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Health and social care access for adults with learning disabilities across the UK during the COVID-19 pandemic in 2020
- Authors:
- FLYNN Samantha, HATTON Chris
- Journal article citation:
- Tizard Learning Disability Review, 26(3), 2021, pp.174-179.
- Publisher:
- Emerald
Purpose: This paper aims to present data about access to health and social care services during the COVID-19 pandemic for adults with learning disabilities across England, Northern Ireland, Scotland and Wales. Design/methodology/approach: Data were collected directly from 621 adults with learning disabilities and through separate proxy reports by family carers and paid support staff of another 378 adults with learning disabilities. The data were collected between December 2020 and February 2021 and concerned the use of health and social care services since the start of the first COVID-19 national lockdown in March 2020. Findings: Access to and use of health and social care services significantly reduced for adults with learning disabilities across the UK during the COVID-19 pandemic between March 2020 and February 2021, with many people not receiving any services at all during that period. Similar patterns were seen across England, Northern Ireland, Scotland and Wales. However, data suggest some variations between countries for some services. Practical implications: Future pandemic planning must ensure that access to these essential services is not completely lost for adults with learning disabilities and their family carers, as it was in some cases during the COVID-19 pandemic in 2020. Originality/value: This is the largest study about the impact of the COVID-19 pandemic on health and social care services for adults with learning disabilities in the UK. The authors primarily collected data directly from adults with learning disabilities, and worked with partner organisations of people with learning disabilities throughout the study. (Edited publisher abstract)
AUDIT Scotland 10 years on: explaining how funding decisions link to increased risk for drug related deaths among the poor
- Authors:
- MCPHEE Iain, SHERIDAN Barry
- Journal article citation:
- Drugs and Alcohol Today, 20(4), 2020, pp.313-322.
- Publisher:
- Emerald
Purpose: In response to Scottish Government assertions that an ageing cohort explained increases in drug-related death (DRD), the previous research by the authors established that socio-economic inequalities were additional risk factors explaining the significant increases in DRD in Scotland. This paper aims to subject the drug policy narratives provided by Scottish Government in relation to the governance of drug and alcohol services to critical scrutiny and reveal the social consequences of the funding formula used to direct funding to services via NHS Scotland Boards, and Alcohol and Drug Partnerships (ADP). Design/methodology/approach: The paper provides a narrative review in the context of the AUDIT Scotland reports “Drug and Alcohol Services in Scotland” from 2009 and follow-up report published in 2019. The authors refer to the recommendations made in the 2009 report on effectiveness of drug and alcohol services and subject Scottish Government funding processes, and governance of drug and alcohol services to critical scrutiny. Findings: This analysis provides robust evidence that Scottish Government funding processes and governance of drug and alcohol services increased risk to vulnerable drug users and document evidence that link these risk factors to increased DRD. Research limitations/implications: The authors have focused on Scottish drug policy and drug services funding. Alcohol services funding is not subject to critical analysis due to limitations of time and resources. Practical implications: This case study investigates AUDIT Scotland’s recommendations in 2009 to Scottish Government to provide researchers, government policy advisors and media with robust critical analysis that links drug policy decisions to increased DRD. Social implications: Drug policy governance by the Scottish Government and NHS Scotland since 2009 have disproportionately affected communities of interest and communities of place already experiencing stark inequalities. These budget decisions have resulted in widening inequalities, and increased DRD within communities in Scotland. The authors conclude that in diverging politically and ideologically from Public Health England, and the Westminster Parliament, Scottish Government drug policy and financial governance of drugs services contributes to increased risk factors explaining DRD within deprived communities. Originality/value: The 2009 AUDIT Scotland recommendations to Scottish Government subject their governance of drug services to critical scrutiny. This analysis provides a counterpoint to the explanations that rising DRD are unconnected to drug policy and drug services governance. (Edited publisher abstract)
Respecting the autonomy of the living and dying
- Author:
- STAVERT Jill
- Journal article citation:
- Journal of Integrated Care, 28(4), 2020, pp.379-385.
- Publisher:
- Emerald
Purpose: The purpose of this study is to inform those who are supporting persons who are dying and are responsible for planning, commissioning or delivering palliative care about the need to support and maximise the decision-making ability and choices of persons with advanced dementia or severe frailty. Design/methodology/approach: This article will consider the legal and human rights principles applicable to Scotland, and indeed to other jurisdictions, which govern decisions about care and treatment of persons with and without capacity and the application of these principles to palliative care situations. Findings: It is important that those involved in the care and support of the dying are fully aware of the need to support and maximise their decision-making ability concerning palliative care and treatment choices. Research limitations/implications: It is a well-established legal and human rights principle that the decisions of a person with capacity must be respected, including decisions about palliative care and treatment at the end of life. Moreover, recent developments in international human rights law reinforce the message that this principle applies equally to all. Applying this principle into persons with advanced dementia or severe frailty therefore requires skilled assessment and supported decision-making in order to optimise capacity and respect autonomy. Originality/value: The discussion applies the United Nations Convention on the Rights of Persons with Disabilities approach concerning equality of rights enjoyment and supported decision-making to palliative care and treatment situations. (Edited publisher abstract)
Learning disability, autism and the Criminal Procedure (Scotland) Act
- Authors:
- WILLIAMS Fionnuala, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 14(5), 2020, pp.149-167.
- Publisher:
- Emerald
This paper aims to investigate the use of Part VI of the Criminal Procedure (Scotland) Act 1995 (CPSA) for people with Learning Disability (LD) and/or Autism. This is in the context of a recent review commissioned by the Scottish Government into whether the provisions in the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) meet the needs of these groups which would also affect associated legislation such as CPSA.Design/methodology/approach: All CPSA orders active on the 3 January 2018 were identified and analysed for a number of variables including diagnoses, detention length, level of hospital security and medication use. Findings: Of the 580 people on CPSA orders, 69 (11.9%) had LD and 27 (4.7%) had possible/definite Autism. Most people with LD (56.5%) did not have a mental illness or personality disorder. Most (81.2%) had mild LD. There were two patients whose only diagnosis was Autism. Mean duration of detention was longer for those with LD than for those without. Most patients with LD alone were prescribed medication (61.5%) and, if in hospital, were managed in low secure units (59%). Originality/value: The results indicate that people with LD or Autism are differently affected by the application of the CPSA from other people with mental disorders, and that this is potentially discriminatory, if it is not objectively justified . It supports the stance from the recent review that to reduce the potential for discrimination, substantial changes to MHA and CPSA should be considered in the wider review of the MHA in Scotland. (Edited publisher abstract)
Mandatory reporting and adult safeguarding: a rapid realist review
- Author:
- DONNELLY Sarah
- Journal article citation:
- Journal of Adult Protection, 21(5), 2019, pp.241-251.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to critically analyse the concept of mandatory reporting in adult safeguarding in the jurisdictions of Australia, Canada, England, Northern Ireland and Scotland. Design/methodology/approach: A rapid realist evaluation of the literature on this topic was carried out in order to answer the question: "what works, for whom and in what circumstances?” Particular attention was paid to Context(s), Mechanism(s) and Outcome(s) configurations of adult safeguarding reporting systems and processes. Findings: The evaluation found a range of arguments for and against mandatory reporting and international variations on the scope and powers of mandatory reporting. Research limitations/implications: This review was undertaken in late 2018 so subsequent policy and practice developments will be missing from the evaluation. The evaluation focused on five jurisdictions therefore, the findings are not necessarily translatable to other contexts. Practical implications: Some jurisdictions have introduced mandatory reporting and others are considering doing so. The potential advantages and challenges of introducing mandatory reporting are highlighted. Social implications: The introduction of mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults, but this could also change the dynamic of relationships within families, and between families and professionals. Originality/value: This paper provides an accessible discussion of mandatory reporting across Ireland and internationally which to date has been lacking from the literature. (Edited publisher abstract)
Partnership working across sectors: a multi-professional perspective
- Author:
- EL-FARARGY Nancy
- Journal article citation:
- Journal of Integrated Care, 27(4), 2019, pp.328-345.
- Publisher:
- Emerald
Purpose: The Public Bodies (Joint Working) (Scotland) Act 2014 set the framework for the integration of adult health and social care services. Teams, organisations and sectors are now required to work in partnership and interdependently to deliver shared outcomes for the people they serve. The purpose of this paper is to explore any features, practices and behaviours that could influence effective partnership working across sectors. Design/methodology/approach: A questionnaire was designed and distributed to a range of stakeholders working in health, social care and the third sector. With reference to the changing health and social care reform agenda, the aims of the survey were to gather views, experiences and perceptions of working across sectors, and any workforce development needs. Findings: The majority of respondents were from the NHS (80.3 per cent, 118/147), and experiences were largely drawn from those working with the third sector. The utility of working with the third sector was positively highlighted; however, there were limited opportunities to fully engage. Whilst formal education and training was welcomed, workforce development needs were mostly related to fostering relationships and building mutual trust. Originality/value: This paper highlights views, perceptions, enablers and barriers to integrated care in Scotland. Whilst the Scottish integration landscape is currently not fully fledged, insights into prevailing attitudes towards integrated care, by a cohort of the Scottish health and care workforce, are offered. In particular, reflections by the NHS workforce to working with third sector services are discussed. (Edited publisher abstract)
Implementing a step down intermediate care service
- Authors:
- LEVIN Kate A., et al
- Journal article citation:
- Journal of Integrated Care, 27(4), 2019, pp.276-284.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore implementation and development of step-down intermediate care (IC) in Glasgow City from the perspective of staff. Design/methodology/approach: The study used qualitative methods. Nine key members of staff were interviewed and three focus groups were run for social work, rehabilitation and care home staff. Framework analysis was used to identify common themes. Findings: The proposed benefits of IC were supported anecdotally by staff. Perceived enablers included: having a range of engaged stakeholders, strong leadership and a risk management system in place, good relationships, trust and communication between agencies, a discharge target, training of staff, changing perception of risk and risk aversion, the right infrastructure and staffing, an accommodation-based strategy for patients discharged from IC, the right context of political priorities, funding and ongoing adaptation of the model in discussion with frontline staff. Potential improvements included a common recording system shared across all agencies, improving transition of patients from hospital to IC, development of a tool for identifying suitable candidates for IC, overcoming placement issues on discharge from IC, ensuring appropriate rehabilitation facilities within IC units, attachment of social work staff to IC units and finding solutions to issues related to variation in health and social care systems between sectors and hospitals. Originality/value: The findings of this study help the ongoing refinement of the IC service. Some of the recommendations have already been implemented and will be of value to similar services being developed elsewhere. (Edited publisher abstract)
Linkage of social care and hospital admissions data to explore non-delivery of planned home care for older people in Scotland
- Authors:
- EVANS Josie, METHVEN Karen, CUNNINGHAM Nicola
- Journal article citation:
- Quality in Ageing and Older Adults, 20(2), 2019, pp.48-55.
- Publisher:
- Emerald
Purpose: As part of a pilot study assessing the feasibility of record-linking health and social care data, the purpose of this paper is to examine patterns of non-delivery of home care among older clients (>65 years) of a social home care provider in Glasgow, Scotland. The paper also assesses whether non-delivery is associated with subsequent emergency hospital admission. Design/methodology/approach: After obtaining appropriate permissions, the electronic records of all home care clients were linked to a hospital inpatient database and anonymised. Data on home care plans were collated for 4,815 older non-hospitalised clients, and non-delivered visits were examined. Using case-control methodology, those who had an emergency hospital admission in the next calendar month were identified (n=586), along with age and sex-matched controls, to determine whether non-delivery was a risk factor for hospital admission. Findings: There were 4,170 instances of “No Access” non-delivery among 1,411 people, and 960 instances of “Service Refusal” non-delivery among 427 people. The median number of undelivered visits was two among the one-third of clients who did not receive all their planned care. There were independent associations between being male and living alone, and non-delivery, while increasing age was associated with a decreased likelihood of non-delivery. Having any undelivered home care was associated with an increased risk of emergency hospital admission, but this could be due to uncontrolled confounding. Research limitations/implications: This study demonstrates untapped potential for innovative research into the quality of social care and effects on health outcomes. Originality/value: Non-delivery of planned home care, for whatever reason, is associated with emergency hospital admission; this could be a useful indicator of vulnerable clients needing increased surveillance. (Edited publisher abstract)
Dr Jekyll and Mr Hyde: the strange case of the two selves of clandestine drug users in Scotland
- Authors:
- MCPHEE Iain, et al
- Journal article citation:
- Drugs and Alcohol Today, 19(2), 2019, pp.133-146.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the hidden social worlds of competent clandestine users of drugs controlled within the confines of the UK Misuse of Drugs Act 1971, which now includes NPS substances. The authors explore how and in what way socially competent drug users differ from others who are visible to the authorities as criminals by criminal justice bureaucracies and known to treatment agencies as defined problem drug users. Design/methodology/approach: This qualitative research utilises a bricoleur ethnographic methodology considered as a critical, multi-perspectival, multi-theoretical and multi-methodological approach to inquiry. Findings: This paper challenges addiction discourses and, drawing upon empirical evidence, argues the user of controlled drugs should not be homogenised. Using several key strategies of identity management, drug takers employ a range of risk awareness and risk neutralisation techniques to protect self-esteem, avoid social affronts and in maintaining untainted identities. The authors present illicit drug use as one activity amongst other social activities that (some) people, conventionally, pursue. The findings from this study suggest that punitive drug policy, which links drug use with addiction, crime and antisocial behaviour, is inconsistent with the experience of the participants. Research limitations/implications: Due to the small sample size (n=24) employed, the possibility that findings can be generalised is rendered difficult. However, generalisation was never an objective of the research; the experiences of this hidden population are deeply subjective and generalising findings and applying them to other populations would be an unproductive endeavour. While the research attempted to recruit an equal number of males and females to this research, gendered analysis was not a primary objective of this research. However, it is acknowledged that future research would greatly benefit from such a gendered focus. Practical implications: The insights from the study may be useful in helping to inform future policy discourse on issues of drug use. In particular, the insights suggest that a more nuanced perspective should be adopted. This perspective should recognise the non-deviant identities of many drug users in the contemporary era, and challenge the use of a universally stigmatising discourse and dominance of prohibition narratives. Social implications: It is envisaged that this paper will contribute to knowledge on how socially competent users of controlled drugs identify and manage the risks of moral, medical and legal censure. Originality/value: The evidence in this paper indicates that drug use is an activity often associated with non-deviant, productive members of the population. However, the continuing dominance of stigmatising policy discourses often leads to drug users engaging in identity concealment within the context of a deeply capitalist Western landscape. (Edited publisher abstract)
Inter-agency adult support and protection practice: a realistic evaluation with police, health and social care professionals
- Authors:
- JOSEPH Sundari, et al
- Journal article citation:
- Journal of Integrated Care, 27(1), 2019, pp.50-63.
- Publisher:
- Emerald
Purpose: Collaborative inter-agency working is of paramount importance for the public protection agenda worldwide. The purpose of this paper is to disseminate the findings from a research study on the inter-agency working within adult support and protection (ASP) roles in the police, health and social care. Design/methodology/approach: This realistic evaluation study with two inter-related phases was funded by the Scottish Institute for Policing Research. This paper reports on Phase 1 which identified existing gaps in the implementation of effective inter-agency practice by reviewing the “state of play” in inter-agency collaboration between the police and health and social care professionals. In total, 13 focus groups comprising representatives from Police Scotland (n=52), Social Care (n=31) and Health (n=18), engaged in single profession and mixed profession groups addressing issues including referral and information exchange. Findings: On analysing context-mechanism-outcome (CMO), gaps in joint working were identified and attributed to the professionals’ own understanding of inter-agency working and the expectations of partner agencies. It recommended the need for further research and inter-agency training on public protection. Research limitations/implications: This unique Scottish study successfully identified the inter-agency practices of health, social services and police. By means of a modified realistic evaluation approach, it provides an in-depth understanding of the challenges that professionals face on a day-to-day basis when safeguarding adults and informed strategic recommendations to overcome the barriers to good practices in organisational working. The methods used to determine CMO could benefit other researchers to develop studies exploring the complexities of multi-causal effects of cross-boundary working. The use of the same case study in each focus group helped to neutralise bias. However, the voluntary nature of participation could have resulted in biased perceptions. The limited numbers of health professionals may have resulted in less representation of health sector views. Practical implications: This paper reports on a Scottish study that focused on the coordinated and integrated practices amongst the police, health and social services’ professionals who support and protect adult members of society at risk of harm and has implications for their practice. Social implications: Whilst the focus of this study has been on ASP, the conclusions and recommendations are transferable to public protection issues in many other contexts. Originality/value: Studies on the joint-working practices amongst police and health and social services’ professionals who support and protect adult members of society at risk of harm are uncommon. This study investigated professionals’ perceptions of gaps and concerns pertaining to integrated working by means of a realistic evaluation approach. It recommended the need for further research and inter-agency training on public protection. (Edited publisher abstract)