How self directed support is failing to deliver personal budgets and personalisation

Copyright © Social Services Research Group 2012. This article is available open access from the publisher’s website at the link below.Over the past five years, social care has been experiencing a period of change described as 'transformational'. It has largely been based on a model initiated by the organisation 'In Control' (Poll et al., 2006), variously called 'personalisation', 'personal budgets' and 'self directed support'. The drive to create personalised services through self directed support and personal budgets was implemented before the model was fully tested. Indeed, its implementation was announced before completion of a national evaluation set up by the Government. One advantage of such speedy, widespread implementation is that we are now beginning to have substantial evidence regarding its efficacy. At the same time, we are the on the cusp of new legislation likely to shape social care for the foreseeable future. It is essential that legislation takes on board what the evidence says about this model – its strengths and weaknesses. The following discussion shows why the underpinning notion of self directed support seems to have failed in its ambitions. However, the concepts of personalisation and personal budgets associated with it may retain value if interpreted in an appropriate way, delivered through an appropriate strategy. Then even so long as resources fall short of needs, they are likely to ensure the best possible outcomes for service users are secured. If and when adequate levels of funding are also provided, there may be the real prospect of enabling all to live their lives on the same terms as others who do not need social care support

From ‘other’ to involved: User involvement in research: An emerging paradigm

This article has been made available through the Brunel Open Access Publishing Fund. Copyright @ 2013 The Author(s). This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.This article explores the issue of ‘othering’ service users and the role that involving them, particularly in social policy and social work research may play in reducing this. It takes, as its starting point, the concept of ‘social exclusion’, which has developed in Europe and the marginal role that those who have been included in this construct have played in its development and the damaging effects this may have. The article explores service user involvement in research and is itself written from a service user perspective. It pays particular attention to the ideological, practical, theoretical, ethical and methodological issues that such user involvement may raise for research. It examines problems that both research and user involvement may give rise to and also considers developments internationally to involve service users/subjects of research, highlighting some of the possible implications and gains of engaging service user knowledge in research and the need for this to be evaluated

Citizen Involvement In Public' Policy

The theme of this research work is citizen involvement in public policy.Participation is both a subject of the research and the perspective through which a range of different policy areas are approached. These include land-use planning, social services, community care, poverty, child care and the future of welfare. Participation is also central to the chosen research methodology and methods. A particular focus is placed on the perspective of the subjects of public policy. The research also explores social care service users' discourses on their rights and needs and the relation of public policy to them, particularly the discourses of psychiatric system survivors and disabled people. 23 publications have been submitted as part of this application (see Appendix). They' are part of a much larger body of work undertaken by the candidate over the same period. They have been selected to reflect some of the key themes identified, explored and developed in the candidate's work. These works have been undertaken over a period of 18 years. Such a length of time means that there have not only been significant developments in the research, but also in its subject matter. The two are in close and dynamic relationship. Over this period, there have been major changes and developments in public policy, politics, welfare and academic debates. The research work has responded to these broader developments.They have influenced its focus and direction and it has sought to influence them. There is currently considerable interest in issues of participation and empowerment. They have gained priority over the period of this work as subjects of study, research, practice and public policy. They are now embodied in a wide range of UK government legislation and guidance. However this is a relatively recent development. The candidate's work starts at a time when participation was much lower on political, academic and professional agendas and it both reflects and takes forward discussion and developments in this field. The particular history of participation has implications both for the kind of questions which the research has asked and the way in which it has been financed and supported. Participation is also associated with a range of key concepts which currently have high priority on public and academic agendas. These include: citizenship, social exclusion, empowerment, community, identity and diversity. The research work has addressed all of these. The work has sought to address a series of key research questions which participation raises. These have emerged, changed and developed over time

Working with Children with Learning Disabilities and/or who Communicate Non-verbally: Research experiences and their implications for social work education, increased participation and social inclusion

Social exclusion, although much debated in the UK, frequently focuses on children as a key 'at risk' group. However, some groups, such as disabled children, receive less consideration. Similarly, despite both UK and international policy and guidance encouraging the involvement of disabled children and their right to participate in decision-making arenas, they are frequently denied this right. UK based evidence suggests that disabled children's participation lags behind that of their non-disabled peers, often due to social work practitioners' lack of skills, expertise and knowledge on how to facilitate participation. The exclusion of disabled children from decision-making in social care processes echoes their exclusion from participation in society. This paper seeks to begin to address this situation, and to provide some examples of tools that social work educators can introduce into pre- and post-qualifying training programmes, as well as in-service training. The paper draws on the experiences of researchers using non-traditional qualitative research methods, especially non-verbal methods, and describes two research projects, focusing on the methods employed to communicate with and involve disabled children, the barriers encountered and lessons learnt. Some of the ways in which these methods of communication can inform social work education are explored alongside wider issues of how and if increased communication can facilitate greater social inclusion

On large-scale diagonalization techniques for the Anderson model of localization

We propose efficient preconditioning algorithms for an eigenvalue problem arising in quantum physics, namely the computation of a few interior eigenvalues and their associated eigenvectors for large-scale sparse real and symmetric indefinite matrices of the Anderson model of localization. We compare the Lanczos algorithm in the 1987 implementation by Cullum and Willoughby with the shift-and-invert techniques in the implicitly restarted Lanczos method and in the Jacobi–Davidson method. Our preconditioning approaches for the shift-and-invert symmetric indefinite linear system are based on maximum weighted matchings and algebraic multilevel incomplete LDLT factorizations. These techniques can be seen as a complement to the alternative idea of using more complete pivoting techniques for the highly ill-conditioned symmetric indefinite Anderson matrices. We demonstrate the effectiveness and the numerical accuracy of these algorithms. Our numerical examples reveal that recent algebraic multilevel preconditioning solvers can accelerate the computation of a large-scale eigenvalue problem corresponding to the Anderson model of localization by several orders of magnitude

Selecting passive dosimetry technologies for measuring the external dose of terrestrial wildlife

Dosimeters attached to wild animals can be used to validate regulatory assessment approaches and models for estimating radiation exposure of wild animals. Such measurements are also necessary to ensure that robust dose-effect relationships can be developed from the results of field research programmes. This paper presents the first comprehensive evaluation of the different dosimetry technologies available for specifically measuring the external exposure of wildlife. Guidance is provided on the selection of appropriate passive dosimetry approaches for directly measuring external exposure of terrestrial wildlife under field conditions. The characteristics and performance of four available dosimetry technologies (thermoluminescent dosimeter (TLD), optically stimulated luminescent dosimeter (OSLD), radiophotoluminescent dosimeter (RPLD) and direct ion storage, (DIS)) are reviewed. Dosimeter properties, detection limit and dose range, study organisms and the intended application are variables that need to be considered when selecting a suitable dosimetry technology. Evaluated against these criteria, it is suggested that LiF based and Al2O3:C TLDs, OSLD and RPLD could all be used to estimate doses to wildlife. However, only LiF based TLDs have been used to directly measure wildlife doses in field studies to date. DIS is only suitable for comparatively large species (e.g. medium to large mammals), but has the advantage that temporal variation in dose can be recorded. In all cases, dosimeter calibration is required to ensure that the dose measurements reported can be interpreted appropriately for the organisms of interest

Mesangial cells are key contributors to the fibrotic damage seen in the lupus nephritis glomerulus.

Background: Lupus nephritis (LN) affects up to 80% of juvenile-onset systemic lupus erythematosus patients. Mesangial cells (MCs) comprise a third of the glomerular cells and are key contributors to fibrotic changes within the kidney. This project aims to identify the roles of MCs in an in vitro model of LN. Methods: Conditionally immortalised MCs were treated with pro-inflammatory cytokines or with patient sera in an in vitro model of LN and assessed for their roles in inflammation and fibrosis. Results: MCs were shown to produce pro-inflammatory cytokines in response to a model of the inflammatory environment in LN. Further the cells expressed increased levels of mRNA for extracellular matrix (ECM) proteins (COL1A1, COL1A2, COL4A1 and LAMB1), matrix metalloproteinase enzymes (MMP9) and tissue inhibitors of matrix metalloproteinases (TIMP1). Treatment of MCs with serum from patients with active LN was able to induce a similar, albeit milder phenotype. Treatment of MCs with cytokines or patient sera was able to induce secretion of TGF-β1, a known inducer of fibrotic changes. Inhibition of TGF-β1 actions through SB-431542 (an activin A receptor type II-like kinase (ALK5) inhibitor) was able to reduce these responses suggesting that the release of TGF-β1 plays a role in these changes. Conclusions: MCs contribute to the inflammatory environment in LN by producing cytokines involved in leukocyte recruitment, activation and maturation. Further the cells remodel the ECM via protein deposition and enzymatic degradation. This occurs through the actions of TGF-β1 on its receptor, ALK5. This may represent a potential therapeutic target for treatment of LN-associated fibrosis

Ethical dilemmas are not simply black and white

This is an Accepted Manuscript of an article published by Taylor & Francis Group in Ethics and Social Practice on 1 July 2008, available online at: http://dx.doi.org/10.1080/17496530801948838.This article aims to highlight some of the ethical issues that arise when social work educators plan to involve service users and carers from black and minority ethnic (BME) communities in the teaching of social work students. Between 2005 and 2007, the authors carried out a two-part project that involved working with service users and carers from BME communities in the area around Liverpool in Britain. The article first discusses the background for this two-part project, highlighting two themes relating to the ethical dilemmas we experienced. The first of these themes concerned conducting a project in a political context based on short and intermittent funding and intransigent bureaucracy. Our second theme concerned how to reconcile bringing together a group of people because they were recognized as having a shared experience while at the same time there were a myriad differences within the group. We then discuss these issues in light of the ethical approach we adopted, based on being open and honest, flexible in a respectful and meaningful way, and on anti-oppressive ethics and shared responsibility.Peer reviewe

How many children and young people with life-limiting conditions are clinically unstable? A national data linkage study

Objective: To determine the clinical stage (stable, unstable, deteriorating or dying) for children and young people (CYP) aged 0-25 years in Scotland with lifelimiting conditions (LLCs). Design: National cohort of CYP with LLCs using linked routinely collected healthcare data. Setting: Scotland. Patients: 20 436 CYP identified as having LLCs and resident in Scotland between 1 April 2009 and 31 March 2014. Main outcome: Clinical stage based on emergency inpatient and intensive care unit admissions and date of death. Results: Over 2200 CYP with LLCs in Scotland were unstable, deteriorating or dying in each year. Compared with 1-year-olds to 5-year-olds, children under 1 year of age had the highest risk of instability (OR 6.4, 95% CI 5.7 to 7.1); all older age groups had lower risk. Girls were more likely to be unstable than boys (OR 1.15, 95% CI 1.06 to 1.24). CYP of South Asian (OR 1.61, 95% CI 1.28 to 2.01), Black (OR 1.58, 95% CI 1.04 to 2.41) and Other (OR 1.33, 95% CI 1.02 to 1.74) ethnicity were more likely to experience instability than White CYP. Deprivation was not a significant predictor of instability. Compared with congenital abnormalities, CYP with most other primary diagnoses had a higher risk of instability; only CYP with a primary perinatal diagnosis had significantly lower risk (OR 0.23, 95% CI 0.19 to 0.29). Conclusions: The large number of CYP with LLCs who are unstable, deteriorating or dying may benefit from input from specialist paediatric palliative care. The age group under 1 and CYP of South Asian, Black and Other ethnicities should be priority groups