Promoting ‘communities of practice’ can help to better support people experiencing multiple-exclusion homelessness

How can local services be organised best to support people who have complex, overlapping needs? What are the implications for practice and governance when these needs crossover existing organisational boundaries? Michael Clark and Michelle Cornes examine these issues from the perspective of supporting people experiencing homelessness combined with other complex needs. They argue that the idea of ‘communities of practice’ can help humanise the system

Supporting rural carers: understanding the role of the voluntary sector

Findings from a small scale evaluation of one local carers’ organisation in the north of England are used to discuss the commissioning of carer support services in rural areas. The issues raised match closely those identified in the new national strategy for carers both in terms of analysis of need and suggested responses. Respite in order to facilitate ‘time out’ and personalisation of services through a dedicated support officer emerge as the most important elements of service delivery from the carer’s perspective. However, the evidence suggests that current provision is still too limited and that much remains to be done to support carers in their role more effectively

Citizen science as a framework for improving the science-society interface in long-term care research

Context: Engaging with and involving the public in research has become a widespread consideration in many research fields, including long-term (social) and health care. Perspective: Citizen science (CS) is an umbrella concept that has grown rapidly in many scientific areas and has been noted as increasing in health research. Its root is the need to work at the science-society interface and its place in societal development. This interface is understood to operate in several ways, and the overarching CS goal is to strengthen it through a variety of practices. We seek to encourage a dialogue across long-term care research and CS to the benefit of both sides. Implications: We argue that using CS as an overarching concept for engaging with the public in long-term care research would provide a variety of benefits to that scientific field. These would include opportunities to examine the state of citizen involvement across the field, employing the most appropriate modes of involvement and engagement in specific contexts. It would also open opportunities to develop the methodological imagination by examining examples of CS in other research areas. CS could also benefit from the experience of public involvement in long-term care research, including its extensive consideration of power, payments, and including people with additional support needs. There is a need generally for greater dialogue about being more inclusive and addressing inequalities

Rethinking multiple exclusion homelessness: implications for workforce development and interprofessional practice: summary of findings

In February 2009, the Economic and Social Research Council launched the ‘Multiple Exclusion Homelessness Research Programme’ with the aim of informing government policy and practice and finding solutions to bring the most vulnerable ‘homeless people’ in from the margins of society. The concept of ‘multiple exclusion homelessness’ alerts us to the potential for complex interplay between many different professional or occupational groups, reflecting how drug or alcohol dependencies; severe mental health problems; domestic violence; local authority care and prison; and participation in ‘street culture’ and ‘survival activities’ such as sex work, begging, street drinking and street-level drug dealing frequently (but not always) intersect with homelessness (Fitzpatrick, Johnson and White, 2010). As part of the Programme, the ‘Social Care Workforce Research Unit’ at King’s College London was commissioned to undertake a two year exploratory study exploring how different agencies and professionals work together to support people with experience of multiple exclusion homelessness. The study commenced in July 2009 and is due for completion in June 2011. The objectives of the study were threefold. First, to conceptualise and describe the workforce as it relates to multiple exclusion homelessness. Second, to enhance understanding of how interprofessional collaboration works to identify and manage the intersections between homelessness and other facets of deep social exclusion. And thirdly, to make recommendations as regards for whom and when, and in what respects, interprofessional collaboration might work best to prevent multiple exclusion homelessness

The care act, personalisation and the new eligibility regulations: a discussion paper about the future of care and support services for homeless people in England

As funding for Housing Related Support (formerly Supporting People) services continues to shrink, it is timely to revisit the question as to whether ‘homeless people’ are eligible for publically funded care and support, including personal budgets, organised through the local authority. The Care Act 2014 due to be implemented from April 2015 in England, heralds some positive changes which may serve to open the door to this funding stream which has rarely been used in support of ‘homeless people’. As the law currently stands ‘homeless people’ as a service user group are not eligible for community care assessment (though people who are homeless and who fall into one of the ‘eligible groups’ by virtue of having a mental health or drug and alcohol problem may be). The Care Act 2014 removes reference to ‘eligible’ and ‘ineligible’ groups so that any adult with any level of need will have a right to an assessment. Exploring some of the ways in which homeless people have been excluded from care and support in the past, this paper outlines how homeless organisations can work with local authorities to ensure fairer and more consistent access and in so doing, potentially secure their own futures in the face of fewer ‘block contracts’ and more individualised forms of commissioning

Self-Directed Support: A Review of the Barriers and Facilitators

This is a report on the published literature on the barriers and facilitators of self- directed support. It was undertaken to inform a research study funded by the Scottish Government 2009-2011 that is evaluating initiatives in three local authorities. These initiatives aim to improve take up of self-directed support for people eligible for social care and other public funds. The three test site areas are working to reduce bureaucracy; to make the processes easy and 'light touch'; and to provide training and leadership to people working on these developments. Scottish Government has provided extra money to assist these three authorities and to help people in other areas learn from their experiences

Beyond clinical trials: extending the role of the clinical research nurse into social care and homeless research

Aim: Clinical research nurses work at the fulcrum of clinical trials with clearly defined roles and responsibilities. In England, the National Institute for Health Research (the main funder of health research) has broadened its scope to encompass social care research. The expectation is that clinical research nurses will expand their skill set to support these new studies, many of which will employ qualitative and mixed methods. This discussion paper explores the challenges of facilitating this clinical academic workforce development through a case study of a homeless health and social care research project. This was one of the first studies to engage clinical research nurses in this new and expanded role. Background: Much of what is known about the research nurse workforce has been generated through studies of clinical trials in oncology. The ‘caring-recruiting’ dichotomy has been used as a heuristic device for identifying workforce issues that can impact on study delivery such as how intense pressure to recruit study participants leads to low job satisfaction. Design: This case study reflects on the authors' experiences of employing a clinical research nurse in a social care research project concerned with the discharge of homeless people from hospital. The ‘caring-recruiting’ dichotomy is used to generate new information about the relationship between workforce development and the successful delivery of social care research. Conclusion: The case study illuminates how social care research can generate different pressures and ethical challenges for research nurses. The time and skill it took to recruit study participants identified as ‘hard to reach’ was suggestive of the need to move beyond performance measures that prioritise recruitment metrics. The need for different types of staff supervision and training was also warranted as supporting study participants who were homeless was often distressing, leading to professional boundary issues. Relevance to workforce development: This study highlights that performance management, training and supervisory arrangements must be tailored to the characteristics of each new study coming onto the portfolio to ensure research nurses are fully supported in this new and expanded role

Social care practice with carers: What social care support is provided to family carers? What support do family carers want?

Most social care support for carers is delivered through the voluntary sector, although most councils still directly undertake carer assessments. Changes in commissioning and contracting arrangements have created additional opportunities for the voluntary sector but also some uncertainties. Carers have mixed views on the extent to which they feel their social care needs are met. However, they are positive about the help provided by carers’ workers with a specific remit to provide them with support. Activities by carers’ workers are varied and include outreach work, information provision, counselling, advocacy and ongoing support. Different ways of improving carers’ access to information, such as websites, carers’ cafes and outreach workers, have been developed, although these rarely seem to be evaluated for their effectiveness. Identifying carers in need of additional support seems mainly to take place when the person for whom they care is assessed. This disadvantages those caring for someone who is not eligible for, or who refuses, social care support from their local authority. The Care Act 2014 has implications for the way that social care support to carers is delivered. Currently, carers caring for someone not meeting the eligibility criteria for social care support may have substantial or critical unmet needs of their own. Carers’ organisations argue that an important part of their role is to encourage carers to complete selfassessments but they are concerned that not enough support is then available to those carers who have been assessed. Some local councils are working with local clinical commissioning groups on integrating support for carers, though these developments have yet to become established everywhere. Personalisation has brought mixed benefits; with some positive examples of carers having more control over their support but some concerns that the preferences of carers who simply want a regular and reliable break are not being properly met