• Development and preliminary testing of a framework for quantifying local service provision for people with dementia

      Hughes, Jane; Challis, David (2020)
      Purpose: It was hypothesised that there were variations in health and social care services available for older people with dementia and their carers, and that measurement of this between localities was possible. The purpose of this paper is to present a framework for examining this. Design/methodology/approach: Using a case study approach, data from national surveys of local authorities providing social care and National Health Services Trusts providing old age mental health services conducted in 2014/2015 in England were used. From these, indicators of variation in services for people with dementia and their carers in different geographical areas were created. Measurement of the presence/absence of each service permitted the creation of a service mix score for each area. Findings: The framework comprised 16 attributes each with indicators describing the characteristics of the organisations providing the services; the skill mix of community mental health teams for older people; and the health care and social care services available in localities. Variation was evident, confirmed by quartile analysis and exemplars, suggesting that older people with dementia and their carers in different localities are likely to experience differences in the range of provision available, particularly social care services. Originality/value: The case study approach used achieved its objectives, and the resultant framework has potential for generalisability and utility, given acceptable ecological validity and discriminant validity in identifying variations in service mix. It could be used in both research and practice. © 2020, Emerald Publishing Limited.
    • Home-care providers as collaborators in commissioning arrangements for older people

      Hughes, Jane; Chester, Helen; Challis, David (2020)
      In England, care to support people living at home is largely commissioned by local authorities (statutory organisations with responsibility for social care in specific localities) from non-statutory home-care providers (for-profit, not-for-profit, voluntary). This paper explores how managers of these services perceive commissioning arrangements and their impact on home-care providers, the care workforce and service users. Little formal research of providers' experiences of working with local authorities in a commissioning model is available. A qualitative study employed semi-structured telephone interviews with 20 managers of for-profit home-care providers from 10 selected local authority areas in England. Data were analysed using thematic analysis to identify main and subsidiary themes. Home-care providers reported operating in a complex and changeable partnership with commissioners, characterised by: (a) relationships ranging from transactional to collaborative, (b) providers expressing a strong sense of public service motivation, (c) commissioning practices that were complex to negotiate, time-consuming and overly prescriptive, (d) frequent changes in commissioning practices and a perceived lack of strategic planning, which were reported as contributing to uncertainty and tension for providers and confusion for service users. Attempting to operate a market model with tightly prescribed contracts is likely to be unsustainable. An alternative approach based on a collaborative model of joint responsibility for providing home care is recommended drawing on a conceptual framework of principal-steward relationships in contracting.
    • Older people as victims and perpetrators of crime

      Di Lorito, Claudio (2020)
      Older people are at a higher risk of becoming the victims of crime than of being the perpetrators of it, given the added vulnerability that comes with aging. This chapter examines crime in relation to old age. The first section presents data around older people as victims of crime, and further discusses different types of abuse against older people, which, in the presence of intensive care needs and carer burden, may be perpetrated within the family or in residential and institutional settings. The second section of the chapter examines older people as the perpetrators of crime. In particular, it describes how older offenders are dealt within the justice system. It presents data on the growing population of older offenders in prisons and in forensic psychiatric services and reports on whether the unique needs of older offenders are being met in these settings.
    • Perceptions of the social worker role in adult community mental health teams in England

      Hughes, Jane; Challis, David (2020)
      There is a growing recognition of the importance of the social work contribution within community mental health services. However, although many texts describe what the mental health social work contribution should be, little empirical evidence exists about their role in practice and the difference it might make to service users. This qualitative study sought to articulate this contribution through the voices of social workers and their multidisciplinary colleagues via focus group discussions across four English Mental Health Trusts. These considered the impact of the social worker on the service user. Thematic analysis resulted in the identification of three over-arching themes: social workers own perceptions of their contribution situated within the social model; the high value their colleagues placed on social work support and leadership in a range of situations and the concerns for service users if social workers were withdrawn from teams. Key findings were that social workers are the only professional group to lead on the social model; that this model enhances the whole teams’ practice and is required if service users are to be offered support that promotes long-term recovery and that without social workers, the community mental health team offer would be more transactional, less timely, with the potential for the loss of the service users’ voice. If social work is to make a full contribution to community mental health team practice, it must be clearly understood and provided with the support to enable social workers to operate to their full potential. © The Author(s) 2020.
    • Relationship-based social work and its compatibility with the person-centred approach: Principled versus instrumental perspectives

      Murphy, David; Joseph, Stephen (2013)
      In recent years, there has been a resurgence of interest in social work towards relationship-based practice. In this article, we discuss the conceptualisation of relationship-based practice from a person-centred point of view and its applicability to contemporary social work. It will be shown that the person-centred point of view has a meta-theoretical basis that makes it incompatible with modern statutory social work practice. First, we outline the theoretical and philosophical underpinnings of the person-centred approach and argue that a potential conflict lies at the heart of the contemporary social workers' capacity to truly accommodate person-centred theory. Next, the resurgence of interest in relationship-based practice, paying particular attention to the person-centred approach, is considered within the context and influence of risk management, managerialism and consumerism on social work. We then challenge the assumption that relationship-based social work founded on the person-centred approach legitimately supports service users' ability and capacity towards self-determination. Our challenge is based on the premise that the person-centred approach is defined by principled non-directive practice. On this basis, we conclude that a person-centred relationship-based approach to contemporary social work is untenable.
    • Trauma: A unifying concept for social work

      Joseph, Stephen; Murphy, David (2014)
      The aim is to show how traumatic stress provides a unifying concept for social work. In the last ten years, there have been significant changes in the nature of organisations that provide social care for people in the UK, with social work practice no longer confined to traditional local authority services. Increasingly, social workers are taking up posts in a variety of settings and sectors demanding new knowledge and skills. The field of traumatic stress is not currently viewed as a social work discipline. However, trauma cuts across a range of contexts and client groups and, as such, needs to be a core component of education and training in social work. The concept of trauma and recent developments in post-traumatic growth offer a new way of thinking that necessitates the development of genuinely psycho-social and relationship-based help and support for individuals, families, groups, communities and organisations affected by adversity.
    • What do service users want from mental health social work? A best-worst scaling analysis

      Challis, David; Hughes, Jane (2020)
      Despite being a profession dedicated to the empowerment of service users, empirical study of mental health social work appears dominated by the perspectives of social workers themselves. What service users value is less often reported. This study, authored by a mix of academics and service users/carers, reports a Best–Worst Scaling analysis of ten social worker ‘qualities’, representing both those highly specialist to social work and those generic to other mental health professionals. Fieldwork was undertaken during 2018 with 144 working-age service users, living at home, in five regions of England. Of specialist social work qualities, service users rated ‘[the social worker] thinks about my whole life, not just my illness’ particularly highly, indicating that person-centred approaches drawing on the social model of mental health are crucial to defining social work. However, service users did not value help accessing other community resources, particularly those who had spent the longest time within mental health services. Continuity of care was the most highly valued of all, although this is arguably a system-level feature of support. The research can assist the profession to promote the added value of their work, focusing on their expertise in person-centred care and the social model of mental health.