The purpose of this cross-sectional survey was to examine the relationship between assessments and eligibility decisions made by health and social care staff in multidisciplinary community teams in England. The data were collected between December 2004 and August 2005. The study was a replication of a study that took place in the same eight locations in England before the modernization of health and social care by the present government. Four hundred and thirteen care coordinators responded from 71 teams to produce a total of 1481 clients. Sixty per cent (n = 884) of the sample of clients were categorised as having a psychotic illness compared to 63% in 1997 to 1998. Fair Access to Care Services (FACS) criteria determine access to social care services, and the Care Programme Approach (CPA) determines the level of mental health services provided. There was a close but an incomplete association between FACS and CPA judgements (kappa = 0.37; 95% confidence interval 0.31-0.43). Compared to the standardised Matching Resources to Care version 2 indication of complex needs, social workers' judgements were the most closely aligned to FACS judgements (F = 5.80; d.f. = 2 and 1203; P < 0.01). This raises the question of the need for training for health professionals in order to make decisions about social assessment and eligibility determination.
Since April 2003, all adults requiring social care services must have an assessment to determine their eligibility, which is set within the four-level framework of Fair Access to Care Services [FACS; LAC (2002)13]. This paper examines the implementation of FACS by community mental health teams in eight sites in mental health partnership trusts, and one in a mental health and social care trust in the UK. Twenty-eight respondents (managers within trusts and social services departments) participated in in-depth qualitative interviews, which were undertaken between August 2004 and February 2005. The interviews covered: consultation with users and partner organisations; training and briefings for staff; FACS thresholds; integration of FACS and the Care Programme Approach; and the impact of implementing FACS on budgetary arrangements between health and social care. Using the framework analysis approach to analyse data, it was found that FACS implementation in mental health services has been somewhat haphazard, and has identified real differences between health and social care approaches to eligibility determination, assessment and priorities. In particular, the type and amount of consultation, training and induction into FACS was variable, and in some cases, unacceptably poor. While FACS may have reduced variability between authorities, the exercise of professional judgement in the operation of FACS and the lack of high-quality preventative services remain as potential sources of inequity within the system. The authors conclude that FACS has revealed and reinforced a growing separation rather than an integration of mental health and social care ideas and practices, at least in the participating sites.
This paper presents the results of a survey of international recruitment of social workers and social care workers into the United Kingdom. The literature on international recruitment, especially in relation to social care workers, is extremely sparse. Reviews conducted by the authors for the UK Department of Health did not find any definitive answer to the question of the numbers at present in the UK workforce, their movement between jobs, and their length of stay in the UK. The present study is based on qualitative interviews with three senior managers, four human resources managers, one employment agency manager, one senior social services inspector and three inspectors and three staff from the voluntary and private sectors. The interviews confirmed some of the major benefits associated with international recruitment: a reduction in vacancy rates; filling gaps in key shortage areas; improved sickness records; and once training has been provided the standards of care have improved. In addition, recruitment from overseas has the effect of creating a more diverse staff mix through the appointment of people with more varied experience and experiences. There may also be cost benefits associated with the reduction in costs of employing agency staff. The challenges involved are: having an ethical recruitment policy; the transferability of qualifications and skill sets, and cultural expectations and differences. Employers need to recognize that higher levels of induction are needed in order to meet the unique local knowledge requirements of an overseas candidate. Generally however, there are very few problems, and employers recruiting from overseas find that any problems that exist diminish with each round of recruitment, that is, as employers learn from their previous mistakes. Nevertheless, international recruitment is only a short term strategy, and, alone, does not solve the fundamental domestic problems that lead to the shortages in the first place.
This paper sets out to look at social inclusion among users within services, asking the questions is there a general measure of agreement about what social inclusion means to people, and is there an accepted way of measuring these views? The initiative was funded by the NIHR Research Methods programme now part of the Health Technology Assessment group at Southampton. Nine focus groups explored what people understand by ‘social inclusion’ and concept mapping was used to try and define the term. The research methods are reported here, along with plans for the future.
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