Living well, dying well - the importance of housing

David Clark and Sandy Whitelaw outline their vision for a new type of ‘care campus’ that would provide an environment in which older people, ranging from those able to live with complete independence to those with palliative care needs, would become part of the community of the Crichton Campus in dumfries

Physical activity promotion in care homes

Purpose: The purpose of this paper is to report on the implementation of a physical activity (PA) scheme – Let’s Motivate (LM) – within private care homes (CHs) in Dumfries and Galloway (D&G), Scotland; aiming to provide an insight into the different factors which might contribute to its success and further sustainability. Design/methodology/approach: A qualitative study is described in which one-to-one semi-structured interviews were carried out with eight key staff involved in implementing the project within two purposively sampled CHs; in order to explore their views and experiences of implementation. Findings: The paper provides an insight into the different factors which stand to both promote and impede the successful implementation of LM, within the two CHs involved. Originality/value: This paper explores a new and innovative PA initiative in CHs in D&G, Scotland. Studies exploring the factors which can both promote and impede implementation are important as they can help to usefully inform the implementation and sustainability of initiatives

Mapping the “housing with care” concept with stakeholders: insights from a UK case study

Purpose - The purpose of this paper is to present the findings of an early stage, exploratory case study of a proposed housing with care initiative (the Crichton Care Campus (CCC)). This sought the perspectives of a range of key stakeholders on the proposed model and how it might be best realised. The analyses of these findings show their relevance to debates on integrated housing with care, and reflect on the methodology used and its potential relevance to similar projects. Design/methodology/approach - The study used a transactive planning approach, where grounded views are sought from a variety of stakeholders. A purposive sample identified informants from relevant health, social care and housing organisations and nine semi-structured interviews were conducted. These were transcribed and data analysis was undertaken on an “interactive” basis, relating care theory to empirical expressions. Findings - The authors identify two contrasting orientations – inclusive “community-oriented” and professional “service-oriented”. This distinction provides the basis for a rudimentary conceptual map which can continue to be used in the planning process. Two significant variables within the conceptual map were the extent to which CCC should be intergenerational and as such, the degree to which care should come from formalised and self-care/informal sources. The potential to achieve an integrated approach was high with stakeholders across all sectors fully supporting the CCC concept and agreeing on the need for it to have a mixed tenure basis and include a range of non-care amenities. Originality/value- This paper offers originality in two respects. Methodologically, it describes an attempt to undertake early stage care planning using a needs led transactive methodology. In more practical terms, it also offers an innovative environment for considering any approach to care planning that actively seeks integration – based on an acknowledgement of complexity, a variety of perspectives and possible conflicts. The authors propose that the concepts of “community-orientation” and “service-orientation” are used as a helpful basis for planning negotiations, making implicit divergences explicit and thus better delineated

Promoting integration within the public health domain of physical activity promotion: insights from a UK case study

Purpose: The purpose of this paper is to report and critically reflect on the methodological processes involved in a formal attempt to promote health and social integration in the rarely reported public health domain of physical activity promotion. Design/methodology/approach: A quality improvement (QI) methodology was deployed, comprising three elements: a diagnostic tool that assessed strategic and practice positions; a half-day workshop that brought senior leaders together for to reflect this evidence; and a structured process that sought to generate proposals for future integrated action. A mixed-method evaluative approach was used, capturing insights of the integration processes via quantitative and qualitative data collection pre-event, in-event, immediate post-event and at six-month follow-up. Findings: Insights suggested that despite some critical concerns, this QI process can be considered as robust, offering pointers to elements required to successfully promote integration in this domain, including the significance of leadership, the preparatory contribution of a diagnostic tool and position paper, the opportunities for active exchange and planning within a workshop situation and the initiation of a process of integrated work via tangible “pledges”. Originality/value: The paper offers originality in two respects. Generally, it describes and reflects on the relationship between theoretical and empirical dimensions of a model of integration promotion. Specifically, in offering an account of integrative public health work across health service, local authority and third sector partners, it addressed an area that has received relatively limited prior attention

Utilising community engagement approaches to influence public mental health policy in a rural setting

Purpose – Drawing on the notion of “mental health policy participation”, the purpose of this paper is to describe and reflect on a regional case study of a community engagement approach that explored community perspectives on mental health and the factors that influence it. It established three expectations, that: the development of the Dumfries and Galloway Public Mental Health Strategy is informed by project outputs; services and innovations are based on what people want; active involvement of local people in decision making around mental health services and strategy is achieved. Design/methodology/approach – A “participatory appraisal” approach was used to engage with communities. A three-day “Training of Trainers” exercise was undertaken. These individuals then accessed a number of community groups. Data collection was based on five key questions. A total of 443 were engaged in the process. Insights were reviewed by 20 stakeholders froma range of services to identify key actions. This led to the development of the mental health forum and, in turn, a Public Mental Health Strategy for Dumfries and Galloway. Community members were further included in processes through feedback mechanisms. Findings – Factors of resilience, support of families and friends, social inclusion, access to social and leisure opportunities were most important. This was followed by structural issues like fear of judgement, lack of transport, discrimination and financial support. Finally, individual factors (sleep, meaningful hobbies and health) were highlighted. Originality/value – This approach sought to go beyond a traditional focus to explore broader community perspectives on mental health and the factors that influence it. Keywords Public mental health, Community engagement Paper type Case study

Interventions at the end of life – a taxonomy for ‘overlapping consensus’

Context: Around the world there is increasing interest in end of life issues. An unprecedented number of people dying in future decades will put new strains on families, communities, services and governments. It will also have implications for representations of death and dying within society and for the overall orientation of health and social care. What interventions are emerging in the face of these challenges? Methods: We conceptualize a comprehensive taxonomy of interventions, defined as ‘organized responses to end of life issues’. Findings: We classify the range of end of life interventions into 10 substantive categories: policy, advocacy, educational, ethico-legal, service, clinical, research, cultural, intangible, self-determined. We distinguish between two empirical aspects of any end of life intervention: the ‘locus’ refers to the space or spaces in which it is situated; the ‘focus’ captures its distinct character and purpose. We also contend that end of life interventions can be seen conceptually in two ways – as ‘frames’ (organized responses that primarily construct a shared understanding of an end of life issue) or as ‘instruments’ (organized responses that assume a shared understanding and then move to act in that context). Conclusions: Our taxonomy opens up the debate about end of life interventions in new ways to provide protagonists, activists, policy makers, clinicians, researchers and educators with a comprehensive framework in which to place their endeavours and more effectively to assess their efficacy. Following the inspiration of political philosopher John Rawls, we seek to foster an ‘overlapping consensus’ on how interventions at the end of life can be construed, understood and assessed

Developing and implementing a social prescribing initiative in primary care: insights into the possibility of normalization and sustainability from a UK case study

Aim: To conduct a process based evaluation of the inception and early implementation of a social prescribing initiative ('Healthy Connections Stewartry') in two UK General Practices. Background: Prescribing a range of social, cultural, arts and educational activities to clients in primary care (known as 'social prescribing' or 'community linking schemes') as a means of addressing long-term physical health conditions and promoting mental health and wellbeing is becoming increasingly prominent and popular. However, concerns exist over a lack of evidence of effectiveness and formalised insights into how such initiatives may be optimally implemented. Methods: Within a case study design and using 1-1 semi-structured interviews, 3 related datasets were developed over a 12 month period from 30 purposively sampled informants: the project steering group; the wider primary care team; and various community groups. Data analysis drew on various theoretical resources, particularly those pertaining to nurturing sufficient capacity for the organisational 'normalisation' of this practice and understanding the dynamic flows and linkages between potential clients, 'prescribing' primary care staff and the available community resources. Findings: The inception and implementation of the initiative had been broadly successful and that more generally, there were grounds to suggest that these practices were becoming 'normalised' into the day-to-day cultures and routines of the primary care organisations. A series of procedural features are considered significant in achieving such ends. Some specific barriers to change are identified and ultimately in the context of potential 'transferability', a wider reflection is undertaken of the potential for such innovative practice to become established in less advantageous organisational circumstances. Fundamental difficulties are recognised and thus the need for formally implemented 'change' processes. Furthermore, for social prescribing to become a pervasive feature of health care provision, the need for necessary capacity and resources is stressed

Palliative care in public policy: results from a global survey

Background: Public policy has been a foundational component of the World Health Organization public health model for palliative care development since 1990. There is, however, limited evidence on the existence and character of palliative care policy at the country level. Objective: To identify, report on, and map the presence of national palliative care strategies, plans, legislation, and dedicated government resources in 198 countries. Design: An online survey generated 2017 data on indicators of national policy for palliative care. Subjects: In-country experts on palliative care. Measurements: The survey included specific questions on the existence and status of national strategies or plans, recognition of palliative care in national law, and dedicated government support. Results: Fifty-five countries have a national strategy or plan for palliative care of some sort, though levels of implementation vary. Forty-seven countries have some reference to palliative care in national law, and 24 have some form of stand-alone national law on palliative care provision or recognize it as a right in the constitution. Sixty-six countries have a dedicated section within government with responsibility for palliative care. Conclusions: There is a long way to go before palliative care around the world is universally supported by public policy intentions that will support its required development

Fostering resilience in young people with intellectual disabilities using a ‘settings’ approach

The need to foster resilience amongst young people with intellectual disabilities is increasingly recognised within policy. Critically, understanding of the actual means by which this aspiration might be most sensitively and effectively met is considered weak. This paper reports on an exploratory case-study of a social enterprise community café – The Usual Place - that through the promotion of employability, seeks to promote resilience amongst its young ‘trainees’ with intellectual disabilities. Two research questions were set: “how is ‘resilience’ conceptualized within the organisation” and “what features within the organisation are significant in fostering resilience”? We identify a range of significant features associated with being able to successfully foster resilience – the need for a foundational ‘whole organisation’(settings) approach based on high levels of participation and choice; the negotiation of a constructive dynamic tension between ‘support’ and ‘exposure’; and the embedding of these actions in embodied actions and day-to-day organisational activities

The Dumfries Arts Award Project: towards building a programme theory of innovation transfer across two social organisations

Purpose: The purpose of this paper is to critically understand a programme theory of the “transfer” of work in one social organisation and sector (an innovative and successful social enterprise community café, The Usual Place that seeks to enhance the employability of young people with additional support needs in “hospitality”) to another (Dumfries Theatre Royal, a regional theatre and registered charity, specifically the “Dumfries Arts Award Project” and more generally, “the arts”). Design/methodology/approach: By means of gaining insight into the complexity of the transfer of innovative practices between two socially oriented organisations and theoretical insights into associated conducive contexts and optimal processes, the work used realist evaluation resources within a longitudinal ethnographic approach. Within this, a series of specific methods were deployed, including semi structured key stakeholder interviews, non-participant observation and “walking” and “paired” interviews with service users in each organisation. Findings: The principle finding is that with attention being paid to the context and intervention processes associated with transfer processes and having sufficient capacity and strong partnership working, it is possible to take an innovative idea from one context, transfer it to another setting and have relatively immediate “success” in terms of achieving a degree of sustainability. The authors propose a provisional programme theory that illuminates this transfer. They were also able to show that, whilst working with the potentially conservative concept of “employability”; both organisations were able to maintain a progressive ethos associated with social innovation. Originality/value: The work offers theoretical and methodological originality. The significance of “scaling up” social innovation is recognised as under-researched and under-theorised and the use of a realistic evaluation approach and the associated development of provisional programme theory address this