Choice and control for older people using home care services : how far have council-managed personal budgets helped?

Purpose: This paper reports the experiences of older people who use council-managed personal budgets (PBs) to fund home care services and their satisfaction with the level of choice and control they are able to exercise. Design/methodology/approach: Data were collected from 18 older people from eight home care agencies across three councils in England. All interviews were semi-structured and face-to-face. Findings: Despite some optimism about improvements in choice and flexibility experienced by older people using home care services, the findings from this small study suggest that the gap between the 'ideal' of user choice and the 'reality' of practice continues to be significant. The level of choice and control older people felt able to exercise to tailor home care services to their personal needs and preferences was restricted to low level choices. Other choices were constrained by the low levels of older people's PBs and council restrictions on what PBs can be spent on. Older people's understanding of limitations in public funding/pressures on agencies and their reluctance to play an active consumer role including willingness to 'exit' from unsatisfactory care arrangements appeared to further challenge the potential for achieving greater choice and control through council-managed PBs. Originality/value: The English government's policy emphasis on personalisation of care and support and new organisational arrangements for managed PBs aim to promote user choice and control. This is the first study to report the experiences of older people using managed PBs under these new arrangements. The paper highlights areas of interests and concerns that social care staff, support planners and commissioners may need to consider

Estimating the unit costs of vision rehabilitation services

Sight loss is a major health issue that impacts on all aspects of wellbeing including daily functioning and mental health. Vision rehabilitation services aim to help people learn how to live as independently as possible, to build confidence and to maintain quality of life following full or partial sight loss. Vision rehabilitation services are provided by qualified vision rehabilitation officers. The services they offer include a range of interventions such as: orientation and mobility training; emotional support; communication skills; independent living skills; equipment training; and risk assessments. Vision rehabilitation services are usually funded by local councils and provided either by in-house teams or contracted-out services. As with other preventive services, early access to vision rehabilitation is recommended (ADASS, 2013; Vision2020UK, 2013; UK Vision Strategy Advisory Group, 2013). A literature review undertaken as part of a wider study (Rabiee et al., 2015) showed that there have been few economic studies of vision rehabilitation services and none that estimates unit costs. This short article therefore uses data from Rabiee et al. (2015) to estimate the unit costs of vision rehabilitation services in England. The calculations are based on detailed data from three case studies with additional data collected from a national survey

The Individual Budgets Pilot Projects: Impact and Outcomes for Carers

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Vision rehabilitation services : what is the evidence? Final report.

Sight loss affects all aspects of well-being including daily functioning and mental health. Demographic trends suggest that the number of people with visual impairment is set to rise significantly, with many people experiencing an additional disability or health problems. By 2050, the number of blind and partially sighted people in the UK is estimated to increase by around 122 per cent, to approximately four million. Promoting preventive and rehabilitation interventions is recognised as a high priority for all care settings as a way of reducing demands on health and social care services. This research, funded by the Thomas Pocklington Trust, aimed to provide an overview of the evidence base for community-based vision rehabilitation services for people over the age of 18 with visual impairment. The study focused on rehabilitation services funded by local authorities to find out how these services are currently supporting people with visual impairment, what possible outcomes they might achieve and to identify gaps in the evidence base about current service arrangements. The study was carried out in England. Findings were intended to inform a future full scale evaluation as well as inform services

Supporting choice : Support planning, older people and managed personal budgets

Summary: English policy emphasises personalised and flexible social care support using ‘Personal Budgets’ (PB) – preferably as cash direct payments. However, most older people opt for their council to manage personal budgets on their behalf. It is not clear what benefits of personalisation are available to this group of older people. This article reports research into the choices available to older people using managed personal budgets to fund home care services in three councils. It focuses on the roles of support planners, in councils and service provider agencies, who are central to supporting choice on the part of service users. Data were collected from three focus groups with 19 council support planning practitioners and interviews with 15 managers of home care agencies. • Findings: The study suggests that new commissioning and brokerage arrangements have the potential to give older people using managed personal budgets greater choice and control over their support. However, new communication barriers have also been introduced and some staff report receiving inadequate training for their new roles. Above all, resource constraints were reported to impede council support planners in encouraging users to plan creatively how to use personal budgets. Resource constraints also meant councils placed constraints on how flexibly home care agencies could respond to changing needs and preferences of older users. • Applications: The paper concludes by highlighting the implications of new arrangements for social work practice and some of the barriers that need to be addressed if the potential benefits of personalisation for older people holding managed personal budgets are to be achieved

Identifying Loneliness and Social Isolation in Care Home Residents with Sight Loss : Lessons from Using the De Jong Gierveld Scale

Context: Experience of loneliness amongst care home residents with sight loss is associated with limitations in activities of daily living, poor self-reported health, and increased rates of depression. Care homes are encouraged to use screening tools to identify those at risk of loneliness. Objectives: The study aimed to describe the findings and experience of applying a validated, multi-item scale to identify loneliness and isolation in care home residents with sight loss in England, UK. Methods: The six-item De Jong Gierveld Loneliness Scale was administered to residents residing in long-term care homes with sight loss. Participants were aged 65+ years old with vision impairment that could not be corrected by glasses. Descriptive analysis of loneliness scale data was undertaken supplemented with observational field notes of implementation challenges. Findings: Only 42 applications of the De Jong Gierveld Loneliness Scale were possible. The mean sub-scale scores for emotional loneliness, social loneliness and the mean overall loneliness score were 1.36 (sd = 1.16), 1.19 (sd = 1.04) and 2.55 (sd = 1.9) respectively. Challenges observed in scale administration and understanding of scale items by residents might preclude it as a loneliness case-identification tool in busy care home environments. Limitations: The study reports on the challenges implementing a questionnaire which achieved a low rate of data collection. Implications: For case-identification of loneliness, care homes may wish to consider use of a single-item loneliness question rather than multi-item scales due to variable length of administration and resident comprehension

Cost-effectiveness of in-house vs contracted-out vision rehabilitation services in England

Context: Vision rehabilitation (VR) services in England promote users’ health and wellbeing, and support all aspects of daily living through two dominant models: in-house and contracted-out VR services. The two models differ in terms of service delivery, but they share a common aim to enhance service users’ quality of life and reduce utilisation of social and health care services. Objective: This study investigated the cost-effectiveness of in-house vs contracted-out VR services. Methods: The analysis was performed from a social care perspective and a social and health care perspective. The analyses used data from a 6-month follow-up observational study of VR users. Regression analysis was used to estimate differential outcomes and costs, taking user and local authority characteristics into account. Findings: At a cost-effectiveness threshold of £13,000 and £30,000 per QALY, in-house VR services have a high probability (greater than 90% vs contracted-out VR services) of being cost-effective from a social care perspective. In-house VR services have a lower probability (lower than XX% vs contracted-out VR services) of being cost-effective from a social and health care perspective. Limitations: Observational studies are prone to selection bias compared to randomised controlled trials due to confounding. We employed econometric techniques that control for several user and LA characteristics to reduce potential bias. Implications: Contracted-out VR services may be better value for money compared to in-house VR services in the context of integrated social and health care due to substantial healthcare resource savings

Reablement services for people at risk of needing social care: the MoRe mixed-methods evaluation.

Background Reablement is an intensive, time-limited intervention for people at risk of needing social care or increased intensity of care. Differing from homecare, it seeks to restore functioning and self-care skills. In England, it as a core element of intermediate care. The existing evidence base is limited. Aims Describe reablement services in England and develop a service model typology; Conduct a mixed method comparative evaluation of service models investigating outcomes, factors impacting outcomes, costs and cost-effectiveness, and user and practitioner experiences; Investigate specialist reablement services/practices for people with dementia. Methods Work package 1 (WP1), taking place in 2015, surveyed reablement services in England. Data were collected on organisational characteristics, service delivery and practice, and service costs and caseload. Work package 2 (WP2) was an observational study of three reablement services, each representing a different service model. Data collected included: health- (EQ-5D-5L) and social care-related (ASCOT SCT-4) quality of life, practitioner (Barthel Index) and self-reported (NEADL scale) functioning, individual and service characteristics, and resource use. It was collected on entry into reablement (n=186), at discharge (n=128) and, for those reaching the timepoint within the study timeline, six months post-discharge (n=64). Interviews with staff and service users explored experiences of delivering or receiving reablement and its perceived impacts. Work package 3 (WP3) interviewed staff in eight reablement services to investigate experiences of reabling people with dementia. Results 201 services, located in 139 Local Authorities took part in the survey. Services varied in their organisational base, relationship with other intermediate care services, use of out-sourced providers, skill mix, and scope of reablement input. These characteristics influenced aspects of service delivery and practice. Average cost per case was £1,728. Lower than expected sample sizes meant a comparison of service models in WP2 was not possible. Findings are preliminary. At T1, significant improvements in mean score on outcome measures except self-reported functioning were observed. Further improvements were observed at T2, but only significant for self-reported functioning. There was some evidence that individual (e.g. engagement, mental health) and service (e.g. service structure) characteristics were associated with T1 outcomes and resource use. Staff views on factors affecting outcomes typically aligned with, or offered possible explanations for, these associations. However, it was not possible to establish the significance of these findings in terms of practice or commissioning decisions. Service users expressed satisfaction with reablement and identified two core impacts: regained independence and, during reablement, companionship. Staff participating in WP3 believed people with dementia can benefit from reablement, but objectives may differ and expectations for regained independence inappropriate. Furthermore, practice (e.g. duration of home visits) should be adjusted and staff adequately trained. Conclusions The study contributes to our understanding of reablement, and what impacts on outcomes and costs. Staff believe reablement can be appropriate for people with dementia. Findings will be of interest to commissioners and service managers. Future research should further investigate factors impacting on outcomes, and reabling people with dementia

Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-Adjusted life-years for 29 cancer groups, 1990 to 2017 : A systematic analysis for the global burden of disease study

Importance: Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. Objective: To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. Evidence Review: We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-Adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. Findings: In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572000 deaths and 15.2 million DALYs), and stomach cancer (542000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601000 deaths and 17.4 million DALYs), TBL cancer (596000 deaths and 12.6 million DALYs), and colorectal cancer (414000 deaths and 8.3 million DALYs). Conclusions and Relevance: The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care. © 2019 American Medical Association. All rights reserved.Peer reviewe

How far do managed personal budgets offer choice and control for older people using home care services?

Based in three English councils (two unitary boroughs and one shire county), this study explored factors affecting the delivery of personalised home care to older people who opt for council-managed personal budgets rather than cash direct payments