Use of quality information in decision-making about health and social care services - a systematic review

User choice and personalisation have been at the centre of health and social care policies in many countries. Exercising choice can be especially challenging for people with long-term conditions (LTC) or disabilities. Information about the quality, cost and availability of services is central to user choice. This study used systematic review methods to synthesise evidence in three main areas: (i) how people with LTC or disabilities and their family carers ?nd and access information about the quality of services; (ii) how quality information is used in decision-making; and (iii) what type of quality information is most useful. Quality information was de?ned broadly and could include formal quality reports (e.g. inspection reports, report cards, etc.), information about the characteristics of a service or provider (e.g. number and quali?cations of staff, facilities, etc.) and informal reports about quality (e.g. personal experience, etc.). Literature searches were carried out using electronic databases in January 2012. Thirteen papers reporting ?ndings from empirical studies published between 2001 and 2012 were included in the review. The majority of papers (n = 9) had a qualitative design. The analysis highlighted the use of multiple sources of information in decision-making about services and in particular the importance of informal sources and extended social networks in accessing information. There is limited awareness and use of ‘of?cial’ and online information sources. Service users or family carers place greater emphasis on general information and structural indicators. Clinical or quality-of-life outcomes are often dif?cult to interpret and apply. Trust emerged a key issue in relation to quality information. Experiential and subjective information is highly valued and trusted. Various barriers to the effective use of quality information in making choices about services are identi?ed. Implications for policy and future research are discussed

The history of institutions in Hungary: what can we learn from it for the future?

This presentation provides an overview of the history of long-stay institutions for people with intellectual disabilities in Hungary. It discusses reform attempts to change institutions and why these failed. It also reflects on the role of disabled people’s organisations and self-advocates in promoting change

Estimating demand and supply of migrant home care workers in the UK

In 2019, as part of a study on Migrant care workers in the UK, we launched a Delphi Survey to generate possible scenarios to guide future statistical modelling of the migrant home care workforce in the UK. The aim of the modelling will be to explore what the future role and composition of this workforce could look like after Brexit, within the context of wider sectoral challenges. The present report summarises the responses received in Round 1 of the survey, which were collected in the first phase of the larger study

Migrant care workers and their future in the UK context

Recruiting and retaining quality care staff is one of the main challenges facing the care sector. The home care workforce has one of the highest rates of turnover and vacancy rates in the British economy. About 15% of those employed in the home care workforce are migrant workers, with large regional variations (the per- centage is considerably higher in London and the South East). The demand for home care workers is likely to increase due to population ageing and growing demand for long term care. • The UK’s referendum on European Union membership in June 2016 produced a 52% vote for ‘leave’, and negotiations are currently under way on the conditions for ‘Brexit’. It is likely that the outcomes of these will fundamentally alter existing policies, rules and patterns of workforce migration, while the free movement of labour from the EU / EEA will end. In this case, and with the current level of migrant workers in the care sector, existing UK work visa schemes would be unable to satisfy demand. • This Policy Perspective provides insight from expert contributors on these issues (based on a Round Table discussion on 19th June 2018) and makes recommendations relevant to policymakers, care sector employers and researchers in the Sustainable Care programme. It considers the potential advantages and disadvan- tages of existing work visa and migrant worker schemes from the perspective of the home care sector and highlights some of the risks associated with restricted migrant workers’ rights post-Brexit

Brexit and the migrant care workforce: Future policy directions. Findings from the second round of Delphi Surveys of UK experts

Migrant workers have been vital in helping to fill labour gaps locally and regionally and across different types of social care services in the UK over the last few decades. Brexit and the UK’s decision to end free movement for EEA workers was expected to bring significant new challenges to the sector as a whole, and homecare in particular. In 2019, we launched a two-wave expert (Delphi) survey to explore what the future role and composition of this workforce could look like after Brexit within the context of broader sectoral challenges. In March 2020, the first wave of the Covid-19 pandemic hit the UK and created unprecedented challenges for social care. The second (final) round of the survey was conducted in the summer of 2020. It set out to identify points of consensus about major considerations associated with recruitment and retention in homecare in the context of the ongoing Covid-19 pandemic and Brexit. This short report summarises the second-round results of the expert survey and sets out some primary considerations and policy directions for the homecare sector at a time of uncertainty

Recruitment and retention of the social care workforce: longstanding and emerging challenges during the COVID-19 pandemic

Several factors associated with turnover identified in this review can be controlled or influenced by care providers. These include managerial support, organisational culture, work organisation, and adequate equipment to ensure health and safety at work. Therefore, one of the critical findings of this review is the need for the sector to be able to offer ‘quality jobs’ in order to improve recruitment and retention; this includes, but not exclusive to, ensuring decent pay and terms of employment, job security, and quality of the working environment. Another important message of the review is that social care needs better systems to support care providers in creating and offering quality jobs. In particular, there is a need to reconsider how services are commissioned and funded by local authorities, acknowledging the employment implications of funding constraints and commissioning practices. The current situation of significant job losses in some industries (particularly hospitality and retail) during COVID-19 might offer a unique opportunity to redistribute the workforce. For the sector to attract and retain available workers due to such redistributions, social care urgently needs both a financial and image boost. The impact of the COVID-19 pandemic on the social care workforce is still unfolding. It will need to be analysed in the ever-changing context of government policies and local implementation in the coming months

Migrant Home Care Workers in the UK: a Scoping Review of Outcomes and Sustainability and Implications in the Context of Brexit.

Migrant care workers play a significant role in meeting the escalating demand for social care in the UK. Workforce shortages create opportunities for new migrants to enter the social care workforce. This scoping review aims to identify and synthesise available evidence on the contribution of migrant workers to the provision of home care in the UK focusing on care worker and service outcomes as well as sustainability, and identify challenges and gaps in the context of Brexit and changing immigration policies. Twenty-two articles were identified for inclusion in the review and extracted using a structured format. The analysis presents a narrative description and synthesis of the research. Findings from the reviewed articles were grouped into five main themes: migrant, user and employer outcomes, effect on workforce, and sustainability-and 15 sub-themes that were described in detail. Much of the existing research on migrant care work is qualitative and focuses on migrant outcomes. The review identified some important gaps in research, namely, the impact of immigration status on migrant care worker outcomes, the cultural and psychological adaptation of migrant care workers to care practices, and the emerging UK live-in care market. Implications of findings are discussed in the context of post-Brexit immigration system

When Legislation Is Not Enough: The Adverse Environment for Independent Living in Hungary

The history of disability policies in Hungary is one of legal progress since the 1990s and EU-funded investments since 2004, yet mixed outcomes for disabled people. To date this paradox remains unexplored, especially how it plays out in the lived experiences of disabled people and their families. This paper aims to fill this knowledge-gap by exploring disabled people’s experiences of independent living over the past three decades in Hungary. Based upon 53 life course interviews – 34 with disabled people and 19 with family members – we identify seven barriers to independent living in Hungary, which create an adverse environment. We also highlight a number of facilitators that help people to overcome or mitigate this adverse environment. In the conclusion, we discuss trends in Hungarian disability policies that impact opportunities for independent living. Results suggest decades of human-rights inspired legal progress has made little difference in people’s lived realities