Gridley Kate, Brooks Jenni, Glendinning Caroline
Social Policy Research Unit, University of York, York, UK.
Health Soc Care Community. 2014 Nov;22(6):588-97. doi: 10.1111/hsc.12105. Epub 2014 Apr 3.
This paper reports findings drawn from a study of good practice in English social care for adults with disability and older people with severe and complex needs. People with severe and complex needs are a relatively small proportion of adult social care service users, but they are growing in numbers and have resource-intensive needs. The study involved qualitative research with adults with disability and older people with severe and complex needs, family carers and members of specialist organisations (n = 67), focusing on the features of social care services they considered to be good practice. Data were collected between August 2010 and June 2011. The approach to data collection was flexible, to accommodate participants' communication needs and preferences, including face-to-face and telephone interviews, Talking Mats(©) sessions and a focus group. Data were managed using Framework and analysed thematically. Features of good practice were considered at three levels: (i) everyday support; (ii) service organisation; and (iii) commissioning. Findings relating to the first two of these are presented here. Participants emphasised the importance of person-centred ways of working at all levels. Personalisation, as currently implemented in English social care, aims to shift power from professionals to service users through the allocation of personal budgets. This approach focuses very much on the role of the individual in directing his/her own support arrangements. However, participants in this study also stressed the importance of ongoing professional support, for example, from a specialist key worker or case manager to co-ordinate diverse services and ensure good practice at an organisational level. The paper argues that, despite the recent move to shift power from professionals to service users, people with the most complex needs still value support from professionals and appropriate organisational support. Without these, they risk being excluded from the benefits that personalisation, properly supported, could yield.
本文报告了一项关于英国为残疾成年人及有严重复杂需求的老年人提供社会护理的良好实践研究的结果。有严重复杂需求的人群在成年社会护理服务使用者中所占比例相对较小，但人数正在增加，且有资源密集型需求。该研究对残疾成年人、有严重复杂需求的老年人、家庭照顾者和专业组织成员（n = 67）进行了定性研究，重点关注他们认为是良好实践的社会护理服务的特征。数据收集于2010年8月至2011年6月之间。数据收集方法灵活，以适应参与者的沟通需求和偏好，包括面对面和电话访谈、使用“谈话垫”（Talking Mats(©)）进行的访谈以及焦点小组。使用“框架”（Framework）管理数据并进行主题分析。良好实践的特征在三个层面进行了考量：（i）日常支持；（ii）服务组织；（iii）委托安排。这里呈现了与前两个层面相关的研究结果。参与者强调了在各个层面以个人为中心的工作方式的重要性。目前英国社会护理中实施的个性化旨在通过分配个人预算将权力从专业人员转移到服务使用者手中。这种方法非常注重个人在指导自己的支持安排方面的作用。然而，本研究的参与者还强调了持续专业支持的重要性，例如，来自专业关键工作者或个案经理的支持，以协调各种服务并确保组织层面的良好实践。本文认为，尽管最近已将权力从专业人员转移到服务使用者手中，但需求最复杂的人群仍然重视专业人员的支持和适当的组织支持。没有这些，他们可能会被排除在得到适当支持的个性化所能带来的益处之外。
