Search

There is a growing emphasis on prevention to reconcile demographic pressures, resource scarcity and expectations of better quality care and support. The Care Act 2014 placed a statutory duty on English local authorities to prevent and delay the development of needs for care and support. However, evidence suggests that the prevention approach has secured less impact than intended. Given that existing approaches have achieved such limited results, new ways of addressing this apparently intractable challenge should be considered. We argue here that theory-based models that support the understanding of, and responses to, implementation barriers and facilitators can provide tools to support the development of more successful implementation. Drawing on in-depth interviews (n  = 20) in selected English councils and analyses of their policy documents, we explore the 'Ready, Willing and Able' (RWA) model, which posits that those three preconditions must be satisfied before new practices can be implemented sustainably. We argue that RWA can provide a straightforward and parsimonious framework for identifying implementation barriers and facilitators. Using the model to identify potential bottlenecks prior to the implementation can help local actors clarify baseline barriers to progress. RWA could help to inform opportunities to target identified problems, by reinforcing facilitators and moderating barriers. [ABSTRACT FROM AUTHOR]

While debate on how best to pay for social care in England continues, information about public attitudes on this issue is limited. We asked representative samples of the public whether care costs for older people should be met by the state, met by the service user or shared between state and user. We used an online survey of people aged 18–75 (n = 3,000) and interview survey of people aged 65 and over (n = 466). Respondents were given four vignettes (two home care, two residential care) and asked who should pay at different levels of user resources; and how much users should contribute when costs were shared. Fewer than one-fifth of the online sample and one-quarter of the interview sample considered that the state should meet the full costs whatever users' resources; considerably lower proportions believed that users should meet the full costs in all cases. Two-thirds of the online sample and half the interview sample thought costs should be shared. The proportion of costs that users should contribute was relatively low (20–50 per cent, varying by user resources). The study illustrates that public views elicited through vignettes can provide evidence to inform policy on social care funding. [ABSTRACT FROM AUTHOR]

Circles of Support aim to enable people with learning disabilities (and others) to live full lives as part of their communities. As part of a wider study of the economic case for community capacity building conducted from 2012 to 2014, we conducted a mixed methods study of five Circles in North West England. Members of these Circles were supporting adults with moderate to profound learning disabilities and provided accounts of success in enabling the core member to live more independent lives with improved social care outcomes within cost envelopes that appeared to be less than more traditional types of support. The Circles also reported success in harnessing community resources to promote social inclusion and improve well-being. This very small-scale study can only offer tentative evidence but does appear to justify more rigorous research into the potential of Circles to secure cost-effective means of providing support to people with learning disabilities than the alternative, which in most cases would have been a long-term residential care placement.

Advocacy can help service users both to understand their rights and choices and also to support them in resolving issues of great significance to their lives. We investigated some of the costs and outcomes of advocacy provided to parents with learning disabilities at risk of having their children taken into care. Through two workshops and a survey, we gathered information about service use and outcomes at case- and project-levels. We used evidence from previous studies to assign unit costs to service use and to value the economic consequences of outcomes. We combined data with simple decision-modelling techniques. The mean cost of the advocacy intervention was £3040; potential cost savings per case ranged from £720 if we only considered the impact on children's social services, to over £3130 if savings to other public services were considered. Estimated improvements in quality of life and earnings were worth an additional £550. The limitations of our study mean those findings should be interpreted cautiously. Nonetheless, they suggest there is scope for securing better value for money through introducing advocacy for parents with learning disabilities.