Background: Long-term care (LTC) workers are subjected to structural and inherent difficult con-ditions that are likely to impact their quality of life at work; however, no agreed scale measures it. This study aims to develop a scale to measure the work-related quality of life among LTC work-ers in England (CWRQoL). The study establishes the domains/sub-domains of CWRQoL, inves-tigates the tool's utility, and collates information on existing supporting strategies for CWRQoL. Methods: We adopt a mixed-methods employing inductive/deductive processes at three stages: 1- a scoping review of the literature; 2- interviews and focus groups with frontline LTC workers, managers and LTC stakeholders and 3- a content validity consensus survey. Results: CWRQoL is composed of seven domains (and 23 sub-domains). Additional domains to those in the literature include financial wellbeing and managing grief and emotions associated with client death and end of life care. Stakeholders identified several benefits and challenges related to the CWRQoL tool's utility. COVID19 significantly impacted LTC workers' mental well-being and spillover between work and home. Conclusions: The study highlighted the complex nature of CWRQoL and provided a solid ground for developing and validating a CWRQoL scale.

Policymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI − 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.

This article investigates responses to EU public procurement directives in Norway, England and Germany, with a particular focus on health and social services. We used a comparative national patterns approach to analyse parliamentary debates, consultative statements, the media and interviews with stakeholders. The literature contains prominent arguments suggesting that health and social service governance regimes are converging on the liberal model. Some authors argue that with its focus on policies which create markets, the EU is a driving force with an increasing relevance for market-based governance practices. However, the role of EU legislation is unclear as procurement regimes in relation to the governance of health and social services constitute a highly ambiguous terrain. Our study enabled us to show that the form of the debate is highly dependent on path-dependent mechanisms and the degree of openness of the national political system that provides channels for interests to be articulated. Indeed, the Norwegian case study serves as an excellent example of why marketisation has not advanced to the degree predicted in the literature: an inclusive and open political system and a strong non-profit health and service sector meant that the non-profit groups managed to turn the debate in their favour.

In the article, we analyse the impact of changing policy environments on the development of the third sector in Europe. Based on the results of systematic comparative research in eight European countries (Austria, Croatia, France, Germany, the Netherlands, Poland, Spain and the UK), we identify commonalities and differences. In a three-step analysis, we examine policy changes, effects on the third sector and responses by third sector organizations (TSOs) in the social domain. Overall, the third sector in Europe has proven resilient. However, not only have public and private funding decreased, the process for acquiring such funding has become more demanding for TSOs, as have requirements to be accountable. There are signs of a proliferation of more market-based, hybrid organizations. Despite this general trend towards marketization, the impact of policy changes varies across Europe with TSOs being better equipped to adapt and survive in countries where collaborative ties between the state and the third sector have traditionally been strong.

The financial position of English social policy charities has received much attention, with a particular focus on the difficulties that small- and medium-sized organisations are experiencing. However, in this article we show that the evidence base has a number of limitations. We then demonstrate, analysing data from a survey of more than 1,000 charities, that organisational size, per se, is only one dimension of the problem: perceptions that the operating and financial environment is challenging are related to other organisational characteristics. We then add to the survey data indicators of financial vulnerability to investigate whether there is a relationship between perception (responses to questions about the resources available to charities) and financial reality (the recent financial history of these charities). Somewhat reassuringly, however, we demonstrate that there is a degree of consistency between the perceptions that organisations report and we discuss the implications of the findings.

Aim: Adult placement, known in the United Kingdom as Shared Lives (SL), has a long history throughout Europe and beyond. In England in 2016 over 8,000 people with intellectual disabilities were being supported to live in the community in this way. There is little research in this area, and this study aimed to generate information about the effectiveness of SL. Method: Data were collected from people supported by SL using a number of well-being measures and qualitative interviews. The economic case was explored through individual case studies, using data from the measures and service use information. The experiences of people providing support were also captured through interviews. Both quantitative and qualitative analysis techniques were used. Results: Overall, social care related outcomes, capability and mental well-being were good amongst participants, and examples of how SL had made a positive difference to their lives were provided . SL appears to result in good outcomes within a cost envelope less than for alternative provision. SL carers highlighted the skills and support required, and the unique dynamic of formal care in a family setting. Conclusion: The study is on-going but suggests that SL is meeting people's needs and has promising aspects which merit further study.

This paper considers the situation of the English voluntary sector in relation to austerity-driven social policies. Existing characterisations are outlined and it is argued that the quantitative evidence used to represent the situation of these organisations to date has been partial because it relies too narrowly on financial resource input measures. We argue that the situation of these organisations needs to be conceptualised in a more holistic way and, to initiate a move in this direction, we identify and explicate two relevant dimensions: the perceived capacity of organisations to rely on volunteers for support (a non-financial resource input); and their perception of the effect of the policy climate in shaping their capacity to flourish, including their ability to perform multiple roles beyond service provision alone. We draw on an original mixed methods empirical study undertaken in England in 2015 to operationalise these dimensions, combining qualitative interviews with national 'policy community' members with a large scale on-line survey of social policy charities. We find a complex and variegated situation that, while acknowledging the fundamental importance of financial resource pressures, also points to the salience of the volunteering situation, and to the relevance of the challenging policy climate that these organisations have to navigate.

Shared Lives (adult placement) is a model of community-based support where an adult who needs support and/or accommodation moves into or regularly visits the home of an approved Shared Lives carer, after they have been matched for compatibility. It is an established but small service which has been used mainly by people with learning disabilities but which has the potential to offer an alternative to traditional services for some older people. However, there is little research on the outcomes for older users of Shared Lives. This paper presents findings from a survey of 150 older people using Shared Lives support across 10 Shared Lives schemes in England which took place between June 2013 and January 2014. The aim was to identify outcomes for older users of Shared Lives and compare these to outcomes for older users of other social care services. In the absence of an ideal study design involving randomised allocation, statistical matching was used to generate a comparison group from the Adult Social Care Survey (ASCS) from 2011/12, with 121 cases matched to 121 Shared Lives cases. The main outcome measures were Social Care-Related Quality of Life (measured by the ASCOT) and overall quality of life. Findings indicated that Shared Lives can deliver good outcomes for older people, particularly for overall quality of life. In comparison to the matched group of older people using other forms of support, there was some evidence that Shared Lives may deliver better outcomes in some aspects of quality of life. Limitations to the research mean, however, that more work is needed to fully understand the role Shared Lives could play in supporting older people.

Given the increasing numbers of people living with dementia it is imperative that new, practical solutions are found to the issues faced by this group of people and their families. This article draws on findings from a qualitative study which explored the implementation of a community-based project to support people living with dementia in one local area in England. This approach has different names, and in the United Kingdom it is known as Shared Lives or adult placement, which would be most comparable to family care in Europe, and adult foster care in the United States. Interviews were conducted with 14 staff connected to the Shared Lives project. Interview data were coded using the normalisation process theory constructs of coherence, cognitive participation and collective action. Supportive program factors identified were a dedicated staff member and resources, and the availability of specialist knowledge and skills. Detriments to program success included: a lack of understanding about the service, perceptions it was a poor fit with existing practice, and wider organizational issues that impacted negatively on the normalization of the intervention. Suggestions for future research are made that go beyond staff opinions, stressing the importance of using a wider range of stakeholders and incorporating measurement of outcomes for people using the service.

Purpose: The purpose of this paper is to report on the views and experiences of older people using Shared Lives (adult placement) in 2012/2013. Design/methodology/approach: As part of a survey collecting information about outcomes for older users of Shared Lives issues of whether it had made a difference to quality of life, and positive and negative experiences of support were explored. Findings: Questionnaires were returned by 150 older people using Shared Lives services. Findings suggest that this model of community-based support has a number of advantages for some older people, such as reducing social isolation and loneliness, promoting independence, choice and control, providing emotional support and increased well-being. Research limitations/implications: The questionnaire was self-completed and so responses were not followed up to provide deeper insights. Practical implications: Shared Lives is not appropriate for everyone but it is suggested that this option should form part of local commissioning strategies, be part of a range of options for social care practitioners to consider in their work with older people and helps to meet various current policy imperatives. Originality/value: The potential of Shared Lives for older people is under-researched and this paper contributes to the literature in exploring the views of older people about family-based support in the community.

RNIB is a large national charity founded in 1868. The RNIB Group delivers services directly to people affected by sight loss and campaigning, policy and large-scale infrastructure projects. In common with other organizations within the sector it suffered from rising costs, reduction in income and competition with other charities. RNIB addressed this by bringing in leadership with a specific mandate to change the organization. Its survival and that of other organizations was ensured by adopting innovative practice adapted from the business world, most notably mergers with other charities. It has also actively engaged in collaboration across the sight loss sector and beyond, re-invigorated and invested in traditional fundraising routes and embedded evidencing impact across all services and campaigns.

Shared Lives Plus is a charity and the UK network for family-based and smallscale ways of supporting adults. Members are Shared Lives carers and workers, and Homeshare programs. Shared Lives is an alternative to home care and care homes for disabled adults and older people. The organization has needed to grow to be able to fulfill its ambitions to double the size of the Shared Lives sector. Shared Lives Plus has been able to expand in scale and scope in challenging times due to strong leadership, a focus on evidence of outcomes and costs, and combining innovative and more traditional routes for investment.

Salus was founded in 2011 as a community interest company without charitable status. It primarily delivers support to children, young people and families experiencing difficulties at school. Financing for this work comes largely from public bodies such as schools and colleges, and the main hurdles the organization faces is competition for contracts. Salus has embraced a business-oriented approach which permeates through the organization and has helped it to operate successfully. It has consciously sought to operate as a "player" in very demanding and competitive commissioning contexts and positioned itself as a "premium brand" in these situations. This has meant ensuring that "quality" is always present within its portfolio of projects by only taking on services where both "high caliber" professionals were available and where it would be able to provide evidence of impact by including an evaluative element.

The governance system in Birmingham over the decades has been rooted in a pro-growth strategy. This has resulted in an environment not typically conducive to large-scale social innovation. The impact of history is of significance, with the impact of recession and deindustrialisation that started in the 1980s, and that still continues today, influencing the policy and practice of actors in the city. The major, lasting innovation in the city is partnership working seen as essential to deliver the economic regeneration agenda. Until recently this was a 'closed' form of partnership comprising existing local political and economic power holders, but this has evolved to more inclusive engagement. The city council has focused over the years on the promotion of local economic development and employment growth, and to a lesser extent on the provision of services. However, the council has always seen economic development as also serving the objective of improving the quality of life of its citizens and therefore policies do not always show an obvious divide between social and economic policy. Using analysis of local labour market and housing and regeneration policy, the situation in Birmingham can be described as a case of urban governance where solutions to social problems are stated in terms of economic priorities. Innovation does occur but is marginal, through opportunistic and short-term support for small-scale projects, largely through national funding streams. Looking to the future, enhanced devolved decision-making was seen by local actors as a potential vehicle for innovation at the (very) local level.

The locality approach to worklessness in Birmingham is an approach to tackling worklessness developed by the city. It was locality driven and focused on areas where worklessness was high. Detailed consultation took place to agree neighbourhood employment and skills plans and services commissioned on that basis. It also had a strong client focus adopting an integrated employment and skills model. The aim of the model was to offer a continuous service, incorporating the provision of targeted action and support that each individual required no matter which provider they accessed. It enabled an in-depth understanding of issues for local residents where worklessness was high, which provided the opportunity for provider organisations to work together for the first time and to develop small-scale innovative projects. Key was the agreement of the major players in the local welfare system and their signing up to the model.

Youth Employment and Enterprise Rehearsal (YEER) was set up by The Future Melting Pot, a community interest company, to provide business support to black and minority ethnic young people who were not in employment, education or training. The main aim was to enable participants to set up their own enterprises. The project included training, support and access to accredited advisors. The approach was innovative in that it offered young people an alternative to the conventional focus on getting a job by providing the opportunity to explore the option of self-employment in an environment which was needs led. The approach could be described as intensive, personalised support to stimulate entrepreneurialism and an example of integrating economic and social domains.

This guide draws on a study which aimed to begin developing a care work-related quality of life tool for the adult social care workforce in England. We asked what matters most for care workers' quality of life at work, how it was supported by employers and what staff would find helpful in the future. These findings are summarised here, along with recommendations for actions. Our findings come from focus groups and interviews with frontline care workers (n=11), national level stakeholders involved in social care (n=12) and a consensus survey of their views and those of other experts in adult social care (n=35). The research was undertaken at a time of unprecedented pressure on the social care workforce in England: the COVID19 pandemic. Like the NHS, social care has been on the front line of the pandemic. However, unlike the NHS, social care is not a unified workforce with a professional identity. Social care is delivered by around 18,200 independent providers and many of its workforce are low-paid and under-valued. Turn-over within the sector is high and recruitment challenging, even for those with professional registration, such as social workers. Understanding and supporting people's quality of life at work is paramount if we want to retain skilled staff and ensure the best outcomes for those they care for. We want to thank all our participants, including our advisory group members, who contributed to the study and shared their experiences and expertise. Together they helped shape the recommendations in this guide, which we hope will inspire social care policy makers and leaders to create positive workplace cultures that nurture the wellbeing of staff and those they care for.

Background: Work-related quality (WRQoL) of life has become an important concept internationally across different professions including adult social care and is one of the factors associated with higher retention. More importantly, in adult social care, WRQoL is linked to the quality of services provided and outcomes related to patients and service users. Objective: The main objective was to understand how WRQoL has been defined and measured in the literature and to map key components of WRQoL among those working in adult social care and other similar contexts. Design: We conducted the scoping review following the updated guidance by the Joanna Briggs Institute and a pre-defined study protocol. Reporting followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. Data sources: We performed an electronic literature search of eight major databases (e.g. PubMed; CINAHL Plus with Full Text through EBSCO and Social Care Online). The grey literature was searched through the following databases: PROSPERO; OpenGrey; EThOS e-theses online service; and ProQuest Dissertations & Theses Global: full search strategy. We complemented these electronic searches by searching the reference list of included full-text reports and articles and by contacting our existing network of 15 experts. Eligibility criteria: We included studies that: 1- focused on WRQoL/work-related wellbeing (and their synonyms) where the concept is defined as a multidimensional construct consisting of several components (at least two); and 2- included adult social care or community health care and individuals working in those contexts as participants groups. Results: In total, we included 61 publications. There is an absence of agreement on a definition of WRQoL. Very few studies provided an explicit definition of WRQoL and of those even fewer linked those definitions to specific theoretical models. Based on a thematic analysis of definitions of WRQoL, measures, and factors associated with WRQoL or general wellbeing we identified six key components: organisational characteristics; job characteristics; mental wellbeing and health; physical wellbeing and health; spillover from work to home; and professional identity. Strategies implemented and evaluated in adult social care that addressed social care staff's WRQoL are almost entirely lacking. Conclusions: While WRQoL in adult social care is recognised as an important concept (given the volume of identified studies), there is very little consensus on what WRQoL is and how best it should be measured. Without a clear understanding of what WRQoL is and how to measure it, development of any interventions and recommendations to the sector and policymakers on how to improve WRQoL among those working in adult social care remains challenging.

In Shared Lives an adult who needs support moves in with or regularly visits a Shared Lives carer after they have been matched for compatibility. In 2016 over 8,000 people with intellectual disabilities were being supported to live in the community in this way. Shared Lives is under-researched and there is a need to develop the evidence base further. Our study aimed to describe who was being supported by Shared Lives, explore whether Shared Lives is meeting people's needs, and examine the experiences of Shared Lives carers. Information was collected about a small number of individuals including measures of quality of life, capability, and mental well-being. Peer interviewers conducted interviews with people supported by Shared Lives, and researchers interviewed Shared Lives carers. Overall, the findings suggested that social care related outcomes, capability and mental well-being were good amongst participants, and examples were given of how SL had made a positive difference to their lives. Shared Lives carers described their experiences of caring for someone in a SL arrangement, the skills and support required, and the unique dynamic of formal care in a family setting

Aim: Adult placement, known in the United Kingdom as Shared Lives (SL), has a long history throughout Europe and beyond. In England in 2016 over 8,000 people with intellectual disabilities were being supported to live in the community in this way. There is little research in this area, and this study aimed to generate information about the effectiveness of SL. Method: Data were collected from people supported by SL using a number of well-being measures and qualitative interviews. The economic case was explored through individual case studies, using data from the measures and service use information. The experiences of people providing support were also captured through interviews. Both quantitative and qualitative analysis techniques were used. Results: Overall, social care related outcomes, capability and mental well-being were good amongst participants, and examples of how SL had made a positive difference to their lives were provided. SL appears to result in good outcomes within a cost envelope less than for alternative provision. SL carers highlighted the skills and support required, and the unique dynamic of formal care in a family setting. Conclusion: The study is on-going but suggests that SL is meeting people's needs and has promising aspects which merit further study.