Thinking ahead? Exploring adult social care provision with older people in Northern Ireland

A plethora of government policies impacting older people in the United Kingdom (UK) have been strongly influenced by the rhetoric that service users should be actively involved in their social care; including decisions and delivery. User involvement is integral to the government's current drive to make service more “person‐centred” or “personalised” in adult social care. However, there has been little engagement with the broader Northern Ireland public on future adult social care policies. It has been suggested that knowing preferences for the type of future care and where and how it should be provided can be valuable for service users, providers and policy‐makers. Using a qualitative approach, this paper draws on data collected from three focus groups with people aged over 60 who are not in receipt of social care services. The focus groups took place between April 2016 and January 2017. The findings demonstrate that participants had limited knowledge and understanding of the current social care system in Northern Ireland. In addition, participants had not thought about their possible future care needs. The findings emphasise the importance of promoting and engaging the public in social care debates, particularly at a time when the need for reform of the health and social care system has been identified in Northern Ireland.     

The challenges associated with providing community care for people with complex needs in rural areas: a qualitative investigation

The aim of the present study was to explore the experiences of recipients and providers of community care in rural areas in Northern Ireland. Additionally, the authors sought to examine the impact of location, housing and environmental factors on the delivery of community care to older people with complex needs. Individual, semistructured interviews were held with service users (n = 17) and family carers (n = 14). Individual and focus group interviews were conducted with care assistants, health and social care professionals, and senior managers from a large health and social care trust and health and social services board in Northern Ireland. The importance of enabling older people to remain in their own homes and communities was emphasised by all participants. The main challenges associated with care provision in rural areas included: difficulties recruiting care assistants; lack of choice of care assistants; isolation; travel and distance between clients and their care assistants; and poor housing conditions. There was a general consensus among participants that the effectiveness of rural community care was perceived to be reliant upon the goodwill of the community. Additionally, changing demographic trends and the predicted shortfall in the number of formal and informal carers were considered key issues for service planners. A number of creative strategies could be used to address many of the limitations associated with rural isolation. These should involve capitalising on available community networks. However, planners should also acknowledge that additional resources are required to maintain older people in rural communities.     

An evaluation of mental health service provision in Northern Ireland

Although Northern Ireland has high levels of mental health problems, there has been a relative lack of systematic research on mental health services that can provide an evidence base for legal, policy, and service developments. This article aims to provide a review of the central issues relating to mental health service provision in Northern Ireland, and to gather the perceptions of different stakeholders of these services. The study utilised in‐depth qualitative interviews, focus groups, and an online survey to collect data from respondents throughout the region. This method involved the completion of semistructured interviews with significant mental health commissioners and senior managers, and with service‐users and their key workers. Focus groups sessions were also completed with mental health professionals, service‐users, and carers. Data collection occurred between December 2014 and June 2015. Thematic analysis was used to identify key issues. The findings identified that considerable progress had been made not only in the development of mental health services in the last decade, but also highlighted the significant limitations in current services. Most notably, strengths in provision included the transition from long‐stay hospital care to community‐based services and person‐centred approaches. The researchers identified the need to improve funding, address problems with fragmentation, and gaps in service provision. Based on these findings, the authors consider the implications for practice and policy relating to the human and organisational aspects of service development. In particular, services should be developed focusing on a recovery ethos and on person‐centred and relationship‐based approaches. The needs of carers should additionally be considered and programmes developed to tackle stigma.     

Primary Care Trusts involving the community: is community development the way forward?

Patient and user involvement is central to current government thinking on the NHS. More comprehensive approaches to organised community participation and community development have received less support and examples of effective and genuine participation in key areas such as primary care decision-making are rare. The initiative described in this paper was established in Newcastle upon Tyne in 1995 to promote community participation in decision-making about local health services. It has particular relevance to current concerns about addressing social exclusion and tackling health inequalities since it operates in an area of social disadvantage with a significant black and ethnic minority population (6 percent). This case study is based on an independent evaluation which used multiple research methods, including interviews, questionnaire surveys and direct observation, to assess the project's practice and impact. Describes a community development approach to public participation. An emphasis on inclusive practices has facilitated meaningful involvement of minority groups such as ethnic minority residents and those with disabilities who tend to be marginalised in public debate. Argues that the project has made a significant impact on the ways in which local health services are planned and delivered     

The challenges and potential of developing a more effective youth work curriculum with young men

Whilst traditional approaches to youth work in Northern Ireland have always engaged young men, until very recently there has been an absence of a youth work concern in regard to young men's emotional and health needs. In a world that has undergone significant social and economic change during the past thirty years, the lives of many young men have become increasingly complex and contradictory making them feel vulnerable and insecure. Central to this is appreciation of how narrow and unrealistic interpretations of masculinity impact upon male behaviour and development. Influenced by Youth Action Northern Ireland's model of practice with young men aged 14-25, this article highlights ways in which practitioners can better respond to the needs of young men living in areas of social and economic deprivation. Crucially this article presents some of the challenges and potential of developing a more coherent and strategic approach to the way in which the Youth Service in Northern Ireland should work with young men.     

Toward a national health risk management approach in Australia

There has been increasing international consensus about the importance of competition for achieving national growth and community well-being. The Australian government accordingly has introduced policies to promote such competition. Major legislative review and many public inquiries have assisted implementation of national competition policy and the development of national goals and standards related to international agreements to promote health and sustainable development. Since the 1980s, Australia has had legislation that requires the identification and control of health risks arising at work. The management structures necessary for coordinated delivery of national programs designed for effective identification and control of health risks arising in communities to achieve national health and development goals are still being developed, however. Major difficulties related to this development are discussed. National health development programs should be approached primarily through establishment of regional partnerships between bodies responsible for managing community health, local government, and employment placement, in consultation with other relevant organizations and the community. Related research and evaluation programs are required.     

Key factors impeding discharge planning in hospital social work: an exploratory study

Despite its long historical tradition in Northern Ireland, there is a dearth of research studies on the role of hospital social work and the professional challenges involved at the health and social care interface. This is the first small-scale exploratory study in Northern Ireland that sought to identify the key factors that hospital social workers perceive as impeding their practice in the discharge planning process. A 15-item postal questionnaire was developed and distributed to 30 hospital social workers from four hospital social work departments in a city in Northern Ireland. The study group comprised social workers based in a range of hospital directorates who had differing levels of hospital social work experience. Data generated from the questionnaires suggested that deficits in community resources impacted most negatively on social workers' practice in discharge planning. The length of time respondents had been in their current post was also shown to influence their responses to the perceived impediments in their discharge planning role. The implications of the study and recommendations are discussed in relation to in-service training, social work practice and continuing education in Northern Ireland.     

Building the infrastructure for primary health care: an overview of vertical and integrated approaches

In the past four decades there has been a succession of different approaches to the development of infrastructure for the delivery of health services. There have been striking similarities among these approaches in both direction and timing in many different countries, particularly in the developing world. While the general trend has been strongly in the direction of a more comprehensive, integrated health infrastructure, there have been important regressions from this path. It is suggested that the recent attention given to the delivery of 'selective' packages of interventions has often diverted energy and resources from the essential task of developing comprehensive, efficient and effective health services. This paper begins with an historical review of trends in the development of health services infrastructure in recent decades. It proceeds to analyse the implications for the organization of health services and for resource allocation when the health services infrastructure is viewed as part of a health system based on primary health care. Finally, we maintain that district health systems based on primary health care provide an excellent practical model for health development, including an appropriate health system infrastructure. Within this model the concerns with accelerating the application of known and effective technologies and the concerns with strengthening of community involvement and intersectoral action for health are both accommodated. The district health system provides a realistic setting for dialogue and planning involving both professionals and non-professionals concerned with health and social development.     

The health of Travellers' children in Northern Ireland.

A study was carried out to examine aspects of the health status of children from a group of 'travelling people' in Northern Ireland. A total of 350 children, aged under 16 years, were included in the study. Data were gathered by community health doctors and health visitors using a standardised questionnaire. The study revealed that this community has a high degree of consanguinity and points to higher levels of congenital abnormalities than in the settled community. Uptake of immunisation was less than the settled community and hospital admissions in the younger age group were particularly due to infectious diseases. The authors conclude that provision of health services for travelling people in Northern Ireland should be urgently reviewed with consideration of the needs and lifestyle of this group. The provision of suitable sites for travelling people with adequate water and sewage facilities to reduce potential risks to health is also advocated.     

Interorganisational cooperation and its effects on community rehabilitation for people with severe mental disorders in Beijing,China: A case study

A national comprehensive management pilot project for mental health has been implemented in China to provide integrated care for people with severe mental disorders through strengthened cooperation among government organisations and between government and other relevant social organisations. The promotion of community rehabilitation has been included as a key part of this pilot program. The present study took the AD district of Beijing as a case study to examine interorganisational cooperation and its effects on community rehabilitation in a real-world setting. Interviews were conducted with 14 frontline workers, including 7 mental health workers from community health centres and 3 staff and 4 social workers working in rehabilitation centres. Five officials from relevant health and social welfare departments and a social work organisation were also interviewed. Experiences in Beijing revealed that interorganisational cooperation helped to build a multiagency workforce furnished with basic mental health knowledge at the community level, which rendered it possible for frontline workers to provide fundamental follow-up services, pilot the case management model of service provision and increase the provision of psychosocial rehabilitation services within the poorly resourced context of Chinese mental healthcare. Moreover, the engagement of social organisations provided bottom-up pressure to innovate through the active bringing forward of new ideas concerning cooperation and service delivery. However, differences in professional authority and commitment were observed. Health department officials and health professionals seemed to exercise a dominant role as compared to social welfare department officials and social workers. Future policy making should motivate social welfare department officials to improve social care for people with severe mental disorders. Social workers require training to improve their knowledge of mental health matters, and social organisations need greater latitude to strengthen their influence over the development of community rehabilitation services for people with severe mental disorders.     

Modernisation, the NHS Plan and healthy communities.

This paper reviews the NHS Plan from the perspective of the Government's wider programme of "modernising" public services. Although broadly focussed, particularly highlights older people. Two dimensions of modernisation are identified. The NHS Plan is seen to be patient-cited--rather than citizen-centred. Argues further, that, if the economic, social and environmental causes of ill health are to be addressed more generally and if citizens are to be enabled to live in healthy, sustainable communities, planning for health services should logically be subordinate to planning for health. Health improvement plans should, therefore, be integrated within the wider community strategies for which local authorities are to have lead responsibility. Similarly, as ill health is recognised to be an important aspect of poverty, inequality and social exclusion, there is a strong case for the integration of the regional offices of the NHSE within the wider structure of regional governance. Finally, the personal social services should ensure that the values of social work and social care are not displaced by medical and nursing models which, historically, have shown little understanding of community development processes.     

Models of specialist employment for people with mental health problems

There is a growing interest in work schemes for people with mental health problems. They appear to offer great promise, both in the delivery of community care and in social re-integration. However, the models operating in Britain are diverse and little is known about their operation, much less their effectiveness. In this paper the characteristics of nine models of specialist employment are described, and their similarities and differences are portrayed on three dimensions: productivity, integration, and permanence. Within this proto-typology it is hoped that clearer distinctions may be made between work schemes and what they have to offer. Recognition of fundamental differences between work opportunities should aid matching needs to services, facilitate more effective use of rehabilitation resources, and guide the commissioning of mental health services.     

Resource allocation modelling for home-based health and social care services in areas having differential population density levels: a case study in Northern Ireland.

This project arose from deliberations within the Department of Health and Social Services (DHSS) in Northern Ireland concerning the acceptability of the revenue resource allocation methodology they were using. One problem with the method being used had been the absence of a component that adequately reflected the relative costs associated with the differential population densities of the four health boards into which the Province is divided. This study investigates a particular element of this issue, viz differences in the travelling distances and times of those health and social service professionals who provide visiting services to patients in their own homes. A modelling approach has been developed and used in conjunction with a comprehensive spatial and geographical information system for Northern Ireland. An important outcome of the study has been estimates of the targets that should be set for the annual health and social care travelling distances and times per head of population in the boards, for a range of home-based services. Also, the project has contributed to decisions made by the DHSS in Northern Ireland concerning the annual financial compensations required by boards for costs associated with their relative population densities.     

社区卫生服务管理体制面临的挑战分析——基于六城区的抽样调查

目的：分析我国社区卫生服务管理体制面临的挑战。方法：运用焦点组访谈和个人深入访谈的方法收集六城区有关社区卫生服务管理体制的资料,并运用归纳总结的方法对定性资料进行分析。结果：区级政府作为举办主体理顺社区卫生服务管理体制存在困难;各级政府的事权与财力不相适应;卫生部门与其他部门的跨部门合作机制有待加强;社管中心成立的必要性与功能定位仍然悬而未决;如何管理社会资本举办的社区卫生机构有待进一步探索;缺乏居民参与管理的有效途径。建议：理顺政府相关部门之间的关系,促进财力与事权相匹配;建立有效的跨部门合作机制;制定和完善鼓励社会资本发展社区卫生的相关政策;进一步探索成立社管中心的可行性与必要性;探索和完善居民参与管理的有效途径。     

Developing sustainable models of rural health care: a community development approach

Globally, small rural communities frequently are demographically similar to their neighbours and are consistently found to have a number of problems linked to the international phenomenon of rural decline and urban drift. For example, it is widely noted that rural populations have poor health status and aging populations. In Australia, multiple state and national policies and programs have been instigated to redress this situation. Yet few rural residents would agree that their town is the same as an apparently similar sized one nearby or across the country. This article reports a project that investigated the way government policies, health and community services, population characteristics and local peculiarities combined for residents in two small rural towns in New South Wales. Interviews and focus groups with policy makers, health and community service workers and community members identified the felt, expressed, normative and comparative needs of residents in the case-study towns. Key findings include substantial variation in service provision between towns because of historical funding allocations, workforce composition, natural disasters and distance from the nearest regional centre. Health and community services were more likely to be provided because of available funding, rather than identified community needs. While some services, such as mental illness intervention and GPs, are clearly in demand in rural areas, in these examples, more health services were not needed. Rather, flexibility in the services provided and work practices, role diversity for health and community workers and community profiling would be more effective to target services. The impact of industry, employment and recreation on health status cannot be ignored in local development.     

Primary health care: a preferred health service delivery option for women

It is well known that gender is a determinant of health, but less understood is whether differences in health status attributable to gender can be mitigated through the implementation of primary health care. Primary health care, notably distinct from primary care, refers to a wide-ranging approach to the delivery of a comprehensive variety of health services. This article traces the similarities between primary health care and women-centred care from their overlapping philosophical foundations to the similar health, social, and economic benefits of both approaches. It is argued that investments in primary health care positively impact women's health, and, as such, should be a preferred option for the delivery of women's community health services. Several models of health service delivery that operate in accordance with principles of primary health care and also address the key tenets of women's-centred care are examined and their merits are compared. The article also identifies the major impediments to the adoption of both primary health care and women's-centred care approaches.     

社区卫生服务中心人力资源现状分析与建议：以南京市建邺区为例

目的了解南京市建邺区社区卫生服务中心人力资源状况,探索改善社区卫生服务中心人力资源配置的有效措施。方法对南京市建邺区7家社区卫生服务中心的人力资源状况进行调查。结果部分社区卫生服务机构人员配备不足,结构不合理,缺少中高级职称人才,女性偏多。收入低、工作量大、社会地位低是影响人员稳定和工作积极性的主要因素。结论各级行政部门应建立合理的人员配置评定体系;应加大投入力度,加强人才队伍建设;应制定合理的社区卫生服务机构考核细则等。     

Guthrie house: a rural community organizing for wellness

This paper is interested in the issue of community participation and empowerment in health care provision and decision-making. In Canada, the present scope for public involvement in planning or managing the state's health and social services system is limited. This poses a particular problem for rural communities--places where the provision of health care services has historically been limited when compared to urban locations. These rural communities are now facing a double burden as public policy moves increasingly towards a retrenchment of the welfare state. This paper examines one rural community's response to this double burden. The village of Elgin in rural Ontario recently established Guthrie House, a community-based resource center for health and wellness services. Community participation in this case involved a level of control whereby local citizens together defined the health and social care services that they saw as best meeting the needs of their community. This form of community participation is considerably different from the forms of public involvement in the established medical system and represents a critical link to 'empowering' the local community as partners in health care. Through an examination of Guthrie House, the paper presents a review of some critical 'characteristics' which mark successful community self-help organizations and concludes with a discussion of the policy implications for greater community participation. It is argued that such community participation in health care is a policy option which government should be paying particular attention to in these times of fiscal constraint, increasing health care needs and increasing consumer dissatisfaction with government service provision mechanisms.     

Involving communities in health service planning in primary care

Recent health service policy in the United Kingdom has emphasized the need to involve local people in health service planning. This paper will describe how local communities were involved in the development of Primary Care Resource Centres. These centres are designed to provide a base for the delivery of a range of health, social welfare and information services within a community setting. Four centres in the process of being developed in one region were selected for in-depth study. The main method of data collection consisted of semi-structured interviews with key “stakeholders”, namely purchasers and providers of primary health care, social care providers, hospital outreach staff and local community and voluntary group workers (Weiss 1983). This paper examines how the health service organizations developing the centres involved local communities in planning them and the obstacles and difficulties encountered. The paper suggests lessons that can be learned for future community involvement in the planning of local health services.     

卫生立法的国际经验对我国的启示

本文通过分析典型国家卫生立法的现状和发展的共同点,结合我国政治、社会和经济环境,对我国《基本卫生法》立法提出政策建议。多数工业化国家都有一个相同的价值观,即政府确保公民不受地域和经济能力的限制享有卫生服务。各国卫生立法都经历了与政治发展同步的数次改革。几乎每一个以公共筹资体系为主的国家,都同时存在商业医疗保险和私人医疗服务,但医疗卫生服务体系很少以市场为主导。所有国家都在向建立整合的协同医疗服务体系方向努力,并已建立了与经济发展和国民收入相适应的、长期稳定的卫生筹资模式。作为卫生领域的根本法,《基本卫生法》应以更宏观的视角对卫生和健康问题的基本定位、基本价值和基本框架进行定位,突出"无论公民的性别、年龄、宗教、社会地位和经济状况,政府都有责任确保其获得基本医疗卫生服务和基本药物"的核心价值观。