Do professionals know best?: observations from recent research Jill Manthorpe & Kritika Samsi 8 th June 2009

Do professionals know best?  Illustrated by 5 studies + I starting  Commissioned to be policy, practice and system relevant and rapid  Chosen for today to cover a range of professionals  Cover a range of methods & approaches

Professional truisms 1. We know who should be one of us 2. There are some things that are within our expertise 3. We follow an ethical code 4. Professionals are an experienced body 5. Society wisely puts some decisions in the hands of professionals

Control over membership  Study of the Protection of Vulnerable Adults List (POVA) – lists people banned from working in regulated social care  Now Independent Safeguarding Authority (ISA) covering health, prisons & children’s sectors – a vetting and barring system  Relationship with professional regulators?

The POVA study  Analysis of large numbers of referrals  Sample of cases scrutinised  Devising & discussing vignettes  Interviews  Construction of ‘unsuitability’  Recommendations for ISA  Encouragement of public trust?  Evidence for civil servants & ministers Disseminated in 5 articles, report, conferences etc

Some things that are within our expertise  Being safe to discharge from hospital is a multidisciplinary decision (CC Discharges etc Act 2003), not just medical or clinical  The multi-disciplinary team has to decide that a patient is safe to discharge/transfer (if social services delay then they are fined)

Jigsaw – reimbursement in practice  Perennial problems of hospital ‘bed blocking’  Financial levers (stick) of fines  Less attention to MD shift round ‘safe’ state and safe place  Comparing policy experiment (England & Scotland) – Scotland performance targets  No real argument re: MD shift Is team-work working?

Following an ethical code  GSCC code of practice for social workers and linked codes in rest of UK – interview study  Rare instance of Code applying to professionals and another Code applying to their employers  GSCC using evidence to argue for employer Code to be mandatory

Professionals are an experienced body and trained to do their job  Choice and control policy themes – user knows best  Cash for care  Extended to 13 pilots, RCT design (IBSEN)  What people chose  Explanations for professional caution

IBSEN evaluation questions CORE QUESTION  Do individual budgets offer a better way to support disabled adults and older people than conventional methods of resource allocation and service delivery? If so, which models work best and for whom? User experience Carer impact Workforce Care management Provider impact Risk & protection Commissioning Outcomes Costs Cost-effectiveness Evaluation dimensions

What people bought Cleaning service Classes/arts and crafts Massage for carer Going out: trips/cinema etc. Admission fees for service user and PA Decorating service Gym membership/ swimming Gardening service Alternative therapy Private health care Computer maintenance

Society wisely puts some decisions in the hands of professionals  But the Mental Capacity Act 2005 allows people to make advanced decisions and to appoint proxies (Lasting Powers of Attorney LPA)  And stresses the presumption of capacity, importance of consent and rights to make ‘unwise’ decisions

EviDEM-MCA  Do professionals know about this?  How is it working in practice?  What do older people think? Are they taking up these new rights?  What happens when decision making capacity starts to become affected eg on set of dementia?

Findings  Awareness of knowledge among professionals very variable Knowledge is general (‘common sense’ definitions) rather than specific Sometimes limited to knowing whom they can contact if the need arises Work ethos may be within principles of Act  Older people are interested in making plans, but not always sure whom to turn to Often rely on professionals to bring up the issue Family network usually initiator of discussions Single older people may have little support

Conclusions and reflections  Public sector professional work is shifting  Professional regulation is changing  Located in wider changes – complexity theory seems appropriate  Next steps: ESRC study of the workforce supporting people with multiple exclusion/homelessness – doing professional roles without professional status? And with the most vulnerable?  Priorities for NIHR School for Social Care Research