WALES. Welsh Parliament. Health and Social Care Committee
Publisher:
Wales. Welsh Parliament
Publication year:
2022
Pagination:
71
Place of publication:
Cardiff
...families and unpaid carers; patient with dementia; barriers to discharge; communication and joint working. The inquiry found that there is currently a huge problem with patient flow through hospitals. While issues around patient flow and delayed discharges have no doubt been exacerbated as a result of the pandemic, these are long standing problems. However, delayed transfers of care are only one part
(Edited publisher abstract)
This report sets out the findings of a short inquiry focusing on hospital discharge and its impact on patient flow through hospitals in Wales. We gathered evidence in writing and by holding oral evidence sessions with stakeholders, including the Minister and the Deputy Minister for Social Services. The inquiry explored Welsh Government policies; scale of the problem; impact of delayed transfers; families and unpaid carers; patient with dementia; barriers to discharge; communication and joint working. The inquiry found that there is currently a huge problem with patient flow through hospitals. While issues around patient flow and delayed discharges have no doubt been exacerbated as a result of the pandemic, these are long standing problems. However, delayed transfers of care are only one part of the picture. A whole-system approach is needed, with multi-disciplinary teams working across all sectors to achieve better integration of health and social care services and improved patient experience. The lack of social care capacity is considered the biggest contributor to delayed discharges by the majority of stakeholders that responded to our consultation. Severe staff shortages mean assessments are often delayed and services are not available for care packages to be put in place to enable safe discharge. In addition to the lack of capacity in social care, there are a number of other issues that can contribute to holding up the discharge process. including suitability of housing, delay in medication being prepared and delivered and a lack of transport where this cannot be provided by friends or family.
(Edited publisher abstract)
Subject terms:
hospital discharge, service transitions, hospitals, adult social care, housing, integrated care;
OXFORD BROOKES UNIVERSITY. Institute of Public Care
Publisher:
Oxford Brookes University. Institute of Public Care
Publication year:
2022
Pagination:
107
Place of publication:
Oxford
...children's homes, and care homes for working aged adults across the region as a whole, many of these are purchased by authorities from outside the region and are therefore not available locally in practice - leading to out of county or out of region placements. There are also gaps either geographically or for more specialist services such as younger onset dementia and CAMHS.
(Edited publisher abstract)
This is the first regional Market Stability Report (MSR) for West Wales. Its purpose is to: assess the market for services for individuals requiring care and support and their carers; inform action; and ultimately to improve outcomes for people. This MSR covers the whole of Carmarthenshire, Ceredigion, and Pembrokeshire, which is the area covered by the Hywel Dda University Health Board. In line with the national Code of Practice it comprises two inter-linked assessments: the sufficiency of care and support services; and the stability of the market for regulated services. Analysis undertaken for this report indicates that the market for domiciliary care for older people is currently presenting the greatest risk of market instability as workforce pressures continue to mount and complexity of need increases, whilst prices paid for care are reported by providers as being insufficient to pay staff at competitive rates. This market segment has seen all three counties taking on more in-house domiciliary hours and reablement support over the last 3 years. However, there is also a growing risk of market instability within the residential / nursing home market for older people across the region. Providers are facing significant workforce pressures, rising levels of complexity, increased costs and reduced occupancy levels. Likewise in children services and services for working aged adults, there are growing challenges in ensuring access to the right services and support - with many placements being made outside of the county (and region) at significant cost. Whilst there are sufficient places in fostering, children's homes, and care homes for working aged adults across the region as a whole, many of these are purchased by authorities from outside the region and are therefore not available locally in practice - leading to out of county or out of region placements. There are also gaps either geographically or for more specialist services such as younger onset dementia and CAMHS.
(Edited publisher abstract)
Subject terms:
social care, childrens social care, adult social care, market development, care providers;
Based on data from 5970 case notes of patients seen for initial assessment between January and August 2021, this report looks at community-based memory assessment services in England and Wales. The report found that the average waiting time from referral to diagnosis has increased to 17.7 weeks since 2019, up from 13 weeks. It also found that over 70% of services experienced periods of closure, and over 80% had staff redeployed during 2020. Other key findings include: 35% of patients had an appointment via phone or video call, while 45% took place at their usual place of residence; as part of their initial assessment, 61% of patients had a discussion recorded about their eyesight, 58% had a discussion recorded about hearing, and 76% had a falls history discussed and recorded; CT/MRI scans were requested for 47% of patients, with variation in requests of 0-97.4% of patients per service. This range implies that variation is at service/protocol level, rather than assessed as appropriate in each case. The report goes on to make a number of recommendations, including a call for services to use quality improvement methods to actively monitor waiting times from referral to diagnosis, and identify problem areas and barriers to access, including demographic and other factors (e.g. care home residents), as services continue to recover from the impact of the COVID-19 pandemic and associated service closures and staff redeployment.
(Edited publisher abstract)
Based on data from 5970 case notes of patients seen for initial assessment between January and August 2021, this report looks at community-based memory assessment services in England and Wales. The report found that the average waiting time from referral to diagnosis has increased to 17.7 weeks since 2019, up from 13 weeks. It also found that over 70% of services experienced periods of closure, and over 80% had staff redeployed during 2020. Other key findings include: 35% of patients had an appointment via phone or video call, while 45% took place at their usual place of residence; as part of their initial assessment, 61% of patients had a discussion recorded about their eyesight, 58% had a discussion recorded about hearing, and 76% had a falls history discussed and recorded; CT/MRI scans were requested for 47% of patients, with variation in requests of 0-97.4% of patients per service. This range implies that variation is at service/protocol level, rather than assessed as appropriate in each case. The report goes on to make a number of recommendations, including a call for services to use quality improvement methods to actively monitor waiting times from referral to diagnosis, and identify problem areas and barriers to access, including demographic and other factors (e.g. care home residents), as services continue to recover from the impact of the COVID-19 pandemic and associated service closures and staff redeployment.
(Edited publisher abstract)
Subject terms:
dementia, memory, assessment, waiting lists, access to services, Covid-19;
This study aimed to understand the experiences and needs of unpaid carers for people with dementia. The purpose is to use the findings to provide recommendations to policy and decision makers and to add to the body of evidence to be best equipped to campaign nationally for better support for carers, raising awareness of unmet needs. Three male carers and four female carers were interviewed. All
(Edited publisher abstract)
This study aimed to understand the experiences and needs of unpaid carers for people with dementia. The purpose is to use the findings to provide recommendations to policy and decision makers and to add to the body of evidence to be best equipped to campaign nationally for better support for carers, raising awareness of unmet needs. Three male carers and four female carers were interviewed. All interviewees cared for a family member with two carers looking after at least one grandparent, four caring for a parent and one caring for a spouse. The following are the key themes to emerge: the carer role is not something that is well recognised but also not clearly defined; the identity of the individual can be intertwined with caring; care work often negatively impacts on carer wellbeing; the changed relationship between the carer and cared for can be particularly emotive; carers want a different relationship with social services. Concerted and sustained efforts should be made to recognise 'hidden carers', carers who do not recognise themselves as such. Health and social care professionals should be encouraged to recognise and identify unpaid carers so that they can access any necessary support, advice and entitlements accordingly.
(Edited publisher abstract)
Subject terms:
carers, carer views, dementia, access to services;
International Journal of Geriatric Psychiatry, early cite March 2022,
Publisher:
Wiley
Objective: Unpaid carers for people with dementia play a crucial role in society. Emerging evidence suggests the COVID-19 pandemic has negatively impacted on carers. This study sought to explore the impact of the COVID-19 pandemic on carers for community-dwelling people with dementia and compare responses with pre-pandemic data. Methods: Data were collected between September 2020 and April 2021
(Edited publisher abstract)
Objective: Unpaid carers for people with dementia play a crucial role in society. Emerging evidence suggests the COVID-19 pandemic has negatively impacted on carers. This study sought to explore the impact of the COVID-19 pandemic on carers for community-dwelling people with dementia and compare responses with pre-pandemic data. Methods: Data were collected between September 2020 and April 2021 in England and Wales. Carers were identified from the IDEAL cohort and data were collected either through the telephone, video conferencing, or an online questionnaire. Responses from 242 carers were compared against benchmark data from the IDEAL cohort collected pre-pandemic. Analyses were conducted for the full sample of carers and spousal/partner carers only. Results: In total 48.8% of carers thought their healthcare needs were negatively affected during the pandemic. Compared with pre-pandemic data carers were more lonely and experienced less life satisfaction. There was little impact on carers’ experience of caregiving, although carers felt trapped in their caregiving role. Carers were more optimistic and had higher social contact with relatives. There were changes in the methods carers used for contacting relatives and friends. Most carers coped very or fairly well during the pandemic. There was little difference in the experiences of spousal/partner carers and the full sample. Conclusions: After a long period of providing care under pandemic conditions carers require additional support. This support needs to be focused on alleviating feelings of loneliness and increasing life satisfaction. Services need to consider how to improve access to health care, particularly resuming face-to-face appointments.
(Edited publisher abstract)
Health and Social Care in the Community, 30(4), 2022, pp.e1255-e1267.
Publisher:
Wiley
The importance of supporting unpaid carers for people living with dementia (PLWD) is recognised in adult social care policy both nationally and internationally. In the UK, social care legislation emphasises care and support should help people achieve the outcomes that matter to them in their life; this includes the opportunity to take a break from caring routines and responsibilities. Accordingly...
(Edited publisher abstract)
The importance of supporting unpaid carers for people living with dementia (PLWD) is recognised in adult social care policy both nationally and internationally. In the UK, social care legislation emphasises care and support should help people achieve the outcomes that matter to them in their life; this includes the opportunity to take a break from caring routines and responsibilities. Accordingly, there is growing policy and practice interest in short breaks provision to address the diversity of carer break needs and preferences and deliver meaningful outcomes for carers and those they support. This paper reports findings from qualitative staff interviews that offered strategic and operational insights into short breaks provision. It presents a dynamic model of the short break landscape in a region of Wales, describing factors shaping local and regional decision-making. The model identifies key challenges (barriers) and opportunities (enablers) that shape the planning, commissioning and delivery of bespoke short breaks for spousal carers and their partner living with dementia. Through highlighting the interplay between complex context-specific processes and contingences, the model informs initial theory development in short breaks provision.
(Edited publisher abstract)
Subject terms:
short break care, commissioning, dementia, carers, partners, staff views, service provision, models;
CALLANAN Sam, SOCIAL CARE INSTITUTE FOR EXCELLENCE
Publisher:
Social Care Wales
Publication year:
2021
Pagination:
95
Place of publication:
Cardiff
...people took part in the pilot programme and it consisted of six days of face-to-face training on topics aligned to the All Wales Induction Framework for Health and Social Care. It covered topics such as principles and values, person-centred care and safeguarding, as well as health and safety, dementia and essential health observations. The evaluation draws on survey data collected from learners
(Edited publisher abstract)
Evaluation report of joint health and social care induction training pilot at Hywel Dda University Health Board and local authorities in Carmarthenshire, Ceredigion and Pembrokeshire. The pilot ran between 2019 and 2021. The goal of the pilot was to generate confident workers who could deliver person-centred care, leading to better outcomes for people receiving care and support. Eighty-three people took part in the pilot programme and it consisted of six days of face-to-face training on topics aligned to the All Wales Induction Framework for Health and Social Care. It covered topics such as principles and values, person-centred care and safeguarding, as well as health and safety, dementia and essential health observations. The evaluation draws on survey data collected from learners, interviews (22) with learners, managers, mentors, and interviews (12) with other key stakeholders. Key finding: the pilot increased learners' confidence and competence, and supported workforce recruitment and retention. In addition, effective joint working between health and social care was essential to the pilot's success. The evaluation report's other findings included: those working in social care and employers valued the opportunity to carry out health observations and complete clinical skills training; having mentors and workplace support helped the workers taking part in the pilot; having experienced practitioners from health and social care, along with specialists, acting as tutors was an important element of the pilot's success; and creating a more flexible workforce that had elements of health and social care training helped with integrating the two sectors.
(Edited publisher abstract)
Subject terms:
evaluation, training, skills, adult social care, health care, staff induction, care workers, joint working;
...to people who have dementia, but also to people with a wide range of mental disorders, including those with functional mental illnesses, neurodevelopment and neurological conditions. Participants report most commonly applying this decision to people in community settings, but application also occurs in mental health and acute hospitals including in the emergency department. There is a lack of common
(Edited publisher abstract)
This report explores the context in which the decision of whether to use the MHA or the MCA to authorise a deprivation of liberty is made and the different factors that practitioners use to assess and weigh up which Act is most appropriate and ‘least restrictive’ for the individual concerned. The research used a mixed-methods approach with an online survey to capture the diversity of factors that influence decision-making across clinical groups, and qualitative interviews with clinicians and professionals to explore in depth their understanding of the interface and experiences of making this decision in practice. A large proportion of participants in this research report encountering people to whom this decision applies at least once a month, if not weekly. This decision most commonly applies to people who have dementia, but also to people with a wide range of mental disorders, including those with functional mental illnesses, neurodevelopment and neurological conditions. Participants report most commonly applying this decision to people in community settings, but application also occurs in mental health and acute hospitals including in the emergency department. There is a lack of common understanding around fundamental issues on which this decision is based including core concepts of capacity and objection. Blanket rules exist within professional groups and across different settings that restrict decision-making. The rights afforded to people admitted and treated in some settings and areas of England may not be afforded to those in others. The majority of participants report that their training covered decision-making at the interface of the Acts. However, codes of practice and case law are described as difficult to understand and keep up to date with. Understanding clinical decision-making at the in. Practitioners highlight a number of different ways in which patients are unlawfully deprived of their liberty as a result of the factors outlined above.
(Edited publisher abstract)
Subject terms:
Mental Capacity Act 2005, mental health law, Deprivation of Liberty Safeguards, mental capacity, compulsory treatment, decision making;
...upon their role and practice, and to work positively and safely. Part four contains additional information and resources, including resources for supporting people with autism, learning disabilities, dementia, mental health problems, and children and young people. The resource can be used by individual social care workers to reflect on their own practice, but is more it is more suited for discussions
(Edited publisher abstract)
Learning resource developed to help social care workers faced with difficult situations and behaviour that challenge. It is relevant to organisations and social care workers who providing social care and support to adults, children and young people. It provides examples of positive and proactive ways of working that support safe practice, and can reduce the need for restrictive practices. The resource is divided into four parts. Part one sets out how the resource should be used and provides definitions of what we mean by behaviour that challenges. It also gives an overview of current legislation and ethical considerations. Part two provides advice on ways to take a positive approach when supporting a person positively to prevent behaviours that may be perceived as challenging. It also includes definitions of the range of restrictive physical interventions and case illustrations of when they should or should not be used. It organised around the key principles of: voice and control; prevention and early intervention; well-being; co-production; and multi-agency approaches. Part three outlines guidance for ongoing support and training for social care workers, to enable them to reflect upon their role and practice, and to work positively and safely. Part four contains additional information and resources, including resources for supporting people with autism, learning disabilities, dementia, mental health problems, and children and young people. The resource can be used by individual social care workers to reflect on their own practice, but is more it is more suited for discussions either in group situations such as team meetings or training sessions.
(Edited publisher abstract)
Subject terms:
challenging behaviour, restraint, training, person-centred care, good practice, case studies, social care;
GREAT BRITAIN. Department of Health and Social Care
Publisher:
Great Britain. Department of Health and Social Care
Publication year:
2021
Place of publication:
London
The Liberty Protection Safeguards (LPS) will provide protection for people aged 16 and above who are, or who need to be, deprived of their liberty in order to enable their care or treatment and who lack the mental capacity to consent to their arrangements. People who might have an LPS authorisation include those with dementia, autism and learning disabilities who lack the relevant capacity. Under
(Edited publisher abstract)
The Liberty Protection Safeguards (LPS) will provide protection for people aged 16 and above who are, or who need to be, deprived of their liberty in order to enable their care or treatment and who lack the mental capacity to consent to their arrangements. People who might have an LPS authorisation include those with dementia, autism and learning disabilities who lack the relevant capacity. Under LPS, the Responsible Body will authorise arrangements that amount to a deprivation of liberty to enable care or treatment. This guidance explains which organisations are Responsible Bodies, which will vary according to where the arrangements are mainly carried out.
[Last updated 11 June 2021]
(Edited publisher abstract)
Subject terms:
Liberty Protection Safeguards, mental capacity, compulsory treatment, Mental Capacity Act 2005, Deprivation of Liberty Safeguards, responsibilities;