Direct payments -cash for people eligible for adult social care and spent by them on care and support -are claimed to enable care to better reflect user preferences and goals which improve outcomes. This paper compares outcomes of older direct payment users and those receiving care via a managed personal budget (where the budget is spent on the recipients behalf by a third party). The study adopted a retrospective, comparative design using a postal questionnaire in three English councils with adult social care responsibilities in -. Included in the study were , budget users aged +, living in ordinary community settings. The overall response rate was . per cent ( respondents). Three validated scales measured outcomes: EQ-D-L (health status), the Sheldon-Cohen Perceived Stress Scale and the Adult Social Care Outcomes Toolkit (social care-related quality of life). The study found that direct payment users appreciated the control conferred by budget ownership, but in practice, for many it did not 'translate' into improved living arrangements. It also found no statistically significant difference in outcomes between direct payment and managed personal budget users. The paper argues that despite policy and other guidance and research evidence about effective implementation of direct payments for older people, the absence of evidence for better outcomes may at least in part be attributable to values underpinning policies relating to personalisation and personal budgets.KEY WORDS -adult social care, older people, personal budgets, direct payments, outcomes.
Housing stock transfer is arguably one of the more controversial aspects of New Labour's housing policy. It was a policy originally pursued under the Conservative governments from the 1980s into the early 1990s and has gained pace under New Labour since 1997. Across Britain, the Westminster government, along with the devolved Scottish and Welsh administrations in Edinburgh and Cardiff, have all demonstrated a commitment of late to the use of stock transfer to reshape and reconfigure social housing provision. This paper considers some of the key aspects of stock transfer, not least the underlying national policy drivers of demunicipalization and use of private finance, and then explores the contrasting fortunes of stock transfer in the two largest local authority social housing authorities in Britain, that is Birmingham and Glasgow. In 2002 Birmingham tenants rejected stock transfer while in Glasgow, following a tenant vote for transfer, the city's entire council housing stock was transferred to a not-for-profit housing agency. The different experiences of the pursuance of stock transfer in these two cities together highlight some of the key questions and issues that are now being asked of this central component of New Labour's approach to social housing.Social rented housing, stock transfer, demunicipalization, community empowerment, Birmingham, Glasgow,
A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.
Summary: This paper focuses on the impact of a personal budget (PB) -either in the form of a direct payment (DP) or managed personal budget (MPB) -on the role of unpaid carers of older budget holders. Data were collected via postal survey of 1500 unpaid carers and semistructured interviews with 31 carers. However, carers supporting DP users did experience higher levels of stress. This seemed linked to the additional responsibilities involved in administering the DP. Carers seemed relatively unsupported by their local Adult Social Care Department: the survey found that only 1 in 5 said they had ever received a carer assessment. Application:The findings offer a detailed exploration of the impact of PBs on carers, suggesting that even in countries with relatively well-developed systems of support for carers such as England their impact remains overlooked. The paper may be of interest to social work practitioners, managers, academics and social work policy specialists working in countries that have, or are about to introduce, personal budgets or other forms of cash-for-care scheme.
Mental ill-health is the leading cause of sickness absence, creating a high economic burden. Workplace interventions aimed at supporting employers in the prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work is a digital intervention aimed at supporting line managers in promoting better mental health at work through a preventative approach. This intervention was developed as part of the Mental Health and Productivity Pilot, a wider initiative aimed at supporting employers across the Midlands region of the United Kingdom to improve the future of workplace mental health and wellbeing. The aim of the study is to describe the design and development of the Managing Minds at Work digital training program, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). An agile methodology was used to co-create intervention content with a stakeholder virtual community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions. The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. It was considered by stakeholders to be appropriate for any type of organization, irrespective of their size or resources. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that the program was perceived to be useful, relevant, and easy to use by managers across sectors, organization types, and sizes. We identified positive impacts on manager attitudes and behavioral intentions related to preventing mental ill-health and promoting good mental wellbeing at work. The next step is to explore the feasibility and acceptability of Managing Minds at Work with line managers in diverse employment settings.
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