Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk.

These preferences concur with emerging evidence on psychosocial interventions in dementia. Support with personal feelings, information and social engagement are important components. Additionally, knowledge of preferences of people with dementia and their carers can identify other attributes that may be important to effectiveness in 'living well' but for which there remains limited evidence.

Objectives To estimate the rate of mental disorder in those convicted of homicide and to examine the social and clinical characteristics of those with a history of contact with psychiatric services. Design National clinical survey. Setting England and Wales. Subjects Eighteen month sample of people convicted of homicide. Main outcome measures Offence related and clinical information collected from psychiatric court reports on people convicted of homicide. Detailed clinical data collected on those with a history of contact with psychiatric services.

Introduction Decisions about allocation of public funds to pay for care or treatment are reliant on a composite assessment process usually involving contributions from a number of professions (New Zealand Government, 2016; Australian Government, 2018; Department of Health and Social Care, 2018a). Communication is facilitated by appropriate tools and other mechanisms to coordinate multiple contributions to the process (Taylor, 2012). In England, one such example is decision-making relating to the provision of NHS Continuing Healthcare, a package of ongoing care that is arranged and funded solely by the health service for individuals outside a hospital setting who have complex ongoing healthcare needs. Guidance sets out a process for the NHS to work in partnership with its local authority partners to assess health needs and determine eligibility for NHS Continuing Healthcare (Department of Health and Social Care, 2018a). This provides the context for the study reported in this paper. Information sharing between professionals within the assessment process to improve outcomes for patients and service users is a longstanding policy objective (Department for Communities and Local Government,

Purpose The purpose of this paper is to evaluate the implementation and potential value of an electronic referral system to improve integrated discharge planning for hospitalised older adults with complex care needs. This new technology formed part of the “Common Assessment Framework for Adults” policy in England. Design/methodology/approach Mixed methods were undertaken as part of a case study approach within an acute hospital in the North West of England. First, qualitative interviews were undertaken with practitioners to explore early experiences using the new technology. Second, routinely collected administrative data were analysed, comparing referrals made using the new technology and those made through the usual paper-based process. Findings Qualitative interviews found that an electronic discharge system has, in principle, the potential to improve the efficiency and suitability of integrated care planning. However, the implementation proved fragile to decisions taken elsewhere in the local care system, meaning its scope was severely curtailed in practice. Several “socio-technical” issues were identified, including the loss of valuable face-to-face communication by replacing manual with electronic referrals. Research limitations/implications The small number of patients referred during the implementation phase meant that patient outcomes could not be definitively judged. Research into the longer-term implications and value of electronic referral systems is needed. Originality/value There is concern that attempts to integrate health and social care are stymied by incompatible systems for recording service user information. This research explores a novel attempt to share assessment information and improve support planning across health and social care boundaries.

These carer preferences concur with emerging evidence on home support interventions for dementia. Respite care, home care and training on managing difficulties provided at home are important components. Carers' preferences revealed the daily challenges of caring for individuals with later stage dementia and the need for tailored and specialised home support.

Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers.The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette. Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.

Context: Many people over the age of 65 receive support from home care providers to enable them to continue to live at home. In the UK, local authorities (England, Wales and Scotland) and Health and Social Care Trusts (Northern Ireland) commission these support services. However, little is known about these arrangements. Objectives: To address this knowledge gap through identifying the lessons from research for commissioners of home care for older people. Method: A scoping review was undertaken to extrapolate the lessons from research for future practice. Searches were conducted in 2016/17 and the analysis was completed 2017/18. Electronic and manual searches of UK literature were undertaken using distinct terms to investigate the people, organisations and processes intrinsic to commissioning home care for older people. Findings: From a total of 1,819 papers and government reports, 22 met the inclusion criteria, indicative of a limited body of knowledge. A variety of research methods and designs were included with mixed methods most frequently used. Four lessons were identified relating to: the marketisation of home care; the future of care at home; promoting integration with local partners in commissioning home care; and areas for future research. Limitations:The focus on research evidence may have meant that potentially interesting insights to inform future commissioning strategies from conceptual articles were omitted from the review. Implications: Understanding the complexities of market management in commissioning home care for older people is still at an early stage of development. This review provides evidence to inform its future development of value to policy makers and practitioners.