A comparative overview of health and social care policy for older people in England and Scotland, United Kingdom (UK).

BACKGROUND: Responsibility for health and social care was devolved to Scotland in 1999 with evidence of diverging policy and organisation of care compared to England. This paper provides a comparative overview of major health and social care policies in England and Scotland published between 2011 and 2023 relating to the care of older people. METHODS: We searched United Kingdom (UK) and Scotland government websites for macro-level policy documents between 2011 and 2023 relating to the health and social care of older people (aged 65+). Data were extracted and emergent themes were summarised according to Donabedian's structure-process-outcome model. RESULTS: We reviewed 27 policies in England and 28 in Scotland. Four main policy themes emerged that were common to both countries. Two related to the structure of care: integration of care and adult social care reform. Two related to service delivery/processes of care: prevention and supported self-management and improving mental health care. Cross-cutting themes included person-centred care, addressing health inequalities, promoting use of technology, and improving outcomes. CONCLUSION: Despite differences in the structure of care, including more competition, financial incentivization, and consumer-based care in England compared to Scotland, there are similarities in policy vision around delivery/processes of care (e.g. person-centred care) and performance and patient outcomes. Lack of UK-wide health and social care datasets hinders evaluation of policies and comparison of outcomes between both countries.

A trial of an iPad™ intervention targeting social communication skills in children with autism.

This study evaluated a technology-based early intervention for social communication skills in pre-schoolers in a randomised controlled trial. Participants were 54 children aged under 6 years with a diagnosis of autism, assigned to either intervention or control conditions. The app engaged children, who played consistently, regardless of developmental level, and was rated highly by parents. There were no significant group differences in parent-report measures post-intervention, nor in a measure of parent-child play at follow-up. Therefore, this intervention did not have an observable impact on real-world social communication skills and caution is recommended about the potential usefulness of iPad(™) apps for amelioration of difficulties in interaction. However, positive attitudes among participants, lack of harms and the potential of apps to deliver therapeutic content at low economic cost suggest this approach is worth pursuing further, perhaps targeting other skill domains.

The continuing professional development for nurses and allied health professionals working within musculoskeletal services: a national UK survey.

OBJECTIVES: To explore the current UK status of continuing professional development (CPD) for nurses and allied health professionals (AHPs) working in musculoskeletal (MSK) services in the UK. METHODS: A web-based survey was developed and used to collect data from service managers, nurses and AHPs who work with people who have MSK conditions, recruited through professional interest groups via email and website notices. The questionnaire was designed following focus groups and telephone conference calls with managers and AHPs from MSK services to ensure content validity. Results were collected online and analysed in SPSS PASW 17 using frequency data and χ² analyses. RESULTS: A total of 354 responses were analysed. The most frequently reported reason for undertaking CPD was to improve patient care. The level of staff experience made no significant difference to the CPD activities undertaken. The majority of respondents reported that their organization was supportive of CPD activities and in applying new knowledge to practice, but lack of funding and having too many other tasks to complete at work were the most frequently reported barriers to CPD. Many commented about the difficulty in accessing CPD in the face of increasing workload pressure and tightened budgets. CONCLUSIONS: The results indicate that despite the organizational support for CPD, respondents faced substantial challenges in accessing CPD when under pressure to achieve productivity targets, with little assistance in terms of funding. This discrepancy may indicate that greater support is required to meet MSK nurses' and AHPs' CPD needs.

Continuing professional development: issues raised by nurses and allied health professionals working in musculoskeletal settings.

BACKGROUND: Nurses and allied health professionals (AHPs) are required to evidence their engagement in continuing professional development (CPD) in order to retain their professional registration. Many challenges to CPD are reported, but little literature has explored pertinent CPD issues for clinicians with specialist roles or working in specialist services. No literature to date has explored the perceptions of CPD held by patients who receive these specialist services. METHODS: Three focus groups and two conference calls were conducted with nurses, physiotherapists, podiatrists and occupational therapists who work in musculoskeletal (MSK) services; managers of these services; and people who use MSK services. These focus groups aimed: to explore the CPD needs and issues for this group of clinicians; to explore the perceptions of CPD held by people who have MSK conditions; and to compare the above with current literature to discern any factors specific to MSK settings. The focus groups and conference calls were audio-recorded. The recordings were coded by the researchers using a priori and inductive coding. RESULTS: The main issues discussed were: funding and time for CPD, providing examples of ways to provide CPD in spite of the challenges faced; that CPD needs changed with level of experience; initiatives by clinical specialists to reduce professional isolation; and future trends in CPD, including concerns about succession planning. The views of people with MSK conditions demonstrated an emphasis on communication skills that was seldom raised by managers and clinicians. CONCLUSIONS: Sufficient time, funding and provision of study leave were key to facilitating CPD activity for nurses and AHPs working in MSK services. People with MSK conditions particularly valued health professionals who combined good listening and communication skills with an attempt to understand what it was like to live with their condition.

Engagement with continuing professional development: development of a service model.

UNLABELLED: An increasing number of extended-scope practitioner roles for nurses and allied health professionals can be found within the national health services in the UK. There has been little specific research into the facilitators and barriers for engagement with continuing professional development (CPD) of this group of health care professionals. This paper presents a review of the issues surrounding participation in, and influencing factors of, continuing professional development for nurses and allied health professionals. These findings are summarised in a conceptual model relevant to service planning and delivery for health care professionals and their managers. METHOD: Literature databases were searched using the key term "continu* professional development," "clinical competence," and "professional competence" for relevant papers published in English from 2006 to 2010. FINDINGS: From over 900 papers that were identified, 133 were selected and are presented in a narrative synthesis describing the supra-organisational, organisational, and personal factors identified in the literature and how the support of managers and colleagues is critical. CONCLUSION: A model that illustrates the multi-faceted nature of CPD is constructed from the review's findings, which could assist clinicians at all levels of seniority and their managers in optimising CPD in their workplaces and when seeking to identify and address hindrances to CPD.

The experience of being disabled and obese.

PURPOSE: This qualitative study was designed to explore the experiences of disabled and severely obese people living in the community. The challenges that their size and disabilities posed within their homes and in accessing community facilities were explored, with particular reference to the provision and use of assistive technologies. METHODS: The study comprised in-depth interviews with a sample of six severely obese, disabled people using a grounded theory approach. RESULTS: Three key themes emerged: the experience of daily life; accessing services; and responses to challenges. The study participants found that their home and community environments were seldom adequate for their size. Difficulties were identified in relation to accessing and using NHS services and negative attitudes and treatment from staff. Assessments and quality of assistive devices and housing adaptations received were criticised by some. Participants identified a range of responses to these challenges. CONCLUSION: The challenges that obesity bring are compounded by disability, including the need for higher levels of care and the higher costs of assistive devices for this client group. The study suggests there may be a need for training for professionals who work with obese, disabled people to ensure their needs are met in appropriate and cost-effective ways.

Using telemedicine to provide post-discharge support for patients with spinal cord injuries.

We are conducting a randomized controlled trial of telemedicine with patients with spinal cord injuries in their own homes. Internet videoconferencing is used at a bandwidth of 128 kbit/s. Data collection began in March 2004. Twelve patients had entered the study by August 2004, but none had completed it. Preliminary results in one case suggest that telemedicine provided various benefits: (1) the patient received advice he would probably not have solicited; (2) it enabled an expert to view the entry site of a pin in the patient's halo brace, to determine whether the general practitioner should be contacted to arrange a swab; (3) it made it easier for the interviewer to understand family interactions during the session. Telemedicine offers an additional tool in the care of geographically widespread outpatients.