Health and Social Care
The Faculty of Health and Social Care is one of the major providers of Health and Social Care education in the North West and offers a wide range of programmes at both undergraduate and postgraduate levels.
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Three and Twelve Month Body Mass Outcomes After Attendance at a Community-Based Weight Management Intervention in the North West of EnglandResearch suggests that commercial weight management services are efficacious in helping people manage their body mass, but they typically only include education and advice on physical activity. The objective of this analysis was to assess 3- and 12-month body mass after attendance at a community-based weight management programme delivered by a commercial slimming group, which included the provision of tailored physical activity sessions by a local leisure trust between January 2009 and November 2014. Methods: After institutional ethical approval and participants giving informed consent, a retrospective analysis of a 12-week multi-component intervention, tier 2 community weight management service for adults in Wigan, North West England, United Kingdom, was undertaken. Participants’ (n = 8514) mean ± SD age was 47.4 ± 14.3 years and starting body mass was 86.7 ± 14.3 kg. The main outcome measure was body mass (kg) at 0 months (baseline), 3 months (immediately post intervention) and 12 months. Significant differences in body mass were ascertained if p < 0.05 using repeated measures ANOVA with Bonferroni post hoc test, with effect sizes calculated using partial eta squared. To confirm and account for missing data, the Last Observation Carried Forward (LOCF) approach was used. Results: Repeated measures ANOVA showed a significant effect of time (p < 0.01, ηp2 = 0.36). Post hoc tests revealed there was a significant reduction in body mass from baseline to 3 months (86.7 ± 14.3 kg vs. 81.2 ± 13.6 kg) and baseline to 12 months (79.7 ± 14.0 kg). The difference between 3 months and 12 months was also significant. LOCF confirmed a significant effect of time (p < 0.01, ηp2 = 0.42), with all previously highlighted significant differences remaining. Conclusions: Significant reductions in body mass were reported at 3 and 12 months, providing evidence for the efficacy of the community weight management programme that included tailored physical activity opportunities for participants. Whilst comparisons to a resting control group cannot be made, partnerships between commercial slimming groups and local leisure providers should be encouraged and explored nationally.
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Safeguarding Care Home Patients and Staff During Infectious Disease Outbreaks: A CommentaryThis commentary introduces the PROTECToolkit (referred to as the “Toolkit”) which aims to address the relevant factors associated with infectious disease outbreaks and infection prevention and control (IPC) in nursing and residential care homes.
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Protocol: Assessing the outcomes and impact of Professional doctorate programmes in health and social care on the individual, their profession, their employing organisation and wider society: A comprehensive systematic reviewThis is the protocol for a Campbell systematic review. This review's objectives are to find out (in relation to health and/or social care): (1) What is known about the outcomes and impact of completing (or not completing) a professional doctorate in health and/or social care on the individual professional? (2) What is known about the outcome and impact of completing (or not completing) a professional doctorate in health and/or social care on the employing organisation? (3) What is known about the outcome and impact of completing (or not completing) a professional doctorate in health and/or social care on the profession? (4) What is known about the outcome and impact of completing (or not completing) a professional doctorate in health and/or social care on service users and the wider society? (5) How do we use the findings from this review to inform educators, higher education institutions, professionals, investors in employing organisations and policymakers? (6) What further research will be needed to answer any knowledge gaps or recommendations? (7) Where possible, we will identify and report on any demographic data and discuss their relevance to the impact and outcomes from professional doctorates.
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Enabling and embedding creative participation in child and family social workWe all have a need to be seen and heard. For children who have experienced disruption, harm, danger or trauma, this need is crucial and it is the job of child and family social work professionals to ensure this happens. The ability to make connections and ‘move' with children (Ferguson, 2016; Winter et al., 2017) requires trusting relationships with reliable practitioners, particularly when they have the power to make decisions on a child’s behalf (Cossar et al., 2016). However, research identifies that: > children can be unsure what is written in the plans designed to keep them safe > participation is infrequently embedded into everyday social work practice > the concept of wishes and feelings is often misunderstood. (Dillon et al., 2016; Dillon, 2021) Serious Case Reviews (now known as Child Safeguarding Practice Reviews) have consistently emphasised the missed opportunities of talking and listening to children in social work (for example, Laming, 2003; Rogers, 2013). Despite this, there remains an absence of practice guidance on ways to do this. The need to develop effective communication skills to improve the quality of everyday interactions with children is an important component of professional education and practice (Lefevre, 2018; Ruch et al., 2019). Just as all children are unique, each relationship and interaction between a child and practitioner will be distinctive and influenced by the child’s individual experiences. This practice tool considers the degree to which children can actively take part in decision-making processes that affect their safety and security. It focuses on: > keeping the child ‘visible’ (Ferguson, 2017) > encouraging deeper collaborative and relational encounters with children > providing examples of good practice, using a fictional and unfolding case study to explore how social workers can creatively facilitate children’s participation.
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Participation in Child Protection: A Small-Scale Qualitative StudyThis small-scale qualitative study explores how children participate in their own child protection/child in need planning within a statutory setting in England. Their experience of participation and the impact that voicing their wishes and feelings had on outcomes are highlighted and discussed against a background of conflicting discourses of statutory safeguarding and empowering participation, barriers to engagement and hearing the child’s voice.
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Defining the Role of the Fire and Rescue Service in Mental Health Support for Older Adults: A Qualitative StudyIntroduction: Anxiety and depression in older adults (60+ years of age) are under‐diagnosed and under‐treated. Older adults are less likely to seek help for these problems due to a lack of awareness, difficulty accessing health care due to availability or disability and fear of loss of independence. Existing points of contact between older adults and non‐traditional services, for example, the Fire and Rescue Service (FRS), could provide opportunities to support help‐seeking for mental ill‐health. The FRS conduct Home Fire Safety Visits (HFSVs) with older adults and are well positioned to provide health‐related support. This study examines a range of perspectives on the potential role of the FRS in the identification of, and signposting for, anxiety and depression in older adults. Methods: This was a qualitative study carried out using mixed methods in West Midlands, UK. Semi‐structured interviews were conducted with older adults and health and social care providers (practitioners, managers, commissioners) to explore the acceptability of the FRS expanding its role to detect and signpost for anxiety and depression in older adults. Observations examined delivery of existing HFSVs to older adults. Data were combined and analysed using a reflexive thematic approach. Results: Eighteen health and social care providers and 8 older adults were interviewed; 10 HFSVs were observed. Two overarching themes were identified: (1) Potential role for the FRS and (2) Operationalising identification of mental health problems by FRS. Interviews and observations demonstrated how HFSVs offer a suitable opportunity to start conversations about mental health. All interview participants felt that although the FRS would be well placed to deliver an intervention, they would require training, support and a referral pathway co‐produced with and supported by health and social care partners. Conclusion: A whole‐system approach is needed if the FRS are to expand HFSVs to identify mental health problems in older adults and provide signposting to appropriate services. Patient or Public Contribution: J.S. is a public co‐investigator. A Patient Advisory Group contributed to the initial funding application, design and conduct of the study, including data analysis and advice on dissemination.
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Optimising sexual health and wellbeing services for raciosexual minorities in England using constructivist grounded theoryBackground Racism, stigma, and discrimination can result in poor experiences, marginalisation, misinformation, and thus detrimental health outcomes for racially and sexually minoritised (Lesbian, Gay, Bisexual, Trans and Queer+ Black Persons of Colour (LGBTQ+ BPoC) identifying) individuals. By considering what culturally safe, sensitive, and inclusive services can look like, we can begin to advocate for better, more appropriate health service development. This study aims to examine the experiences of racially and sexually minoritised individuals in accessing sexual health services to develop a theoretical explanation of how to optimise sexual health and well-being services for raciosexual minorities in England. Design Charmaz's constructivist grounded theory was used to develop a theoretical explanation of how to optimise sexual health and well-being services for raciosexual minorities in England. Fourteen in depth interviews were used to collect data. Broun and Clarke's thematic analysis was used to analyse the data. Results From five fundamental themes, three key factors emerged from the data i) access to credible sexual health information, ii) culturally competent lived experience leadership, and iii) culturally safe environments and conditions. Findings highlight disparities with regards to access, outcomes, and experiences of care for raciosexual minority individuals in England. Factors such as the absence of lived experience practitioners, a lack of sensitivity and privacy, and a lack of diverse prevention options were said to compromise the accessibility and usability of existing sexual health services. Similarly, factors such as practitioner competency, trauma-informed approaches, access to practical information, were all said to optimise this experience, leading to greater openness and likelihood of service user engagement (see Figure 25). Conclusion In line with the recommendations made by the participants of this study, culturally safely, sensitivity, and inclusivity remain key drivers toward the design of more optimal sexual health provision in England. This will be achieved through an improved access to credible sexual health information, an increase in lived experience practitioners, provision of cultural competency training across the workforce, and the curation of culturally safe clinical environments and conditions. While it will require significant changes, where intersectionality is honoured, a shift will be observed toward a more optimal sexual health service delivery model. In turn, improved access, experiences, and overall health and wellbeing outcomes will be noted for raciosexual minorities in England.
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Clinical and Humanistic Burden of Non-inhibitor Haemophilia A in Five European Countries: Insights from the CHESS II StudyHaemophilia A (HA) is a congenital bleeding disorder caused by a deficiency/absence of factor VIII (FVIII) and characterised by frequent, acute and prolonged spontaneous or traumatic bleeding events, often leading to haemophilic arthropathy and progressive joint deterioration. HA severity is characterized by endogenous FVIII activity: mild (> 5-40%), moderate (1-5%), or severe (< 1%). HA poses a substantial clinical and socioeconomic burden on people with HA (PWHA), their caregivers, and society. This analysis evaluates clinical and patient-centric outcomes of a cohort of individuals with non-inhibitor HA sampled from France, Germany, Italy, Spain, and the UK in the 'Cost of Haemophilia in Europe: A Socioeconomic Survey II' (CHESS II) study. CHESS II was a cross-sectional burden-of-illness study collecting clinical and socioeconomic data on adult (≥ 18 years) individuals with haemophilia A or B of any severity with or without inhibitors from eight European countries. Descriptive analyses were conducted examining physician-reported demographics, clinical and health resource utilisation information. PWHA-reported health-related quality of life (HRQoL) using the EQ-5D-5L and Work Productivity and Activity Impairment (WPAI) were also examined. Outcomes were stratified by HA severity and reported at country level. Demographics and clinical characteristics of the cohort (N = 880) were generally consistent across countries. Individuals with severe HA experienced more frequent bleeding events and joint disease despite broad use of factor replacement therapy long-term prophylaxis. A minority of those with mild or moderate HA also experienced such challenges. HRQoL and workforce participation diminished, and chronic pain increased, with increasing HA severity. This analysis provides up-to-date insights on the impact of HA across five European countries. Increasing HA severity was generally associated with worse clinical outcomes, HRQoL and workforce participation. These findings suggest a place for continued evidence-based tailored treatment and clinical management approaches in addressing the residual burden of HA. [Abstract copyright: © 2024. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.]
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The policy and prevalence of dyslexia in WalesAbstract available in hard copy
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Priorities in Simulated Practice Learning PlacementsCommentary piece
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Exploring the relationship between condition severity and health-related quality of life in people with haemophilia A across Europe: a multivariable analysis of data from the CHESS II studyBackground: Haemophilia A (HA; Factor VIII deficiency) is a congenital X-linked bleeding disorder characterized by trauma-related or spontaneous bleeding events, most notably arising within the intraarticular space and resulting in chronic inflammation and degeneration of affected joints. Endogenous clotting factor activity relative to normal levels determines the severity of HA symptoms, as mild (> 5–40%), moderate (1–5%), or severe (< 1%). Within the current environment of rapid evolution in HA management, we seek to understand the interplay of condition severity and health-related quality of life (HRQoL) to characterise and differentiate unmet needs among people with HA (PwHA). Methods: A generalised linear regression model (GLM) was developed to explore the relationship between HA severity and EQ-5D-5 L index score from adult HA patients sampled in the “Cost of Haemophilia across Europe – a Socioeconomic Survey II” (CHESS II) cross-sectional, retrospective burden of illness study among adults with hereditary haemophilia A or B from eight European countries. HA patients of any severity with no active inhibitors during the 12 months prior to data capture and a completeEQ-5D-5 L response were included. A base GLM model was specified with covariates for demographic and clinical characteristics (age, body mass index, country, employment, HA severity, annual bleeding rate, problem joints, and chronic pain). Results: Of 381 evaluable patients, 221 (58.0%) had severe HA, 96 (25.2%) had moderate HA, and 64 (16.8%) had mild HA. Among the covariates included in the GLM model and after controlling for haemophilia-related outcomes, a significant association was observed between mild HA and higher EQ-5D-5 L index score (average marginal effects, 0.084; p = 0.016) relative to severe HA. Patient country of residence and magnitude of HA-related chronic pain were also associated with significant differences in index scores, with the latter showing a negative relationship with HRQoL outcomes. Conclusions: Condition severity and chronic pain are significant predictors of HRQoL in PwHA. Durable bleeding protection and effective management of chronic pain have the potential to address unmet treatment needs in this population.
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Being different: what it means to be a person with albinism in NigeriaPersons with albinism experience visual impairments and have unusually white hair and skin colour. In Nigeria, they face social disadvantages due to misconceptions about albinism, which create barriers to equal participation in education, employment, and society. This study explored the life stories of persons with albinism in Nigeria to understand the meanings they ascribe to their experiences. Using a Constructivist Grounded Theory methodology, forty-two interviews were conducted with eleven persons with albinism. ‘Being Different’ emerged as the main theme representing the life experiences of persons with albinism in Nigeria from childhood to adulthood. Participants expressed ‘Being Different’ through subthemes such as ‘being in a tug of war’, ‘disadvantaging schooling system’, and ‘suffering double tragedy’. The study concludes that strongly enforcing anti-discrimination laws, promoting inclusive education, and regularly educating the public about albinism can significantly reduce the negative effects of ‘Being Different’ in Nigeria.
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Food insecurity: The resilient, but “silent poverty” perspectives of older ethnic minority individuals within UK communitiesFood insecurity is acknowledged as a key social determinant of health among older adults. Despite recording significantly higher levels of poverty in comparison to white ethnic groups, older individuals from ethnic minorities are under-represented as recipients of food aid. Thus, there are knowledge gaps in our understanding of older people and their experiences of food insecurity within ethnic minority communities. Through the theoretical lens of Individual and Community Resilience, we empirically advance our understanding of food security and resilience within South Asian communities via in-depth interviews with community stakeholders and older individuals from Bangladeshi and Pakistani communities across the Greater Manchester region. Our findings reveal that the integration of temporal, environmental and social constructs within a resilience framework reveals significant potential for further negative social, cultural and economic impact on older ethnic minorities in the future, especially as current food support services do not appear to cater for ethnic dietary preferences, language accessibility and/or cultural norms regarding asking for help/charity outside the home. We predict therefore, in combination with the identified persistent stressors, that food insecurity issues within older ethnic minority communities are likely to get much worse, resulting in the need for extensive resilient capacities to cope with future cost-of-living challenges. In acknowledging previous limitations within previous resilience frameworks, we propose an incremental contribution to theory and conclude by identifying culturally and operationally appropriate food support system approaches, which can be used to address the increasing prevalence of “silent poverty” within ethnic minority communities.
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Neurodiverse inclusive social work education considered through a student partnershipTo improve inclusion in one social work teaching department, a ‘Students-as-Partners’ project employed four social work students with lived experience of neurodiversity to work in partnership with staff on pedagogical design. The student partners’ role was to evaluate teaching and learning through neurodivergent lenses and co-design strategies to enhance provision. Higher education can often adopt an individualised, adaptive approach to difference (Clouder et al., 2020), rather than a social approach to inclusion where whole courses and environments are designed with neurotypical and neurodivergent learners in mind. ‘Neurodiversity’ offers social work education a constructive new paradigm for understanding learning experiences and for considering individuals’ strengths alongside challenges (Long, 2023). Using a reflective, critical storytelling approach (Beresford, 2016), this article weaves published research findings with the experiences of three student partners and one staff partner, to reflect on and analyse a Students-as-Partners neurodiversity pilot. We conclude that educational designs which actively include the perspectives and ideas of neurodivergent students can deepen understanding of individual challenges and strengths and facilitate the co-creation of more inclusive teaching and assessment strategies.
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Sexual Safety in English mental health in-patient beds: has nothing been learned?All mental health Trusts in England were surveyed, using freedom of Information Requests, as part of an enquiry into sexual safety incidents. A response rate of 72 % was obtained. Results revealed that sexual safety incidents and mixed-sex ward breaches are both increasing. Very few Trusts are adhering to the national guidance on sexual safety standards. Only one audit of safety standards was provided with full data. The Minister of Health has ordered an enquiry by the Health Services Safety Investigation Board with findings to be reported in 12 months' time. We argue more urgent action is needed now. [Abstract copyright: Copyright © 2024 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.]
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Time to consider social care nursing as the fifth field of practiceThe social care workforce is struggling, with an estimated 44% turnover rate across the UK and numbers entering into social care are continually dwindling. According to The State of the Adult Social Care Sector and Workforce in England report (Skills for Care, 2023) there are currently 152 000 unfilled workforce posts in social care.
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Editorial: The Case for More Action and More Research into Health Care Provision and Health Inequalities for People with Intellectual DisabilitiesWhen we accepted the role of guest editors for this special edition on health inequalities, we did not foresee the range and variance of submissions that reflected the lived experience of the health inequalities in people with intellectual disabilities. This is reflected in the diverse and rich mix of studies covering a broad range of topics and methodologies included in this special edition. The pursuit of equity of access to health care is a central objective of many health care systems. These papers collectively illustrate the urgent need to recognise the intersecting influences of gender, disability and other social determinants of health in shaping individuals’ experiences and access to healthcare services. Moreover, these findings highlight the critical importance of incorporating the lived experiences and perspectives of people with intellectual disabilities into research, policy and practice. Looking ahead, it is essential to adopt an intersectional approach that acknowledges diverse and intersecting identities of people with intellectual disabilities, particularly women, in designing and implementing interventions designed to address health inequalities. This requires, not only addressing systemic barriers within healthcare systems, but also challenging societal attitudes and prejudices that perpetuate discrimination and marginalisation.
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Food bank perceptions and food insecurity of older people: findings from an empirical study and how health and social care professionals might offer more supportFood insecurity continues to increase in the UK, and includes a lack of adequate resources to shop, cook, and eat. Among social groups most likely to experience poverty, food insecurity and malnutrition, relatively few older adults have traditionally accessed food banks. This is despite malnutrition representing a common cause of functional decline and mortality amongst older people. This article draws from interviews in Cambridge with older adults, volunteers and others working with older people. It details why some older people who experience hunger or malnutrition may not access the services of a food bank. Among other findings, we highlight the impact of stigma and pride upon many older adult’s viewpoints, as well as the possible negative effects of chronic illness, isolation, reductions in social care funding and policy-based reforms. The potential of social and health care services to better support older people experiencing food insecurity and malnutrition is highlighted.
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The COVID-19 Pandemic as a Public Health Teacher—the Lessons We Must LearnStatement of the Association of Schools of Public Health in the European Region (ASPHER)
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Building the Future One Health WorkforceA ‘new normal’ in public health and healthcare has arisen with socioeconomic shifts, technological developments, political strife, climate change, environmental degradation, and COVID-19. Challenges cannot be solved by one discipline or profession alone, but requires multiple sectors coming together, combining knowledge, expertise and methods. One Health is an integrated epidemiological and economic approach aiming to sustainably optimise the health of people, animals and ecosystem. This article reflects on the roles of Association of Schools of Public Health in the European Region (ASPHER) and European Health Management Association (EHMA) and the concrete steps needed to address skills for One Health.