Hospital Admission Avoidance  June 2024 

We hear a lot about delayed hospital discharges and the challenges of achieving high quality timely discharges that support people's independence and wherever possible enable 'Home First' strategies. The flip side of this focus is ensuring admission avoidance when possible. In this blog for IPC I offer some reflections on 'what good looks like', informed by recent personal experience. 
 

 The Infected Blood Inquiry: Findings and implications  20 May 2024 

 
The "worst treatment disaster in the history of the NHS" is recognised in the long-standing contaminated blood disaster which saw 30,000 people infected with AIDS/HIV or Hepatitis and more than 3,000 deaths due to treatment with infected blood, blood products and plasma. The report of the independent inquiry Chaired by Sir Brian Langstaff was published on 20 May, and is widely seen as a landmark in trying to give a voice to the infected and affected and to finally begin to make redress. 
 
In this Blog for IPC I reflect on the key findings and explore what needs to happen to move on from the 'never again' and 'lessons learned' mantras that so often follow reports into catastrophic events, cover-up and evasion of responsibility. Cultural change is needed, but ensuring this is more than warm words demands far reaching redistribution of power and ensuring genuine accountability throughout public services. Past experience does not give grounds for optimism.. 
 
 
 
 

 Carer Support: Ten Years after the Care Act  March 2024 

Ten years after the Care Act came into being, with considerable expectations and hopes for a change in approach, more emphasis on rights and parity of esteem for carers, what has been achieved? 
 
This Discussion Paper for the Institute of Public Care at Oxford Brookes University considers the positive developments alongside the frustrations of delayed implementation and the further challenges brought by Covid-19. 
The core principles and values of the Act (wellbeing, prevention, and personalisation) are well established, and the importance of recognising and supporting carers is also a feature of policy and practice. However, delivery still often falls short in carers' experience, not least given the continuing financial pressures on local authorities.  

 Carers Matter: Evaluation findings   12 February 2024 

Over a three year period from 2020 I have been working with colleages at IPC, Oxford Brookes University to evaluate a model of support for carers commissioned by Norfolk County Council. This was a large mixed-methods study and our findings highlight what worked well for carers, with positive impact on wellbeing and carers particularly valuing flexible support giving them time away from caring. Support for carers requires both low-level support to reach as many carers as possible and targeted support to address those with intensive or complex needs while addressing the needs of the supported person (and treating the caring dyad holistically). Our key findings and full report can be accessed here

 Poor support for carers  7 November 2023 

The annual report from the Care Quality Commission (CQC) published in October highlighted a range of continuing shortcomings in support for unpaid carers. Carers are coping for longer without support, and managing more intensive and complex care needs. 
 
My latest blog for the Institute of Public Care at Oxford Brookes University explores the latest evidence and considers what better support looks like and what factors encourage such developments.  
These considerations are especially relevant with new initiatives from the Department of Health and Social Care (DHSC) to support carers through the Better Care Fund and the Accelerating Reform Fund, and to enable people to stay safe, well and independent at home for longer. 

 Cambridge University Press Award   5 July 2023 

I am delighted that the Cambridge University Press Awards for Excellence in Social Policy Scholarship were announced at the annual conference of the Social Policy Association on 5 July, and together with my co-authors, Jon Glasby, Steve McKay and Catherine Needham, our article on self-funders in the social care system was the winner for the journal Social Policy & Society

 Commissioning for Wellbeing  3 May 2023 

Skills for Care, is the strategic workforce and development body for adult social care in England, with a central focus on ensuring that people have the right skills to work in social care. Skills for Care and partners developed a Level 5 qualification in Principles of Commissioning for Wellbeing that has been accessed by hundreds of commissioners in health and social care, including a version of the qualification contextualised to autism and learning disability. 
I was commissioned by Skills for Care to evaluate the impact of the qualification and engaged with many of the past and current learners to explore their experience and insights. The evaluation highlights the positive impact of the qualification in increasing confidence; improving knowledge and understanding of commissioning; increasing commissioners' commitment to co-production, and commissioning in innovative person-centred ways. The report (full document and a summary version) are published on the Skills for Care website. 

 Supporting People Living with Dementia  21 April 2023 

With 1 in 13 people aged 80-84, and 1 in 5 of those aged 90+ living with dementia, understanding what good support should look like is a vital question for care commissioners and providers. In this review undertaken at IPC, Oxford Brookes I have distilled the key evidence around: 
 
Timely diagnosis and prevention. 
Dementia care and support. 
Support for carers of people living with dementia. 
 
The review highlights the factors to consider to ensure that quality of life is maximised, and the best outcomes and value for money can be delivered.  

 Winter Pressures on the NHS & Social Care  2 February 2023 

Every year there are grim stories of ambulances queueing outside hospitals; long delays in responding to emergency 999 calls; patients enduring hours on trolleys in corridors because of the lack of bed capacity on wards., and delays in discharging patients home from hospital. These are all too familiar. This winter has seen such events intensify and reach record levels, but every winter bears witness to similar challenges. 
Solutions are also familiar: improved patient flow; increased capacity; better streamlined discharge processes; more joined up working between health and social care, and greater focus on hospital admission avoidance and health prevention. But these are not magic bullets. In this blog for IPC at Oxford Brookes I explore the issues and challenges. 

 First Responder Trauma from Major Incidents  28 June 2022 

Barely a day passes without national or international news of some natural disaster, major accident or terrorist incident causing fatalities and life changing consequences for survivors. From the recurrent mass shootings and murder of multiple school children in the US, to a car being deliberately driven into a crowd in Berlin, or earthquakes, tsunami, and famine devastating communities, particularly in the developing world. 

 Long-term care and short-term thinking  22 November 2017 

The announcement on 16th November 2017 that a green paper on social care for older people will be published by next summer is a familiar tale. We have been around this issue multiple times over the past two decades. The case for an equitable, transparent and sustainable solution is self-evident and demands cross-party support. 
In this blog for LSE British Politics and Policy I examine the underlying issues that are proving so intractable, and argue that it is time for resolution not Groundhog Day. 

 Organ Donation: Opting in or out?  27 October 2017 

Organ (and blood) donation is of vital importance, but should it remain voluntary, rather than on the basis of presumed consent? 
 
The Government is to consult on a change of law on organ donation, but what are the arguments for opting-out and would they increase donation levels? The issues are complex, but I offer a personal perspective for the Huffington Post. 

 NHS Continuing healthcare funding  11 July 2017 

Funding for NHS continuing care is anomalous, irregular and often baffling for those trying to get support from the system, why are these issues still recurring over many years? 
The National Audit Office investigation into continuing healthcare funding highlights major anomalies and inconsistencies in this area of long term care. I explore the implications in this blog for British Politics and Policy. 

 Grenfell Tower Tragedy  21 June 2017 

The response to the Grenfell Tower fire in the days that followed appeared chaotic, and a contrast with other major emergency response. What went wrong? 
Response to the fire at Grenfell Tower revealed major shortcomings on the part of both local and national government. 

 Election manifestos and social care  24 May 2017 

A dementia tax or a National Care Service? Political positioning on adult social care during the 2017 election campaign. 
Social care emerged as a key issue in the surprise 2017 General Election campaign; see what the three main parties had to say about it. 

 Conservative Manifesto and social care  22 May 2017 

The unravelling of the Tory proposals for adult social care raise some fundamental questions. 
 
Policy making 'on the hoof' for social care appears to have been a major error by the Conservative Party. I explore the issues in this British Politics and Policy blog 

 Abuse in home care  02 March 2017 

Inadequate investment and a continued failure to regular care workers will ensure a downward spiral of falling standards, low expectations and a culture of complacency that is unsustainable. 
Without regulation and better funding home care is open to abusive practice. I explore the issues in the Guardian social care network 

 Hospital Discharge: Not rocket science  16 May 2016 

System-wide leadership and shared ownership still lacking 
 
Unsafe discharges from hospital have been highlighted by the Parliamentary and health services Ombudsman - a depressingly familiar tale. My blog for the Social care network. 
 

 Robbing Peter to pay Paul?  06 April 2016 

Welfare reform is increasingly divisive and putting the interests of different cohorts in tension with one another. 
 
Social justice and benefit cuts; are we all in this together? I explore some of the challenges in this Policy and Politics blog. 

 Transforming learning disability support  05 November 2015 

A new national plan to transform learning disability services is right, but have we heard it all before? 
 
The publication of national plan for learning disability services will require fundamental change to succeed. Blog for the Guardian Professional Social Care Network. 
 

 Refugee Crisis in Europe  04 September 2015 

Britain must not stand by as a spectator to the unfolding refugee crisis. 
 
As the refugee crisis in Europe intensifies, I explore some of the moral and ethical issues in this British Politics and Policy blog. 

 Long term care policy back in the long grass?  31 July 2015 

The Government's announcement that it will delay by four years a cap on people's liability for the costs of social care is the latest in a long line of failures by successive administrations to resolve the challenge of paying for long term care. 
Following the confirmation that implementation of the 'capped cost' model of paying for long term care is to be postponed for four years, all bets are off on the future of this policy. I explore the issues in this blog for Policy & Politics at the LSE. 

 Carers movement turns 50  08 July 2015 

50 years after carers became a public issue thanks to Mary Webster, it is time to reflect on achievements and to look to the future. 
As the Carers movement turns 50, carers are perhaps no longer the welfare state's 'forgotten army', but there are still challenges ahead and no room for complacency, as I explore in Guardian Society. 

 Dementia Friendly Communities & Skills for Care  21 May 2015 

A number of pilot projects were funded by Skills for Care through 2013/14 to develop Dementia Friendly Communities. 
 
Skills for Care funded a programme of 12 pilot projects supporting the development of Dementia Friendly Communities. An evaluation of the work was carried out by me and can be downloaded below. 

 The Dementia Challenge  07 February 2015 

NHS South of England established a Dementia Challenge Fund in 2012/13 allocating £9 million across around 70 projects to drive local improvements and identify and implement practical solutions to the problems faced by people living with dementia. An independent evaluation of the programme was commissioned from Henwood Associates and the University of the West of England. 
 
The Prime Minister's Challenge on Dementia was launched in 2012, aiming to deliver major improvements in dementia care and research by 2015. A Dementia Challenge Fund was established by NHS South of England to support local developments, and an independent evaluation was commissioned from Henwood Associates, Terry Butler and colleagues at the University of the West of England. 
The projects addressed a number of themes including: 
 
Dementia friendly communities. 
Living well at home. 
Better care in hospitals. 
Improving diagnosis. 
End of life care. 
Reducing anti-psychotic prescribing. 
Better support for carers. 
Living well in care homes. 
 
The evaluation report (Slaying the Demon) concludes that much has been achieved, but that this is work in progress. It is vital for cultural change and new ways of working to be embedded in organisations. The dementia challenge is not a strategic task that can be achieved within a year or two, and this work will need continued attention and refreshing if it is to achieve maximum potential. 

 Standing Commission on Carers  31 December 2014 

In December 2014 Melanie was co-opted as a member of the Standing Commission on Carers. This is an independent advisory group providing expert advice to Ministers on carers' issues, and progress in delivering the National Carers Strategy. 

 Beyond Eligibility - Age UK  30 September 2012 

This study for Age UK examines local councils' approaches to universal and open access services for people who do not meet eligibility criteria for adult social care. 
 
Age UK commissioned this study to explore councils' approaches to developing universal and open access services for older people whose needs do not meet the eligibility criteria for publicly financed social care. The report explores the importance of such support in terms of prevention, the barriers to developing universal support and levers that can encourage improvement. 

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