The Application of Systems Thinking Approaches to the Development of Integrated Care Services for Adults with Complex Care Needs: Findings from a Systematic Review of the Literature
The review has identified that integration is always changing to meet the needs of citizens – however there does not seem to be an indicator of whether the change is driven by citizen demands and expectations or whether the ‘system’ changes to influence citizens. The need to take into account interdependency of all sections of a ‘system’ but also the need to ensure the citizen is at the heart of the system with solutions developed around them. The desktop review screened with 1030 documents, which were then reduced to 20, which were relevant to include in the review. The review findings were discussed and further explored at a knowledge exchange event, which involved people working in public services. The funding for the research came from Knowledge Economy Skills Scholarship II (KESS2) and was conducted jointly between Bangor University and Gwynedd Council. The systematic review did not include the public or patients. However, professionals were involved through a knowledge exchange event that discussed and sense-checked the review findings. The review references the need to involve stakeholders including the public, patients, and service users in making changes The overarching finding was “Involving stakeholders emerged as fundamental to effecting system level change, especially in community services.” There were four key themes identified – Leadership, Sustainability, Governance and Transformation. The use of the term ‘sustainability’ is often taken as being a financial marker and not about ‘future proofing’. As the overarching finding indicated, citizens need to be at the heart of redesigning sustainable services. Stakeholder participation – the general term does not take into account that the various parts of the system that are being reviewed/improved all use different terminology for the people they are helping. Having a core purpose is vital and can lead to system changes towards the clearly identified aims as a core purpose. The review has identified that integration is always changing to meet the needs of citizens – however there does not seem to be an indicator of whether the change is driven by citizen demands and expectations or whether the ‘system’ changes to influence citizens. The need to take into account interdependency of all sections of a ‘system’ but also the need to ensure the citizen is at the heart of the system with solutions developed around them. The need to ensure that centrally generated policies to meet political aspirations need to be converted to local interpretation and that an adaptable approach is needed that is not just driven by politicians but by citizen led services. Further research could involve focus groups of existing and potential services users, patients and participants to test out suggested models of integration – in particular, it might be helpful to explore the difference between citizen expectation vs system expectations as these will often be disjointed.
Planning, commissioning and delivering bespoke short breaks for carers and their partner living with dementia: Challenges and opportunities.
The importance of supporting unpaid carers for people living with dementia (PLWD) is recognised in adult social care policy both nationally and internationally. In the UK, social care legislation emphasises care and support should help people achieve the outcomes that matter to them in their life; this includes the opportunity to take a break from caring routines and responsibilities. Accordingly, there is growing policy and practice interest in short breaks provision to address the diversity of carer break needs and preferences and deliver meaningful outcomes for carers and those they support. This paper reports findings from qualitative staff interviews that offered strategic and operational insights into short breaks provision. It presents a dynamic model of the short break landscape in a region of Wales, describing factors shaping local and regional decision-making. The model identifies key challenges (barriers) and opportunities (enablers) that shape the planning, commissioning and delivery of bespoke short breaks for spousal carers and their partner living with dementia. Through highlighting the interplay between complex context-specific processes and contingences, the model informs initial theory development in short breaks provision. Caulfield, M., Seddon, D., Williams, S. and Hedd Jones, C.
Making personalised short breaks meaningful: A future research agenda to connect academia, policy and practice
There is a growing policy impetus to promote carer well-being through the provision of personalised short breaks. However, understanding of what makes for a successful personalised short break is limited. This paper identifies key evidence gaps and considers how these could be addressed. Design/methodology/approach A scoping review mapping the evidence base relevant to respite and short breaks for carers for older people, including those living with dementia, was completed. National and international literature published from 2000 onwards was reviewed. The scoping review focused on wellbeing outcomes, identified by previous research, as being important to carers. Findings Most studies investigating the outcomes of short breaks for carers supporting older people focus on traditional day and residential respite care. Although there have been developments in more personalised break options for carers, research exploring their impact is scarce. There is limited knowledge about how these personalised breaks might support carers to realise important outcomes, including: carer health and wellbeing; a life alongside caring; positive caregiving relationships; choices in caring; and satisfaction in caring. Three priority lines of inquiry to shape a future research agenda are identified: understanding what matters - evidencing personalised short break needs and intended outcomes; capturing what matters - outcomes from personalised short breaks; and, commissioning, delivering and scaling up personalised short breaks provision to reflect what matters. Diane Seddon, Emma Miller, Louise Prendergast, Don Williamson, Joyce Elizabeth Cavaye Quality in Ageing and Older Adults, June 2021, Emerald.
Public transport use in later life.
Musselwhite, C.B.A. and Attard, M. (2021). Public transport use in later life. In Mulley, C., Nelson, J.D. and Ison, S. (eds.) Routledge Handbook of Public Transport. Abingdon, Oxford, UK: Routledge. 393-404
Mobility planning/policies for older people.
Musselwhite, C. (2021) Importance of Mobility in Later Life An Example of Positive Transport Policy for Older People—Free Bus Pass in the United Kingdom Use of Life Stages in Transport Planning and Policy Involving Older People in Policy-Making
Building relational research capacity in care homes in the covid-19 era
Toms, Green, Orrell and Verity (2020) Research can be an influential driver in raising care home standards and the well-being and human rights of residents. This paper aims to present a case for how a relational research capacity building programme could advance this agenda.
Dementia care from behind the mask?
Page, S., Davies-Abbott, I. and Jones, A. (2021) Maintaining well-being during Covid-19 pandemic restrictions; observations from Dementia Care Mapping on NHS mental health hospital wards in Wales.
Resilience in Later Life
Windle, G. (2021). Responding to Criticisms and Applying New Knowledge to the Experience of Dementia. In: Resilience and Aging. Emerging Science and Future Possibilities. Wister, Andrew, Cosco, Theodore (Eds.) Springer International Publishing.
The effects of ageing on personality
Book chapters: Woods, B. and Windle, G. (2020).In Denning, T., Stewart, R., Thomas, A., and Taylor, J.P. Oxford Textbook of Old Age Psychiatry. 3rd Edition. UK: Oxford University Press
Resilience in older persons: A systematic review of the conceptual literature
Angevaare, M.J., Roberts, J., van Hout, H,P.J., Joling, K. J., Smallbrugge, M., Schoonmade, L. J., Windle, G., Hertogh, C. M. P. Ageing Research Reviews (Impact Factor 10.39).