Wednesday, July 16, 2014
End of life care – something needs to change
As the population ages, the question of how we as a society care for people at the end of their lives is becoming ever more pressing. It is widely recognised that current systems for providing care for people at the end of life are not up to scratch. Only 7% of the population want to die in a hospital, with 66% saying they would prefer to die at home; yet in 2010 about 60% of deaths were in hospitals. This is putting a huge strain on individuals and their loved ones, as well as on the healthcare system.
What is preventing people from dying in their own homes if that is their choice? One major factor can be the lack of social care support for everyday needs such as washing, feeding, and emotional support. Social care currently falls within the remit of local authorities and is subject to means testing – which means that many people at the end of their lives are required to pay if they want to have their social care needs met at home. Social care support can, however, also be obtained for free through the NHS Continuing Healthcare route. But this system is widely regarded as too difficult and slow to access. When it comes to providing care for the dying, we only have one chance to get it right – but too often we do not.
The calls to correct this situation have become louder in recent years, with a number of reports and reviews, such as the 2010 Dilnot Commission and the 2011 Palliative Care Funding Review, urging for change. It is in this context that a coalition of six charities has come together to campaign for universal, free social care at the end of life, to enable people to die in the place of their choosing. The coalition brings together Macmillan Cancer Support, Help the Hospices, the National Council for Palliative Care, Motor Neurone Disease Association, Sue Ryder and Marie Curie Cancer Care.
As part of their campaign the coalition commissioned OPM to conduct research on how free social care at the end of life could work in practice. Earlier this month OPM’s Dr Chih Hoong Sin presented our research at the All-Party Parliamentary Group on Hospice and Palliative Care, highlighting key findings from our recently published report, ‘How could free social care at end of life work in practice’.
We looked at a number of existing models of end of life care where social care is free, to learn what was effective about these and how they might be replicated elsewhere. We reviewed existing literature, examined 12 different services including two in-depth case studies, and spoke to a number of practitioners, to try to work out how free social care at end of life can work in practice.
We found that a range of different localities and services are working to make free social care at the end of life a reality. However, this provision is by no means consistent nor universally available. Our key recommendations for how to change this so that everyone has access to free end of life care were:
- Improving what is already available, such as NHS Continuing Healthcare Fast Track funding. National guidance already exists but all too often this is not being followed locally; relevant measures need to be put in place to overcome the ‘implementation gap’;
- Encouraging innovation and new models such as the successful STARS Care programme in Liverpool, which provides a tailored, specialist care service for people at end of life;
- Ensuring commissioning of end of life care is more consistent across the country and prioritises holistic, person-centred care; whilst allowing for adaptation and innovation at the local level;
- Focusing on quality to make sure that everyone has access to the same good standard of care – and robustly monitoring this;
- Supporting strong partnerships between commissioners, services, professionals, providers, patients, carers and families, to embed a collaborative approach centred on the dying person.
There was consensus at the APPG event on 2nd July that the case for free social care at end of life has been definitively made; as Imelda Redmond from Marie Curie put it, “the moral argument has been won.” It is now a case of thinking about how, which our research set out to do. A key remaining question is where funding for free social care at end of life can be found; a significant step has been made in a recent Macmillan report which suggests that the NHS could actually save money by supporting people to die in their own homes rather than in expensive hospital beds.
In the end of life care arena there is much action afoot – with changes in the Care Act, and the Palliative Care Funding Review pilots. But more still needs to happen. And it won’t be a moment too soon, in the face of our ageing society, ongoing patchy provision, and the real challenges of soon ‘unsustainable’ local authority care budgets highlighted in this month’s ADASS report.
These challenges are pressing, and we urgently need a better system for care at the end of life. The campaign for free social care at end of life is thus bound to gather momentum in the months ahead. And, with all three of the main parties expressing support for this policy, can we hope that it will soon be a matter of when, and not how, free social care at end of life will become a reality for everyone?
Leadbeater, C. and Garber, J. (2010). Dying for Change. Demos. p.20.
 Dilnot, A. (2011). ‘Findings of the Commission on Funding of Care and Support’. Slideshow. The King’s Fund website.
 Hughes-Hallett T, Craft A, Davies D (2011). Funding the right care and support for everyone. Report of the Independent Palliative Care Funding Review. London: Department of Health.
Thursday, June 12, 2014
Teaching approaches that help to build resilience to extremism among young people
This report presents the findings from a large-scale, in-depth research study into teaching methods – knowledge, skills, teaching practices and behaviours – that help to build resilience to extremism. The focus is on teaching methods to be used in a general classroom setting rather than as part of interventions targeted at those deemed at risk of extremism.
The research methods used were 10 in-depth case studies of relevant projects and interventions, including interviews with teachers, practitioners and students and classroom observation, a literature review conducted according to systematic principles, and close engagement with 20 academic and other experts in the field.
The study was commissioned by the former Department for Children Schools and Families (DCSF), now the Department for Education (DfE), with support from the Home Office. OPM conducted the research in partnership with the National Foundation for Educational Research (NFER), which is the UK’s largest independent provider of research, assessment and information services for education, training and children’s services.
The primary aim of the research was to provide a strong evidence base for schools and other education providers to help them adopt and commission the appropriate interventions to build resilience to extremism.
Following detailed analysis and synthesis of findings from the case study visits, together with findings from the literature review, we identified a number of key ingredients which were important for resilience-building teaching activities. Taken together, these ingredients help to counteract the impact of factors that can help to either push or pull young people towards extremism and / or violent extremism, such as a sense of injustice or feelings of exclusion.
The key ingredients can be clustered under three headings:
1. making a connection through good design and a young-person centred approach
2. facilitating a safe space for dialogue and positive interaction
3. equipping young people with appropriate capabilities – skills, knowledge, understanding and awareness.
Tuesday, May 13, 2014
Research into young Londoners’ experiences and perceptions of stop and search
Stop and search is a part of day to day life for many young people in London who hold very strong views on stop and search and on the police. Undoubtedly the use of stop and search powers is a major contributor to negative attitudes held by young people towards the police and is seen as part of the cause for the riots in August 2011. The Metropolitan Police Service (MPS) introduced a new approach to stop and search and the London Assembly wanted to assess whether young people had noticed any changes to the use of the power since its implementation. The London Assembly Police and Crime Committee therefore commissioned OPM to undertake independent research into young Londoners’ experience and perceptions of stop and search in September 2013 as part of a wider investigation into changes to the MPS’s use of stop and search powers.
What we did
The research comprised of five focus groups with 36 young people in five areas of London, to seek their views on police use of stop and search. We worked with youth organisations to set up and run these focus groups that took place in Hackney, Waltham Forest, Hammersmith, Southwark and Tower Hamlets. The majority of participants were male, aged 16-20 and of black or Asian ethnic background, due to this demographic being the most likely to be stopped and searched, There was a broad mix of backgrounds, including ex-youth offenders, ex-gang members, students, community volunteers and NEETs (those not in education, employment or training). To inform the design of the materials for the focus groups, we held a workshop with members of the GLA’s peer outreach team, a group of young people aged 15-25 who engage with and gather the opinions of young Londoners to inform the work of the GLA.
The five key research questions which this work sought to address were:
- How stop and search affects young people’s relationships with, and attitudes to, the police.
- Whether young people are aware of the MPS Commissioner’s commitments to improve stop and search and the associated targets.
- Whether they believe the targets will make a difference and whether other action is needed by the MPS leadership team.
- Whether young people have noticed any changes in the quantity, type or quality of stop and search since the new policy was introduced.
- Whether young people’s views change when they see performance data on stop and search.
The report aimed to inform the London Assembly Police and Crime Committee of OPM findings regarding young people’s views on police use of stop and search and provide recommendations on possible improvements and developments that could be made to the stop and search approach. Key findings and recommendations included:
- While there was widespread acceptance that the stop and search powers are necessary for tackling crime, many perceived that young people are often stopped because of their appearance rather than based on specific intelligence. Furthermore, it was felt that that police officers do not always follow procedure or conduct stop and search in a professional manner. Young people felt victimised by repeated stop and searches, embarrassed to be seen involved in a stop and search, and annoyed to have their time, and police time, wasted.
- The impact of this on their attitudes to and relationships with the police was to create a strong sense of injustice and resentment.
- Most (although not all) participants had noticed changes to stop and search over the past year to 18 months, primarily fewer stop and searches, but some also noted more targeted stop and searches (less ‘random’). Participants were uniformly unaware that this may have been linked to a change in approach. Clearly any intended communications from the MPS to young people about the existence of the new approach had not reached them. OPM found that most agreed any data regarding changes in approach should be communicated to young people, especially data which shows that stop and search is becoming more targeted, ‘smarter’ and more effective (rather than simply the overall reduction).
- The reports concluded that the new MPS policy on stop and search seems to be having an impact on young people’s experiences on the ground, to varying degrees (depending on the area they live in and/or their age). Furthermore, again with varying degrees, it has had an impact on their overall perceptions of the police (depending on their pre-existing perceptions).
- The key change that young people wished to see going forward was around the attitude and manner of the police when conducting a stop and search. They wanted the police to be more respectful, polite, calm and friendly, and avoid aggressive or patronising language and behaviours. They requested that police ensure discretion and dignity by avoiding conducting a search in a busy place in view of others, and avoiding unnecessary personal contact.
- Other potential improvements included a proportionate number of officers to conduct a stop and search, an extended time limit between stops and a more intelligence-led approach rather than targeting of ‘familiar faces’. The police should clearly explain both their reasons for the stop and search, and the young person’s rights.
- To really make a difference to young people’s views, the commitments and targets for change must be backed up by visible action.
Thursday, May 8, 2014
Removing barriers, raising disabled people’s living standards
This report contains the findings from a research programme aimed at understanding disabled people’s priorities for change. The research was commissioned by the disability charity Scope, and conducted by OPM (focus groups and qualitative interviews) and Ipsos MORI (national survey).
This research contributes to the evidence base and to the case for action to work with disabled people to improve living standards.
Friday, March 14, 2014
Social media’s flaws are old friends to researchers
Social media is one of the biggest phenomena of the past few years, changing the ways in which we communicate and generate knowledge. These technologies have vast potential as additional tools for deliberative public dialogue and social research, but they are extremely new and some researchers are hesitant due to concerns about their validity and reliability. Are these concerns well founded, or are the problems that social media present really very similar to those found with other research methods?
This was an argument put forward by Caroline Turley and Carol McNaughton Nicholls from NatCen Social Research at a seminar run by the Social Research Association (SRA) on 27th February. Caroline and Carol were presenting an overview of the new edition of ‘Qualitative Research Practice’, outlining the areas that have changed most significantly in the 10 years since the first edition was published.
The evolution of the internet and in particular the arrival of social media is, of course, one of the defining changes of the last decade, so one of the topics discussed at the seminar was the way in which qualitative social research has engaged with this technology. Caroline and Carol noted the concerns relating to validity and reliability, but argued that we have a tendency to over-think the impact of the internet, when in fact it could be seen as an extension to the variety of communication tools available to us, and one which carries the kinds of limitations and risks we are already familiar with. So, what are some of the common concerns raised about using social media, how are these similar to the challenges posed by other research tools and how does this experience help us to find ways to overcome social media’s challenges?
The way in which we represent ourselves as individuals has been affected by social media, and this can be a cause for concern in qualitative research. But people represent themselves differently in all other situations too, and the influence of power dynamics between researchers and participants is well documented, so this isn’t really a novel challenge for researchers.
Communicating via social media channels often involves a mixture of media types, including photographs, video, and text, so researchers have decisions to make about what data to analyse and how to do so. But in any research project we have to identify and rationalise our data and methodology choices, so this isn’t a new problem either, and social media presents interesting ways in which we can combine different types of analysis.
The ‘digital divide’ is another subject that often comes up in discussions about using the internet as a tool for research and engagement. But the need to address and consider accessibility and participation is relevant for any research method we might choose, so this is simply a variation of this issue.
Practical issues, like obtaining written consent from participants, can also present challenges in an online environment, but these kinds of problems also arise in other forms of interaction such as telephone interviews. The seminar group discussed how we need to develop more flexible ethical consent processes that adapt to the research method, rather than allowing these processes to limit the research. Indeed, one of the valuable things about qualitative, as opposed to quantitative, research is the ability to respond flexibly to use the right method for each particular subject area and for each individual participant.
Social media is certainly not an online silver bullet able to unlock untapped sources of evidence with one click, and its potential to connect researchers with participants will vary depending on the project and subject area. However, it is obvious that social media has an important role to play in social research, and this role is destined to become more important as technologies become more widely adopted. But although social media is a relatively new technology, researchers should avoid getting too preoccupied with the perceived novelty of the challenges it presents, and should use the same caution and expertise they would with any other research tool. Indeed, no matter what medium or method we use, as qualitative research practitioners we all have a responsibility to maintain an ethical conscience, to carry out good quality research, and to be reflective about the strengths and limitations of our work. By extending this approach to social media it can be incorporated as a research tool among all the others at our disposal, and best practice in this area will develop through its increased use and shared reflection and learning.
Thursday, March 6, 2014
Quality Assurance in the Voluntary and Community Sector
VCOs are increasingly expected to adopt more business-like approaches to demonstrate their performance and effectiveness, and to evidence their impact. Commissioners cite quality standards on their Pre-Qualification Questionnaires (PQQs) and often reward points to organisations that have a quality standard in place. Whilst funders from charitable trusts and foundations do not award points on the same basis as public sector commissioners, they want to see evidence of quality organisations, so that they can be sure that the grant funding they award will be managed well and have the desired outcomes.
OPM and NCVO were commissioned by the Big Lottery Fund to gather evidence about the quality standards used in the voluntary and community sector. The aim of the research was to find evidence about the types of quality standards that are available to the VCS, how they are used and how useful they are to whom. This in turn would enable the BIG Lottery to consider the value it attaches to such standards as part of its assessment process.
What we did
BIG identified six key questions to be addressed to meet the aims of the research:
- What quality assurance approaches (accredited and otherwise) are available for VCOs?
- How do accredited quality standards in the sector differ from ISO in terms of their rigour or consistency? What perceptions of reliability exist around quality assurance standards as a result of the different types of accreditation or its absence?
- How do organisations make use of standards they use?
- How are models or standards adapted?
- Does the type and size of an organisation have a bearing on the take-up of particular approaches and quality marks? If so, why is this?
- What evidence from the literature and from practice is there of the effectiveness and understanding of these quality assurance approaches
To answer these questions OPM reviewed literature on quality standards, analysed funding bids, conducted 18 interviews with VCOs, funders and commissioners, and designed an online survey for over 300 respondents.
The research suggested that even the most popular quality standards, such as PQASSO and Investors in People appear to be used fairly marginally when compared with the wide range of other methods of improving quality in this sector, such as user satisfaction surveys, service reviews and complaints monitoring.
Reflecting on the breadth of continuous quality improvement systems and processes being used in the sector, the report points to the value in commissioners and funders taking these into consideration and asks if more widely recognised validated standards might be an option.
The report also recommends supporting voluntary and community organisations to make informed choices about their approach to quality assurance and the use of quality standards and makes suggestions of how to go about this.
Tuesday, February 11, 2014
Tackling hate crime against people with learning disabilities
Mencap were planning to launch a three year Stand by Me campaign the aim of which in the first year was to encourage the police to do more to tackle hate crimes against people with learning disabilities. Mencap were keen to take an evidence based approach to campaigning and whereas they felt they had some knowledge of the issues that make tackling hate crime difficult, they knew further research was needed in order for the campaign to be received positively by the public and the police. They felt that having an independent organisation such as OPM conduct the research would lend their campaign greater credibility.
Mencap were initially keen to work specifically with us on this project because they had been impressed by our work on disabled people’s experiences of targeted violence and hostility for the Equality and Human Rights Commission (EHRC), which helped trigger a Formal Inquiry.
What we did
Mencap initially wanted to run a large scale survey with all police services. However, we felt that given their aims and objectives a smaller, more in-depth qualitative study with a sample of police services would be more suitable and a better use of their resources, and they were happy to follow our lead. We therefore conducted research with 14 police services across England.
We reviewed key documents from each police service, including hate crime strategies and procedures for reporting and recording hate crime. We also conducted in-depth interviews with representatives from each police service which asked them to reflect on the incidence of hate crime against disabled people, the services’ structural and organisational set-up for tackling disability hate crime and implementation and delivery ‘on the ground’.
We also conducted one focus group with people with a learning disability where participants reflected on their personal experiences of reporting hate crime and key expectations in terms of how victims should be treated and hate crime tackled. Mencap were very happy with the report we produced, in particular the rich and varied evidence that had been captured from a small sample. We also helped disseminate the research by writing a series of blogs during Learning Disability week and an article for Learning Disability Today.
Mencap used the final output from the research to launch the Stand by Me campaign which resulted in 22 out of 43 police services in England and Wales ‘signing up’ to the changes suggested, which for Mencap was a resounding success. Many others are also in the process of signing up. They also received good feedback from the Association of Chief Police Officers (ACPO) about the balanced evidence presented in the report and this has led to an ongoing relationship and further conversations about how police services can improve their practice.
The research has also raised Mencap’s profile in the sector and has given them the evidence base they needed to play a role in influencing change. For example, they are now part of an advisory group for the Metropolitan Police and are in discussions with the EHRC about how they can better support their work.
Tuesday, February 11, 2014
Customer Insight Research at Thurrock Council
‘Channel shift’ happens when residents choose (or are requested) to use a different method of communication to contact and do business with their Council or service providers. It is believed to contribute to a more effective and efficient customer services and bring financial advantages over costlier face to face and telephone -based customer services.
Thurrock Council wants to examine the business case for pursuing a programme of channel shift. The Council are also keen to ensure any changes to customer services are informed by the views of local residents including those who may be disempowered or excluded by channel shift. OPM’s role was to undertake customer insight research to improve understanding of Thurrock residents’ willingness and ability to contact and interact with the Council differently.
What we did
Over six weeks OPM:
- Undertook a 500 person telephone survey (broadly representative of the Thurrock population);
- Facilitated five focus groups (Grays, South Ockendon, Purfleet, West Tilbury, East Thurrock);
- Used Mosaic data to segment Thurrock’s total population and understand each segments geo-demographic profile and their more likely behaviours. We then brought these segments to life using the deep customer insights we gained by talking to Thurrock’s customers during the survey and focus groups; and
- Conducted face to face and telephone interviews with key personnel from across the Council and delivered an internal workshop to report headline findings.
Although we recognise Thurrock have many different types of customer, our research found that Thurrock residents could be broadly clustered and characterised by five personas – which we created and clearly illustrated different segments willingness and ability to interact with the council. This research helped to secure a significant amount of money (c£1.6million) to take forward the next stages of the Thurruck’s channel shift programme.
Tuesday, February 11, 2014
Affinity Water: Customer Deliberative Forums
Every five years water companies are required by the regulator Ofwat to take part in a Price Review process which determines the balance of investment, price and service packages water companies provide customers. Affinity Water, like all water companies in England, is required to submit a Business Plan as part of this process and ensure that customers are engaged in this process.
What we did
In July 2013 OPM hosted 4 deliberative forums for Affinity Water customers across Affinity Water’s region. The purpose of these events was to discuss the:
- Acceptability of the draft business plan: does the proposed plan achieve the right balance between the service people receive and the cost they pay?
- Outcome measures: do the proposed measures of success enable customers to judge Affinity Water’s performance?
- Style, content and language of the ‘Our Business Plan Consultation’ document.
Each event involved a cross section of 50 customers from the local area and were designed so that the majority of the discussion sessions were held in small groups, each supported by an OPM facilitator. Periodically, plenary sessions were held to feedback on the main points raised in the small group discussions.There were also 4 interactive voting sessions. At the start of each event every participants was provided with a remote control keypad which they could use to vote on questions throughout the day.
At several points during each event a senior staff member from Affinity Water gave a presentation. After each presentation, participants had a chance to discuss on their tables what they had heard. For the majority of the day participants were asked to discuss the following 4 customer ‘expectations’:
- Making sure our customers have enough water;
- Supplying high quality water you can trust;
- Minimising disruption to you and your community; and
- Providing a value for money service.
For each of these expectations they were asked to discuss how they felt about Affinity Water’s proposed investment level in terms of what it would deliver against the amount it would add to their bills. They were also asked to contrast this with slower and faster pace investment levels.
For each expectation they were then asked to look at the proposed measures for assessing how well Affinity Water is performing against it. For each measure they were asked to discuss whether it was clear what the measure means, whether it would measure what it is intended to measure and whether they felt that any other measures would be helpful.
The final small group discussion today tasked participants with looking at the ‘Our Business Plan Consultation’ and commenting on: whether the language used is accessible; if any diagrams or photos used are helpful; if the report looks interesting; and whether they felt it was the right length or not.
The events were well received, with attendees giving consistently high quality feedback on the event facilitation and design. The results of the event were fed directly into the deliberations of the Affinity Water Senior Management and some of the findings, particularly on options for investment were taking into account in the final business plan.
You can read more about OPM and Affinity Water’s experience of engaging customers in the Price Review process in a joint article written for Utility Week.
Friday, February 7, 2014
Quick wins for local councils and disabled people
The RNIB, as a national organisation representing more than 15,000 members and campaigners, was acutely aware that disabled people across the country stood to be amongst the hardest hit by the cuts in public spending.
Almost two million people in the UK have a sight problem which has a serious impact on their daily lives. The vast majority of these people rely on a core bedrock of services – e.g. accessible information or support with getting around or regaining employment – in order to live independently. Much of this support is provided by local councils.
These services are not luxuries, and often don’t cost much. Yet if withdrawn the impact on people’s lives can be dramatic. At the same time the RNIB knew that to make the case for even modest continued investment, they needed independent evidence of impact, and practical recommendations – which is where OPM came in.
What we did
A wide range of RNIB members from nine places across England were invited to take part in the research, including young and old people with different backgrounds and experiences.
The research included focus groups, in-depth ethnographic interviews to ‘tell the story’ of a day in the life of a blind or partially sighted person, and three participative case studies exploring the good work three local authorities were doing (Leicester, Plymouth and South Tyneside).
OPM and the RNIB launched the report based on the findings from the research at the national Local Government Association conference, with speakers including the (then) leader of South Tyneside Council.
The research went a considerable way to achieving its aim of raising awareness of the practical steps needed to improve outcomes for disabled people when the findings were covered by The Guardian, as well as in local papers where the research had taken place.
Since the launch of the report the RNIB has continued to work with a network of local authorities to encourage and support them to adopt best practice like the innovations showcased by the research.