Abstract
The closure of day centres during the COVID-19 pandemic placed these, generally under-researched, services of day centres under the spotlight. We report priority areas for support and research concerning English adult and older people’s day centres identified by a 2021 survey. Day centres and other day centre stakeholders have an appetite for evidence and supportive resource materials, covering how to remain current and sustainable, demonstrate impact, and support the workforce. An underlying focus on day centres for older people and people living with dementia suggested that centres catering for these groups experienced the most difficulty in providing appealing evidence to service funders.
Background
Day centres are potentially valuable places for some people with multiple and complex care and support needs who want to remain living in the community. These are enabling services that offer companionship, care, advice and support, and may be targeted at different groups of people, including people at the end of life, people with mental illness, homeless people, people with learning (intellectual) or physical disabilities, people living with dementia, and their family/friend carers. They may provide support at specific times, such as when a period of enablement or rehabilitation is needed, or a carer break. Typologically, these services vary in their ownership, target clientele, admission criteria, size and building designation. Even when sharing typological characteristics, there are variations in what they offer, the way they are funded and their quality (Moriarty and Manthorpe, 2012; Orellana et al, 2020b; Orellana et al, 2023).
Despite falling within the remit of social care (National Audit Office, 2018: 4), in England, day centres are not regulated by the Care Quality Commission (unless day care takes place where people are living and also provides personal care to people who need it as part of the service). These services, as well as other unregulated day services like lunch clubs, tend to be missing from discussions about ‘fixing’, reforming or rebuilding social care (see, for example, Bottery, 2019; London Councils, 2021), which focus on homecare and residential care homes. Additionally, they are under-researched. Much of the large-scale evidence about English day services was collected in a different policy context (see, for example, Carter, 1981; Tester, 1989). Furthermore, while providing useful background, non-UK (international) research may cover different policy, statutory, funding and cultural settings, which operate different models of day service, and, hence, may not be relevant to the English context (Orellana et al, 2020b; Lunt et al, 2021). While a few important English studies were published in the early 2000s (see, for example, Andrew et al, 2000; Burch and Borland, 2001), it is possible that the policy focus on choice and control in social care services (for example, directly employing a personal assistant for personalised support) has drawn research attention away from congregate services, such as day centres.
Under the Care Act 2014 (HM Government, 2014), English local authorities (LAs) are required to have a ‘market-shaping’ role, that is, to ensure a choice of high-quality care services is available for people who need them. Yet, day centre provision overall has been affected by policy and practice change, and by reductions in LA funding. Decommissioning or closing day services, particularly ‘low-level’ voluntary sector provision or services previously relying on LA grants, has been common (Association of Directors of Adult Social Services, 2011).
Due to LA social care funding constraints, in England, fewer people with higher needs – whether older people or younger adults with learning/physical disabilities or mental health problems – receive publicly funded care (Fernandez et al, 2013; National Audit Office, 2018; Age UK, 2022), and some people with lower needs receive nothing. For some, day services help fill this gap when provided by not-for-profit or community groups. However, many subsequently faced heavy funding cuts and closures (Green, 2018; Roberton, 2018). Approximately one tenth of publicly funded older people and one tenth of publicly funded people with learning disabilities attended day services in 2013–14; after this time, statistics on LA-funded day services ceased to be reported nationally (NHS Digital, 2014; Hatton, 2017).
Building on earlier definitions (Orellana et al, 2020b), this article defines day centres as community building-based services that provide care and/or health-related services and/or activities specifically for people who are disabled and/or in need, which people can attend for a whole day or part of a day (at least four hours), and that support people to remain living at home and enable carers to sustain care. This is increasingly important, as there is a focus on enabling people to live in the community with more flexible support that may be individualised (Department of Health and Social Care, 2021).
The previously reported value of day centres, which closed for face-to-face support during the COVID-19 pandemic (except those for homeless people), was confirmed by evidence gathered during this period. There were reports of how older people, carers and people living with dementia or with learning disabilities were negatively affected by the temporary closures (see, for example, Gaugler et al, 2021; Giebel et al, 2021; Masterson-Algar et al, 2021; Wong et al, 2021; Shakespeare et al, 2022; Teramura et al, 2022). Many older people support family members with a learning disability, and they too were severely affected (Mencap, 2020). In England, increased numbers of people sought support from other social care services while day centres were closed (Association of Directors of Adult Social Services, 2021). In the US, pandemic experiences led to calls for adult day services to be classified as essential services (Gaugler et al, 2021; Parker et al, 2021). In Scotland, a survey revealed high demand from carers and service users for adult day services to reopen (Shared Care Scotland, 2020).
In this context, the need for evidence to inform the recovery of services following the pandemic was observed. This article reports the findings of a stakeholder engagement exercise that aimed to co-produce priorities (research gaps and opportunities for development and action) through an online survey in order to inform the National Institute for Health Research Applied Research Collaboration (NIHR ARC) South London social-care-themed research programme, one aim of which is to support the sustainability of day services and strengthen them as community assets in South London and beyond. The NIHR ARC South London’s applied research is designed to solve practical problems faced by local health and social care services; it brings together researchers, health and social care practitioners, and local people. The local context and rationale for this work are detailed elsewhere (Green et al, 2021).
Methods
Study design
A stakeholder engagement exercise aimed to identify priorities for practical research programmes by addressing the research question: ‘What are the most important priorities for action, development and research from the perspectives of day centres and their stakeholders?’
A self-completion survey was administered in 2021 with people with experience of day centres, either through their work or otherwise (stakeholders). This exercise was conducted online to enable the submission of individual responses in the then COVID-19 context of social distancing. Original plans, revised due to the impact of the pandemic and consequent day centre closures, had been to build on data gathered in a detailed mapping exercise with day centres in four case-study LAs by conducting priority-setting interviews and focus groups with day centre managers, providers, staff, volunteers and family carers, and potential funders/commissioners of, and referrers to, day services, as well as audience engagement with social care user groups.
Survey design
An existing group of day centre stakeholders, which meets twice annually, was consulted in the survey’s development. The survey built on questions posed to participants at a Day Centre Research Forum meeting (n = 58) in 2020 via its evaluation form (‘Thinking of day centres, in your view, what are the most important priorities for action, development and research? What topics of interest would you like to see researched as a priority in day centres?’). Relevant comments were also harvested from earlier forum meetings’ evaluation forms and post-meeting correspondence. Those responding included day centre providers and managers, LA commissioners and social care professionals, service users, researchers, and anonymous responders. Priorities were summarised into four areas and used as the basis for designing the survey:
- •Exploring what day centre provision could look like and provide in the future: encompassing exploring the possibilities of blending face-to-face and online/virtual support, and (re)designing services, including future-proofing for needs/wants/commissioning priorities/the need for marketing.
- •Partnership working opportunities: working in partnership with the statutory National Health Service (NHS), LAs and the community.
- •Focusing on quality, workforce culture and outcomes/impact: encompassing ways to deliver quality services and gathering evidence on quality.
- •The development of a centralised hub of information about/for day centres: to meet information needs, for knowledge exchange, as a source of practical day-to-day operational examples, for research findings as supportive material and so on.
The Microsoft Forms survey (also available in Word format) was live from mid-May to the end of July 2021. Its structure aimed to engage a broad range of stakeholders: those familiar with policy and practice language; and those who were not but who were interested in day centres. It sought views on: first, the four priority areas and the ranking of their importance on a five-point Likert scale; and, second, perspectives and insights on possible additional priorities. The second part aimed to elicit more creative thinking about priorities, particularly from people lacking confidence to comment on the four identified priorities. Participants were informed of the purpose of this engagement exercise before completing the survey and offered the opportunity to ask questions. Survey questions appear in Online Appendix 1.
Data collection
Day centre stakeholders were identified using the ‘7Ps’ framework of engagement: patients and the public; providers; purchasers; payers; public policymakers and advocates in the non-governmental sector; product makers; and principal investigators (Concannon et al, 2012). This group includes potential LA and NHS funders or commissioners of day services, as well as potential referrers, such as social workers, occupational therapists and other allied health professionals, social prescribing workers (employed to link patients with community resources), other service providers, family carers, and social-care-related organisations (including those supporting or researching provision for specific groups). The survey was widely publicised to these groups (through a web page, social media, networks and emailing lists, patient- and public-involvement contacts, and newsletters), and targeted emails encouraged recipients to further circulate the survey. Inclusion criteria were that respondents needed to have links with, or expertise in, day centres in any capacity (including ‘experts by experience’, for example, of attending or caring for someone who attends/attended one, or volunteering at one) and, preferably, to have South London interest or coverage; stakeholders working nationally or regionally (where their work covered South London or day centre services more generally) were also included.
Ethical considerations
The survey met the criteria for King’s College London’s Minimal Ethical Risk Registration Process and was registered (Ref: MRA-20/21-23389). As detailed in the participant information material, completion and submission of the survey implied consent to participate. Personal data were not collected. Participants selected suitable categories describing themselves from a list, which included ‘other’ and the option of supplying further details.
Data analysis
Likert-scale responses were entered into an Excel spreadsheet, and a bar chart was generated. Qualitative survey data were imported into Nvivo 12 (QSR, 2015), grouped by survey question, and analysed inductively for further themes and sub-themes by one researcher (Katharine Orellana). These were then discussed, and consensus was reached following a second researcher (Kritika Samsi) reviewing the data and further discussions and engagement with the study’s lay advisors. The research team included members with experience of the not-for-profit care sector and social care research.
Stakeholder involvement
Co-production and stakeholder involvement were highlighted in a newsletter containing a request for survey responses from public stakeholders. One of the study’s two lay advisors completed the survey as a day centre stakeholder; both were consulted about the preliminary analysis and contributed to this article.
Findings
Participant characteristics
Of the 43 respondents, three were excluded due to not meeting the inclusion criteria. Table 1 details survey respondents’ stakeholder categories; most indicated multiple categories, meaning that numbers do not total 40. All stakeholder groups identified, except for primary healthcare professionals, NHS commissioners and housing workers, were represented among them. A total of 20 respondents had received information about the survey by email; 13 received information from a colleague, manager or network they belonged to, or via a newsletter; five were given information by a day centre; one received information by a friend; and one saw it on Twitter.
Survey respondent stakeholder categories
| Stakeholder category | Survey respondents (n = 40) |
|---|---|
| Commissioner (LA) | 2 |
| Healthcare professional (allied healthcare professional, secondary care services) (no responses were from primary care professionals) | 7 |
| Social worker or social care team member | 2 |
| Social prescribing worker | 3 |
| Other LA or healthcare professional/volunteer | 5 |
| Social care worker, volunteer or provider (not day centres) | 4 |
| Day centre provider organisation and/or manager, staff member or volunteer | 20 |
| Goes to a day centre | 3 |
| Carer/former carer/family member/friend of day centre attender | 7 |
| Researcher/academic | 14 |
| Information specialist | 2 |
| Advocate | 1 |
| Member of the general public | 5 |
| Other | 1 |
Priorities for day centre stakeholders
All four of the already-identified priorities were regarded as important. Over half of respondents considered that all four already-identified priorities were ‘quite important’, ‘important’ or ‘highly important’ (see Figure 1). Three priorities were the most important: exploring what day centres could look like and provide in the future; working with local providers and communities; and focusing on day centre quality, workforce culture and outcomes/impact. Developing a centralised hub (repository) of information about day centres was also important.
Numbers of respondents rating already-identified themes as ‘highly important’, ‘important’ or ‘quite important’
Citation: International Journal of Care and Caring 8, 1; 10.1332/239788221X16917415568825
Three themes covering both priority support needs and research priorities, and a fourth theme related to how to address priority support needs overall, were identified from the qualitative findings. These were: (1) remaining current and sustainable; (2) demonstrating impact; (3) supporting the workforce; and (4) creating a centralised set of day centre-related resources. These confirmed and further developed themes identified in the pre-survey consultation that informed the survey. There was a strong focus on the importance of person centredness and on day centres for older people, people living with dementia and their carers. Themes are detailed in the following with supporting participant quotes.
Seven priority research questions were identified. Some were implementation questions, deriving from and addressing the identified support needs, while others aimed to generate new knowledge. Further sub-questions exemplifying their coverage and corresponding quotes from respondents appear in Online Appendix 2.
Remaining current and sustainable
Priority support needs
‘There’s a new generation of older people who may not like the idea of attending “day centres” as previously viewed, yet they require similar service in terms of social interaction, meeting up with their peers, organised outings. They will also be technology “savvy”. They essentially need the same emotional, mental and physical support but who yet don’t identify themselves as people who would be attending a day centre.’ (R12, day centre provider/worker)
Visions of future day centre offers included “meeting the needs of diverse communities” (R20, general public, researcher) and, “for clients, there must be the element of choice” (R22, general public, researcher [emphasis in original]): “It needs to have a personalised approach to meet the individual needs of the service users – so they can decide what they prefer. This needs to have the flexibility to support different wishes” (R28, allied health professional).
Day centre providers were thought to need support with marketing and external communications, including related skills and technologies; the sourcing of this was less specified. There were calls to: update the image of, and narrative about, day centres; extend their reach by raising awareness of their impact; promote an understanding of the value of investment in them; promote them as skilled employers; open conversations about mental health, for instance, and reduce stigma. As stated by R38 (day centre worker): “The priority for day centres is to shake off the (mostly) outdated traditional image of poor-quality health and social care.”
“Continuing to sell the idea of day services as flexible and valuable to the local authority” (R16, day centre worker) was seen as important as marketing to individuals. As stated by R47 (former commissioner, day centre provider): “They need to market themselves at self-funders and people with personalised budgets so that they can see the value they are getting and will be in competition with ‘sitting services’ or ‘respite services’.” Consideration could be given to how a day centre could become a centralised hub or location of services and support; this would involve “exploring new directions for day centres and the relationships with other services” (R6, researcher).
Priority research questions
Significant research themes under this question included: what day centres could look like and provide in the future; what various stakeholders’ perspectives and experiences were; how day centres could be better equipped to market themselves; how day centres ‘fit’ within overall service provision within a locality; and the facilitators of, barriers to and current/opportunities for local partnership/community working with and by day centres: “I sometimes feel that, perhaps because we are a small service and, therefore, slightly insignificant, there are very few professionals, outside of my service, that are interested in the work that we do, and worse, nobody cares” (R38, day centre worker). Funding was another important element of this theme, with emphasis on the need for different funding models in order to remain current and sustainable: “Day services cannot rely on statutory funding. They need to look at other ways of generating income, e.g., from other services/facilities offered at the centre” (R47, commissioner).
Demonstrating impact
Priority support needs
Some stressed that metrics and data on outcomes were needed, and that day centres should join in activities common to registered and regulated health and social care services. Their priority was for day centres to get or to develop support and guidance to deliver best practice, high-quality care and quality assurance, and to demonstrate impact. Learning from others and the evidence was seen as central to this and to improving others’ confidence and their own self-confidence in service quality: “It will be useful to learn lessons on what does ‘good’ or ‘bad’ mean on running day centres, what is an effective management team, why are some day centres more stable and sustainable to effectively serve their local communities whilst some are very poor in managing themselves” (R45, day centre attender, carer/friend of day centre attender, general public).
‘For example, if it is about having fun, then measure fun outcomes; if it is about mixing with the community, then measure community engagement. It could have more than one purpose, but if commissioning outcomes do not align with the operational purpose, the real value of day centres remains muddy.’ (R9, day centre worker)
‘There needs to be real shift in workforce culture in most places to ensure a truly person-centred approach. What I mean by this is that staff need to stop “doing to” or “doing for”. They need to step back and spend time really getting to know the service users, and create the space and opportunity for the service user to be themselves, choose who and how they interactive with, and choose what activities they take part in (or not).’ (R47, commissioner, other)
Demonstrating impact was acknowledged as challenging because “the lack of regulation within this sector enables a divergent market to thrive without any recourse to suitable and effective monitoring of the support which is actually being delivered” (R40, other LA or healthcare professional) and because day centre purposes vary.
‘I think the pandemic has highlighted the important role of day services for people who may have limited social contact. It has shown the value of blended support via face-to-face and online. It has also shown that day services have a legitimate role and should not be seen as a “legacy” service for a small minority.’ (R7, researcher)
Priority research questions
‘The challenge will be to find ways of collecting meaningful data.… I think that the variety of work done in the day centres in my borough by the staff is difficult to capture - the networks that are built up over years with clients, carers, medical and social care professionals in borough agencies and community resources, such as local businesses, charities, football teams. All of these contacts create a community which has a value which is hard to evaluate but is the heart of the work.’ (R16, day centre worker)
Supporting the workforce
Priority support needs
Day centre providers/managers were thought to need support to improve their professionalism around business and planning skills, and to develop positive employment cultures. One view expressed was that staff recruitment strategies need to attract a more diverse workforce. Although many day centres are firmly based in their local communities, the lack of engagement with social care data collection in many areas means that staff (and volunteer) profiles are not collected and analysed. Overall, staff were thought to need to deliver high-quality and welcoming care, undertake training – including in how culture impacts on service delivery, person-centred practice and collaborative working – and to be aware of day centre-related evidence. Such evidence was broadly defined, with mentions of, for example: the importance of relationships and the value of socialising and meaningful activity; effective interventions; the use of technology; specialist training, such as signing for people with impaired hearing, leading certain activities and supporting life skills; knowledge about, and skills to support, people with, for example, autism, learning disabilities, dementia, frailty or mental illness; diversity and equality awareness; therapeutic engagement; and new skills appropriate for diversification. Such ambitions not only suggested a view that professionalism may currently be lacking but also reflected an impression that day centres should have parity with NHS and LA staffing and training models. The journey to meeting such developments was not generally explored.
Support is needed with understanding the day centre evidence base and how to use it. This was considered important within day centres for all aspects of service delivery and for external funders or referrers to day centres: “Expertise in the field is now lacking at senior levels in the NHS and social services where a generation of staff have come through with little first-hand experience working in day centres” (R44, day centre provider and worker).
Priority research questions
There was emphasis on the need to understand the ways day centres do and could recruit and retain the right people for the job, and the workforce culture that supports this: “Staff motivation for engagement in change – should we stop recruiting carers and start recruiting therapists, entertainers, gardeners, and instead train them to also be carers? Have we got it the wrong way around?” (R15, researcher).
A centralised set of day centre-related resources
Priority support needs
There was a clear wish for a web-based centralised information resource to support day centres and other day centre stakeholders. For most respondents, this would be a ‘knowledge’ source, covering evidence regarding the activities and interventions taking place in day centres, the outcomes for and experiences of individuals currently or previously involved with day centres, and the systemic/financial benefits of day centres, as well as other materials that could assist day centre stakeholders with their support needs (as identified by this survey).
For a small number, it would take the form of a directory of day centre services. Views on the usefulness of such a directory varied from very valuable to less valuable because information frequently changes and may involve burdensome maintenance.
‘This will facilitate research in other areas and also provide a source of information for potential users and providers. Such a hub would be a useful route to impact for research.’ (R6, researcher)
‘Whilst the scope of this survey is London centric, there is a commonality of central themes for the future provision of day opportunities, and it would be useful to consider how to incorporate experiences from other areas into the vision for South London.’ (R40, other LA or healthcare professional)
Discussion
This stakeholder engagement work conveys a sense that day centres feel under-supported and underprepared for the current and future environment, that all stakeholder groups want better evidence, and that there is an appetite for joint working and for supportive resources for day centre stakeholders. It may be that day centres should take more advantage of local bodies that have substantial input into funding decisions, whether these are not-for-profit ‘umbrella’ bodies or groups representing public voices or special interest groups. Many stakeholders reflected the need to ‘prove’ effectiveness, suggesting their understanding of the acute financial pressures on the care sector.
Increasing numbers of engagement exercises address priority setting for research in the UK, such as the James Lind Alliance, which has completed over 100 such partnerships covering mainly health-related topics, as well as adult social work and dementia.1 This article has reported on a more localised exercise, and readers will judge whether responses are generalisable to other contexts. Day centres vary considerably within localities and there may be scope for the development of typologies to enable research and development priorities to be more finely tailored.
Support priorities confirm acknowledged challenges for day centres in the international literature. These include marketing (Sanders et al, 2009; Sheikh et al, 2012) and being attractive to future cohorts (MaloneBeach and Langeland, 2011). Questions around what the future of day centres may or should look like have been raised (Liu et al, 2015; Liao and DeLiema, 2021), with examples of innovative, time-limited programming reported (Hagan and Manktelow, 2021). This study confirms English research that highlighted how ‘limited contact of day centres with other social care provision may mean that opportunities to share good practice are under-developed’ (Orellana et al, 2021: 1330), in contrast to UK care homes, which may connect with the My Home Life support programme that also provides a centralised source of supportive information.2
With respect to the expressed wish for a centralised set of supportive resources, topical web-based information repositories are not new. Many specialised toolkits for varied audiences are freely available. Examples include the Dementia Evidence Toolkit,3 the EconomicS-of-Social-carE-CompEndium (ESSENCE),4 the National Institute for Health and Care Excellence’s planning tools, guidance and quality-improvement resources,5 Centre for Ageing Better’s age-friendly resources,6 South West London’s Integrated Care System’s Diabetes Toolkit,7 Social Care Wales’s curated research on loneliness,8 New Philanthropy Capital’s implementing and evaluating co-design ‘resource hub’9 and the (Scottish) Care Inspectorate’s ‘The Hub’,10 which includes an area for adult day care.
In England, as an unregulated service, older people’s day centres are generally invisible in national guidance and evidence summaries, with one notable exception: the Social Care Institute for Excellence’s ‘Care providers improvement support’ web page includes some materials for day care providers and front-line staff.11 However, its Social Care Online database of resources published by others is due to close at the end of 2023. England also lacks a national umbrella organisation, such as the US National Adult Day Services Association, which provides web-based toolkits for its members. NHS and LA commissioners and policymakers juggle multiple responsibilities, with their preferred ‘evidence’ being informational summaries, individual ‘stories’, clear and brief messages concerning research evidence (Wye et al, 2015), and easily accessible and trusted publications (Miller et al, 2014) rather than generally inaccessible academic literature. The foregoing suggests that a curated older people’s day centre-related information source may better address these preferences, both directly and by enabling day centres to produce these preferred materials. A central source for diverse audiences would also address some of the support needs raised in this study and complement the study programme’s existing Day Centre Research Forum. Elsewhere, we have discussed some of the factors contributing to the importance of remaining current, demonstrating impact and supporting the workforce to deliver high-quality services (see Orellana et al, 2020b; 2021).
The suggested research questions are closely linked with the highlighted priority support needs. They are relevant to some previously identified gaps, mainly in the international literature. These include: commissioners’ and NHS professionals’ awareness and views on day centres and their potential (Orellana et al, 2020a); cost-effectiveness (Ellen et al, 2017), financing and potential health and social care savings linked with their use (Orellana et al, 2020a); the need to explore person-centred service development for people living with dementia (O’Shea et al, 2020); linking attendance with attenders’ wider lives, something relevant to day centres’ ‘fit’ within the local overall service offer (Symonds-Brown et al, 2021); and the service’s ‘software’ (culture), including how relationships and engagement with family carers are created and operationalised (Orellana et al, 2021; Symonds-Brown et al, 2021), and how role of leadership and integration impacts on sustainability (Powell et al, 2019). In the US, non-use of uniform outcome measures is highlighted as problematic, alongside a set of proposed tools that aims to standardise data collection, support programme development and leverage funding (Anderson et al, 2020). Although suggested measures are deemed applicable, outcome oriented, appropriate, valid and reliable, easily administered, time effective, and affordable, their administration is estimated to take 60 minutes, which may not be feasible in UK settings.
The influence of the COVID-19 pandemic on the future of day centres is both positive and negative. Overall provision in England has reduced (Association of Directors of Adult Social Services, 2021) due, partly, to operational challenges, such as reduced fundraising income and volunteer unavailability (Groundwork UK, 2020; Townsend, 2021). Conversely, pandemic restrictions have spotlighted day centres’ importance for their attenders, carers and the wider social care system. Temporary building closure prompted creative expansion of face-to-face building-based programmes to include virtual, telephone or doorstep support, with varying success (see, for example, Vervaecke et al, 2021). In England, one survey found that residential care may be a less attractive option post-COVID-19, suggesting greater demand for alternatives, such as day centres (Quilter-Pinner and Sloggett, 2020). Groundwork UK (2020) suggested increased need for more voluntary sector community services.
Some extended support options offered by day centres may complement, though not completely substitute for, out-of-home services in these safe, social settings. Replacing face-to-face services completely would be inappropriate given the widespread lack of Internet access, skills or support among older people (Hargittai et al, 2019; Age UK London, 2021; Giebel et al, 2021), as well as the valued outcome of day centre attendance providing the opportunity to venture outside the home (Orellana et al, 2020a). Some believe that ‘this is not the time to consider any local overhaul of adult day services’ (Shared Care Scotland, 2020: 16).
Survey respondents’ focus on day centres for older people and people living with dementia suggests that these services have the greatest support needs. Alternatively, it may reflect acknowledgement of older people’s declining health and mobility, meaning that community-based, ‘out-and-about’-style services do not always suit their needs as much as a dedicated setting would.
This article has highlighted day centres’ priority support needs, some research priorities and how some day centres and their other stakeholders feel that their support needs may be partly met by making available a centralised set of resources. Some future research may adopt a care infrastructure approach, as proposed by (Symonds-Brown et al, 2021), following their analysis of trends in the 1990–2018 literature reporting research on day centres for people living with dementia and their carers.
Limitations and strengths
The survey took place at a time when restrictions were placed on gatherings, necessitating remote engagement. Many day centres had not reopened, hindering efforts to engage with attenders, carers, staff and volunteers. Additional carer stress may have led to a lack of time or energy to engage with external requests. Managers and staff are likely to have been fully occupied providing alternative support or planning their reopening. Organisational stakeholders may have been overburdened. Primary healthcare professionals, NHS commissioners and housing workers were not represented. Digital exclusion may have restricted participation. The strengths lie in the variety of responses and engagement with the subject matter.
Conclusion
Day centres can be an important community resource for people with social care needs. However, the requirements of day centres to evolve with the developments in social care practice have been under-researched and are therefore not well understood. This engagement exercise sets the scene for further engagement in the context of more integrated service commissioning, as the NHS has moved to local integrated care systems in England and seeks to work with partners to develop and maximise community resources. It provides evidence for researchers seeking to develop studies including day centres that such work is needed and that the sector is keen to engage with research findings and make use of them. The national and international literature suggests that these findings are relevant beyond South London, regardless of the variety of operational models of day centres. Lastly, it evidences a wish for centralised resources to support day centre operation and other stakeholders’ understanding of these services, which is also likely to be useful outside South London and that would benefit from incorporating learning from other geographic areas.
Notes
Funding
This study is funded by the NIHR ARC South London at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Acknowledgements
We thank the Day Centre Research Forum members involved in the pre-survey consultation, the survey respondents, our lay advisors (Rekha Elaswarapu and Stan Burridge) and the anonymous peer reviewers for their valuable comments that improved the quality of this article.
Conflict of interest
The authors declare that there is no conflict of interest.
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