The feasibility of introducing an adult safeguarding measure for inclusion in the Adult Social Care Outcomes Framework (ASCOF):findings from a pilot study

Adult Social Care Safeguarding Survey Interview Schedule – adult at risk. (DOCX 368 kb

The Advantages and Disadvantages of Different Models of Organising Adult Safeguarding

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

Media reactions to the Panorama programme ‘Behind Closed Doors:Social Care Exposed’ and care staff reflections on publicity of poor practice in the care sector

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. </jats:sec

Caring in Covid-19: Personal Assistants’ Changing Relationships with their Clients’ Family Members

Context: The impact of Covid-19 on people working as personal assistants (PAs) or directly employed care workers potentially affects not only themselves and their clients but sometimes clients’ family members or carers. Objectives: This interview-based study aimed to hear directly from PAs of their experiences during the pandemic to inform policy and practice. Methods: A sample of 41 PAs working in England were interviewed by telephone during the early months of Covid-19 (April–June 2020) in England. Interview data were analysed thematically and accounts of PAs’ engagement with their clients’ family members were explored. Findings: Study findings illustrate the fluidity of relationships at this time within four dimensions: 1) some family members working more closely with PAs, 2) the development of tensions between PAs and family members, 3) displacement by family members of PAs and other care services, 4) PA accounts of working with clients who had little or no family contact or other assistance during the pandemic. Limitations: This study did not interview family members to hear their views of the relationships and circumstances discussed by the PAs. Implications for research include a need to hear from other care workers operating as live-in PAs and from family members and employers and to follow-up with PAs as the pandemic progressed. Policy implications include the need to encourage contingency planning and to ensure support for PAs. Practice implications are for staff responsible for individualised funding to ensure PAs are known to their systems to enable their support

Addressing incontinence for people with dementia living at home: a documentary analysis of local English community nursing service continence policies and clinical guidance

Aim and objectives.  To establish whether the problems and issues experienced by people with dementia living at home and their carers were addressed in the clinical guidance for continence management for community nursing services in England. Background.  Internationally, the numbers of people with dementia are rising. Managing incontinence is a significant issue as the presence of incontinence is one of the triggers for people with dementia to move their residence to a care home. People with dementia living at home and their family carers report difficulties in accessing knowledgeable professionals and acceptable continence products. Design.  A review by documentary analysis of clinical policies and guidance from a sample of community nursing services in all Strategic Health Authority regions of England. Methods.  A sample of clinical policy and guidance documents for continence assessment and management from up to four community nursing services in each of the ten Strategic Health Authority regions in England was sought. Documentary analysis was undertaken on the relevance of the documents identified for people with dementia living at home. Findings.  Ninety-eight documents from 38 local community nursing services spread across ten Strategic Health Authority areas were obtained and analysed. Only in the documents of three services were nurses offered detailed guidance about the management of incontinence for people with dementia at home. In the documentation of only one service were people with dementia identified as a special case which warranted the provision of additional continence products. Conclusion.  Clinical guidance on continence assessment and management for community nurses in many parts of England does not address the specific needs of people with dementia living at home or their carers. Relevance for clinical practice.  Nurses working in community settings and those providing clinical leadership in continence care should review their clinical guidance and policies to ensure relevance for people with dementia living at home and their family carers

Oral ketamine vs placebo in patients with cancer-related neuropathic pain

Ketamine hydrochloride is used as an adjuvant treatment for cancer-related neuropathic pain, but evidence of its effectiveness is limited.1 Findings of a large trial investigating the use of ketamine for general cancer pain were negative, but the population studied did not specifically have neuropathic pain. A randomized trial of oral ketamine for cancer-related neuropathic pain has been called for, and the present trial addresses that need