catheter care? While there are an increasing number of studies reporting on the experiences of those working as, or employing, these types of worker, very little is known about the triadic relationships between workers, people employing them, and other health professionals. The presentation will describe the early stages of a new exploratory study designed to explore working relationships between primary care and directly employed home care workers from the perspective of older people, family carers, primary care professionals and directly employed workers themselves. The aim is to develop evidence based guidance and resources to enhance communication, and facilitate co-ordination of care between the older people receiving care and support and their family where applicable, directly employed care workers, and NHS professionals to promote the wellbeing of older people. The presentation will highlight some of the methodological challenges in negotiating access to study participants and analysing data from different sources.

ObjectivesTo investigate residents’ and relatives’ views and experiences of handovers in care homes. This paper reports residents’ and relatives’ awareness of handovers, knowledge of and views on handover practices and purpose, and views on handover effectiveness. Outcomes, safety and satisfaction in clinical settings are influenced by shift handovers. Despite this link with quality, residents’ increasing support needs and the provision of 24 hours care in care homes for older people, little is known about handovers in these settings from a resident and visiting relative perspective.SettingFive purposively sampled care homes for older people in South East England.ParticipantsHome managers (n=5), residents (n=16) relatives of residents (n=10) were interviewed; residents (n=15) and their interactions with staff were observed during handover periods. Participation was voluntary and subject to consent. Residents were identified by managers as having mental capacity to take a decision about participation which was then assessed. An ethnographic approach to data collection was taken, preceded by an evidence review.ResultsShift handovers were largely invisible processes to participating residents and relatives, many of whom had given little thought to handover practice, logistics or effectiveness prior to study participation. Their awareness and understanding of handovers, handover practices, and handover purpose and effectiveness varied. There appeared to be an underlying assumption that administrative procedures in care homes would operate without input from residents or relatives. A small number of residents, however, were highly aware of the routine of handovers and the implications of this for the timing of and response to their requests for care or support.ConclusionsThe care home setting and perspectives of the effectiveness of handovers may influence awareness of, knowledge of and levels of interest in involvement in handovers.

In the UK care sector, as much as other fields of work, managers need to check and monitor the immigration status of their staff. In this article, we examine accounts from care home and home care managers of making decisions about recruitment and employment practices placing these in the context of risk work. We use data from a secondary analysis of interviews with 121 social care managers that took place in four contrasting English local authority areas in two rounds over the period 2009-2014. In the interviews we explored managers’ views and experiences of employing or deciding not to recruit migrant workers and the extra work this potentially entailed. We identified three major themes in these interviews: vigilance, being caught, and shifting resources. The Vigilance in recruitment and managing staff theme highlighted managers’ experiences of and concerns about implementing the regulations around employment permissions and indicated their feelings that it was essential to comply with new government regulations relating to migrant workers. The Being caught theme was based on managers’ fears about the risks of being in breach of the regulations and worry about the severity of the penalties. The Shifting sources theme highlighted managers’ continued work in reaching out to fresh sources of recruitment as a response to changes in immigration regulations. Our findings expose the potentially stressful nature of managers’ roles in implementing new regulations and managing the risks of non-compliance. This new aspect of risk work reveals the tensions of managers’ role in performing their obligations to scrutinise documentation and abide by changing regulations while still running their services. As the UK moves to Brexit (leaving the European Union) these tensions look set to increase in the context of further migrant working regulations and amendments to immigration permissions.

Professionals express divergent views about whether adults at risk are best served by safeguarding work being incorporated into social workers’ casework or being undertaken by specialist workers within local area or centralised teams. This paper draws on findings from the final two phases of a three-phase study which aimed to identify a typology of different models of organising adult safeguarding and compare the advantages and disadvantages of these. We used mixed-methods to investigate four different models of organising adult safeguarding which we termed: A) Dispersed-Generic, B) Dispersed-Specialist, C) Partly-Centralised-Specialist and D) Fully-Centralised-Specialist. In each model, we analysed staff interviews (n = 38), staff survey responses (n = 206), feedback interviews (with care home managers, solicitors and Independent Mental Capacity Advocates) (n = 28), Abuse of Vulnerable Adults (AVA) Returns, Adult Social Care User Survey Returns (ASCS) and service costs. This paper focuses on qualitative data from staff and feedback interviews and the staff survey. Our findings focus on safeguarding as a specialism, safeguarding practice (including multi-agency working, prioritisation, tensions, handover, staff confidence and deskilling) and managing safeguarding. Local authority (LA) participants described and commented on the advantages and disadvantages of their organisational model. Feedback interviews offered different perspectives on safeguarding services and implications of different models.

Adult safeguarding is the subject of increasing attention in England and internationally. This article draws on research which developed a typology of ‘models of safeguarding’. ‘Models’ refer to different ways local authorities in England organise adult safeguarding (about which there is little evidence) rather than ‘model’ approaches to be emulated. The four models identified were: Dispersed-Generic (safeguarding work undertaken by operational teams); Dispersed-Specialist (safeguarding work undertaken partly by specialist social workers located in operational teams); Partially Centralised-Specialist (some safeguarding work undertaken by a central specialist safeguarding team); and Fully- Centralised-Specialist (all safeguarding work undertaken by a specialist safeguarding team). We explored associations between these models and other important variables (numbers of referrals, kinds of alleged abuse and characteristics of adults at risk) and outcomes. The article reports secondary analysis of English local authority safeguarding referral data and on the possible different costs of different models. Dispersed-Specialist sites appeared to have a higher rate of substantiating alleged abuse compared with other models. Statistical correlations were found with types of victim profiles and the perpetrator/victim relationship. It may be that decisions about local organisation of safeguarding are more affected by local organisational contexts than local authority model.

Summary Greater priority is now being given to improving responses to concerns that adults may be at risk of abuse or neglect in England and internationally. In England, the Care Act 2014 placed ‘adult safeguarding’ on a firmer statutory footing. Although local authorities were given the lead responsibility for adult safeguarding over a decade ago, little is known about how they organised their responses. This article reports one element of a national study in which semi-structured interviews with 23 local authority adult safeguarding managers in 2013–14 were conducted. The interviews sought to understand how local authorities arrange their responses to adult safeguarding concerns. Findings Several models of practice were identified. Confirming a central theme reported in the literature, the extent and nature of specialism within safeguarding practice varied. Safeguarding specialists were reported to be based in centralised teams or were located as specialists in locality social work teams. In some areas, the role of specialist safeguarding practitioners was linked to an analysis of risk severity or location of concern. Other areas emphasised the importance of safeguarding work as the core of mainstream social work practice. Applications These findings offer a basis for analysis and managerial considerations about the implications of different organisational models of adult safeguarding. These may be relevant to option appraisals and decision-making about future organisational planning.

The term ‘day opportunities’ is used in the context of personalisation in England to refer to alternatives to day centres. This article employs the lens of legislation on equalities to comment on access to day opportunities by different groups of eligible older people. It reports and discusses findings from a scoping review of the literature conducted in 2012 and updated in 2013 which searched for research and ‘grey literature’ material. Findings from the scoping review are presented using the different elements of the Equalities Act 2010. We conclude that social workers need to be aware of definitions when describing what is being suggested as part of a support plan or reviewed in the context of desired outcomes. We draw attention to the need to think about levels of needs and access to any day opportunity. Social workers are well placed to identify whether these changes have a differential impact on certain groups. This exploration of the literature on user experiences and outcomes from day opportunitie...

PurposeLittle is known about the implications of employing agency staff on safeguarding or the reasons why employers recruit staff from agencies who specialise in supplying staff to the sector or why social care staff work for such agencies. This paper aims to present findings from a study of agency workers in social care services in England.Design/methodology/approachDrawing on a review of the literature and policy documents, the study involved a survey of local authorities and interviews were conducted with 93 agency workers and other stakeholders. The interviews took place in three selected localities and data were analysed thematically. The survey investigated local authorities' use of agency workers, enquiring about reasons for this means of employment and any trends. The survey findings were contextualised by national data from England.FindingsAnalysis of interview and survey data revealed a variety of reasons for the employment of agency staff. In relation to safeguarding, agency workers filled staffing gaps and met needs for social care services or assessment; however, their abilities to offer continuity of care and sometimes to work within existing systems were compromised. Some employers did not provide agency workers with access to professional development opportunities or supervision.Practical implicationsThe findings are used to develop recommendations for safeguarding practice at local level.Originality/valueThere is a temptation to depict agency workers as presenting safeguarding risks: this paper argues that a more rounded picture should be offered and a systems approach adopted.

This article focuses on people with learning disabilities and their families who employ care or support workers using public (government) and/or private (self and family) funds. Such consumer-directed support takes place in England through personal budgets and direct payments. Research and material relevant to these employment relationships were explored in a scoping review undertaken by the authors in 2010. The review identified a small number of studies that involved people with learning disabilities as respondents, although more relied on family carers as proxy respondents. The findings from these studies covered recruitment and administration, employment of family members, training needs, the nature and content of employment relationships, and ending employment. The review observed that employment relationships, practices, and dynamics are surprisingly little explored in the literature and generally unobserved. The article concludes with specific messages from the review for family carers, for people with learning disabilities and for care and support workers.

Providing housing with care may seem to be integration at its best. This paper investigates the workforce implications of this form of provision with a focus on older people with high support needs.

This paper reports the findings of a scoping study designed to describe the evidence base with regard to support workers in social care in the United Kingdom and to identify gaps in knowledge. Multiple bibliographic databases were searched for studies published since 2003. The results revealed that the support worker role, though not well-defined, could be characterised as one aimed at fostering independence among service users, undertaking tasks across social and health-care, and not being trained in, or a member of, a specific profession. The studies identified were predominantly small-scale qualitative projects which considered issues such as role clarity, training and pay, worker satisfaction, service user views and the amount of time support workers are able to spend with service users compared to other staff. The review concluded that the research base lacks longitudinal studies, there is definitional confusion and imprecision, and there is limited evidence about employment terms and conditions for support workers or about their accountability and performance. The desirability and value of training and how it is resourced need further analysis. It is concluded that moves to self-directed support or personalisation and the increased reliance on and use of support workers, in the form of personal assistants, call for closer scrutiny of the role.

At a time of increasing interest in mental health in later life, the role of public health approaches is potentially heightened. This paper draws on interview data with older people living in London to consider the interplay between personal and public approaches to health and well‐being. The interviews were under taken as part of the midpoint review of the UK government's 10‐year strategy for older people (Healthcare Commission et al, 2006) and the social characteristics of London are considered.

Despite the growing evidence base about depression and anxiety and its application to service settings and practice, we are short of practice examples about what works and for whom. This applies to older people in general but particularly to groups, such as people from black and minority ethnic backgrounds. This article discusses policy and legislative encouragements to think about equality of access and diversity issues in mental health services and wider mental health promotion activities. It analyses recent research and policy documents in the context of demographic change and practice. It argues that the context of personalisation in England may provide new opportunities to consider what older people will find most acceptable and effective in meeting their needs, but notes the challenges that this will bring to community‐based organisations and specialist services.

After many years of debate in the UK about the need for a degree-level qualification in social work, the arguments for a minimum degree-level qualification were accepted. The requirements for the degree in England were developed drawing on work from a number of sources, including a benchmark statement for undergraduate degrees in social work and focus groups with stakeholders. The new degree in England, launched in 2003, involves one extra year's study; improvements in the qualifying standard for social work; and specific curriculum and entrance requirements. At the time of launching the degree, the government department responsible for funding (Department of Health) commissioned a three-year evaluation of the implementation of the new degree to establish whether the new qualifying level leads to improvements in the qualified workforce. The aim of the evaluation is to describe the experiences of those undertaking the degree, collect the views of the various stakeholders about the effectiveness of the degree and measure the impact of a degree-level qualification on those entering the workforce. This article, written by the team undertaking the evaluation of the England degree, explores the reasons for the methodological approach adopted and the issues that have arisen in setting up the research.

Improving access to culturally-appropriate services and enhancing responses to the needs of older people from black and minority ethnic backgrounds were among the aims of theNational Service Framework for Older People(NSFOP) that was introduced in England in 2001. Progress in meeting the aims of the NSFOP was evaluated by a mid-term independent review led by the Healthcare Commission, the body responsible for regulating health-care services in England. This paper reports the consultation with older people that underpinned the evaluation. It focuses on the views and experiences of older people from black and minority ethnic (BME) groups and of the staff that work in BME voluntary organisations. A rapid appraisal approach was used in 10 purposively selected local councils, and plural methods were used, including public listening events, nominal groups and individual interviews. In total 1,839 older people participated in the consultations and 1,280 (70%) completed a monitoring form. Some 30 per cent defined themselves as of a minority ethnic background. The concerns were more about the low recognition of culturally-specific and language needs than for the development of services exclusively for BME older people.

This paper draws on the evaluation of the impact of the English National Service Framework for Older People (NSFOP) on the experiences and expectations of older people, four years into its ten-year programme. The NSFOP focuses on achieving cultural changes so that older people and their carers are treated with respect, dignity and fairness. The evaluation took a mixed methods consultation approach in ten localities. This paper focuses on what was said by older people, their carers and in voluntary sector groups about social workers’ roles and activities. The data suggest that they find social workers’ roles unclear and variable. They appreciate a person-centred approach, informed about older people’s needs in a confusing social care system. Their perceptions tally with those of social workers that the tasks of care management can be reductionist, but older people also desire specialist knowledge combined with a relationship that is ‘on their side’. Social workers’ roles in rationing support and means-testing did not seem to promote such models. At a time of rising expectations about the skills of social workers and of changes to social work roles in England and Scotland, this study provides one of the few examples of information directly gathered from older people themselves.

This article describes a consultation event held as part of the process of reviewing the qualitative evidence for the National Institute for Clinical Excellence (NICE) and Social Care Institute for Excellence Guidelines (SCIE) on dementia (2006). It shows how events such as these can provide valuable information to be included in systematic reviews but also help identify research priorities for the future.

English This article reports on an innovatory partnership between regulatory bodies and researchers to assess progress in improving NHS, local authority and other services for older people in 10 different parts of England. It discusses how consultation exercises held as part of local inspections that fed into a national review of the National Service Framework for Older People may enlarge the evidence base for planning and service improvement purposes. The results provide an example of the need for greater debate about different sources of evidence in health and social care. There is comparatively little recent UK research-based evidence on what people with dementia and their carers think about the services they receive and policy makers may need to draw on wide-ranging sources of evidence if they are to make necessary service improvements and to develop policy initiatives.

AIM: evaluation of the impact of the National Service Framework for Older People (NSFOP) on the experiences and expectations of older people, 4 years into its 10 year programme. BACKGROUND: the NSFOP is a comprehensive strategy designed to promote fair, high quality, integrated health and social care services for older people in England. It emphasises (i) the need for services to support independence and promote health, (ii) the specialisation of services for key conditions (stroke, falls and mental illness) and (iii) advocates a cultural change in services so that the older people and their carers are treated with respect, dignity and fairness. It has a 10-year timetable for implementation, starting in 2001. Method: a mixed methods approach to evaluation was taken in ten purposively selected localities in England. A portfolio of methods (listening events, nominal groups and interviews) was used with older people and carers to focus on processes as well as on outcomes and to allow for the possibility of conflicting or differing judgements about service quality. Findings: one thousand eight hundred and thirty-nine people participated in public listening events, 1,639 took part in nominal groups and 120 were interviewed individually. The existence of the NSFOP was not widely known beyond the NSFOP local implementation teams and voluntary sector activists. Many, but not all older people, identified themselves as members of a group that was subject to age prejudice that altered the quality and standard of their care. This identity included a role as carer for others, but there was less emphasis on the rights of older people. Positive changes in primary care services were offset by difficulties in accessing general practice and a sense that services were becoming impersonal. The quality of social care at home varied from sensitive and personal to fragmentary, hurried and impersonal. Hospitals treatment was perceived as improved in speed and quality in most places, but hospitals were also seen as risky and insufficiently caring, with discharge sometimes being unprepared, over-zealous and disorganised. CONCLUSIONS: if asked, older people do not perceive improvements as the result of a NSFOP, but nonetheless they do perceive improvements in systems. It is difficult to attribute any of the changes in experiences that we identified to the NSFOP itself, but we can see that other change processes run contrary to some aspects of the NSFOP whilst some trends are congruent with the aspirations of the NSFOP. Government initiatives face the difficulty of distinguishing experiences that may be attributable to multiple causes. They are influenced nonetheless by the outcome of public consultation since these provide relatively rapid means of feedback and commentary by citizens and regulators on the performance of services. Language: en

This article reports on the findings of the inspections and consultations undertaken as part of the evaluation of the National Service Framework for Older People. It focuses on what was found about the implementation of adult protection systems, by synthesising the inspectors' findings, drawing on older people's comments in meetings and interviews concerning care in hospitals, as an illustration, and by reporting the results from a survey. Together these sources of information revealed that adult protection systems are in place, and that the majority of older people say that they know to whom they can report concerns, but that older people and their families weigh up the decision to make complaints carefully. Questions are raised about the interface between adult protection and concerns about dignity and quality of hospital care.

In this article we consider community well‐being and new approaches to reinvigorating partnership working for older people's services. In particular, we focus on improving transport for older people. We draw on findings from a series of public consultations, group discussions and interviews with older people in 10 purposively selected localities in England. Although there was great diversity in the issues raised by older people on the subject of transport, both across and between the sites, we point to a number of core analytical themes which could assist commissioners in developing a citizens' framework designed to address this traditionally ‘wicked’ issue.