'I wasn't on the front line per se, but I was part of health care': Contributions and experiences of ancillary staff in care homes in England during the COVID-19 pandemic.

OBJECTIVES: Ancillary staff - cleaning, catering, housekeeping and laundry workers - play a crucial role in care homes, by promoting infection control, food preparation and hygiene, and contributing to the care home environment. This study sought to understand the experiences of ancillary staff working in English care homes during the COVID-19 pandemic. The results will inform policy makers, employers, care home managers and others, both in England and overseas, as how to best support the ancillary workforce. METHODS: Between March and August 2021, video and telephone interviews were conducted with those working or living in care homes in England. Participants comprised ancillary staff (n = 38), care home managers (n = 8), care home residents' family members and friends (n = 7), human resource managers (n = 5) and care home residents (n = 5). RESULTS: Ancillary staff often had increased responsibilities and contributed to pandemic efforts by changing working practices, routines and job roles with the aim of supporting residents and other staff. Teamwork, underpinned by strong leadership, helped ancillary staff feel supported. CONCLUSIONS: Ancillary staff should be better recognised as being central to care home care. They are essential workers helping to keep residents safe and well.

Adult safeguarding managers' understandings of self-neglect and hoarding.

Self-neglect and hoarding are behaviours that are hard to define, measure and address. They are more prevalent among older people because of bio-psycho-social factors, which may be exacerbated by advancing age. This paper aims to further understandings of self-neglect and hoarding in England's Care Act 2014 context, drawing on a study involving qualitative interviews with local authority adult safeguarding managers who play an important role in determining interventions with individuals who self-neglect and/or hoard. Online interviews were conducted with adult safeguarding leads and managers from 31 English local authorities in 2021. Interview data were subject to thematic analysis. This paper explores the commonalities and differences in adult safeguarding managers' understandings of the causes and consequences of self-neglect and/or hoarding among older people, which are likely to have tangible impacts on service provision in their local authority, and influencing of wider changes to policies and procedures. Most participants understood these phenomena as caused by a range of bio-psycho-social factors, including chronic physical conditions, bereavement, isolation. A minority took a more clinical or psycho-medical perspective, focusing on mental ill-health, or referred to the social construction of norms of cleanliness and tidiness. Whatever their understanding, by the time such behaviours are brought to the attention of safeguarding professionals a crisis response may be all that is offered. The implications of the findings are that other agencies should be encouraged to provide more early help to older people at risk of self-neglect and/or of developing harmful hoarding behaviours, and that sustained engagement with those affected may help to understand some of the causes of these behaviours to enable effective support or practice interventions.

Experiences of adult social work addressing self-neglect during the Covid-19 pandemic.

Summary: Internationally there has been much interest in the impact of the COVID-19 pandemic on the care and support of older people including those with needs arising from self-neglect and/or hoarding. During the pandemic English local authorities' legal duties remained to respond to concerns about harm about people with care and support needs living in the community. This paper reports interviews with 44 participants working for adult safeguarding/adult protective services (APS) in 31 local authorities recruited from all English regions. Interviews took place online in November-December 2020 as the pandemic's second UK wave was emerging. Analytic induction methods were used to develop themes. Findings: Participants reported some of the variations in referrals to their services with more contact being received from community sources concerned about their neighbours' welfare. Participants provided accounts of the local organisation of adult safeguarding services during the pandemic, including in some areas the potential for offering early help to older people at risk of harm from self-neglect or hoarding behaviour. Online inter-agency meetings were positively received but were acknowledged to potentially exclude some older people. Applications: This article reports observations from adult safeguarding practitioners about their services which may be of interest internationally and in renewing services that can sustain public interest in the welfare of their older citizens and in developing early help. The findings reflect those from children's services where online meetings are also predicted to enhance professional communications post-pandemic but similarly need to ensure effective engagement with service users and their families.

An exploration of why health professionals seek to hold statutory powers in mental health services in England: considerations of the approved mental health professional role.

BACKGROUND: There is a shortage of Approved Mental Health Professionals (AMHPs), who are responsible for compulsory admission decisions under the Mental Health Act (MHA), 1983. Only 5% of AMHPs are health professionals, over a decade after the role was opened to them. AIMS: The research aimed to identify factors motivating and discouraging health professionals from becoming and working as AMHPs. METHODS: Semi-structured interviews (n = 52) with professionals enabled to become AMHPs by the MHA, 2007, including AMHPs; those that had not become AMHPs; and AMHP managers. Additionally, a survey of AMHP senior managers. Interviews and open-ended survey questions were analysed thematically. RESULTS: Motivating and discouraging factors were grouped as intrinsic and extrinsic. Intrinsic motivations were: altruism; the dynamic and contained nature of the work; and fit with experience. Intrinsic discouraging factors were: damage to therapeutic relationships; the perceived clash between AMHP work and professional values. Extrinsic motivations were: career progression; and professional esteem. Extrinsic discouraging factors were: profile and reputation of the service; organisational commitment; management support; and level of remuneration. CONCLUSIONS: The research suggests that changes in organisational responsibility for running AMHP services and raising the profile of the role might help increase recruitment and retention of health professionals.

Support workers in social care in England: a scoping study.

This paper reports the findings of a scoping study designed to describe the evidence base with regard to support workers in social care in the United Kingdom and to identify gaps in knowledge. Multiple bibliographic databases were searched for studies published since 2003. The results revealed that the support worker role, though not well-defined, could be characterised as one aimed at fostering independence among service users, undertaking tasks across social and health-care, and not being trained in, or a member of, a specific profession. The studies identified were predominantly small-scale qualitative projects which considered issues such as role clarity, training and pay, worker satisfaction, service user views and the amount of time support workers are able to spend with service users compared to other staff. The review concluded that the research base lacks longitudinal studies, there is definitional confusion and imprecision, and there is limited evidence about employment terms and conditions for support workers or about their accountability and performance. The desirability and value of training and how it is resourced need further analysis. It is concluded that moves to self-directed support or personalisation and the increased reliance on and use of support workers, in the form of personal assistants, call for closer scrutiny of the role.

Banned from working in social care: a secondary analysis of staff characteristics and reasons for their referrals to the POVA list in England and Wales.

Since July 2004, employers of social care staff working with vulnerable adults in England and Wales have been legally required to refer workers or volunteers dismissed for misconduct because they have harmed vulnerable adults or placed them at risk of harm to the Protection of Vulnerable Adults (POVA) list. The POVA list is unique to England and Wales, and is a powerful tool of quality assurance for the care sector and for the safeguarding of vulnerable adults. This article reports on part of a multi-method study including quantitative and qualitative elements to produce a rounded picture of the factors involved in decisions to place staff members on the POVA list. Based on secondary data analysis of all records of POVA referrals from August 2004 to November 2006 (5294 records) as well as a detailed sample of 298 referrals, this article focuses on the prevalence of different types of alleged harm and their association with various staff, employer and service-users' characteristics. The most common form of alleged abuse was physical abuse (33%), while the least was sexual abuse (6%). Some of the other key findings are the over-representation of men referred (31% compared to an average of 15% in the workforce) and significantly different types of abuse in care home and domiciliary settings, where financial abuse was less likely in care homes [odds ratio (OR) 0.17; P < 0.001], while physical abuse more likely in the same setting (OR 3.60; P < 0.001).