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Reducing emergency hospital admissions: what is the role of social care? Strategic briefing
- Author:
- MILLER Robin
- Publisher:
- Research in Practice for Adults
- Publication year:
- 2017
- Pagination:
- 20
- Place of publication:
- Dartington
This briefing looks at the factors that influence emergency admission rates and the role of adult social care in preventing emergency admissions to hospital. It explores how services can adopt strengths-based approaches when working with older people. It also builds an understanding of how preventable factors, such as loneliness, contribute to hospital admissions. Case studies demonstrate how these approaches have been used successfully in practice. It also discusses the concept of 'avoidable' and presents four comprehensive models of hospital avoidance. It concludes by outlining implications for social care commissioning and workforce. The briefing is intended for senior managers, service leads and commissioners. (Edited publisher abstract)
Evidence, insight, or intuition? Investment decisions in the commissioning of prevention services for older people
- Authors:
- MILLER Robin, et al
- Journal article citation:
- Journal of Care Services Management, 7(4), 2013, pp.119-127.
- Publisher:
- Taylor and Francis
English adult social care commissioners are expected to make ‘evidence based’ decisions on how best to invest public sector funding. This study explores the types of evidence that commissioners use in relation to prevention services for older people and the other factors that influence their investment decisions. A study of local authority Directors of Adult Social Services (DASSs) was used to identify three local prevention interventions. Semi-structured interviews with leads for these interventions explored the evidence and other factors that influenced the investment process. Commissioners drew on a variety of published evidence, in particular that deriving from central government and its regional representative bodies, and third sector organizations with specialist knowledge. Local evidence was also generated through the undertaking of pilots and gathering of performance data. Alongside these ‘rational’ decision-making processes were strong political, personal, and relational dimensions related primarily to the influence of elected members and the hierarchical power of DASSs. Capturing experiential evidence and knowledge of service users and frontline practitioners, being clear about expected impacts and monitoring accordingly, and using recognized evaluation tools would provide further local evidence and enable better comparison and sharing across local authorities. (Publisher abstract)
Singing from the same hymn sheet? commissioning of preventative services from the third sector
- Authors:
- MILLER Robin, et al
- Journal article citation:
- Journal of Integrated Care, 21(5), 2013, pp.288-299.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the delivery of preventative services for older people from third sector organisations (TSOs) and the extent to which current commissioning arrangements enables the aspirations of policy to be achieved. Design/methodology/approach: Semi-structured interviews with key-contacts within a sample of TSOs which had been identified by directors of Adult Social Services as delivering one of the top three preventative interventions in their local authority area. Findings: There was evidence of considerable trust between local authorities and TSOs and as a consequence TSOs were given autonomy to develop holistic and integrated models of delivery that supported rather than diverted the TSOs’ core missions. Both sectors found it difficult to set target outcomes and connected performance frameworks for preventative services. As a consequence a major element of the commissioning cycle is not being completed and TSOs cannot be confident that they are using their resources as effectively as possible. Research limitations/implications: This study was based in one English region, and would benefit from being extended to other English regions and home nations. Practical implications: Universities, policy makers, commissioners and the third sector need to work together to develop common outcome frameworks for preventative services and to gather consistent data sets that can be more easily synthesised to give a “realistic” understanding of the impact of different interventions and delivery models. Originality value: The paper contributes to the limited evidence bases of commissioning of TSOs and preventative services. (Publisher abstract)
What the evidence tells us about improving urgent care for older people: a literature review to support the independent Commission on Improving Urgent Care for Older People
- Authors:
- APPLETON Steve, MILLER Robin
- Publisher:
- NHS Confederation
- Publication year:
- 2016
- Pagination:
- 32
- Place of publication:
- London
Reports on a literature review commissioned by the Commission on Improving Urgent Care for Older People to identify factors that deliver better outcomes and success in the improvement of urgent care for older people. Specifically the review aimed to identify current national policy for improving urgent care in both health and social care; relevant national guidance; and examples of research, best practice and innovation. The findings are presented around the themes of: demographics and the population of older people; what is meant by urgent care; the needs of older people, including needs related to multiple long term conditions; the capacity of urgent care, workforce; what works in the current NHS and Adult Social Care system. The review found limited evidence relating specifically to older people in relation to urgent care. It also identified a lack of consensus on what the term ‘urgent care’ means. Factors identified as influencing the effectiveness of urgent care delivery for older people included workforce/skill mix, competence in working with older people and awareness of their particular needs, integration, appropriateness of admission, pre-admission support, effective and safe discharge, the role of social care and capacity. The report also noted that the value of the role of community-based services, including social care, the voluntary sector, ambulatory services and of nursing and residential care homes is sometimes overlooked.