Public health, wellbeing and prevention

Under the new NHS and a personalised social care system, promoting public health and wellbeing, as well as ensuring preventative approaches are fundamental to the commissioning endeavour.

What is public health?

The Government accepts the Faculty of Health’s definition as:

The science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of society (Healthy Lives Healthy People Department of Health 2010).

There are three domains of health: health improvement (including people’s lifestyles as well as inequalities in health and the wider social influences of health), health protection (including infectious diseases, environmental hazards and emergency preparedness) and health services (including service planning, efficiency, audit and evaluation) (Healthy Lives Healthy People Department of Health 2010).

What is wellbeing?

The Government has set out definitions of wellbeing:

We use a broad definition of health that encompasses both physical and mental health, as well as wellbeing. This means we are not only interested in whether or not people are ill or have a health condition, but also in how healthy and well they are (Our Health and Wellbeing Today Department of Health Nov 2010).

[Wellbeing is] a positive physical, social and mental state; it is not just the absence of pain, discomfort and incapacity. It requires that basic needs are met, that individuals have a sense of purpose, that they feel able to achieve important personal goals and participate in society. It is enhanced by conditions that include supportive personal relationships, strong and inclusive communities, good health, financial and personal security, rewarding employment, and a healthy and attractive environment. (Our Health and Wellbeing Today Department of Health Nov 2010).

The Government wants to improve the wellbeing of the nation as they see a direct link between wellbeing and improved social and health care outcomes.  For example:

There are huge opportunities to improve health and wellbeing in England. People living in the poorest areas die on average seven years earlier than people living in richer areas, and have higher rates of mental illness; disability, harm from alcohol, drugs and smoking (Our Health and Social Care Act 2012; factsheets. (Overview of the Health and Social Care Act factsheet).

What is prevention?

Prevention is a broad concept and refers to a range of meanings and actual interventions.  Prevention includes:

  • Protecting vulnerable people, including the elderly, from preventative harms such as falls prevention, potential impacts of seasonal weather extremes and providing vaccinations such as the seasonal flu jabs;
  • Promoting health and wellbeing with a view to preventing or delaying the need for more costly services at a later date;
  • Providing low level services to maintain peoples independence;
  • Preventing the need for institutional care;
  • Avoiding crises which might lead to hospital admission / readmission;
  • Reducing the impact of long term conditions.

Who is responsible for public health, wellbeing and prevention?

The Government perceives there to be many levels of responsibility for public health, promoting wellbeing and developing preventative services.  These include:

  • Individuals and communities
  • GP consortia
  • Local Authorities
  • Directors of Public Health
  • Local Health and Wellbeing boards
  • Public Health England
  • Chief medical officer
  • NHS Commissioning Board

For more details about each level refer to Healthy Lives, Healthy People: our strategy for public health in England  and The Health and Care System April 2013.

Implications for Commissioning

Responsibilities for local public health are now firmly placed with local government as set out in The Health and Social Care Act 2012.  Local authorities are in charge of driving health improvement, collating evidence on public health and public health interventions and ensuring that the right mix of arrangements and services are in place to meet population health and well-being outcomes.  This means that local government has to ensure good partnerships with and between key players such as NHS, social care, housing, environment of health, leisure and transport as well as service users, carer’s and the local population. 

Health and Wellbeing Boards (HWBB’s) are the forum where key leaders from the health and care system work together to improve the health and wellbeing outcomes of their local population and reduce health inequalities.  They will undertake a Joint Strategic Needs Assessment (JSNA) and develop a Joint Health and Wellbeing Strategy for their population which will inform planning and consequent commissioning.  This information should be developed with service users and providers and shared with the market so providers and communities can develop responsive and good quality services that meet specified outcomes. This is shared through a Market Position statement (MPS).  HWBB’s will also liaise and work with CCGs and the electorate. 

Promoting public health, well-being and developing preventative approaches requires conceptualising and working more holistically, which inevitably means working with other organisations, professionals and sectors.  Developing good partnerships is fundamental, notwithstanding the duties placed on the NHS Commissioning Board (NHS England), CCGs, Monitor and HWBB’s to promote and enable integration as enacted by the Health and Social Care Act 2012. The draft Social Care and Support Bill  also sets out a similar duty on the local authority to promote the integration of services.

Sources of further information

For further information on developing health and wellbeing strategies click here.

Working Together For Personalised, Community-Based Care And Support.  A Partnership Agreement 2014-17 (Think Local Act Personal TLAP) A Think Local Act Personal new partnership agreement. (June 2014)  The agreement sets out a new vision for personalisation of care and support based on what people have said are priorities. Organisations from the sector have reaffirmed their commitment for action alongside other work streams to support the Care Act Implementation, extend personal health budgets, take an asset-based approach to building community capacity and overseeing implementation of the Personalisation Action Plan that was released earlier this year. This is a very useful document summarising key changes within the sector.

Transforming Primary Care.  Safe, proactive, personalised care for those who need it most. Department of Health (2014)
The Government’s strategy for the future of out-of hospital care services sets out its vision for primary and community care services to become more accessible, personalised and joined up. It looks in to some detail about how other sectors are critical to implementing this vision such as housing, reablement services and co-ordinated care planning.

Living Safely & Well at Home – A practical guide to improving your home to make it safer and healthier (2014).  A practical self help guide to making the home safer and healthier developed by Care and repair and FirstStop and the Older People’s Housing Champions Network.  It looks at common housing problems, how they can effect health, suggest measures to overcome these problems and who to turn to for further help. This is very useful for people in the community as well as professionals.  They have also published a self-training module for health, care and support staff and volunteers, Enabling Older People to Live Safely & Well at Home.

At Home from the Community Matters Series (May 2014)  is one of a number of briefings from an ILC-UK and Age UK seminar series.  This document concentrates on the home environment and its centrality to the wellbeing of people of all ages.  Housing issues impact on independence, personal choice and prevention; joined up cross sector services are key to support health and wellbeing.  The briefing also examines how people ageing in the community can be supported through good design, planning and adaptation of their homes.

How can local authority commissioners work with the care home sector to ensure older people consistently receive high-quality, relationship-centred care? JRF (June 2014) A report that reviews the improvements Essex County Council made to the commissioning of its care home services for older people and reviews the implementation and outcomes of the My Home Life Essex programme which was introduced to improve the relationships between commissioners and care home providers.

Improving quality of life in care homes through community visiting JRF (June 2014) Another case study from Essex about the pilot Community Visitor (CV) scheme which support community engagement in care homes. CVs visit care homes every week for a couple of hours, aiming to befriend older people and encourage communication between care home managers, staff, residents and their families.  The report demonstrates the successful outcomes and findings from the pilot

The Generation Strain: Collective Solutions To Care In An Ageing Society. IPRR (April 2014) A document by IPPR that considers the adverse impacts of an ageing society unless proactive action is taken.  It suggest as a society we should ‘build’ new community institutions that sustain society through societal changes and ‘adapt’ the social structures already in place, such as family caring, public services, workplaces and neighbourhoods. The report presents a number of major recommendations to be addressed as part of a five-year funding settlement across health and social care which includes the building of new neighbourhood networks to help older people to stay active and healthy, help families balance work and care commitments; Care coordinators providing a single local point of contact, to replace the ‘case management’ currently provided by adult social services in every area by 2020; The option of a shared budget to enable those using community care to arrange this collectively and stronger employment rights for those caring for people who need more than 20 hours of care a week, to make it easier for family members to combine work and care.

2030 Vision.  The best - and worse –futures for older people in the UK.  Independent Age. A new report from Independent Age. Building on Independent Age’s own research this new report compiles opinions and concerns expressed by the public and professionals about ageing in the UK and asks how the country can best respond to an ageing population.  On the Independent Age site there are also blogs and other resources.

A very useful series of briefing papers by the National Housing Federation (NHF) have been published that provide a concise over view of the links between housing and health and how both sectors can work together closely to meet holistic need and outcomes. There are six papers that will prove useful for commissioners and providers trying to plan for services that support people and their wellbeing.  The papers are:

Tackling health inequality through housing

Partnerships with NHS providers to improve discharge and community reablement

Managing long term conditions in the community

Partnerships with health to improve housing and mental health

Creative use of NHS land (March 2014)

Quality governance for housing associations (2014)

Personalising the Housing Offer – New Approaches to Housing with Support for People with Disabilities. Housing LIN (June 2014) case study 89  Case study based on a presentation given at the East of England Housing LIN regional meeting earlier in 2014 in Cambridge. It gives an introduction of a housing brokerage service in Essex and identifies the key phases and activities that took place. It is a useful case study for professionals who are trying to develop a housing offer to suit personalisation approaches and gives the basics of what a brokerage service could look like.

Quality Watch is a research programme which provides independent scrutiny into how the quality of health and social care is changing over time. It has been set up by the Nuffield Trust and the Health Foundation Quality Watch has published a new report Focus on Social care for older people.  Reductions in adult social services for older people in England (March 2014).   It looks at the impacts of budget cuts on spending on adult social services from 2010; impacts of budget cuts on access and volume of adult social services and impacts of budget cuts on outcomes such as wellbeing and health service.

A better life for older people with high support needs: the role of social care May 2014, The Joseph Rowntree Foundation (JRF) A Better Life Programme has identified seven key challenges that should be met for older people with high support needs, so that they can achieve a better quality of life. This briefing summarises each of the seven challenges set out by JRF, along with relevant SCIE resources related to meeting the challenges.  It is a very useful resource to support thinking about wider commissioning approaches and what quality services should look like.

The Housing Learning and Information Network (HLIN) are hosting on their website materials and resources for the Housing and Safeguarding Alliance. Resources include membership of the group, a useful briefing paper on housing and safeguarding and good practice examples of safeguarding adults policy and procedures.

MAKING A START – Dementia Skilling the General Needs Housing Workforce May 2014 Sue Garwood on behalf of the Dementia and Housing Working Group.  An interesting new report and resource pack to assist housing providers to develop their workforce to work effectively with people who have dementia.  The work is targeted at general need housing providers however the materials can apply to specialist and private sector providers.  This is a useful resource when thinking about how housing can contribute to health and social outcomes.

Skills for Care has launched their new microsite Commissioning Assisted Technology, which features three resources aimed at commissioners in the social care and health sector who have responsibility for commissioning assisted living technology (ALT) and assisted living services (ALS). The website is a good source of information and has a commissioner guide as well as a research chapter and an impact assessment toolkit.

Who Cares? The Role That Entrepreneurs And Technology Can Play In Improving Informal Care In The UK by Nesta. 
An interesting report that looks at the importance of informal care to the health and social care system and how technology can assist with informal care arrangements.  This report provides a market analysis and provides four areas of potential growth; communication tools between family and friends to reduce social isolation; platforms or marketplaces that engage potential informal carers from the community; care management/ coordination tools and tools that improve links between individuals, informal carers and formal care providers to improve quality and continuity of care.  This document is particularly useful for commissioners developing the market to promote self-care initiatives and better support for those caring and being cared for.

Caring and Earning Among Low-Income Caribbean, Pakistani and Somali People May 2014 Joseph Rowntree Foundation (JRF)
This research looks at the experiences of low-income Caribbean, Pakistani and Somali people in balancing work and care responsibilities. It looks at both the particular challenges faced by these ethnic minority groups, and the challenges for employers and policy. Its main findings include that discrimination prevents people from balancing work and care effectively; that many people are unaware of free childcare arrangements for 2-4 year olds and that changes in benefits are likely to make balance between work and care more difficult.  It also found that there were many different attitudes to caring and that carers were predominantly women.

Raising concerns at work: whistleblowing guidance for workers and employers in health and social care April 2014 New Department of Health guidance that contains a number of recommendations, aiming to help make whistleblowing an important part of quality improvement across health and social care services. The guidance sets out why it is important to raise concerns, relevant law and top tips and guidance for workers, managers and employers.  A Whistleblowing helpline has been set up to support people to come forward if they have concerns regarding quality.

Common core principles to support good mental health and wellbeing in adult social care 2014.  A Skills for Care report outlining principles for staff working in social care services to help them support and promote good mental health and overall wellbeing for those who use services.  The report is divided into ten principles, setting out the context for each one and corresponding indicative behaviours.  It also provides guidance for leaders and managers, training and education leads, and commissioners to develop a workforce that can support good mental health for people needing care and support.

Mental Healthwatch handbook: improving mental health with your community April 2014.  A handbook developed by the National Survivors User Network (NSUN) which provides information on how Healthwatch can help improve mental health in the community with a range of partners including central government, service users, commissioners, providers, the voluntary sector and councils.  About 30 service users joined 15 Healthwatch from around England to launch the handbook and took part in training together.  It is a good example of a co-produced approach to improving services.

North East Dementia Friendly Communities Resource Guide 2014.  A joint publication by Northumbria University and North East Dementia Alliance which demonstrates some approaches to meeting the spiritual needs of people with dementia.  It is a very useful document which contains a range of information including guides, websites and film clips. The case studies featured in this publication are very useful examples for professionals who want to facilitate and shape local/ grass roots support for people with dementia in their communities.

Think autism: fulfilling and rewarding lives, the strategy for adults with autism in England: an update April 2014.  A document that establishes a clear programme that the Department of Health and other government departments will be taking to improve the lives of people with autism.  The strategy sets out support for local implementation for local authorities, the NHS, other public services and partners. It also focuses on raising awareness of autism in communities and improving accessibility of support for people with autism.

Dementia Friendly Yorkshire: First Steps On The Journey Jan 2014 The Joseph Rowntree Foundation (JRF) have pulled together twenty examples of grass-roots dementia friendly projects in Yorkshire.  This is a useful document for professionals working with local champions and wanting to develop dementia friendly communities.

NHS Health Check: frequently-asked questions.  September 2013 (Local Government Association (LGA) and Public Health England (PHE)) This document lists Frequently Asked Questions (FAQs) to address a number of transitional issues relating to the transfer of responsibility for commissioning NHS Health Check to local government.

National Summary of the Results of the 2013 Community Mental Health Survey (Care Quality Commission CQC) A summary of a survey carried out by CQC which asks about the experiences of more than 13,000 people who have used  community mental health services during the past 12 months.  It highlights a number of areas of concern such as lack of people’s involvement in their own care planning and lack of taking into account people’s views in regard to medication.  The report provides a number of recommendations to improve practice.

Local Healthwatch outcomes and impact development tool, 9th September 2013.  (Local Government Association (LGA) and Healthwatch) An outcome and impact development tool to promote the development of Healthwatch locally.

Delivering effective local Healthwatch Key success factors, 9th September 2013.  (Local Government Association (LGA) and Healthwatch) A document that sets out key factors to assist with the development and implementation of Healthwatch as a consumer champion.  This document is an update on Developing effective local Healthwatch.  It has been written to help councils better understand the commissioning and review of local Healthwatch.  It is also a useful document for local Healthwatch as it sets out what is expected of them and how they can deliver on this.

Attributing a monetary value to patients’ time.  A contingent valuation approach.  September 2013 (The University of York, Centre For Health (CHE).  Bernard van den Berg et al.) An interesting paper that tries to calculate and develop a monetary valuation of patient time.  The paper states that patient’s time is more than simply treatment time but also waiting times, travel time etc.  The paper uses the contingent valuation method and it is hoped a wider perspective and valuation of patient time will give a more realistic insight into the economics of health and well-being interventions.

Potential for Change. Transforming public awareness and demand for health and care technology, attitudes to using technology to support caring for older and disabled loved ones. July 2013 (Carers UK) Carers UK, supported by Tunstall Healthcare (UK), commissioned a national opinion poll exploring attitudes towards health and care technologies.  The research shows a lack of public knowledge of health and care technology, even amongst families using technology

Healthy Life Expectancy at birth for Upper Tier Local Authorities: England, 2009-11 (Office for National Statistics) Statistics in regard to life expectancy at birth for upper tier local authorities. 

Abuse of Vulnerable Adults in England – 2012 -13, Provisional report, Experimental Statistics (Health and Social Care Information centre (hscic) Statistics on abuse of Vulnerable Adults in England 2012-2013.

Building dementia-friendly communities: A priority for everyone, August 2013 (Alzheimer’s Society) This report provides perspectives of dementia-friendly communities from people affected by dementia and their carers. It explores barriers in the community for people with dementia and also reveals that many would like to further engage with their local area and be supported to do so. It brings together existing evidence and describes good practice examples of projects that are making a difference for people with dementia. The report also provides a definition of dementia- friendly communities and ten key areas for communities to focus on to become dementia friendly.

World Alzheimer Report 2013 Journey of Caring.  An Analysis of long-term care for dementia. September 2013 (Alzheimer’s Disease International and Bupa) This report provides international statistics in relation to Alzheimer’s and long-term care.  It looks at how the traditional system of informal care by family, friends and community will require more support and how care and financing has to adapt to cope with demographics.

Health and Wellbeing Boards; Orchestrating The Possible For Integrated Care.  How Boards can harness the energy of partnerships to achieve real change.  OPM, University of Birmingham, Institute for Local Government Studies, Health Services Management Centre (2013) A very useful handbook for members of Health and Wellbeing Boards to assist them in making the best use of relevant partnerships.  It is set out in four clear sections titled; Have you got the basics right? How will you engage with stakeholders? How will you add value? How will you know if you are making a difference?

Developing Supportive Design for People with Dementia. January 2013 (King’s Fund). There is growing awareness of the importance of the environment within health care. The King's Fund's Enhancing the Healing Environment (EHE) programme encourages and enables nurse-led teams to work in partnership with patients to improve the environment in which to deliver care. This publication marks the completion of 26 schemes in 23 NHS acute, community and mental health hospitals in England to improve the environment of care for people with dementia. The programme was funded by the Department of Health as part of work to support the implementation of the National Dementia Strategy in England. This publication seeks to provide practical, value-for-money examples to encourage and inspire staff and their organisations to provide an environment of care that better supports people with dementia. As well as case studies it includes information about the development and evaluation of the assessment tool; design principles for creating a more supportive environment for people with dementia; and a project directory detailing the artists and designers involved in each scheme and costs involved.

Research and development work relating to assistive technology, July 2013 (Department of Health)
This is a government report, prepared by FAST, which outlines the wide range of government funded projects supporting the development, introduction and evaluation of assistive technology for disabled and older people.

CDEC Open Health Data Platform This site takes data from sources like the Health and Social Care Information Centre (HSCIC) and shows how it can be turned into useful analysis.  The website shows how to take a small number of datasets, including data about GP prescriptions and diabetes prevalence, to show the extent of diabetes treatment in the UK.  This is useful information and data when thinking of health and well-being interventions for people with diabetes.

Oxleas Advanced Dementia Service, Supporting carers and building resilience, September 2013 (The Kings Fund) A case study that looks at Oxleas Advanced Dementia Service.  The service provides care co-ordination, and specialist palliative care and support to patients with advanced dementia living at home.  This case study is part of a wider research project carried out by The King’s Fund and funded by Aetna and the Aetna Foundation in the United States.  The research project is to compare five successful UK-based models of care co-ordination

3 million lives, improving your access to telehealth and telecare   is a website committed to promoting telehealth and telecare.  It headlines the findings from the Whole Systems Demonstrator (WSD) programme which is the world’s largest randomised control trial of telehealth and telecare services involving 6,000 people across three sites.  The programme, supported by the Department of health, aims to pull together a fully evaluated evidence base for telehealth and telecare.   This is a very useful resource for commissioners given the increased momentum to commission efficient, integrated and high quality support and care services.

Transforming care: A national response to Winterbourne View Hospital. December 2012 (Department of Health).  The report sets out the government’s final response to the events at Winterbourne View hospital. It sets out a programme of action to transform services for people with learning disabilities or autism and mental health conditions or behaviours described as challenging.

The identification and detection of dementia and its correlates in a social services setting: Impact of a national policy in England. Clarkson, P et al. Dementia 2012 11 (5). Dementia continues to be under-recognised. Policy addressing this has focused on the role of general practice-based staff, but dementia represents an area in which closer collaboration between community health and social services can reap benefits. This study examined the impact of the Single Assessment Process (SAP), aimed at improving assessments by the use of shared procedures and assessment tools. Impact was measured in terms of the reliability by which dementia, and associated conditions, were identified and correctly detected in one area’s statutory community care assessments. Recognition of dementia was significantly improved after the policy.

Health policy under the coalition government. November 2012 (King’s Fund). Written halfway through the 2010–2014 parliament, this review considers how the NHS is performing under the coalition government. It examines the policies introduced by the coalition government, assesses how far these will address current and emerging performance issues, and identifies further action needed. The report focuses its findings on eight key aspects of health care: access, patient safety, promoting health, managing long-term conditions, clinical effectiveness, patient experience, equity, and efficiency. It addresses these against a backdrop of three significant areas of change: major reforms to the NHS, the drive to achieve £20 billion of productivity savings by 2015, and reduced spending on social services.

Falls: measuring the impact on older people. 2012 (WRVS). Interviews were held with 500 older people in England, Scotland and Wales asking about their experiences of falls. One in three people aged over 65 falls every year. Hospital readmissions for the over 75s have risen annually in the period from 2006 – 2011. Falls can be prevented and with the right support, many older people who have fallen can be supported not to fall again.

How is the NHS Performing? November 2012 (King’s Fund). This report aims to take stock of how the NHS is performing, providing an update on how the NHS is coping as it continues to grapple with the £20 billion productivity challenge while implementing the government’s NHS reforms. It finds that NHS performance is continuing to hold up well, but there is concern that quality of care may suffer as financial pressures bite from 2013.

The impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life. November 2012 (Nuffield Trust). This study examines whether the home-based nursing service provided by Marie Curie Cancer Care helps more people to die at home, and reduces hospital use and costs at the end of life.

Cold Weather Plan for England 2012: Protecting health and reducing harm from severe cold. October 2012 (Department of Health). The Cold Weather Plan sets out what should happen before and during severe winter weather in England. The Cold Weather Plan is to help raise awareness of the dangers of cold weather on health with both the general public and professionals alike and to galvanise and focus efforts by local authorities, the NHS and partners in the voluntary and community sector. It spells out what preparations both individuals and organisations could make to reduce health risks and includes specific measures to protect at-risk groups.

Care and support at home: An audit of telecare services in England. September 2012 (Good Governance Institute). This GGI report provides a number of recommendations aimed at Government and local authority officials about how Telecare services and user outcomes can be improved. It is targeted at policy-makers, local authority councillors with an interest in adult social care, local authority directors of adult social services, and health and wellbeing board members. Its purpose is to encourage decision-makers to understand the current provision of Telecare services in England and how services can be improved for the future.

Review of Carers Direct information and advice. July 2012 (Department of Health).  Access to good information and advice is important in supporting carers to get the best from their own lives and assist them in getting the right help to maintain them in their caring role. Carers Direct was set up in 2009 to provide a focused information and advice service to carers. This review looks at the arrangements for delivery of the service. The review found that the service met the initial objectives set for the improvement of advice and information available to carers. It also suggests a way forward towards ensuring a coherent, cost effective approach to services that is aligned with developing policy and delivers a quality service to carers.

Winterbourne View – A serious case review. July 2012 (South Gloucestershire Safeguarding Adults Board). The report into the abuse of people with learning disabilities at Winterbourne View, a private hospital in South Gloucestershire, catalogues a series of serious failings by both the hospital and agencies involved in safeguarding adults. This report follows the BBC Panorama programme Undercover Care: the Abuse Exposed screened in May 2011, which showed Winterbourne View Hospital staff mistreating and assaulting adults with learning disabilities and autism. It aims to identify the lessons to be learned by all organisations involved.

Building a business case for investing in adaptive technologies in England. July 2012 (PSSRU). For thousands of dependent adults in England, equipment and adaptations play a vital role by allowing people to live independently in their own homes.   The range of benefits that can be attributed to these interventions are well documented, both in terms of their impact on quality of life and the significant reduction in the demand for care that can be achieved through the avoidance, or delay in the onset, of the need for health and social care services. The study described in this paper reviews and uses the evidence available in the literature to generate estimates of the overall costs and benefits associated with adaptive technologies.

Loneliness and Cruelty. 2012 (Lemos & Crane and the Foundation for People with Learning Disabilities). This research builds on existing work around disability hate crimes, expanding the debate to look at the full range of experiences of people with mild or moderate learning disabilities living independently in the community. The need for the research emerged from discussions with many organisations working in the learning disability field following the case of Fiona Pilkington who killed her disabled daughter and herself. Reports suggest that people with learning disabilities are suffering routine harassment and abuse, and this is a particular issue in socially deprived neighbourhoods. 

Building social value in the NHS. June 2012 (NHS Confederation). Social value describes the social benefits achieved from public services, and considers more than just the financial transaction. It includes wellbeing, health, inclusion and employment. This paper develops what we understand by social value and what it means for the NHS.

Quick wins … and missed opportunities. June 2012 (RNIB and OPM). This research report looks at how local authorities can work with blind and partially sighted people to build a better future. The research included focus groups with a representative range of blind and partially sighted people, in-depth interviews, and case studies of best practice in three local areas. The report highlights five key areas that were more important to blind and partially sighted people’s lives, where a local authority could make most difference. These are: independence, wellbeing, fulfilling potential, keeping informed, being treated equally. The suggested changes would ensure that transport, information, the built environment and leisure activities are accessible to blind and partially sighted people, and that local voluntary organisations and key preventative and rehabilitative services are supported.

Preventing loneliness and social isolation among elderly people. May 2012 (SCIE). This briefing based on research into loneliness among elderly people includes details of examples of preventative services. It is estimated that among those aged over 65, between 5 and 16 per cent report loneliness, 12 per cent feel isolated, and it is likely that these statistics will increase. Research has shown that social isolation can impact on blood pressure, is associated with depression and also with higher rates of mortality. The services that aim to reduce loneliness tend to be either one-to-one interventions or group services and wider community engagement, but it has been difficult to assess the success of these services. However, from the evidence that does exist, befriending schemes, social group schemes and Community Navigators seem to be the most successful.

Delivering Dignity - Securing dignity in care for older people in hospitals and care homes. June 2012 (Local Government Association, Age UK and NHS Confederation).  Many recent reports have highlighted what is wrong in the care of older people and identify what service they have a right to expect. This report and its 37 recommendations focus on how to tackle the underlying causes of poor care.

Learning Disability Services Inspection Programme National Overview. June 2012 (Care Quality Commission (CQC)).  This national overview report provides an analysis of the findings of 145 inspections. The report highlights the key areas of concern. One of the most significant findings is that in too many cases care was not person centred; people were fitted into services rather than the service being designed and delivered around them. The findings demonstrate that services for people with learning disabilities still need to improve and that this requires a whole system response and approach from the policy makers, the providers, the commissioners and the regulators.

End of Life Care for People with Dementia Living in Care Homes. May 2012 (SCIE). There are a growing number of government initiatives in health and social care relating to end of life care, some of which have a specific focus on dementia care. A high percentage of people with dementia die in a care home, or in hospital having been transferred from a care home, and evidence shows that people with dementia often receive poor care at the end of their lives. This paper looks at some of the issues around end of life and dementia and also some of the opportunities for improving care. Evidence suggests that palliative care in care homes is not always well provided or understood, and little training is given to staff. More support is needed to ensure care home staff are capable and feel comfortable in having these discussions, including training on communication with family carers. 

Redesigning the front end of social care. May 2012  (In Control, Shared Lives Plus, Community Catalysts and Inclusive Neighbourhoods). There are many aspects to the social care system. This paper focuses on the ‘front end’ of the system – what happens when a person first encounters social care. It looks at the experiences of assessments and discussions about eligibility and access to services. It asks what those processes do to an individual’s independence and to their relationships with their family and community. The paper is intended as a starting point for debate.

Older people’s housing: Choice, quality of life and under-occupation. April 2012 (New Policy Institute for Shelter and the Joseph Rowntree Foundation). Recent messages from Government have included the suggestion that some older people are over-occupying properties, and the suggestion is made that they may need to downsize. However, this paper suggests that there is limited choice for older people who want to move to both specialist and alternative mainstream housing. There is a tendency for housing providers to look at retirement villages and housing with care when thinking about housing for older people, the paper suggests that this is not necessarily what people want. The paper is clear that what is needed are better choices for older people. In addition to the issue of freeing up larger homes, there is evidence that older peoples’ health can benefit from moving to more suitable housing, providing it is an informed choice and they remain in control. For many, staying put can also be the right choice.

Improving hospital admission and discharge for people who are homeless. March 2012 (St Mungo’s). This report was commissioned by the Department of Health to support work to deliver a policy commitment to ensuring that people at risk of rough sleeping are not discharged from hospital without accommodation.  It gathered first-hand experience of homeless people and organisations at different stages of the hospital admission and discharge pathway to find out what the different models are, what good practice is, and what the challenges are to put these measures into practice. The researchers found that whilst some areas have put in place measures to help address the accommodation needs of homeless people when they are in hospital, this has not happened routinely. In a lot of cases, homeless people reported being discharged straight back to the streets with nothing being done to address their housing problems, or more chronic health issues.

My Home Life is a UK-wide initiative promoting quality of life for those involved with care homes for older people, through relationship-centred care and evidence-based practice.  Initiated by the National Care Forum and Help the Aged, My Home Life’s vision of best practice is underpinned by an evidence base developed by researchers in partnership with care home practitioners, independent advisors and voluntary groups, to examine evidence on the quality of life of older people in care homes. The My Home Life team have put together a programme of ongoing research and development to help staff optimise the quality of life in care homes. Click here to view the My Home Life website to look at their research and good practice or to download resources and materials.

The Education Act 2011 is an important step in implementing the Government’s education reform programme, helping to create an education system that will deliver higher standards for all children. The Act takes forward the legislative proposals in the Schools White Paper, The Importance of Teaching, and measures from the Department for Business, Innovation and Skills to improve skills.

The Case for Tomorrow: Joint discussion document on the future of services for older people. March 2012 (Association of Directors of Adult Social Services (ADASS) in partnership with the Institute of Public Care (IPC)). This discussion paper offers a timely assessment of the future development needed in services for older people.  The document builds on earlier ADASS research into the over-reliance on complex, acute care and relative shortfall in preventative, community-based provision. Specifically, the paper identifies the challenges remaining if a rebalancing is to be realised, and the interventions required from government to realise that aim.

Prime Minister’s Challenge on Dementia - Delivering major improvements in dementia care and research by 2015. March 2012 (Department of Health).  This document sets out the Prime Minister’s challenge on dementia, an ambitious programme of work to push the delivery of major improvements in dementia care and research by 2015, building on the achievements of the National Dementia Strategy.

Long-term conditions and mental health: the cost of co-morbidities. February 2012 (The King’s Fund and the Centre for Mental Health). Many people with a long-term physical health condition also have mental health problems, and many of them experience significantly poorer health outcomes and reduced quality of life as a result. In terms of NHS spending, at least £1 in every £8 spent on long-term conditions is linked to poor mental health and well-being – between £8 billion and £13 billion in England each year. This paper suggests that care for a large number of people with long-term conditions could be improved and suggests that developing more integrated support for people with mental and physical health problems could improve outcomes and play an important part in helping the NHS meet the quality, innovation, productivity and prevention challenge.

Safeguarding and quality in commissioning care homes and Commissioning care homes: common safeguarding challenges. February 2012 (SCIE). SCIE has published two new sets of guides on commissioning for effective adult safeguarding in care homes. The first looks at how safeguarding in care homes should be central to the commissioning process, whilst the second identifies issues that lead to safeguarding referrals from care homes.

Making Best Interests Decisions. January 2012 (Norah Fry Research Centre at Bristol University and the Mental Health Foundation). This report shares the findings from the Best Interests Decisions Study, the first large-scale national research study that looked at professional practices in best interest decisions under the 2005 Mental Capacity Act. A best interest Decision is made on behalf of someone who may lack capacity to make specific decisions.

Involving older people in commissioning: More power to their elbow? December 2011 (Joseph Rowntree Foundation).  This report studies older people’s wishes and experiences of commissioning health and personal care services.

Close to home: An inquiry into older people and human rights in home care. November 2011 (Equality and Human Rights Commission). The inquiry has found that although many older people receive care at home which respects and enhances their human rights, this is by no means a universal experience. It uncovered areas of real concern in the treatment of some older people and significant shortcomings in the way that care is commissioned by local authorities.

Building Community Capacity: Evidence, efficiency and cost-effectiveness. October 2012 (Think Local Act Personal). This paper briefly draws together some of the evidence that Think Local Act Personal (TLAP) is aware of that contributes to demonstrating better outcomes, or in some cases, the financial benefits of nurturing stronger communities. There are some fundamental lessons to learn about the health-preserving effects of good social networks, connected communities, the value of peer support and the multiplicity of outcomes well beyond social care that can be improved by working with local people in a co-productive way. There is a strong case to be made for a joined-up, local approach to health and wellbeing that seeks to connect people together and to create the conditions for happier, healthier communities through participation and inclusion. 

Making every contact count - A joint approach to preventing homelessness. August 2012 (Department for Communities and Local Government).  This report looks at how services can be managed in a way that prevents all households, regardless of whether they are families, couples, or single people, from reaching a crisis point where they are faced with homelessness. It draws up a list of ten local challenges for local homelessness teams to consider.

Developing effective local Healthwatch. August 2012 (LGA (Local Government Association)). This briefing focuses on developing effective local Healthwatch arrangements. Healthwatch will be the new independent consumer champion for both health and social care, created by the Health and Social Care Act 2012, and will exist at local and national level. It is recognised that a well-performing local Healthwatch will help drive up the quality of local services, resulting in improved experience and outcomes for people who use them. This document sets out a collective view of what the key characteristics of an effective local Healthwatch would look like, structured around the key statutory roles.

End of Life Care for People with Dementia Living in Care Homes. May 2012 (SCIE). There are a growing number of government initiatives in health and social care relating to end of life care, some of which have a specific focus on dementia care. A high percentage of people with dementia die in a care home, or in hospital having been transferred from a care home, and evidence shows that people with dementia often receive poor care at the end of their lives. This paper looks at some of the issues around end of life and dementia and also some of the opportunities for improving care. Evidence suggests that palliative care in care homes is not always well provided or understood, and little training is given to staff. More support is needed to ensure care home staff are capable and feel comfortable in having these discussions, including training on communication with family carers. 

Health care in care homes: A special review of the provision of health care to those in care homes. March 2012 (CQC). This review addresses how older people and people with learning disabilities living in care homes access healthcare services, whether they have choice and control over their healthcare and whether they receive care that is safe and respects their dignity.

Yorkshire and Humber Health Innovation and Education Cluster (HIEC). Health Innovation and Education Clusters (HIECs) have been set up to support health care providers, higher educational institutions and industry to work together at a regional level and local level to drive innovation and improvements in patient care, and raise the quality of healthcare education and training.  The Yorkshire and Humber Health Innovation and Education Cluster (Y&H HIEC) includes all regional NHS organisations and universities with healthcare faculties, making it one of the largest in the country.

A Better Life: what older people with high support needs value. November 2011 (Joseph Rowntree Foundation).  This report explores what older people with high support needs want from and value in their lives, and suggests a model for exploring factors that are facilitatory or compromising in these terms.

The Exemplar Employer Recruitment Framework (Wakefield District Partnership 2011) provides a structure in the form of eight components, each containing practical support, guidance and toolkits based on best practice to support employment and retention of people with learning disabilities, autistic spectrum and mental health conditions, and the contribution they can make to the workforce.

Carers support service. 2011 (Age UK Leeds).  This project was commissioned by the Department of Health and was designed around the success of the Older Carers Support Service [Learning Disabilities] in Leeds, currently operating with over 240 carers in Leeds. In applying for the Carers Innovation Fund the objective was to expand this service to provide support for older carers in Leeds. This report details the progress of the development of this service and illustrates the foundations laid in setting up referral protocols and procedures with statutory and third party sectors, to identify carers and support them in their role. The project has two elements; to develop a Carers Support Service for Older Carers in Leeds, based on the model of the Older Carers Support Service already operating at Age UK Leeds; and to research and assess the need for a Distance Carers service.

Telemonitoring for Long Term Conditions and Teleconsultation for Healthcare Services. October 2011 (Y&H HIEC). "How to" workbooks for Managers and Clinicians. Using best current knowledge and practical insights the Yorkshire and the Humber Health Innovation and Education Cluster (Y&H HIEC) have designed two easy to use "how to guides" for health and care managers and clinicians to increase understanding, set out the benefits and lead step by step implementations of new service models incorporating Telemonitoring and Teleconsultation. The easy read style and jargon-free content should also appeal to users and carers who want both bite size and comprehensive information on this emerging and important subject. Each workbook includes an implementation checklist to guide and assist.

Dignity and Nutrition – Inspection Programme. October 2011 (Care Quality Commission (CQC)). In response to the Secretary of State’s request, CQC planned and delivered a series of 100 unannounced inspections of acute NHS hospitals in England between March and June 2011, looking at standards of dignity and nutrition on wards caring for elderly people. Each individual hospital report has already been published and this national report summarises what was found.  

Issues facing commissioners of end-of-life care.  September 2011 (The King’s Fund). The diverse needs of people nearing the end of life mean that commissioners need to develop approaches to commissioning integrated and personalised care. There are a number of challenges to effective commissioning of end-of-life care, including defining what constitutes end of life, calculating the associated costs, and defining appropriate outcomes.  Further evidence is required about what is known to work in the commissioning and provision of end-of-life care. This paper seeks to address this evidence gap – highlighting current barriers in funding and commissioning as well as opportunities within the system to use commissioning as a lever for meeting the challenges outlined by the coalition government. It  provides a synthesis of and narrative on the issues facing commissioners of end-of-life care and focuses on three major priorities in the approach to organising and commissioning health care: integration, clinically led commissioning and personalisation of care.

Social care and clinical commissioning for people with long-term conditions. September 2011 (Social Care Institute for Excellence). How can clinical commissioners secure best use of social care to maximise outcomes and improve patient experience, while ensuring efficient, affordable care into the future? With an ageing population and rising numbers of adults with long-term conditions (LTCs), more integrated working is vital to achieving good outcomes for people and making best use of scarce resources. This briefing is a summary of some of the ways in which working with adult social care can help clinical commissioning groups manage their new responsibilities.

The British Association for Supported Employment (BASE) is the national trade association representing hundreds of agencies involved in securing employment for people with disabilities.

What standards to expect from the regulation of your care home and What standards to expect from the regulation of agencies that provide care in your own home February 2011. The Care Quality Commission has published two guides for people who receive care in a care home or in their own home.  The leaflets provide an overview of important changes to adult social care regulation. This paper is particularly useful in providing information to service users and their families which should be encouraged by both Local Authorities and providers in supporting service users and their families to make the best informed decisions. CQC have also published information on essential standards of quality and safety service users should expect.

Handypersons evaluation: interim key findings. February 2011. Department for Communities and Local Government.  A research report that provides interim findings from the first year of the Department for Communities and Local Government handyperson programme.  The report looks at value for money and whether service user outcomes/ needs have been met.  Findings include that Handypersons services contribute to the prevention of falls, reduce the risks of burglary or fire, postpone entry to a care home and facilitate earlier hospital discharge. The report also provides details of actual savings that can be made via Handypersons intervention. This provides useful information for commissioners and budget holders because from April 2011 handypersons funding will be rolled into the unringfenced Formula Grant; national allocation will be £15.5m for 2011-12 and £13.5m for 2012-13.

Protecting adults at risk: London multi-agency policy and procedures to safeguard adults from abuse. January 2011 (Social Care Institute for Excellence (SCIE)).  This report is for organisations that have responsibility for safeguarding adults at risk in London, however it is relevant to other local authorities and partnerships.  The report sets out four main areas of focus that all agencies and individuals should commit to, to ensure the safety of vulnerable adults.  Firstly the need to work together to prevent abuse and protect adults at risk, secondly to empower and support people to make their own choices, thirdly to investigate actual or suspected abuse and finally to support adults and provide a service to vulnerable adults who may be experiencing abuse, neglect or exploitation.

Whole Sytem Demonstrator Programme - Headline Findings December 2011. (Department of Health, WSD Action Network (WSDAN)).  The Whole System Demonstrator programme was set up by the Department of Health to show just what telehealth and telecare is capable of. To provide a clear evidence base to support important investment decisions and show how the technology supports people to live independently, take control and be responsible for their own health and care.

Home Care Re-ablement Services: Investigating the longer term impacts. January 2011 (Social Policy research Unit University of York (SPRU)).  This research paper looks at the immediate and longer term impacts and costs of re-ablement and configuration of different re-ablement services.  The report found that re-ablement was associated with a decrease in need for subsequent services, had a positive impact of service users quality of life compared to traditional home care interventions and proved cost effective for health and social care costs, using the National Institute for Health and Clinical Excellence (NICE) cost-effectiveness threshold.  However the reduction in social care costs was almost entirely offset by initial costs of the re-ablement intervention. 

How can local authorities with less money support better outcomes for older people?  January 2011 (Center For Policy on Ageing, Joseph Rowntree Foundation).  The report acknowledges that older people appreciate that ‘little bit of help’ and that low level services are important in increasing well-being, quality of life and delivering improved outcomes for older people. However, low level services may be given less of a priority given the increasing financial pressures on local Authorities. As a response to this the report identifies four approaches to delivering effective and good outcomes for low level services for older people.  Involvement; involving service users in the shaping of the services.  Investment; facilitating the wider market to be able to provide low level services such as developing collective solutions, small grants or seed funding for self help groups.  Refocusing; changing the mind set from thinking of conventional social care services and instead thinking of what assistance older people require and want and then developing or stimulating provision as a response to these.  Connecting; developing place-based approaches that meet holistic requirements which will require commissioners and providers making connections within and across the community and other sectors.   The report provides examples of projects that have proved affordable and effective in providing low level services for older people.

Valuing People Now: Summary Report March 2009 - September 2010. December 2010 (Department of Health). This report looks at progress made in the first 18 months of the Valuing People Now strategy.  It includes findings from Learning Disability Partnership Board self assessments 2009-2010 and shows key improvements such as an increase in people with learning disabilities having an annual health check, increased numbers of people moving into their own homes from residential setting and improvements in people with learning disabilities finding employment.  However areas of improvement are still needed, especially around ensuring appropriate transition from children’s services to adult services, achieving better consistency of choice and quality of  health and social care services and for all health and social care service to fully understand the needs of people with learning disabilities.

The Big Society and innovation in care and support for adults: Key messages from SCIE expert seminars. November 2010 (Social Care Institute for Excellence (SCIE)). This paper presents the key messages from two SCIE expert seminars.  Innovate and Fly: Supporting quality and efficiency in tough times (co-hosted with The Innovation Unit) 9 July 2010 and Big ideas, Big Society: innovation in care and support (co-hosted with the Department of Health) 5 August 2010. The seminars focused discussions on how commissioners can develop innovative and personalised support in adult social care within an environment with fewer resources. They provide useful insights and ideas for all professionals working in commissioning organisations that are faced with these opportunities and challenges.

‘The billion dollar question’: embedding prevention in older people’s services — 10 ‘high impact’ changes Health Services Management Centre, University of Birmingham Policy discussion paper. (August 2010)  This paper looks at the very real challenges of implementing preventative services in the context of increasing demographic and social pressures.  While acknowledging that prevention is difficult to prove the report suggests some interesting ways to further improve older people’s health and wellbeing and suggest arrangements to better preventative approaches. 

‘Only a footstep away’?: neighbourhoods, social capital and their place in the ‘big society’.  A skills for care workforce development background paper (June 2010) This Skills for Care  paper looks at how local communities can support service users and carers in their community to contribute to the ‘big society’. The report explores how Skills for Care and other key stakeholders can build upon the skills of local people in communities to help them contribute to adult social care outcomes by helping vulnerable people in their communities.  The report contains a review of the literature around community skills and leadership approaches.

State of the adult social care workforce in England, 2010.  Skills for Care Skills for Care research report into the social care workforce in England.  The report provides useful statistics about the adult social care workforce.  The report statistics have derived from an improved data set; Skills for Care’s National Minimum Data Set for Social Care and national statistics from the Office of National Statistics.

State of Care CQC (Care Quality Commission) annual report looking at the state of care in England.  It provides details on how well health and social care services have performed in 2009, and highlights improvements.  There is a useful webpage with videos and service user's personal stories.

Commissioning for Carers and Commissioning for Carers: an Action Guide for Decision Makers. These guides are funded by the Department of Health and serve as blueprint for better commissioning to achieve high quality outcomes and targets in respect of carers (September 2009)

The first ever DH National Dementia Strategy 'Living well with Dementia' is a landmark document that will transform the quality of dementia care. It sets out initiatives designed to make the lives of people with dementia, their carers and families better and more fulfilled.  It will increase awareness of dementia, ensure early diagnosis and intervention and radically improve the quality of care that people with the condition receive. Proposals include the introduction of a dementia specialist into every general hospital and care home and for mental health teams to assess people with dementia (February 2009).

The Centre for Policy on Ageing is a research and policy influencing organisation with a remit to focus on the wide-ranging needs of older people. The Centre has a policy and research department, a library and information service, and publications including downloadable research briefings on a variety of topics e.g. social inclusion and living arrangements for older people. The Centre has links to the journals Ageing and Society and the British Society of Gerontology.

Community Care makes articles available for download. These include 'Independent Living Fund is past its prime' (Bob Hudson and Melanie Henwood, March 2007) and 'Taking the accent off the acute' (S Mithran, June 2006), which argues that the shift from acute to community services must overcome conflicts between some of the policy strands currently operating and change fatigue among GPs and within PCTs.

The Health Services Management Centre at Birmingham University specializes in development, education and research in health and social care services. Recent research publications include: Making the Shift : A review of the NHS Experience (July 2006) which explores how to achieve the government's vision of community-based care; Reducing unplanned hospital admissions: what does the literature tell us? (March 2006); and Improving care for people with long-term conditions (May 2006).

The Housing Learning & Improvement Network (LIN) is the national network for promoting new ideas, good practice and supporting change in the delivery of housing, care and support services for older and vulnerable adults, including people with disabilities and long term conditions.

The Joseph Rowntree Foundation at www.jrf.org.uk is a social policy research and development charity. Relevant projects include Older people's views and experiences of resources in later life (April 2007), Building a good life for older people in local communities (October 2004), and the Older people shaping policy and practice programme.

The King's Fund offers papers and research on health policy related issues, some of which are downloadable, these include An anatomy of GP referral decisions (January 2007).

The National Institute for Health Research has a number of research programmes including the Service Delivery and Organisation (SDO) programme where downloadable research summaries include Peter Griffiths, Roz Ullman and Ruth Harris (March 2007) 'Self-assessment of health and social care needs by older people'.

The Personal Social Services Research Unit (PSSRU) at the University of Kent undertakes social and health care research. Accessible papers include Ann-Marie Towers and Ann Netten (2006) Control, Well-Being and the Meaning of Home in Extra Care Housing and Care Homes, PSSRU Discussion Paper No. 2342.

Adult social care outcomes tool kit (ASCOT), developed by the PSSRU, is a new and important tool kit that enables commissioners to actively measure the benefits of social care interventions in terms of the individual’s quality of life. This can measured by eight domains: Control over daily life; Personal cleanliness and comfort; Food and drink; Personal safety; Social participation and involvement; Occupation; Accommodation cleanliness and comfort; and Dignity.

Research in Practice for Adults aims to help front-line practitioners and managers in adult social care make best use of research knowledge. Its website at www.ripfa.org.uk offers news and policy updates, details of learning events and of a number of 'change projects', plus a resource bank. Its evidence clusters are updated from recent articles and policy documents and provide a good overview of the issues. Cluster One is about prevention (click here)

The National Stroke Strategy was launched in 2007 to modernise services and deliver the latest treatments for stroke. The target, which was chieved, was to reduce the death rate from stroke, coronary heart disease and related diseases in people under 75 by at least 40% by 2010.  The strategy sets a clear direction for the development of stroke services in England over the next 10 years.

The Social Policy Research Unit (SPRU) at the University of York offers downloadable research, including Outcomes-focused social care services for older people - progress and possibilities by Caroline Glendinning, Sue Clarke, Philippa Hare et al (November 2006).

Well-being and Choice is a website for social care and health care that promotes service users' own priorities and quality of life. Downloadable publications include:

Back to top