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Introduction
A person’s ability to live independently may be limited by physical and cognitive declines associated with ageing, including disabilities that affect mobility and self-care. This study examines the delays to accessing healthcare facilities among older adults who are frail or have disabilities, using the three-delays model.
Methods
A qualitative study was conducted during March and April 2022 among 21 older adults (aged 60 or above) who were frail or disabled (using assistive devices) in Bengaluru and nine key informants, consisting of geriatricians, physiotherapists, psychologists and NGO workers. Data were analysed using NVivo 12.
Results
Delays in accessing healthcare for older adults were attributed to multidimensional factors related to the individual (disability; lack of trust in healthcare workers; low/no income), the community and household (neglect/lack of awareness by the family; limited, inaccessible and unaffordable transport modes) and the health system (poor staffing; under-supplied healthcare facilities; waiting times at the hospital). Delays led to complications, hospitalisations and financial burdens for the older adults. The key informant interviews supported these findings.
Conclusion
This research highlights that it is important to overcome delays in accessing healthcare for older adults to ensure better health and wellbeing among this group. A holistic approach is needed to reach out to individuals, communities and households, and the healthcare system. Providing adequate transport services to hospitals should be planned in conjunction with the health department for timely delivery of care. Providing health insurance for older adults and improving geriatric care would be highly beneficial to improving health outcomes.
To examine helping professionals’ attitudes toward older adults is of critical importance in improving the quality of gerontological care and promoting a longevity society. The objective of the present study was to examine the current state of knowledge regarding helping professionals’ attitudes toward older people. This has been done through a review of recent systematic reviews. We used ten databases to search for systematic reviews published on peer-reviewed platforms from 2000 to September 2023. Initially, 730 articles were retrieved, of which 14 were found to be eligible for inclusion. Current evidence primarily focuses on three aspects of helping professionals’ attitudes toward older adults: (1) cognitive, affective and behavioural manifestations of ageist attitudes; (2) professional/educational and non-professional/non-educational factors that influence these attitudes; and (3) education-based and experience-based interventions targeting these attitudes. While it is difficult to synthesise the level of positivity or negativity in helping professionals’ attitudes, we found evidence of stereotypes of older people as incompetent and difficult, and passive emotions and behaviours when providing care. Gerontological knowledge, professional values and exposure to older adults are critical factors shaping helping professionals’ attitudes. Interventions based on positive gerontological education and improving intergenerational relationships have shown promising benefits. Our review identifies notable research gaps in current literature, namely the under-representation of non-Western regions and the lack of valid and culturally sensitive instruments for ageism-related concepts. It provides valuable insights for future research, practice and policy on ageism to improve the quality of gerontological care.
This chapter presents a doctrinal analysis of the issue of capacity to consent to sexual relations at the intersection of the civil and criminal law, exploring the various aspects of the Mental Capacity Act 2005 and the Sexual Offences Act 2003. The chapter starts with the position outlined by the Supreme Court in A Local Authority v JB, with which the authors agree, to argue that ‘consent’ as a concept ought to be part of the information relevant to a decision to engage in sex. It then goes on to explore the various boundaries between the civil and criminal legal frameworks regarding capacity to consent to sex, justifying the differences in approach through analysing their differing theoretical and policy functions. Furthermore, the chapter considers whether it is right to view the boundaries between the civil and criminal law here as fixed or unchangeable, and whether, instead, we might usefully learn from a hybrid approach to dealing with the problem of sexual offending towards vulnerable adults.
This chapter examines the approaches and enablers for health and social care service design. It begins by discussing the steps in service design, the scale and circumstances that can affect approaches, and the key phases. The chapter then considers the impact of incumbent services and limited finance on design processes. Co-production is essential for effective design, and the success factors and approaches for implementing co-production with a range of groups, including people in communities and the voluntary, community and social enterprise (VCSE) sector, are explored. The importance of the VCSE alliance model is considered. To capture the efforts involved in the design process, the service specification is described and writing tips are provided. Finally, some of the key issues facing those designing services are examined, including capacity and demand, integrated services, workforce, and shared care records.
There are number of challenges facing health and social care in the future, but this chapter examines those that are key for future planning and readiness. The first challenge discussed is understanding the ageing population and how to plan and design services for the growing demand. The second is the technology revolution, and this covers the priorities of the NHS in the Long Term Plan, examples of change, and future planning. The third is the global pandemic, and the chapter unpicks some of the lasting impacts and how the NHS can ready itself for similar events with actions such as promoting flexibility in delivery and supporting communities to be self-sufficient. Finally, the environmental crisis is discussed in terms of its impact on the NHS, but also the impact of the NHS as deliverers of care services with a large carbon footprint. There is examination of the NHS commitment to sustainability along with suggested local actions and examples of change.
As shown throughout this edited collection, not only has the law around capacity, consent and sexual relationships recently undergone shifts in the form of the Supreme Court case of A Local Authority v JB [2021] UKSC 52, but it is an area of increasing importance for professionals and practitioners working in areas such as social work, health or supporting victims of sexual abuse. The aim of this collection has not been to resolve legal or practical issues, but to re/open some of the existing discussions and debates on mental capacity and sex, as well as offering new perspectives. In doing so, this collection has shown that such conversations and debates must not focus solely on the doctrinal questions which have historically tended to preoccupy lawyers but must also consider the challenges and opportunities the legal framework poses for disabled adults, and for professionals working in health, social care and sectors beyond. It is undoubtedly the case that A Local Authority v JB (JB), as well as many of the other decisions from the lower courts outlined in the Introduction and throughout the chapters, have precipitated a renewed focus on mental capacity and sex, often driven by legally and factually complex cases where there may be concerns about sexual abuse. The clarification offered by the Supreme Court in JB as to what is considered relevant information under the Mental Capacity Act 2005, as well as the relationship between the civil and criminal law frameworks, is – in many ways – to be welcomed.
The NHS standard contract is a key tool for commissioners and this chapter looks at the components and schedules of this document. The discussion includes the parties involved, how to monitor the contract, adjusting a contract, implementing levers and incentives, determining length of contract term, and decommissioning. The other key contract arrangements used in health and care settings are discussed, including primary care contracts, grants, and social care frameworks.
This chapter moves from theory to the current commissioning models. It explores the reforms for health and social care in the Health and Care Act 2022 and outlines the tiers of the NHS and the integrated care systems established legally in 2022. It also covers those working in this relatively new structure, including commissioners and key partners. The chapter then guides the reader through stakeholder analysis and involving multiple voices – including people in communities – in commissioning. Finally, there is a brief examination of the differences between health and care systems in England and those in the other countries of the UK and in some other countries.
This chapter opens with why we need to measure and evaluate in commissioning. It outlines the types of evaluation measures and provides examples for a service. The next steps take the reader through how to design evaluation, including the benefits realisation process. This is inclusive of data collection, triangulation, presenting evaluation findings, and dealing with poor performance. Finally, the commissioner is encouraged to evaluate themselves.
The chapter opens with a brief description of the evolution of NHS tariff systems into the NHS Payment Scheme that is used today. There is exploration of the current system, including the principles of blended payment approaches and examples of their application. Then social care framework arrangements are examined along with joint funding arrangements. With financial resources becoming more stretched, this chapter outlines alternative ways of funding services and finding the money for commissioning improvement.
