Jess Harris

Introduction: People with experience of homelessness (PEH) often have multiple inter-related needs and for support rely on various services working together. To improve Out-of-Hospital Care (OOHC), it is crucial to understand their preferences. This study used a Discrete-Choice Experiment (DCE) to identify what matters most to them, ensuring services align with real-life experiences. Methods: A mixed methods approach combined interviews, group discussions, and DCE data. Service users, providers, and planners participated in workshops. Researchers with lived experience of homelessness co-designed a user-friendly questionnaire and supported data collection, fostering trust. Preferences were analysed using logistic regression, with findings presented in clear, interactive dashboards. Results: A total of 112 PEH participated from 10 sites, with 108 valid responses (35% response rate). Participants preferred care delivered at home, delivered by trusted housing workers, with minimal behavioural restrictions. Accommodation type and behavioural rules significantly influenced service uptake. DCE outputs were shared with PEH, who confirmed that the findings accurately reflected their priorities and real-life experiences. In one locality, insights were used to reshape service modelling. Discussion & conclusion: This study highlights the importance of co-designing OOHC services with PEH. Stability, trust, and fewer restrictions encourage service engagement. These insights can guide policymakers and service providers in developing more effective, person-centred care models, ultimately improving access and outcomes for PEH.

Research investigating the experiences of women experiencing homelessness often highlights the prevalence of (sexual/domestic) violence and abuse in their trajectories. Drawing on observations across a sample of English statutory and voluntary sector homelessness services and 60 semi-structured interviews with practitioners and with women with homelessness experiences, this study explores these experiences of gender-based violence and the relational impact these may have had on women's help-seeking. Findings suggest that experiences of violence are often normalized, leading some of the women to develop informal, often risky, strategies to protect themselves from violence, using precarious social capital to find ways out of homelessness.

This paper explores the economic implications of different support scenarios for individuals who self‐neglect whilst experiencing multiple exclusion homelessness (MEH) or hoarding behaviour (HB). It draws on analysis of six Safeguarding Adults Reviews (SARs) of self‐neglect‐related deaths from across English localities. Focused on the last one or 2 years of an individual’s life, the SARs provide a detailed examination of resource utilisation across various sectors. The study employs economic modelling to compare the costs associated with ‘unmet needs’, the scenario that ended in death, and the potential costs and benefits derived from meeting these needs more effectively. Sensitivity analyses test the robustness of the model, exploring various budgetary adjustments. For MEH cases, the analysis suggests that shifting from uncoordinated use of urgent and emergency services to planned multidisciplinary support for individuals could free up public resources, enabling reinvestment and better outcomes. The study indicates potential cost savings, emphasising the importance of timely and coordinated interventions to improve the well‐being of individuals experiencing MEH. In HB cases, addressing gaps in responses to self‐neglect among older individuals requires increased resource investment mainly for housing and adult social care but also demonstrates a release of resources for health and a significant reduction in costs for criminal justice and fire and rescue services. The study highlights the role of local voluntary sector groups in providing support and guidance. The study evidences the importance of a multidisciplinary approach, early interventions, and ongoing collaboration among diverse professionals to ensure a holistic response to the complex needs of vulnerable populations. It emphasises the need for continuous collection of quality data, to enable service evaluation and facilitate efficient resource allocation for integrated care systems, and ultimately to contribute to better outcomes for individuals experiencing self‐neglect.

This article reports social workers’ attitudes and approaches to working with people experiencing multiple exclusion homelessness (MEH) who self-neglect, and whether these people receive services, including safeguarding, differently from other populations. It draws on telephone interviews in 2020 with twenty-two social workers working with adults in a range of statutory local authority and National Health Service hospital roles in England. Interviews used two almost identical vignettes featuring self-neglect to prompt discussion and solicit experiences; one included homelessness and drug use to draw out any differences. Following transcription, interview data were analysed thematically. What emerged is a rich understanding of practice responses to self-neglect, but also uncertainties within contemporary social work: whether people who are homeless fall under the ‘umbrella’ of Adult Social Care and safeguarding; and whether self-neglect ‘fits’ under safeguarding. Additionally, participants described barriers to successful multi-agency support for people experiencing MEH, including stigma and exclusion from some statutory services. There was evidence that recent learning from Safeguarding Adults Reviews and local deaths has led to some examples of stronger multi-agency working in this context. The findings suggest more clarity is needed within the profession to ensure that people experiencing MEH benefit from strengthened social work input and safeguarding expertise.

The impacts on adult social work in England of the Covid-19 pandemic were sudden and are proving long-standing. In England, many social workers moved to home working and virtual contact with colleagues, managers, staff from other agencies and service users. A first national lockdown was followed by a lessening of restrictions, but a second wave started at the end of Summer 2020 and restrictions were re-introduced. This study draws on telephone interviews with a sample of twenty-two social workers working with adults in a wide range of roles and settings in ten local authorities and two National Health Service Hospital Trusts, interviewed August–October 2020. Following transcription, interview data were analysed thematically. Findings are reported under three emerging themes: using professional judgement, new and emerging case work and embedding change. These are compared with findings from studies of practice in children’s services and of surveys of social workers during the Covid-19 pandemic. Implications for practice, service users and research are explored.

Purpose: The purpose of this paper is to describe some of the changes to the content and delivery of care work in the context of developments in the wider labour market. Design/methodology/approach: A total of 240 interviews with social care practitioners and managers were undertaken at Time 1 (T1) (2009–2012) and Time 2 (T2) (2011–2014) in four local council sites in England. A final round of interviews (T3) with managers (n=60) and staff (n=60) took place between 2015 and 2018. Findings: The way in which many workers found meaning and satisfaction within their work was an important way by which many of them tempered dissatisfaction with pay, status and working conditions. Some workers used the concepts of ethical practice and vocation to differentiate themselves from other workers and organisations whom they considered lack these qualities and from what they saw as a wider societal perception that their work was unskilled and unfulfilling. Research limitations/implications: The interview data may not be generalisable or totally representative of care staff. Those employers who agreed to participate may have been more committed to workforce development and valued their staff more highly. Nonetheless, data were sector wide and there were sizeable numbers of participants. Practical implications: Pride and job satisfaction are important aspects of job satisfaction in care work and could be fostered in care services and by older people. Social implications: Negative perceptions of care work within society may act as a barrier to recruitment and retention. Older people might help raise the positive profile of care work. Originality/value: This is a unique data set from which to document long-term determinants of job satisfaction in care work.

Purpose: The Cameos of Care Homes project is an opportunity to use the medium of film to showcase the experiences and reflections of frontline care home staff whose employers participated in the National Health Service (NHS) England Vanguard programme. Reflecting on their involvement in one of the Enhanced Health in Care Homes Vanguards, 12 staff describe, in front of the camera, the impact on themselves and their colleagues, on their care for their older residents, and on the wider culture of the care home. The paper aims to discuss this initiative. Design/methodology/approach: The paper reports the experiences of care home staff that were purposefully recorded on film about their participation in a care home Vanguard. The recruitment of the care homes and staff is described, as are the development of interview questions and approaches needed when filming is considered as a research method. Findings: Participating care home staff reported that their involvement in the Vanguard programme had improved knowledge, confidence, morale, communication skills and the homes’ learning cultures. They were enthusiastic about reporting their experiences on film. Examples were given of proactive early support from local NHS staff leading to improvements in care, thereby reducing demand on the NHS. However, participation was resource intensive for care homes. Care home staff hoped the support that accompanied the Vanguard programme would continue but were uncertain to what degree this would happen once the Vanguard programme ceased. Research limitations/implications: The interviews were undertaken with a self-selecting group of care home staff from two care homes operating in one of the six Vanguard sites in England. By their very nature, interviews for a public film cannot provide anonymity. Practical implications: Researchers seeking the views of care home staff may wish to consider filming interviews and presenting the film as a research output that is engaging and informative for care home and wider audiences. Originality/value: The paper presents an analysis of filmed interviews with care home managers and care workers working with older people. Their views on the Vanguard initiative have not been widely considered, in contrast to the sizeable literature relating to NHS activity and expenditure.

The purpose of this paper is to explore the impact of personalisation policy on the providers of social care services in England, mainly to older people, within the context of austerity and different conceptions of personalisation. The paper draws on part of a longitudinal study of the care workforce, which involved 188 interviews with managers and staff, undertaken in two rounds. Four themes were identified: changing understandings and awareness of personalisation; adapting services to fit new requirements; differences in contracting; and the impact on business viability. The paper reflects a second look at the data focussing on a particular theme, which was not the focus of the research study. Furthermore, the data were gathered from self-selecting participants working in services in four contrasting areas, rather than a representative sample. The research raises questions about the impact of a commercial model of “personalised care”, involving personal budgets (PBs) and spot contracts, on the stability of social care markets. Without a pluralistic, well-funded and vibrant social care market, it is hard to increase the consumer choice of services from a range of possible providers and, therefore, fulfil the government’s purposes for personalisation, particularly in a context of falling revenues from local authorities. The research presents an analysis of interviews with care providers and care workers mainly working with older people. Their views on personalisation have not often been considered in contrast to the sizeable literature on PBs recipients and social workers.

The care workforce in England is ethnically diverse yet little is known of how managers manage this aspect of human resources work. This article reports findings from a longitudinal study of the care workforce to offer insights into managers’ views of staff demographics, relationships and management challenges and strategies. Three themes emerged from the analysis: sources of conflict; reactive approaches to limiting conflict; and proactive approaches to preventing and limiting conflict. Findings have implications for human resource management and the creation of supportive staff relationships within care work in countries where ethnic diversity is characteristic of the care workforce.