Do professionals know
best?: observations
from recent research
Jill Manthorpe & Kritika Samsi
8th 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.
2.
3.
4.
5.
We know who should be one of us
There are some things that are within our
expertise
We follow an ethical code
Professionals are an experienced body
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?
Evaluation dimensions
User experience
Carer impact
Workforce
Care management
Provider impact
Risk & protection
Commissioning
Outcomes
Costs
Cost-effectiveness
What people bought
Cleaning
service
Computer
maintenance
Private
health care
Gardening
service
Admission fees for
service user and PA
Gym
membership/
swimming
Alternative
therapy
Going out:
trips/cinema
etc.
Decorating
service
Classes/arts
and crafts
Massage for
carer
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