Suchergebnisse

Purpose
Local serious case reviews (SCRs) (now Safeguarding Adults Reviews (SARs)) may be held in England when a vulnerable adult dies or is harmed or at risk of being so, and local agencies may not have responded to the abuse or neglect. The purpose of this paper is to present findings from a documentary analysis of these reviews to ascertain what recommendations are made about pressure ulcer prevention and treatment at home, setting these in the context of safeguarding, and assessing what lessons may be learned by considering them as a group. This analysis is presented at a time of increased interest of the risks of pressure ulcers among frail and very ill populations; and debates about the interface of neglect and safeguarding systems.


Design/methodology/approach
Identification of SCRs from England where the person who died or who was harmed had been suffering from pressure ulcers or their synonyms in their home; termed home acquired pressure ulcers. Narrative and textual analysis of documents summarising the reports was undertaken to explore the reviews' observations and recommendations. The main circumstances, recommendations and common themes were identified.


Findings
The authors located 18 relevant SCRs, one of which was a case summary and two SARs covering pressure ulcers that had been acquired or worsened when the individual was living at home. Most of these inquired into the individual's circumstances, their acceptance of care and support, the actions of others in their family or professionals, and the events leading up to the death or harm. Failures to have followed guidance were noted among professionals, and problems within wider health and care systems were identified. Recommendations include calls for greater training on pressure ulcers for home care workers, but also greater risk communication and better adherence to clinical guidelines. A small number focus on neglect by family members, others on self-neglect, including some vulnerable adults' lack of capacity to care for themselves or to access help. In some SCRs the presence of a pressure ulcer is only mentioned circumstantially.


Research limitations/implications
The value of this documentary analysis is that it draws on case examples and scrutiny at local level. Future research could consider the related findings of SARs as they emerge, similar documents from the rest of the UK, and international perspectives


Practical implications
This analysis highlights the multitude of complex social and health situations that gives rise to pressure ulcers among people living at home. Several SCRs observe problems in the wider communications with and between health and care providers. Nonetheless poor care quality and negligence are reported in some SCRs. Cases of self-neglect give rise to challenging practice situations. While practices and policies about poor quality care and safeguarding in the form of prevention of wilful neglect are emerging, they often relate to hospital and care home settings. Preventing and treating pressure ulcers may be part of safeguarding in its broadest sense but raises the question of whether training, expertise and support on this subject or wider self-neglect and neglect by others are sufficiently robust for home care workers and community-based professionals.


Originality/value
The value of having a set of SCRs is that they lend themselves to analysis and comparison. This analysis is the first to focus on home acquired pressure ulcers and to address wider considerations related to safeguarding policy and practice. Pressure ulcers feature in several SCRs either as contextual information about the vulnerable adults' health-status or as indications of poor care. The potential value of examining home acquired pressure ulcers as a key line of enquiry is that they are "visible" in the system, with consensus about what they are, how to measure them and what is optimal care and treatment. In the new Care Act 2014 context, they may still feature in safeguarding inquiries as symptoms of failings in systems or of personal culpability for poor care. Learning from them may be of interest to other parts of the UK.

Purpose
Serious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.


Design/methodology/approach
Identification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews' observations and recommendations. The main themes were identified.


Findings
The authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are "visible" in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.


Research limitations/implications
Reviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.


Practical implications
This analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.


Social implications
The value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.


Originality/value
The value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.

PurposeThe 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/approachAn initial research review was undertaken in 2012 and updated in 2016.FindingsThe 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 implicationsServices 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/valueThis is an update on a research review undertaken in 2012.

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 inclusion of modern slavery in the Care Act 2014 as a form of abuse means that the subject of modern slavery is now included in the remit of adult safeguarding in England. The purpose of this paper is to discuss the background to the Modern Slavery Act 2015 and its provisions.


Design/methodology/approach
A policy analysis was undertaken in 2016 drawing on research and commentary related to the interface between modern slavery and adult safeguarding.


Findings
There is little material as yet focussing on adult safeguarding and modern slavery but the inclusion of modern slavery in this area of practice and organisations will require practitioner responses, organisational collaboration and revisions of data collection and analysis. Newspaper accounts of criminal charges under the Modern Slavery Act 2015 may be important first evidence of the interface potentially between modern slavery and adults at risk of abuse and neglect that are the focus of adult safeguarding concern.


Practical implications
Information about modern slavery may provide relevant background and contextual detail for adult safeguarding communities, furnishing links and resources for this new area of their work.


Originality/value
This paper is likely to be of interest to policymakers, researchers and practitioners in examining their new duties under the Care Act 2014 and the Modern Slavery Act 2015, and to wider public and private bodies considering their responsibilities in responses to modern slavery more broadly.

Abstract: As a whole there was remarkably little controversy in England over the Care Act 2014, once debates over funding caps had been kicked into the long grass. After all, who could oppose the idea of better information, clearer entitlements, and more support for carers? Among the non-contentious areas were specific proposals for Serious Case Reviews (SCRs) to become Safeguarding Adults Reviews (SARs). In light of the many concerns in children's services about the dominance of SCRs in policy and practice debates this lack of interest and discussion may seem surprising. In this paper we explore why such reviews concerning adults are largely seen as non-contentious and frame our analysis around four different 'prompts'; those from Parliament, from earlier SCRs, from practice analysis and from practice development. We draw on our own wider research programme on Adult SCRs and subsequently SARs. This programme of research has explored different facets of the review process and undertaken different thematic analyses by location or user group.

Purpose
– The purpose of this paper is to describe and discuss the pilot Making Safeguarding Personal (MSP) project that ran in three London boroughs in England in 2014-2015. The project aimed to help local authority social work practitioners better engage with adults at risk at the beginning, middle and end of safeguarding work and to develop a more outcomes focused approach to safeguarding.


Design/methodology/approach
– Three adult social care teams volunteered to take part in the MSP pilot for four months, November 2014-February 2015. They were closely supported through telephone conferencing, bespoke training and individual mentoring. Evaluative data were collected from the participating teams about their work and the MSP change processes to assist in further implementation.


Findings
– The findings suggested that staff felt that the open discussions with adults at risk that were encouraged by the MSP initiative enabled safeguarding to be more effective and provided a better basis of support for adults at risk. The support from the project team was appreciated. Staff reported their own increased confidence as a result of involving adults at risk in decisions about their situations and risks of harm. They also reported their increased awareness of cross-cutting subjects related to adult safeguarding, such as domestic abuse and working with coercive and controlling behaviours. Permission to exercise greater professional discretion to make responses more considered, rather than the need to adhere to time-limited imperatives, was received positively. Staff felt that this enhanced discussions about resolution and recovery with adults at risk although it required greater expertise, more extensive managerial support, and more time. These were available in the pilot.


Research limitations/implications
– The MSP pilot was confined to three teams and took place over four months. The numerical data reported in this paper are provided for illustrative purposes and are not statistically significant. As with other evaluations of implementation, the data provided need to be set in the local contexts of population profiles, care settings and the reporting source. The pilot also took place during the early implementation of the Care Act 2014 which affected the context of practice and training. The views of adults at risk were not collected. There is a risk of bias in that participants may have wished to convey positive views of MSP to their colleagues.


Practical implications
– The paper indicates a need for the roll out of MSP philosophy and MSP approaches to be communicated with other agencies supporting adults at risk and for project support of some form to continue. It will be important to see if the overall enthusiasm, support and motivation reported by the pilot teams when taking a MSP approach in practice extend beyond a pilot period during which the staff received substantial support from a dedicated Professional Standards Safeguarding Team. Many of those staff participating in the pilot perceived the MSP approach as a return to core social work principles and welcomed putting these into practice.


Originality/value
– The paper provides details of one pilot in which the feasibility of the MSP approach was tested by supporting three frontline teams working in different contexts. The pilot suggests that the level and type of support offered to the pilot teams were effective in a variety of practice settings. It draws attention to the need for the MSP concept and approach to be shared with other agencies and for implementation support to continue beyond initial pilot period.

Person-centered dementia care is widely accepted as a value-based commitment to supporting people with dementia and is a guiding principle in care services. Policy ambitions to put people at the center of their own care are being developed internationally. These may be seen as part of the evolution of person-centered care which has its origins in critical perspectives on practice and social responses to people with dementia. In England, one further development of person-centered care has been personalization – a government policy to extend individuals' choice and control over their social care and, latterly, ways to meet their health care needs. This paper charts the evolution of the concept of person-centered care to the policy of personalization (which has international comparators) and summarizes emerging and conflicting evidence about the implications of personal budgets in England on older people with mental health problems such as dementia and their families. It focuses on the evidence base of personalization and on emerging lessons for practice, drawing from the implementation of personalization and the adoption of personal budgets by this group. While personalization may be one policy initiative, the values and practices of person-centered dementia care remain fundamental to practice and are inspiring new ideas related to rights and justice for people with dementia.

Person-centered dementia care is widely accepted as a value-based commitment to supporting people with dementia and is a guiding principle in care services. Policy ambitions to put people at the center of their own care are being developed internationally. These may be seen as part of the evolution of person-centered care which has its origins in critical perspectives on practice and social responses to people with dementia. In England, one further development of person-centered care has been personalization-a government policy to extend individuals' choice and control over their social care and, latterly, ways to meet their health care needs. This paper charts the evolution of the concept of person-centered care to the policy of personalization (which has international comparators) and summarizes emerging and conflicting evidence about the implications of personal budgets in England on older people with mental health problems such as dementia and their families. It focuses on the evidence base of personalization and on emerging lessons for practice, drawing from the implementation of personalization and the adoption of personal budgets by this group. While personalization may be one policy initiative, the values and practices of person-centered dementia care remain fundamental to practice and are inspiring new ideas related to rights and justice for people with dementia.

Many long-term care systems are seeking to address problems of growing demand, increasing expense, and higher user expectations. For many of them fostering care at home and private care arrangements are attractive options. The long-term care sector in England is typical of these systems. Over the last 2 decades, government policy in England has placed stronger emphasis on people's choice and control when receiving care services. People with care and support needs may be eligible for public funds to employ care workers or to use them in other ways promote their well-being. These financial transactions are a major part of the policy of personalisation in adult social care, as confirmed by the Care Act 2014. Drawing on findings from life story interviews with 31 migrant care workers who had worked for disabled or older people in England, conducted 2011–2013, we note the potential for expanding the sociologically inspired concept 'personalised risk'. This necessitates an appreciation of risks potentially faced by the multiple parties in the care relationship and a differentiated set of structural risks. Applying a multilevel analysis we highlight the potential risks of 'informality' of employment conditions experienced by directly employed care workers, the 'emotional' content of care worker-employer relationships, and 'intimacy' of employer/employee roles. In this article, we offer an empirical based contribution to the wider discussion of risks and risk theory derived from policy changes being adopted by many developed countries that increasingly emphasise individual responsibility for personal welfare within an uncertain and mobile social world.

Jill Manthorpe, Kritika Samsi Social Care Workforce Research Unit, NIHR School for Social Care, King's College London, London, UK Abstract: Person-centered dementia care is widely accepted as a value-based commitment to supporting people with dementia and is a guiding principle in care services. Policy ambitions to put people at the center of their own care are being developed internationally. These may be seen as part of the evolution of person-centered care which has its origins in critical perspectives on practice and social responses to people with dementia. In England, one further development of person-centered care has been personalization – a government policy to extend individuals' choice and control over their social care and, latterly, ways to meet their health care needs. This paper charts the evolution of the concept of person-centered care to the policy of personalization (which has international comparators) and summarizes emerging and conflicting evidence about the implications of personal budgets in England on older people with mental health problems such as dementia and their families. It focuses on the evidence base of personalization and on emerging lessons for practice, drawing from the implementation of personalization and the adoption of personal budgets by this group. While personalization may be one policy initiative, the values and practices of person-centered dementia care remain fundamental to practice and are inspiring new ideas related to rights and justice for people with dementia. Keywords: person-centered care, personalization, personhood, person-centered planning, dementia

Purpose
– The purpose of this paper is to summarise the findings of a desk-based international review investigating the checking of staff and volunteers working with adults who are vulnerable or at risk (or similarly defined) receiving social care in their own homes, or in day centres or residential care.


Design/methodology/approach
– In England, as part of the government's attempts to prevent harm to vulnerable people, employers must check if their staff or volunteers are barred from working with vulnerable adults in the health and care sectors or if they have a relevant criminal record. This review sought to explore practices elsewhere, with a view to informing policy and practice debates. The review was undertaken in winter 2014-2015. It mainly involved a search of internet-based material and databases. This was further informed by communications with experts and practitioners from different countries.


Findings
– The review found a variety of practices, ranging from no checks to substantial checks involving fingerprinting. Reasons for checks identified in different national contexts extend from efforts to stop fraudulent use of government subsidies to minimising the risk of harm to vulnerable adults, and more positively to enhance user and public trust in care providers. A small number of countries place particular emphasis on the rights of individuals to privacy and rehabilitation and this moral imperative overrides other policy goals. This review highlighted a lack of clarity in publicly available documents about the potentially multiple policy goals of different schemes and suggests that there may be advantages to clarifying the options available from other countries.


Research limitations/implications
– This review was confined to English language material and to material located through internet searching. Some material may not have been updated on internet sites.


Originality/value
– The details of the processes have not previously been collated to the best of the authors' knowledge.

In England several initiatives are underway in social work education, among which are changes to application and training processes, and the development of shorter employment-based post-graduate qualifying routes. Here trainees are placed with social work employers (local authorities), receive substantial funding compared to other students, and local authority staff are closely engaged with higher education providers. This article presents and analyses the views of the first and second cohorts of trainees undertaking the Step Up to Social Work programme. Data were collected by online survey, administered at four time points. The overall response rate at each of the four points was high; ranging from 64 per cent to 78 per cent for Cohort 1 and 77 per cent to 83 per cent for Cohort 2. Comparison of data across cohorts revealed satisfaction with the training and the Step Up initiative but levels of satisfaction were increased among Cohort 2, which may be attributable to changes made following the first cohort's experiences. The findings from this comparison of trainees may usefully inform other studies and provision of employment-based routes in social work education and the satisfaction levels achieved may be ones to which other programmes may wish to aspire.