Research for Decision-Makers
Issue 50 – March 2013
In this month's bulletin
This monthly bulletin provides short
summaries of relevant new research and
draws out key points for Adult Services in
Hampshire.

Autism – transition

Carers

Disabled people - statistics

Learning disabilities – crisis – mental
health

Older people – dementia

Older people – social exclusion

Palliative care

Prevention
New research
In Brief
A recent report on hospice care usefully collates evidence on people’s preferences
concerning where they wish to die. It includes views from the general public and data on
whether or not people’s requests were met. This includes people in care homes. The
report, Current and future needs for hospice care: an evidence-based report, by the
Cicely Saunders Institute is available at http://www.helpthehospices.org.uk/ourservices/commission/resources/.
On the same theme, My life until the end: Dying well with dementia, published by
Alzheimer’s Society, summarises existing evidence from carers, bereaved carers and
people with dementia. It highlights that just 6% of people with dementia die in their own
home compared to 21% of the population overall. The report is available at
http://www.alzheimers.org.uk/site/scripts/download_info.php?fileID=1537.
Autism – transition
Transition to Adult Services and Adulthood for Young People with Autistic Spectrum
Conditions
Bryony Beresford, Nicola Moran, Tricia Sloper, Linda Cusworth, Wendy Mitchell,
Gemma Spiers, Kath Weston and Jeni Beecham
SPRU, University of York
February 2013
This study took place in five sites. It aimed to investigate the roles of multi-agency
transition services in relation to young people with autistic spectrum conditions (ASC),
and the arrangements that were in place for planning transitions for young people with
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and without learning disabilities; explore young people’s and parents’ experiences of
planning for transition and making the transition from children’s to adults’ services;
explore the costs and outcomes for young people of the transition process.
The research sites had been identified as localities that had established multi-agency
transition planning processes and systems in place and which had actively developed
ASC specific services.
A mixed methods approach was adopted including:
 interviews with managers and practitioners in the five research sites working in
transition services or services which support young people and young adults with
ASC, including both statutory and non-statutory agencies and organisations;
 a survey of young people with ASC and parents: both those who were on the cusp of
leaving school (defined as ‘pre-transition’) and those who had recently left school and
moved into adult services/adulthood (defined as ‘post-transition’);
 interviews with young adults (18 – 24 years) with High Functioning Autism (HFA) and
Asperger’s syndrome (AS);
 interviews with parents/carers of young people with autistic spectrum conditions
(aged 16 – 24 years); and
 an analysis of the costs of providing transition support in each of the research sites.
The survey of parents and young people yielded very low responses rates and was
extremely variable between research sites. This meant the researchers could not
explore and compare families’ ‘post-transition’ outcomes against the different models of
transition planning and support in place in the research sites. In addition, not all research
sites provided adequate financial data. This lack of data, coupled with the low response
to the family survey, significantly restricted the work they could do on costs.
Many of the findings are similar to the findings of our own Autism strategy preconsultation work. Findings include:
 Some research sites had systems and structures in place that sought to ensure all
young people with a diagnosis of ASC were receiving some sort of support during
transition. However, in other sites it was evident that young people with HFA and AS
were not eligible for support from transition teams and thus were vulnerable to
planning and preparing for leaving school with no ASC-specific input or support.
 Experiences of planning for leaving school were mixed – both for those families who
had experienced transition planning within statutory SEN/transition planning
processes and for those who had not.
 The lack of post-school options and, for those ineligible for adult social care, the lack
of support was the issue of greatest concern to parents and practitioners.
 Concerning further education, the greatest area of concern was with regard to
suspensions, expulsions and/or simply dropping out of college. These were typically
viewed by parents and practitioners as outcomes of colleges failing to properly
support young people with ASC and manage any challenging behaviours. This was
particularly felt to be an issue in mainstream college settings.
 The lack of post-school/post-college options was an issue for young people with
ASC. The absence of any meaningful daytime occupation was an enormous worry
for parents. The accounts of some of the young people with HFA and AS that were
interviewed corroborated parents’ views that this had a negative impact on wellbeing.
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 Interviewees agreed that a lack of appropriate employment opportunities, and
insufficient support to gain and maintain employment, were key barriers to paid work.
 Policies and practice with respect to supporting young people with ASC into
employment appeared to be specific to localities. Transition teams did not appear to
view employment as an outcome in which they actively engaged. The perceived (and
actual) role of Connexions varied considerably between sites.
 There were examples of positive practice from ASC-specific services supporting
young people into work. However, there was also evidence to suggest there may be
lack of understanding of ASC among Job Centre and Job Centre Plus staff.
 Community mental health teams and, in some places, specialist ‘Asperger’s teams’,
were identified as the first port of call for young adults with HFA or AS who were
struggling with the transition to adulthood. All these services provided multidisciplinary, but time-limited, support.
 The consistent view of interviewees was that, for many young people with ASC,
moving into an independent living situation was not appropriate or feasible in the
early years of adulthood.
 The lack of meaningful daytime activities for young adults with ASC placed
considerable organisational, time and financial burdens on parents as they sought to
‘create’ a meaningful life for their child. Some third sector organisations were
providing day services and peer support opportunities for those with ASC, particularly
those with HFA or AS. Some of the young people interviewed were very clear that
they preferred spending time in such settings, which they saw as ‘normalising’ them.
The report is available online at http://www.york.ac.uk/inst/spru/pubs/pdf/TransASC.pdf.
Carers
Carers UK Caring & Family Finances Inquiry
Carers UK /YouGov
February 2013
Two online surveys were undertaken in February 2013 for Carers UK by YouGov as part
of Carers UK’s ongoing Caring Family Finances Inquiry. For each of the surveys there
were 2073 participants across the UK. The figures in the results have been weighted in
order to be nationally representative of all adults in the UK.
Findings include:
 Three quarters (76%) of the adult population would be worried about the financial
impact of giving full time care to a family member.
 Those aged 35 to 54, the age group most likely to be taking on caring responsibilities
for older parents, expressed greatest concern - with over half of 35 - 44 year olds
(51%) saying they would be very worried about the financial impact on their family if
they had to give full time care to a family member.
 However, the worry also significantly affects younger generations. Four in 10 of those
aged 18 to 34 said they would be very worried about how they would cope financially
if they had to care for a family member (40%).
 67% of UK adults said they either would be unable or would struggle to pay
household bills if they had to give up work to care and rely on the current level of
state help for carers.
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 Just over 1 in 5 UK adults have seen their work negatively impacted as a result of
caring (22%), including 2.3 million who have quit work and almost 3 million who have
reduced working hours.
 The impact was highest amongst 45-54 year olds, where more than 1 in 4 reported
that caring had taken a toll on their work (27%).
The press releases with information about the surveys are available at
http://www.carersuk.org/newsroom/item/3033-research-reveals-over-2-million-quit-workto-care and http://www.carersuk.org/newsroom/item/2961-3-in-4-fear-cost-of-caring.
Disabled people - statistics
Fulfilling Potential: Building a deeper understanding of disability in the UK today
Department for Work and Pensions
February 2013
This document presents current data on disability in the UK. It aims to be the most
comprehensive overview of the evidence on disability since 2005. As part of the work,
the researchers synthesised published research; carried out secondary analysis of
surveys including the Life Opportunities Survey (LOS), Family Resources Survey (FRS)
and Labour Force Survey (LFS); commissioned focus groups of disabled and nondisabled people undertaken by the Office for National Statistics (ONS); and added
questions to the ONS Opinions Survey 2012.
Some of the key statistics in the document include:
 Although the age-specific prevalence of long-term conditions is expected to remain
stable over the next few years strong growth is expected in the number of people
living with multiple long-term conditions. For example, the number of people with
three or more health conditions is forecast to rise by a third by 2018.
 Whilst the prevalence of mental health conditions has not changed, the perception of
mental health conditions has. There has been a change in awareness amongst
people themselves, doctors, employers and society.
 Only around half (6 million) of the 11.5 million people covered by the disability
provision in the Equality Act are in receipt of disability-related benefits.
 Only around 2-3 percent of disabled people are born with their impairment. Some will
acquire impairments in childhood (or be diagnosed with an impairment in childhood).
Most acquire impairments later in life (for example, 79 percent of disabled people
over State Pension age reported that they acquired their impairment after the age of
50), and increasingly after State Pension age (47 percent of disabled people over
State Pension age acquired their impairment after the age of 65).
 Forecasts predict a rise of 86 percent in the number of disabled people aged 65
years and above by 2026 translating into an additional 730,000 disabled people.
 In addition to this, many people are living longer as disabled people, both those who
are disabled in later life and those who are disabled from birth.
 More than 8 out of 10 people aged 65 or over will need some care and support in
their later years.
 3.2 million disabled people are in work. 11.5 percent of all employed people are
disabled and only 9 percent of working-age disabled people have never worked.
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 15 percent of adults with an impairment provide informal care.
 Over half (55 percent) of disabled people play an active role in civic society by formal
volunteering, civic activism, civic participation and civic consultation.
 Disabled people along with their friends and families make up a large consumer
market. The combined spending power of disabled people in the UK has been
estimated to be at least £80 billion a year.
 Disabled people are more likely than non-disabled people to live in poverty.
 The levels of aspirations among disabled 16 year olds are similar to those of their
non-disabled peers and they expect the same level of earnings from a full-time job.
However, by the age of 26 disabled people are nearly four times as likely to be
unemployed compared to non-disabled people. Among those who were in
employment and with the same level of qualification, earnings were 11 percent lower
for disabled people compared to their non-disabled peers. By the age of 26 disabled
people are less confident and more likely to agree that ‘whatever I do has no real
effect on what happens to me’. At age 16 there had been no significant differences
between them and their non-disabled peers on these measures.
 In 2010, the UK’s employment rate for disabled people was lower than the EU
average (41.9 percent compared to 45.5 percent).
 The employment rates for people with some impairments remain consistently low.
For example, people with learning disabilities or mental health conditions have
employment rates of less than 15 percent.
 Disabled people are around half as likely as non-disabled people to hold a degree
level qualification (15 percent compared with 28 percent) and nearly three times as
likely not to have any qualifications (19 percent compared with 6.5 percent).
 Most disabled people in work are employed in the private sector. Around 800,000 (26
percent) work in the public sector, about the same proportion as non-disabled people
(23 percent).
 International evidence suggests that the key to achieving job outcomes is a focus on
work capacity rather than disability and active engagement with the labour market.
Work should pay and provide clear financial incentives to take up jobs.
 The proportion of social care service users and carers receiving a direct payment has
increased from 12 percent in 2010/11 to 14 percent in 2011/12. 25 percent of those
aged 18-64 with a learning disability receive a direct payment and 35 percent of
carers receive a direct payment.
 There are over 17,000 organisations providing adult social care employing 1.6 million
workers, across the private, voluntary and public sector.
 Disabled people are more likely to remain single (never marry) or to be divorced or
separated. Among those aged 30-44, 36 percent of disabled people remain single
compared with 26 percent of non-disabled people. Similarly, for this age group, 19
percent of disabled people are divorced compared with 14 percent of non-disabled
people.
 People with learning disabilities have poorer health than their non- disabled peers.
Mortality rates among people with moderate to severe learning disabilities are three
times higher than in the general population, with mortality being particularly high for
young adults, women and people with Down’s syndrome.
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 Only 7 percent of disabled adults participate in at least 30 minutes of moderate
intensity sport three times per week compared with 35 percent of all adults.
 Since 2005 a higher proportion of people are likely to think of disabled people as the
same as everyone else (80 percent in 2011 compared to 77 percent in 2005).
 There has been an increase in the proportion of people who have friends or
acquaintances who are disabled – this has increased from 66 percent in 2007 to 73
percent in 2009.
 However, in 2011 86 percent of people thought that disabled people need caring for
some or all of the time, up from 72 percent in 2009.
 Around four in ten people (41 percent) in 2011 felt that disabled people cannot be as
productive as non-disabled people (compared with 36 percent in 2009).
 In 1998, almost three-quarters (74 percent) wanted to see more spending on benefits
for disabled people, compared to 63 percent in 2008 and 53 percent by 2011.
Support for more government spending on those caring for sick and disabled people
has also declined from 85 percent in 2008 to 75 percent in 2011.
 Whilst understanding and tolerance of mental health conditions remained high in
2011, the proportion of adults voicing these tolerant attitudes has decreased since
1994.
 There has been a significant increase in the reporting of disability in the print media
in 2009/10 as compared with 2004/5. During this period, there has been a reduction
in the proportion of articles that describe disabled people in sympathetic and
deserving terms. This was coupled with an increase in the number of articles
documenting the claimed ‘burden’ that disabled people are alleged to place on the
economy.
 Disabled people are significantly more likely to experience unfair treatment at work
than non-disabled people (19 percent compared to 13 percent).
 Motivations for hate crimes experienced by disabled people are not always due to
their disability. In 2009/11, 2 percent of all adults interviewed on LOS had been a
victim of any hate crime in the past 12 months. Victims were asked what they thought
the motivations were for the hate crime they had experienced. For adults with
impairment, ethnicity was the most commonly reported motivation for hate crime
(27%).
 Disabled people are more likely than non-disabled people to be a victim of any crime
 Adults with an impairment have a lower level of social contact (i.e. contact with close
friends and relatives) than those without an impairment. For example, adults with an
impairment are more likely to have no or just one or two close contacts compared
with adults without an impairment (14 percent and 8 percent respectively)
 32 percent of disabled people experience difficulties, related to their impairment or
disability, in accessing goods or services (goods and services include going to the
cinema/theatre/concert, library/art galleries/ museums, shopping, pubs/restaurants,
sporting events, using public telephones, websites, a bank or building society,
arranging insurance, accommodation in a hotel/guest house, accessing health
services/Local Authority services, Central Government services, law enforcement
services, or any other leisure, commercial or public good or service). This figure has
decreased from 42 percent in 1995.
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 Transport is an important factor in supporting participation but remains a barrier for
one in five disabled people
The document is available online at http://odi.dwp.gov.uk/docs/fulfillingpotential/building-understanding-main-report.pdf.
Learning disabilities – crisis – mental health
Mental Health Crisis Information for people with Intellectual Disabilities
Colin Hemmings, Shaymaa Obousy ands Tom Craig
Advances in Mental Health and Intellectual Disabilities
Volume 7 issue 3
2013
This interesting article presents research looking at whether accessible, portable mental
health crisis information was useful for 20 people with mild learning disabilities and
mental health problems. Personalized information to help in a crisis was recorded on
folded A4 sized sheets that could be carried in a conveniently sized wallet. Nine (45%)
participants were men and eleven (55%) were women. Nine were under age of 40 and
eleven were aged over 40. Fifteen (75%) were of white UK or Irish ethnicity and five
(25%) were of Black UK or African or Asian ethnicity. Four (20%) were in independent
accommodation with outreach support whilst sixteen (80%) were in staffed
accommodation of various forms.
The participants were told that certain basic information would be on their crisis
information. This consisted of their name and address and contact numbers for a key
person they would like to have contacted in the event of a crisis, their GP and out of
hours GP service, the local Community Learning Disabilities Team, the local hospital
Accident and Emergency department and Social services including the out of hours
contact number.. They could choose whether they wanted to have a picture of
themselves on a plastic identity card to be kept with the crisis information.
They were also asked if they wanted the following information included: their mobile
telephone number, mental health history, physical health, medications, allergies and
contact numbers of professionals involved in their care. They were then asked if they
wanted the following information included and if so, asked to give details: What happens
when I first become unwell...What I think would help me if I am in a crisis...What doesn't
help me if I am in a crisis...Which things or belongings are important to me...How I would
like people to talk to me...What makes me sad or unhappy...What makes me happy and
cheerful...What makes me irritable or angry...What makes me worried or anxious...What
makes me calm or relaxed...What makes me scared or frightened...Any other important
information I would like people to know. The completed crisis information was colour
printed on A4 paper tri-folded down to fit in provided leather wallets, suitable in size to
be kept in pockets or bags.
Findings include:
 Seventeen of the twenty participants (85%) nominated a carer or relative to assist
them in the completion of their crisis information.
 The majority wanted to include a picture card and their own mobile phone number if
they had one. Nearly all wanted to include contact numbers of professionals involved
in their care (95%), details of their mental health (95%), physical health (90%) and
current medications (85%).
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 The majority wanted to include the following items: How I would like people to talk to
me (95%), What makes me calm or relaxed (95%), What happens when I first
become unwell (90%), What I think would help me if I am in a crisis (90%), What
makes me happy and cheerful...(90%), Which things or belongings are important to
me (90%), What makes me irritable or angry (85%), What makes me sad or unhappy
(80%), What makes me scared or frightened (80%), What doesn't help me if I am in a
crisis (70%), What makes me worried or anxious (65%).
 The item that produced the most detailed response was How I would like people to
talk to me. The details given included: "People being kind", "Please talk softly and
calmly", "I want people to talk to me politely, no big words, not talking too much,
going on and on", "Slow and simple, I don't like too many questions", "Not too many
people, two or three people and that's enough." The participants provided several
comments on what they would not like to happen in a crisis. One said, “I don’t like
people talking about my mum because she is dead”.
 Participants were less inclined to include information about allergies because the
majority did not have any and so possibly did not understand the purpose of
recording this information. It can be speculated also that they were less inclined to
include negative things in their crisis information. Several of the participants did not
want to include information about things that frightened or scared them or made them
feel unhappy, sad, or anxious.
 Only four participants had had a mental health crisis in the preceding six months
before receiving their crisis information. All felt that not enough had been known
about them by the staff who saw them.
 Three quarters of the participants carried their crisis information wallets on a daily
basis for six months before evaluation. They and their carers expressed positive
feedback about them carrying the crisis information. No one carrying the information
actually experienced a mental health crisis in the six months follow up period so their
usefulness in such crises could not be evaluated. However, they were unexpectedly
used in other non-mental health settings and reported to have been helpful. Places
used included a GP practice, an Accident and Emergency Department and an
employment advisory service.
 Two of the participants would not take their crisis information wallets out of the house
as they wanted to keep them safe. Three participants lost or mislaid theirs.
 The participants clearly liked having the crisis information wallets and they seemed to
enhance self- esteem and confidence. 19 out of 20 wanted to continue to use them
after the six-month evaluation period.
 A number of carers commented favourably that the crisis information wallets were
portable, gave reassurance and would be available without any prior planning.
 Care staff suggested they may be useful in other settings, e.g. if the person started to
panic in a shopping centre.
 The crisis information was not expensive, difficult, or time-consuming to produce
once a template had been established. In clinical practice, it would entail at least a
meeting of approximately 30 minutes for the person to choose what would be in their
crisis information and to have their picture taken if they chose to have an identity card
as well. Updating the crisis information would take additional time when changes
were necessary although care staff and key workers may often be able to do that.
The report is available to people with SCIE Athens account at
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http://www.emeraldinsight.com/journals.htm?issn=2044-1282&volume=7&issue=3 or on
request from Rachel Dittrich, rachel.dittrich@hants.gov.uk.
Older people – dementia
Study of the use of antidepressants for depression in dementia: the HTA-SADD trial – a
multicentre, randomised, double-blind, placebo-controlled trial of the clinical
effectiveness and cost-effectiveness of sertraline and mirtazapine
Banerjee S, Hellier J, Romeo R, Dewey M, Knapp M, Ballard C, et al.
Health Technol Assess 2013;17(7)
February 2013
This is yet another report showing that antidepressants should not be given to older
people. It reports on a randomised-controlled trial of the two antidepressants most likely
to be prescribed to people with Alzheimer’s - sertraline and mirtazapine. The trial was
double blind: the medication and placebo were identical for each antidepressant.
Referring clinicians, research workers, participants, pharmacies and statisticians were
not told which was antidepressant and which was placebo. Participants were recruited
from community old-age psychiatry services in nine English centres (including
Southampton). 326 people were randomised to one of three groups – 111 to receive
placebo, 107 to receive sertraline and 108 to receive mirtazapine. Groups were evenly
matched, and the majority of participants were female, with a mean age of 79 years; 146
(45%) were married.
Findings were:
 There was a strong consistent pattern of improvement in the depression at 3- and 9month follow-up for participants. However, this study gives strong evidence that this
improvement is not attributable to antidepressants: improvement was across all
groups. In other words, the trial shows the antidepressants appear to be no more
effective than placebo.
 What this study cannot tell us is if this improvement is a function of the non-drug
‘treatment as usual’ by these old age psychiatric services, or due to things such as
regression of the mean or the Hawthorne effect.
 The placebo group had fewer adverse reactions (29/111, 26%) than the sertraline
(46/107, 43%) or mirtazapine (44/108, 41%) groups. Fewer of the reactions were
severe.
The paper is available online at http://www.hta.ac.uk/fullmono/mon1707.pdf.
Older people – social exclusion
Understanding material deprivation among older people
Anna Bartlett, Claire Frew and Joanne Gilroy
Department for Work and Pensions
March 2013
This report provides in-depth quantitative analysis of the material deprivation and low
income experiences of older people. It is based on 2009/10 - 2010/11 data from the
Family Resources Survey, a major survey completed by 20,000 households in the UK.
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Material deprivation is measured in this survey by asking people if they have access to
the following things:
 At least one filling meal a day
 Go out socially at least once a month
 See friends or family at least once a month
 Take a holiday away from home
 Able to replace cooker if it broke down
 Home kept in a good state of repair
 Heating, electrics, plumbing and drains working
 Have a damp-free home
 Home kept adequately warm
 Able to pay regular bills
 Have a telephone to use, whenever needed
 Have access to a car or taxi, whenever needed
 Have hair done or cut regularly
 Have a warm waterproof coat
 Able to pay an unexpected expense of £200
The respondent is defined as being deprived for that item if they lack it for financial or
non-financial reasons, but not if they choose to not have access to/own that item.
Key points include:
 The vast majority, around 80 per cent, of pensioners do not experience relative
poverty or material deprivation.
 More than half (over 5 million, or 51 per cent) of all pensioners do not report any level
of material deprivation.
 A further 40 per cent (around 3.9 million) report that they lack up to 3 of the 15 items;
this means that they experience some (small) level of material deprivation, but are
not deemed ‘materially deprived’ according to the Family Resources Survey
definition.
 9 per cent (800,000) of pensioners were materially deprived (according to the Family
Resources Survey definition) in 2010/11.
 The majority of those pensioners who are materially deprived lack between 3 and 6
items. These individuals tend to be experiencing some level of social and financial
deprivation. They tend to be lacking the ability to replace a cooker, deal with an
unexpected expense of £200 and take a holiday away from home.
 Social deprivation is the most common form of material deprivation for pensioners,
with over 90 per cent of materially deprived pensioners lacking a social item (e.g.
being able to go on a holiday, or see friends and family regularly).
 Only 2 per cent of pensioners do not have a warm waterproof coat, with the most
common response for not having one being ‘no money for this’.
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 Only 1 per cent of pensioners do not have at least one filling meal per day, with the
responses here for this being ‘health/disability prevents me’ and ‘not something I
want’.
 Lacking access to a telephone, is experienced by 3 per cent of all pensioners.
 Disability appears to be one factor that is associated with material deprivation. This
suggests that disabled pensioners have difficulty in being able to access certain
goods & services.
 Housing tenure is also an important factor, with those pensioners living in socialrented accommodation appearing to be at greater risk of material deprivation than
those who own their own homes.
 The most common reasons given by pensioners for being materially deprived vary by
item and degree. Not being able to afford an item and health/disability issues
affecting them are some of the most common reasons cited.
The report is available online at http://research.dwp.gov.uk/asd/asd5/ih20132014/ihr14.pdf.
Prevention
Prevention services, social care and older people: much discussed but little researched?
Jon Glasby, Robin Miller and Kerry Allen
University of Birmingham
March 2013
This briefing presents findings from a survey sent to Directors of Adult Social Services in
nine Local Authorities (LAs) to identify what they viewed as their top three investments in
prevention services for older people. Interviews took place with the leads for each
intervention. The researchers also reviewed the local evidence as to whether these
interventions lead to a delay or reduction in the uptake of social care services.
I would treat this briefing with a bit of caution: the researchers say that formal research
evidence shows that the three interventions discussed can have an impact - this is true,
but, apart from for reablement and some aspects of telehealth, there is generally little or
no clear evidence they have a preventative impact.
Findings include:
 All of the nine LAs surveyed reported that reablement was one of their ‘top’
approaches to prevention. Reablement services were generally directly provided by
LAs. Most worked with older people in general but a few focused on those with
particular conditions, such as dementia. They were all based around core teams of
specialist home carers with input from occupational therapists. There were also
examples of other health and social care professionals being integrated within the
reablement service.
 Telecare, telehealth and/or other technology based interventions were amongst the
top three interventions in six Las.
 Information and advice services were amongst the top three in three authorities. In all
cases these were provided by a third sector organisation, and older people and/or
their carers could self-refer. There were also links to LA call centres.
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 LAs were often influenced by evidence and/or advice provided by national and
regional sources on the best way to invest in prevention. This included findings from
central government-funded pilot initiatives and reports from third sector organisations
with a focus on the needs and wishes of older people. Many of the reablement and
telecare services, in particular, had begun with pump priming money from the
Department of Health. Formal research studies in relation to reablement, telecare,
and information and advice services suggest that they can have positive impacts on
prevention. However, the number and scope of such studies is limited and there
continues to be a considerable evidence gap.
 Local analysis of current and predicted need referral patterns and current use of
services were often part of the decision-making process. Views of older people and
professionals were sought through both formal consultations and anecdotal
feedback. Learning from the experiences of LAs that had already developed a similar
service was also seen as helpful.
 However, decisions on investing in prevention were not always evidence-based.
Other factors could influence how local funding was spent. This included political
commitment to maintaining the role of a local third sector provider and/or retaining inhouse services and the practice based experience of senior members of staff.
 Reablement services were clear about the outcomes that they were expected to
achieve by the LA and were given targets to reduce the amount of social care
support required by older people accessing their service. They also asked older
people whether their personal outcomes were met.
 LAs were generally not able to state the outcomes they expected from other
interventions clearly, and these services often did not have processes through which
older people could set their own outcomes. Some interventions worked on the basis
that if the older people perceived the service had been useful then it was achieving
the right outcomes.
 Local evidence indicated that by the time they were discharged from reablement
services between 50–90% of older people (depending on the LA concerned) needed
less or no support than when they initially contacted the service. Local evidence also
revealed that many of older people’s personal outcomes were met. These findings
reflect those of formal research studies that have shown that reablement services
can improve outcomes and can sometimes create efficiencies.
The briefing is available online at http://sscr.nihr.ac.uk/PDF/Findings_17_preventioninitiatives_web.pdf. Further outputs from the project will be available shortly.
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