Who needs needs?

1999 ◽  
Vol 14 (4) ◽  
pp. 186-188 ◽  
Author(s):  
S. Priebe ◽  
P. Huxley ◽  
T. Burns
Keyword(s):  
Iterative Process ◽  
Service Use ◽  
Social Care ◽  
Status Quo ◽  
Health And Social Care ◽  
The Status ◽  
Service Need ◽  
Special Risk

SummaryThe idea of assessing needs both in individuals and in populations is popular in health and social care, but has serious conceptual shortcomings. The concept of needs does not distinguish between the identification of a problem and its solution. It inhibits a consideration of the probabilities as to how effective various interventions may be in any given case — nor does it reflect the iterative process that is the reality of most health and social care. It does not specify goals and oversimplifies evaluation of outcome because it does not take into account different degrees of change. In assessing population needs, there is the special risk of equating service use with service need, thereby entrenching the status quo. Instead of assessing needs, it is proposed that we identify problems, specify goals and choose interventions on the basis of probabilities of effectiveness. The outcome of any given intervention can be repeatedly reviewed with respect to its goals, and priorities may be reset accordingly.

scholarly journals Rhetoric or Reform? Changing Health and Social Care in Wales

2020 ◽  
Author(s):  
Alan Willson ◽  
Andrew Davies
Keyword(s):  
National Health Service ◽  
Social Care ◽  
Status Quo ◽  
Top Down ◽  
Frontline Staff ◽  
Performance Targets ◽  
The United Kingdom ◽  
Leadership Behaviour ◽  
Health And Social Care ◽  
The Status

Throughout the United Kingdom, the National Health Service (NHS) struggles to meet demand and achieve performance targets. Services need to work with individuals and communities to reduce avoidable disease and dependence. All four UK nations have separately realised the need for change but 20 years’ experience suggests that vision and rhetoric are not enough. Success requires reformed systems and changed leadership behaviour to enable frontline staff to break the status quo. Top down, target driven behaviour must be replaced with a real focus on improvement, championing those who have the knowledge to deliver it.

scholarly journals End-of-life care for homeless people: A qualitative analysis exploring the challenges to access and provision of palliative care

2017 ◽  
Vol 32 (1) ◽  
pp. 36-45 ◽  
Author(s):  
Caroline Shulman ◽  
Briony F Hudson ◽  
Joseph Low ◽  
Nigel Hewett ◽  
Julian Daley ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Service Use ◽  
Social Care ◽  
Care Service ◽  
Homeless People ◽  
Palliative Care Service ◽  
Care Providers ◽  
Health And Social Care ◽  
Formerly Homeless

Background: Being homeless or vulnerably housed is associated with death at a young age, frequently related to medical problems complicated by drug or alcohol dependence. Homeless people experience high symptom burden at the end of life, yet palliative care service use is limited. Aim: To explore the views and experiences of current and formerly homeless people, frontline homelessness staff (from hostels, day centres and outreach teams) and health- and social-care providers, regarding challenges to supporting homeless people with advanced ill health, and to make suggestions for improving care. Design: Thematic analysis of data collected using focus groups and interviews. Participants: Single homeless people ( n = 28), formerly homeless people ( n = 10), health- and social-care providers ( n = 48), hostel staff ( n = 30) and outreach staff ( n = 10). Results: This research documents growing concern that many homeless people are dying in unsupported, unacceptable situations. It highlights the complexities of identifying who is palliative and lack of appropriate places of care for people who are homeless with high support needs, particularly in combination with substance misuse issues. Conclusion: Due to the lack of alternatives, homeless people with advanced ill health often remain in hostels. Conflict between the recovery-focused nature of many services and the realities of health and illness for often young homeless people result in a lack of person-centred care. Greater multidisciplinary working, extended in-reach into hostels from health and social services and training for all professional groups along with more access to appropriate supported accommodation are required to improve care for homeless people with advanced ill health.

scholarly journals Does a social prescribing ‘holistic’ link-worker for older people with complex, multimorbidity improve well-being and frailty and reduce health and social care use and costs? A 12-month before-and-after evaluation

2019 ◽  
Vol 20 ◽  
Author(s):  
Julian Elston ◽  
Felix Gradinger ◽  
Sheena Asthana ◽  
Caroline Lilley-Woolnough ◽  
Sue Wroe ◽  
...  
Keyword(s):  
Older People ◽  
Service Use ◽  
Social Care ◽  
Patient Activation ◽  
Well Being ◽  
Long Term Conditions ◽  
Social Prescribing ◽  
Health And Social Care ◽  
Before And After ◽  
The Impact

Abstract Aim: To evaluate the impact of ‘holistic’ link-workers on service users’ well-being, activation and frailty, and their use of health and social care services and the associated costs. Background: UK policy is encouraging social prescribing (SP) as a means to improve well-being, self-care and reduce demand on the NHS and social services. However, the evidence to support this policy is generally weak and poorly conceptualised, particularly in relation to frail, older people and patient activation. Torbay and South Devon NHS Foundation Trust, an integrated care organisation, commissioned a Well-being Co-ordinator service to support older adults (≥50 years) with complex health needs (≥2 long-term conditions), as part of its service redesign. Methods: A before-and-after study measuring health and social well-being, activation and frailty at 12 weeks and primary, community and secondary care service use and cost at 12 months prior and after intervention. Findings: Most of the 86 participants achieved their goals (85%). On average health and well-being, patient activation and frailty showed a statistically significant improvement in mean score. Mean activity increased for all services (some changes were statistically significant). Forty-four per cent of participants saw a decrease in service use or no change. Thirteen high-cost users (>£5000 change in costs) accounted for 59% of the overall cost increase. This was largely due to significant, rapid escalation in morbidity and frailty. Co-ordinators played a valuable key-worker role, improving the continuity of care, reducing isolation and supporting carers. No entry-level participant characteristic was associated with change in well-being or service use. Larger, better conceptualised, controlled studies are needed to strengthen claims of causality and develop national policy in this area.

scholarly journals Nature-Based Interventions and Mind–Body Interventions: Saving Public Health Costs Whilst Increasing Life Satisfaction and Happiness

2020 ◽  
Vol 17 (21) ◽  
pp. 7769
Author(s):  
Jules Pretty ◽  
Jo Barton
Keyword(s):  
Life Satisfaction ◽  
Tai Chi ◽  
Service Use ◽  
Social Care ◽  
Well Being ◽  
Economic Benefits ◽  
Positive Life Events ◽  
Psychological Therapies ◽  
Health And Social Care ◽  
Care Systems

A number of countries have begun to adopt prevention pays policies and practices to reduce pressure on health and social care systems. Most affluent countries have seen substantial increases in the incidence and costs of non-communicable diseases. The interest in social models for health has led to the growth in use of social prescribing and psychological therapies. At the same time, there has been growth in application of a variety of nature-based and mind–body interventions (NBIs and MBIs) aimed at improving health and longevity. We assess four NBI/MBI programmes (woodland therapy, therapeutic horticulture, ecotherapy/green care, and tai chi) on life satisfaction/happiness and costs of use of public services. These interventions produce rises in life satisfaction/happiness of 1.00 pts to 7.29 (n = 644; p < 0.001) (for courses or participation >50 h). These increases are greater than many positive life events (e.g., marriage or a new child); few countries or cities see +1 pt increases over a decade. The net present economic benefits per person from reduced public service use are £830–£31,520 (after 1 year) and £6450–£11,980 (after 10 years). We conclude that NBIs and MBIs can play a role in helping to reduce the costs on health systems, while increasing the well-being of participants.

scholarly journals Multimorbidity and access to social Care: exploiting emerging administrative data sources in Scotland.

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
David Henderson ◽  
Nick Bailey ◽  
Colin McCowan ◽  
Stewart Mercer
Keyword(s):  
Health Care ◽  
Socioeconomic Status ◽  
Policy Development ◽  
Service Use ◽  
Social Care ◽  
Information Service ◽  
Health Care Use ◽  
Long Term Conditions ◽  
Care Services ◽  
Health And Social Care

IntroductionIntegration of health and social care services is a potential solution to improving care despite budgetary constraints and increased demand for services. Little is known about how having two-or-more long-term conditions (multimorbidity) and socioeconomic status affect social care use, or how all these factors affect unscheduled health care use. Objectives and ApproachThe project aims to describe the demographic, geographic, and socioeconomic differences in the receipt of social care for over 65s in Scotland and how multimorbidity status influences amounts of social care received. Additional analyses will consider the influence receipt of social care has on use of unscheduled health care services and mortality. Social Care Survey (SCS) data collected by the Scottish Government is linked to administrative health and mortality records. Linkage includes; prescribing information service and USC data which records episodes of A & E attendance, emergency admission to hospital, GP out-of-hours attendance, Scottish Ambulance Service use, and NHS24 contact ResultsThe cohort includes 1.1million individuals over the age of 65 (54.8% Female), of which 274,011 (24.2%) people died during the study period. The linkage rate of the SCS to records with a CHI number in the National Records of Scotland population spine was 90.5%, with one local authority removed for very low linkage rates and the remaining 31 with rates between 76.7% and 97.9%. As of February 2018, all requested data has been transferred to the National Safe Haven and data cleaning and analysis has begun. Significant results are expected to have been produced by August 2018. Conclusion/ImplicationsThis research will help understand if receipt of social care is equitably distributed among the population of Scotland after allowing for multimorbidity and socioeconomic status. Understanding the influence health status has on social care receipt and the influence social care has on unscheduled healthcare use has important implications for policy development.

scholarly journals Education and Resentment

2021 ◽  
Vol 5 (1) ◽  
pp. 19-32
Author(s):  
Daniel Anderson ◽  
Susan Gardner
Keyword(s):  
Social Interaction ◽  
Iterative Process ◽  
Status Quo ◽  
Reactive Attitudes ◽  
The World ◽  
The Status ◽  
Tedious Process

That the world is awash with resentment poses a genuine question for educators. Here, we will suggest that resentment can be better harnessed for good if we stop focusing on people and tribes and, instead, focus on systems: those invisible norms that often produce locked-in structures of social interaction. A “systems lens” is vast, so fixes will have to be an iterative process of reflection, and revision toward a more just system. Nonetheless, resentment toward the status quo may be an important element in keeping that otherwise tedious process going, with the caveat that resentment is only productive when it is combined with reason, and that, therefore, educators, rather than privileging participant reactive attitudes, ought, instead, to promote participant reactive reasoning, as the latter can be a genuine force for both personal and interpersonal growth, while the former might very well do the reverse.

scholarly journals Psichikos sveikatos priežiūros deinstitucionalizacija Lietuvoje: minimalūs pokyčiai „maksimalistinėse“1 organizacijose

2014 ◽  
Vol 8 ◽  
pp. 89-99
Author(s):  
Eglė Šumskienė
Keyword(s):  
Mental Health ◽  
Institutional Theory ◽  
Social Care ◽  
Statistical Data ◽  
Institutional Response ◽  
Health And Social Care ◽  
The Status ◽  
Actual Direction ◽  
Mental Health Care Reform ◽  
And Function

Vilniaus universitetoFilosofijos fakulteto Socialinio darbo katedraUniversiteto g. 9/1, VilniusTel. (8~5) 266 76 10El. paštas: [email protected] Remiantis institucionalizmo teorija straipsnyje nagrinėjama institucinės aplinkos įtaka psichikos sveikatos priežiūros įstaigų struktūrai, funkcijoms ir prisitaikymui prie aplinkos, jų inertiškumas ir priešinimasis psichikos sveikatos priežiūros sistemos reformai. Remiantis atsakingų institucijų renkamais statistiniais duomenimis, įvertinama įstaigų veiklos, gyventojų, pacientų ir darbuotojų skaičiaus dinamika, leidžianti spręsti apie pokyčius socialinės globos bei psichikos sveikatos priežiūros sistemoje. Atsiliepdamos į deinstitucionalizacijos reikalavimus, organizacijos modifikuoja savo veiklą – diegia naujas paslaugas, kuriomis siekia atsiliepti į naujus poreikius bei reikalavimus, tačiau tai – minimalūs pokyčiai, faktiškai nekeičiantys įstaigos dydžio ir darbo principų, o deklaruojami inovatyvūs požiūriai ir veiklos tikslai prasilenkia su tikrove institucijos viduje.Pagrindiniai žodžiai: institucionalizmo teorija, deinstitucionalizacija, psichikos sveikatos priežiūra, socialinė globa.Deinstitutionalisation in Lithuania: Minimal Changes in the “Maximalist” Organisations Eglė Šumskienė Summary The article employs the institutional theory to examine the influence of institutional environments on the structure and function of mental health and social care organizations as well as their resistance to the reform. On the basis of statistical data collected by responsible organizations, the dynamics of mental health and social care organizations’ practice, changes in the numbers of clients and employees are analysed. These alterations allow evaluating the status quo and actual direction of the mental health care reform. The usual institutional response to deinstitutionalization is the modification of activities by introducing new services which respond to the emerging requirements. Nevertheless, these are minimal changes since they do not influence the size of an institution and the principles of its work. Innovative attitudes and organisational goals are of declarative character as they do not correspond to the poor institutional reality. Key words: institutional theory, deinstitutionalisation, mental health and social care

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