‘The Best and the Brightest’: Widening Participation and Social Justice in Contemporary English Social Work Education

Social work education in England has a long track record of success in widening participation to disadvantaged student populations. However, more recently these successes have instead been cast as a burden that is negatively impacting on the calibre of students entering the profession. Alongside this reconceptualisation, new fast-track models of education have been introduced, providing a quicker and more financially supported a route of entry to the profession. This article critically examines the changing nature of widening participation in social work education and how fast-track social work programmes are perpetuating the inequalities that are inherent at all levels of the English educational system. This discussion is shown to have implications for widening participation policy agenda beyond social work. The concerns that are raised should be of interest to any other jurisdictions considering the possibility of a fast-track approach to social work education. A social justice approach-based bringing students together is proposed as an alternative and preferable model of social work education

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

Background: Health services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs). Aim: To develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk. Methods Development: We synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs. Implementation: The Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence. Evaluation: The Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment. Trial results Depression trial: In total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5; p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence. CVD risk trial: In total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9; p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management. The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement. Conclusion: The Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs

Suicide in an ageing UK population: problems and prevention

Purpose Suicide can be an emotive, and at times, controversial subject. The purpose of this paper is to reflect on the social, health, personal, and cultural issues that can arise in later life and the potential reasons for suicide. It will analyse already recognised risk factors of suicide in older adults and focus on improving knowledge about the social meaning and causation of suicide for older people. It will also consider suicide prevention policies, their practice implications, and whether they are successful in protecting this potentially vulnerable cohort. Design/methodology/approach A synopsis of available literature in the form of a general review paper of suicide of older adults. Findings There is evidence that the ageing process often leads to a set of co-morbidities and a complex and diverse set of individual challenges. This in turn equates to an increased risk of suicide. There is no easy answer to why there is evidence of a growing number of older adults deciding that suicide is there only option, and even fewer suggestions on how to manage this risk. Social implications The entry of the “baby boom” generation into retirement will lead to the potential of an increase in both suicide risk factors and older adults completing suicide. This is on the background of a demographic surge which is likely to place additional pressures on already under-resourced, and undervalued, statutory and non-statutory services. Originality/value A literature search found very little information regarding older adults and suicide risk, assessment, treatment or prevention. </jats:sec

Meeting the challenge of change Guidelines

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Sweden A visit by representatives of British Industry 1980

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Meeting the challenge of change Case studies

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General motors corporation Organisation development by improving the quality of working life

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Employee involvement in work redesign

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Effective and satisfactory work systems Notes on some important features of their design and operation

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Quality circles in perspective

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