... the barriers and facilitators to the uptake and development of self-directed support in social care in the UK. A wide definition of self-directed support is used, including direct payments, individual budgets, personal budgets, consumer directed care, and personalisation. Overall, the literature reveals much agreement about the barriers to the development of self-directed support and many suggestions
This is a report on the published literature on the barriers and facilitators to self-directed support. It was undertaken to inform a research study funded by the Scottish Government 2009-2011 that is evaluating initiatives in 3 local authorities which aim to improve take up of self-directed support for people eligible for social care and other public funds. This literature review examines the barriers and facilitators to the uptake and development of self-directed support in social care in the UK. A wide definition of self-directed support is used, including direct payments, individual budgets, personal budgets, consumer directed care, and personalisation. Overall, the literature reveals much agreement about the barriers to the development of self-directed support and many suggestions and experiences about ways in which self-directed support may be facilitated. Some barriers and facilitators are linked, for example, lack of information is a barrier and good or accessible information appears to be a facilitator. Similarly, lack of legal clarity is a barrier, while clarity about legal responsibilities appears to assist users, carers and staff alike. Other areas are not so simple, and there are few easy conclusions to draw about the management of risk and cost-effectiveness and what is regarded as legitimate use of public money.
Subject terms:
literature reviews, personalisation, self-directed support, service uptake;
Journal of Adult Protection, 14(1), 2012, pp.35-38.
Publisher:
Emerald
This short paper reviews the literature on prevention in adult safeguarding and identifies the themes that emerge, with particular reference to personalisation and the views of service users. It is part of a larger piece of work commissioned by SCIE. (The full report is available on the website along with examples of prevention in practice). The review began with a scoping exercise looking
This short paper reviews the literature on prevention in adult safeguarding and identifies the themes that emerge, with particular reference to personalisation and the views of service users. It is part of a larger piece of work commissioned by SCIE. (The full report is available on the website along with examples of prevention in practice). The review began with a scoping exercise looking at the available data, literature, and best practice in relation to prevention in adult safeguarding. Using reference harvesting and expert recommendations the author produced a final list of 52 documents. Many factors were identified that may contribute to preventing abuse in the context of adult safeguarding. However, it can be difficult to demonstrate that abuse has been or is being prevented with any certainty. The views of service users consulted for the review of No Secrets are that they would prefer to be empowered to make their own decisions with regard to safeguarding rather than have the decisions made for them in an overly protective or risk-averse environment. It is recommended that local authorities consider risk enablement for service users as a parallel process to adult safeguarding.
Subject terms:
personalisation, self-determination, user views, safeguarding adults, empowerment;
... It summarises the extent of knowledge on the subject in the UK in early 2009. The benefits, concerns and challenges of introducing personalisation, direct payments and personal budgets are discussed. The review concludes that better targeted training and support is needed to encourage a higher level of uptake of direct payments and personal budgets. In particular it is suggested that there is a need to raise
This is a short summary of a review of academic, practitioner and policy literature about the use of direct payments and personal budgets by people who use mental health services. The literature review, commissioned from the University of Bristol for Mind’s ‘Putting us’ first project, was undertaken to help providers wanting to make changes find the evidence and information they need. It summarises the extent of knowledge on the subject in the UK in early 2009. The benefits, concerns and challenges of introducing personalisation, direct payments and personal budgets are discussed. The review concludes that better targeted training and support is needed to encourage a higher level of uptake of direct payments and personal budgets. In particular it is suggested that there is a need to raise awareness and expertise among service users, practitioners and leaders in relation to their use in the mental health field. Suggested next steps are outlined in the areas of: recruiting and training personal assistants, providing effective support schemes for people using personal budgets, improved joint working at a local level, and more effective and proactive leadership.
Subject terms:
literature reviews, mental health services, personal budgets, personalisation, direct payments;
Journal of Care Services Management, 5(2), April 2011, pp.79-86.
Publisher:
Taylor and Francis
Using the UK as a case study, and in the context of the personalisation agenda, this paper examines contemporary trends in social policy in general and personal support, in particular in Western society. It looks at what personalisation is, what it will mean and how it may work, and discusses public policy, community and personalisation, individual budgets, and the findings of a national evaluation of individual budget pilots. It reviews the existing research evidence for personalisation, noting that the evidence base in relation to the critical success factors of personalisation is scarce. The authors identify 5 themes for future research within a framework related to sustainable care: effective use of resources, service development, safeguarding and risk; participation, community
Using the UK as a case study, and in the context of the personalisation agenda, this paper examines contemporary trends in social policy in general and personal support, in particular in Western society. It looks at what personalisation is, what it will mean and how it may work, and discusses public policy, community and personalisation, individual budgets, and the findings of a national evaluation of individual budget pilots. It reviews the existing research evidence for personalisation, noting that the evidence base in relation to the critical success factors of personalisation is scarce. The authors identify 5 themes for future research within a framework related to sustainable care: effective use of resources, service development, safeguarding and risk; participation, community cohesion, trust, and social capital; effects on urban and rural infrastructure, social care markets, and the workforce; satisfaction, control, choice, self-esteem, and human rights; and evaluating different models.
Subject terms:
personal budgets, personalisation, research methods, social policy, social care provision;
New Economics Foundation, Social Care Institute for Excellence
Publication year:
2011
Pagination:
66
Place of publication:
London
This report reviews current policy and practice of personalisation and provides an analysis of the potential of co-production to improve outcomes for individuals. It is the first stage of a project to find out how to realise the ambitions of personalisation when public funds are increasingly scarce. The report provides a review the literature on personalisation in health and social care. This information in synthesised to focus on key themes: the policy guidance and political context; outcomes achieved through personalisation; costs and benefits; and areas where personalisation is perceived to have gaps or weaknesses. The second part of this report provides a framework for analysing what value and benefits co-production might bring to those intended to benefit from more personalised services. It describes the key features of co-production; an outline framework of how co-production might be applied to personalisation; and a series of case studies showing how co-production can be applied to personalised services. The report shows that transformation to personalisation is at a very early stage. More work is needed to understand how personalisation can work to improve outcomes across all groups, such as older people. There was no clear picture of how personalisation will affect the unit costs of services, and the value of support, in terms of preventing needs arising.
(Edited publisher abstract)
This report reviews current policy and practice of personalisation and provides an analysis of the potential of co-production to improve outcomes for individuals. It is the first stage of a project to find out how to realise the ambitions of personalisation when public funds are increasingly scarce. The report provides a review the literature on personalisation in health and social care. This information in synthesised to focus on key themes: the policy guidance and political context; outcomes achieved through personalisation; costs and benefits; and areas where personalisation is perceived to have gaps or weaknesses. The second part of this report provides a framework for analysing what value and benefits co-production might bring to those intended to benefit from more personalised services. It describes the key features of co-production; an outline framework of how co-production might be applied to personalisation; and a series of case studies showing how co-production can be applied to personalised services. The report shows that transformation to personalisation is at a very early stage. More work is needed to understand how personalisation can work to improve outcomes across all groups, such as older people. There was no clear picture of how personalisation will affect the unit costs of services, and the value of support, in terms of preventing needs arising.
(Edited publisher abstract)
Subject terms:
personalisation, co-production, outcomes, costs, cost effectiveness, personal budgets, policy;
Drawing on an overview of some of the emerging evidence, this report examines the potential for personalisation, particularly self-directed support and personal budgets, to result in cost-efficiencies and improved productivity as well as improved care and support. The relatively underdeveloped nature of the available evidence is also highlighted. Key themes discussed include: business processes; decisions on whether or how personalisation has delivered efficiency savings. Despite this, there is some evidence to suggest that self-directed support and personal budgets could lead to improved outcomes in individual cases. Appendices detail the scoping methods used for the report.
Drawing on an overview of some of the emerging evidence, this report examines the potential for personalisation, particularly self-directed support and personal budgets, to result in cost-efficiencies and improved productivity as well as improved care and support. The relatively underdeveloped nature of the available evidence is also highlighted. Key themes discussed include: business processes; impact on costs in the market; external support planning and brokerage; building community capacity; preventing admissions, other strategic approaches (such as telecare, home care reablement and adaptations and equipment); and emerging cost evidence from personal budgets. Examples of existing practice are provided throughout. It is concluded that there is not enough robust data to make evidence-based decisions on whether or how personalisation has delivered efficiency savings. Despite this, there is some evidence to suggest that self-directed support and personal budgets could lead to improved outcomes in individual cases. Appendices detail the scoping methods used for the report.
Subject terms:
personal budgets, personalisation, self-directed support, service brokerage, social care provision, cost effectiveness;
Health and Social Care Delivery Research, 8(26), 2020, Online only
Publisher:
National Institute for Health Research
Place of publication:
London
Background: The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives: MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design: A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting: The setting was in the community. Participants: Older people, informal carers, and health and care practitioners. Interventions: Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Data sources: MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods: Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results: Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations: Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions: MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work: Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners.
(Edited publisher abstract)
Background: The number and proportion of older people in the UK are increasing, as are multimorbidity (potentially reducing quality of life) and polypharmacy (increasing the risk of adverse drug events). Together, these complex factors are challenging for older people, informal carers, and health and care practitioners. Objectives: MEMORABLE (MEdication Management in Older people: Realist Approaches Based on Literature and Evaluation) aimed to understand how medication management works and propose improvements. Design: A realist approach informed three work packages, combining a realist review of secondary data with a realist evaluation of primary interview data, in a theory-driven, causal analysis. Setting: The setting was in the community. Participants: Older people, informal carers, and health and care practitioners. Interventions: Studies relating to medication management and to reviewing and reconciling medications; and realist-informed interviews. Data sources: MEDLINE, CINAHL (Cumulative Index of Nursing and Allied Health Literature) and EMBASE were searched (all searched from January 2009 to July 2017; searched on 1 August 2017). Supplementary articles were identified by the Research Team. Data were also obtained through interviews. Review methods: Searches of electronic databases were supplemented by citation-tracking for explanatory contributions, as well as accessing topic-relevant grey literature. Following RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) guidelines, articles were screened and iteratively analysed with interview data, to generate theory-informed (normalisation process theory) explanations. Results: Developing a framework to explain medication management as a complex intervention across five stages: identifying problem (Stage 1), starting, changing or stopping medications (Stage 3) and continuing to take medications (Stage 4), where older people, sometimes with informal carers, make individual decisions and follow routines that fit medication management into their day-to-day lives, engendering a sense of control. In getting diagnosis and/or medications (Stage 2) and reviewing/reconciling medications (Stage 5), older people and practitioners share decision-making in time-limited contacts: involving four steps – sense-making, relationships, action and reflection/monitoring (normalisation process theory); and conceptualising burden – through a detailed analysis of Stage 5, generating a theoretical framework and identifying five burden types amendable to mitigation: ambiguity, concealment, unfamiliarity, fragmentation and exclusion. Proposing interventions: risk identification – a simple way of identifying older people and informal carers who are not coping, at risk and who need appropriate help and support; and individualised information – a short, personalised record and reference point, co-produced and shared by older people, informal carers and practitioners that addresses the experience of living with multimorbidities and polypharmacy. Limitations: Few studies directly address the complexity of medication management as a process and how it works. Limitations included, having identified the overall complexity, the need to focus the analysis on reviewing/reconciling medications (Stage 5), the exclusion of non-English-language literature, the focus on non-institutionalised populations and the broad definition of older people. Conclusions: MEMORABLE explored the complexity of medication management. It highlighted the way interpersonal stages in the medication management process, notably reviewing/reconciling medications, contribute to the mitigation of burdens that are often hidden. Future work: Co-produced studies to scope and trial the two proposed interventions; studies to extend the detailed understanding of medication management, linked to burden mitigation; and a study to clarify the medication management outcomes wanted by older people, informal carers and practitioners.
(Edited publisher abstract)
Many of dementia's manifestations are now known to be manageable, and while the underlying illness is generally not curable, it might be modifiable with good dementia care. This report summarises evidence-based approaches to dementia and its symptoms, and makes it clear when the available evidence is not definitive. It itemises interventions that can transform the lives of people with dementia and their families; maximising cognition, decreasing distressing associated symptoms, reducing crises, and improving quality of life. Timely diagnosis is a prerequisite to receiving these interventions. Pharmacological, psychological, environmental, and social interventions are included. If these interventions are implemented, people with dementia will have their cognition optimised and they will be less likely to be agitated, depressed, or have troublesome psychotic symptoms, and family carers will have reduced levels of anxiety and depression. It is also important to discuss future decision making as soon as possible with people with dementia and allow them to nominate someone to enact pre-specified wishes or make choices consistent with their values. The report suggests that overall there is good potential for prevention and, once someone develops dementia, for care to be high-quality, accessible, and give value to an underserved, growing population. Effective dementia prevention, intervention, and care could transform the future for society and vastly improve living and dying for individuals with dementia and their families. Acting now on what we already know can make this difference happen.
(Edited publisher abstract)
Many of dementia's manifestations are now known to be manageable, and while the underlying illness is generally not curable, it might be modifiable with good dementia care. This report summarises evidence-based approaches to dementia and its symptoms, and makes it clear when the available evidence is not definitive. It itemises interventions that can transform the lives of people with dementia and their families; maximising cognition, decreasing distressing associated symptoms, reducing crises, and improving quality of life. Timely diagnosis is a prerequisite to receiving these interventions. Pharmacological, psychological, environmental, and social interventions are included. If these interventions are implemented, people with dementia will have their cognition optimised and they will be less likely to be agitated, depressed, or have troublesome psychotic symptoms, and family carers will have reduced levels of anxiety and depression. It is also important to discuss future decision making as soon as possible with people with dementia and allow them to nominate someone to enact pre-specified wishes or make choices consistent with their values. The report suggests that overall there is good potential for prevention and, once someone develops dementia, for care to be high-quality, accessible, and give value to an underserved, growing population. Effective dementia prevention, intervention, and care could transform the future for society and vastly improve living and dying for individuals with dementia and their families. Acting now on what we already know can make this difference happen.
(Edited publisher abstract)
Subject terms:
dementia, prevention, cognitive impairment, personalisation, end of life care, telecare;
University of Manchester. Personal Social Services Research Unit
Publication year:
2016
Pagination:
41
Place of publication:
Manchester
... included in the review (publication 1991- 2012). The studies were separated into two groups: those conducted early in the review period where the assessment and care management process was largely led by professionals and those conducted more recently in response to self-directed support initiatives within the personalisation agenda. The results are discussed in the following areas: the quality this to be especially true for studies conducted in response to self-directed support initiatives as part of the personalisation agenda.
(Edited publisher abstract)
This scoping review provides an overview of the range of resource allocation approaches that have been adopted in adult social care since the community care reforms of the 1990s, with a particular focus on more recent developments. For the review systematic searches were conducted in Social Care Online, PsycINFO, Medline, Cochrane, OpenGrey, Embase and HMIC. A total of thirty two documents were included in the review (publication 1991- 2012). The studies were separated into two groups: those conducted early in the review period where the assessment and care management process was largely led by professionals and those conducted more recently in response to self-directed support initiatives within the personalisation agenda. The results are discussed in the following areas: the quality of the evidence; perspectives on the principal approaches to resource allocation; the needs and contribution of carers; the role of discretion; the management of finite resources, and long-term prospects are discussed. The review indicates that there is a lack of empirical evidence in terms of both quantity and quality with respect to resource allocation processes and approaches at the micro level. It found this to be especially true for studies conducted in response to self-directed support initiatives as part of the personalisation agenda.
(Edited publisher abstract)
Subject terms:
resource allocation, social care, needs, needs assessment, outcomes, personalisation;
Journal of Adult Protection, 15(2), 2013, pp.69-84.
Publisher:
Emerald
Purpose: This paper presents an overview of research and practice literature on the use of Mediation and Family Group Conferences (FGC) in the context of adult safeguarding in the UK.
Design/methodology/approach: This paper describes the main features of Mediation and (FGC) and explores how such 'family led' approaches to adult safeguarding fit within the wider agenda of personalisation
(Edited publisher abstract)
Purpose: This paper presents an overview of research and practice literature on the use of Mediation and Family Group Conferences (FGC) in the context of adult safeguarding in the UK.
Design/methodology/approach: This paper describes the main features of Mediation and (FGC) and explores how such 'family led' approaches to adult safeguarding fit within the wider agenda of personalisation and empowerment, including the Mental Capacity Act 2005 and its associated Code of Practice. It also considers the main implications for best practice and future research and service priorities.
Findings: Mediation and FGC in an adult context are inclusive processes that enable people to explore choices and options in a supportive environment, assuring maximum possible independence and autonomous control over basic life decisions, while still addressing the person's need for assistance. When used appropriately, both approaches can be a valuable response to safeguarding concerns, promoting choice and control at the same time as protecting people from risk of abuse and harm. However, there are few robust evaluation studies currently available and no systematic research studies were found on cost‐effectiveness.
Originality/value: The paper shows that there is a clear need for further pilots of Mediation and FGC in adult safeguarding. If such research and pilot evaluations find M and/or FGC to be effective, then more consideration will need to be given as to how to integrate such approaches into mainstream social work practice.
(Edited publisher abstract)
Subject terms:
safeguarding adults, mediation, family group conferences, personalisation, family-centred approach, Mental Capacity Act 2005;