On self-neglect and safeguarding adult reviews: diminishing returns or adding value?

Purpose: One purpose is to update the core data set of self-neglect serious case reviews and safeguarding adult reviews, and accompanying thematic analysis. A second purpose is to respond to the critique in the Wood Report of serious case reviews commissioned by Local Safeguarding Children Boards by exploring the degree to which the reviews scrutinised here can transform and improve the quality of adult safeguarding practice. Design/Methodology/approach: Further published reviews are added to the core data set from the web sites of Safeguarding Adults Boards and from contacts with SAB Independent Chairs and Business Managers. Thematic analysis is updated using the four domains employed previously. The findings are then further used to respond to the critique in the Wood Report of serious case reviews commissioned by Local Safeguarding Children Boards, with implications discussed for Safeguarding Adult Boards. Findings: Thematic analysis within and recommendations from reviews have tended to focus on the micro context, namely what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis enables an understanding of local geography. However, there are other wider systems that impact on and influence this work. If review findings and recommendations are to fully answer the question “why”, systemic analysis should appreciate the influence of national geography. Review findings and recommendations may also be used to contest the critique of reviews, namely that they fail to engage practitioners, are insufficiently systemic and of variable quality, and generate repetitive findings from which lessons are not learned. Research limitations/implications: There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here against the strands in the critique of serious case reviews enables conclusions to be reached about their potential to transform adult safeguarding policy and practice. Practical implications: Answering the question “why” is a significant challenge for safeguarding adult reviews. Different approaches have been recommended, some rooted in systems theory. The critique of serious case reviews challenges those now engaged in safeguarding adult reviews to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice. Social implications: Originality/value: The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of conducting safeguarding adult reviews by using the analysis of themes and recommendations within this data set to evaluate the critique that reviews are insufficiently systemic, fail to engage those involved in reviewed cases and in their repetitive conclusions demonstrate that lessons are not being learned

The assessment of dementia in primary care

Dementia is an irreversible and progressive condition characterized by a global deterioration of a person’s cognitive abilities. With an ageing population, the number of people diagnosed with dementia is expected to rise both in the UK and abroad. Consequently, government policies across the world have stressed the need to improve early diagnosis of dementia in the hope that this will facilitate adjustment to the illness and thus to prolong independence. Arguably, one way of achieving this aim is to strengthen the role of primary care in the assessment, diagnosis and subsequent support of people affected by dementia. The purpose of this commentary is to explore the role of mental health and memory nurses in this process drawing on examples from the UK and Australia. Although there are a number of risks about increasing the role of primary care, pressures from limited budgets and resources at a time when the numbers of people affected by dementia are set to increase, means that it is inevitable that primary care will have a more influential role in dementia care than before. Consequently, it is important that the implications of these policy changes for mental health and specialist memory nurses are clearly understood

The Role of Ideas in Policy Transfer: The Case of UK Smoking Bans since Devolution

This article explores the relationship between ideas and interests in policy change by examining tobacco control in each country of the United Kingdom (UK). In all four, the moves towards further prohibition reflected international trends, with evidence of policy transfer and the virus-like spread of ideas which has shifted the way that tobacco is framed. However, there are notable differences in the development of policy in each territory. This reinforces conceptions of transfer in which the importation of policy is mediated by political systems. Differences in policy conditions, institutions and ‘windows of opportunity' mean that our conclusions on the role and influence of interest groups, institutions and agenda-setting vary by territory, even within a member state. This suggests that a focus on an ‘idea whose time has come' should be supplemented by careful analysis of the political context in which the idea was articulated and accepted

Looking after children in the UK – convergence or divergence?

Comparative child welfare administrative data from each of the four jurisdictions of the UK (Scotland, England, Northern Ireland and Wales) was analysed over a ten-year period to examine rates and patterns of public care. Scotland followed by Wales has the highest rates of children in out-of-home care followed by England and NI with similar lower proportions. Despite strong links between deprivation and higher chances of becoming looked after this national variation appears more a reflection of differing legal and operational practice than higher levels of need for public care. Notwithstanding differing devolution settlements, a convergence in the direction of policy across the UK towards early intervention, extensive use of kinship care and adoption as an exit route from public care is apparent. This convergence is most apparent in the increased entry of very young children to public care in Scotland, NI and Wales. The lack of any systematic collection of data by governments on the social and economic conditions of children reflects a missed opportunity to examine separately their influence on rates of children in public care

Sexual health promotion programme: Participants' perspectives on capacity building

Objectives: The aim of this study was to evaluate a Health Service Executive (HSE) Foundation Programme in Sexual Health Promotion (FPSHP) with a specific emphasis on capacity building. Design: A mixed-method design using both quantitative and qualitative methods was used to collect the data. Setting: The FPSHP was delivered to staff working in health, education and community settings and was designed and facilitated by sexual health promotion staff who are part of the Irish HSE. Methods: A survey, designed by the researchers, as well as individual telephone interviews with past participants was used to evaluate the programme. Out of a possible 200 participants, 97 completed the questionnaire (response rate 49%), and a total of 22 telephone interviews were completed. Results: There was generally a high level of satisfaction with the FPSHP. Participants reported high levels of individual and intra-organisational capacity-building activities, but apart from networking, inter-organisational capacity-building activities were reported less frequently and tended to be ad hoc in nature. Satisfaction with the programme was high and so was the perception of its sustained impact. Motivation, satisfaction with the programme and attending of further training were strong predictors of reported sustained impact. Conclusion: Capacity building in sexual health promotion was affected positively by participation in the programme. Nonetheless, a greater emphasis on capacity building at an inter-organisational level needs to be considered. It is recommended that participants need to be motivated, guided and supported in the use of strategies to achieve this