Georgios Mamolis

Introduction: Support staff (e.g., support workers) play a key role in the lives of adults with a learning disability in residential settings in England. However, the care relationship between the two seems under‐researched with potential care practice implications. Methods: We conducted online interviews with 23 support staff, exploring their perspectives on care relationships and what makes them positive. We used reflexive thematic analysis and generated four themes, namely The care relationship as a conundrum ; Care relationships in a material and ideological reality ; The skilled worker ; and Relationships matter . Findings: The care relationship is ‘a strange, grey area’, a conundrum occurring within staff's and residents' intertwined realities. The material and ideological conditions surrounding the relationship can facilitate or hinder it. The person expands beyond the resident. Building and restoring relationships requires various skills. The absence of positive relationships can be detrimental. Conclusions: Praxis is at the core of care relationships as they operate within emotional, practical, and socio‐political spheres, directing us towards a care ecology. Staff's and residents' (shared) humanity can be used relationally.

Introduction Care provided in people’s own homes (domiciliary care) is an increasingly important part of long-term care. There are various services, including home visits, live-in care and housing with care. Some people directly employ care staff, called personal assistants. Services vary in quality, price and availability, and there is currently little evidence of the value these services provide to the public purse and individuals. This study protocol presents planned research to fill this important gap. Methods and analysis This will be a cross-sectional study based on surveys of care recipients, their unpaid carers as well as formal care providers. In the first half of 2026, we will survey 1850 people accessing domiciliary care either through a homecare agency, a housing with care scheme or by directly employing personal assistants and 400 unpaid carers, all based in England. We will conduct a cost-effectiveness analysis taking a ‘production function’ approach and use quality of life as measured by the Adult Social Care Outcomes Toolkit as the main outcome of interest. Ethics and dissemination The study received ethical approval from the School of Social Sciences Staff Review Committee at the University of Kent on 20 May 2025 (reference 1195) and the Health Research Authority, London—Camberwell St Giles Research Ethics Committee on 28 October 2025 (reference 25/LO/0652). Implications around consent, data protection and confidentiality, risk and participant payment are discussed. In addition to academic outputs (eg, academic articles, conference presentations), we aim to coproduce news items and blogs with people with lived experience of accessing long-term care and jointly present findings at events aimed at the care sector. Moreover, we will offer participating care providers benchmarking briefs based on our findings.

Context: Research exploring care relationships between support staff (e.g., support workers) and adults with a learning disability in long-term social care residential settings in the United Kingdom is relatively neglected. This has potential theoretical and care practice implications. Objectives: This study sought to synthesise relevant literature, expand knowledge, and identify directions for future research. We investigated five questions about care relationships and what makes them positive, exploring definitions of care relationships, relational practices and processes, barriers and facilitators to good care relationships, the impact of relationships, and restoration of disrupted relationships. Methods: Following protocol registration in PROSPERO, a systematic literature review was conducted in June–July 2021. The review was informed by official guidelines and focused on the United Kingdom, covering 41 years of relevant work. Twelve databases and five websites were searched, and experts were contacted. Forty-five reports were included and synthesised using the narrative synthesis framework. Findings: Definitions of care relationships revolved around friendship, equality, professionalism, and power. Practices and processes underlying positive relationships included knowing the person, setting boundaries, and shifting power dynamics. Barriers to positive care relationships included staff interactional patterns, attributions, and staff dilemmas, whilst facilitators included receiving training and using communication tools. Good care relationships were key to effective support and ways to restore disrupted relationships included receiving input from systemic therapy. Limitations: Literature was limited for certain review questions and more extensive for others. Only a few reports addressed care relationships as such with the rest focusing on communication or interactions. Time constraints prevented us from including more kinds of reports. The voice of residents was limited. Implications: We hope that this review contributes to and expands knowledge around care relationships and shapes directions for future research. Findings can be used by support staff, service managers, residents, trainers, advocates, regulators, and researchers.