away michelle well good morning paul thank you for for being with me today for offering uh some some of your time so uh just as a brief introduction you're a senior lecturer in social care at the university of manchester and also that a deputy director yes and uh you are currently in the planning stages of feasibility and acceptable acceptability studies with the act assessment so we'll move on to that uh later in the call but at first you could just give us an introduction and some background why you got into the field of geriatrics what it is that you're interested in good question michelle thank you nice to speak to you yeah i've got a long career actually i'm older than that than i look i think i've got a long career in in research and before that i was a social worker in in various hospital settings and community mental health teams with older people um and with adults with serious mental health difficulties so that's my sort of background so really principally a social care background as we call it in the uk uh non-nhs background social work but i worked closely with nhs colleagues that sort of influenced my mindset i think working with them i just closed my emails there working with health colleagues assessing all the people for the care that they need and also promoting services out there in the community you know trying to organize new services for people uh new ways of working with older people to to maintain their health and well-being so that's where i sort of come from that's over many many years but then i transitioned into research again principally in the mental health field i worked at the institute of psychiatry in london and then up in the north of england in leeds in hospitals and then went to the university of manchester quite a long time ago now around 20 years ago and i've worked on research projects at manchester for many many years and led on research projects uh in the field of older people and other people's care principally around you know one of my big interests which is how i came to sct is the assessment of older people and the wider assessments that often take place from social care joining with nhs care in the uk healthcare sort of multi-disciplinary assessments i guess you'd call them that's where my interest lies you know can we can we identify the difficulties vulnerabilities and strengths actually of older people that help to mitigate some of those difficulties can we identify them in a person-centered whole kind of whole systems way uh to identify um all vulnerabilities and strengths that the older people experience in order to help them better basically that's that's one of my prime research interests i i have all the research interests and and i've done all the research principally around um supporting people with dementia living at home and their carers so i work a lot with carers groups as well dementia carers groups on research projects including trials so we've done a few trials at manchester on uh dementia care support and i'm involved in a big trial now actually with primary care across two sites in england so work with gps as well as social care and nhs care so i within that research experience that research um career that i've had i first came across your professor ian phil perm during a demonstration project by our department of health long long long time ago which was looking at evaluating what was called then um this single assessment process which was a policy by the uk department of health to as i mentioned before to bring together all the disparate assessments of older people in different settings of primary care nhs social care into a single kind of resource for assessing older people and one of the tools used in that demonstration project of that policy was the previous easy care assessment and that's how i came to know ian very well and worked with him on a project actually looking at whether we could use that assessment to self-assess so older people could assess what difficulties they had themselves in conjunction with a charity uh age uk as as was then um so they could be helped to um assess their own difficulties their own strengths and then then could be helped to sort of seek having use of support for that so i first became involved in the easy care assessment and ian through that demonstration project a long long time ago this was and then more recently which brings us up to today michelle um aged care technologies and now i'm part of the international research network of act and i look and i'm looking at all the projects and other demonstrations of act that we can get out there in terms of um funded research projects so that's sort of one of my aims so other things sorry so for interrupting so just before we do jump into this i'm very interested in your background in social care do you just if it's uh not too personal do you mind telling me um well first of all what led you into want to uh go into social care and also once you were in social care why did you want to switch onto research and how that experience and background helped you um because it's not you're not just based on theory and and research but you also have this personal experience yeah yeah yeah it's very applied research that i do so it's based on that experience you know trying to make things happen out there rather than theorizing i'm not a great theorizer really although theory is important for assessment obviously yeah i i first got into social work social work career it was through um a very great person a social contact really it was my first boss basically um she was called shirley you know that's not disclosing anything else there were a lot of shirtless around and she was just a great sort of mentor and manager i first worked in a community organization like a voluntary sector organization um looking to help older people in a in a city area and it was my first sort of job realising uh after leaving um uh school between school and university basically between sixth bomb a levels and university um and i worked with with her for two years in this sort of outreach project we called it outreach community outreach project going out there um supporting older people practical tasks as well bringing the shopping in helping them in their own homes and organizing support for for them through a a church organisation with a church-based organization and she she was a social worker and she she was sort of decanted from social work for a couple of years to do something different and that's where i met her and so she was my kind of inspiration really i thought i want to sort of go into social work it seems to have suited her she seems to be quite together and knowing what she wants to do so she kind of led me into social work really so i i applied to university social work courses got on one um and studied for four years in social work and then after that i became a social worker in hospitals as i've said um then um i did a master's degree at university of manchester whilst i was a social worker and that kind of led me into research the research methods because i always wanted to do research and undertake research but at that time um there wasn't really the infrastructure that there is now for non-nhs staff non-healthcare staff to do research whilst doing their jobs it was it was quite rare for a social worker to do research as well it's more common now there's a lot of capacity building activities going on and training of social workers in research methods etc and the msc at manchester was one of the first that did that and it was in psychiatric social work and it contained a heavy research element including um statistical methods and interviewing skills and all sorts of things and and you have to produce a thesis on a research project that you've done and i did mine with older people with mental health problems their quality of life you know how that can be assessed so that was the link to the assessment interest i think so it was sort of personal drive i think through through a sort of inspirational person i guess a kind of mentor that i was lucky enough to meet sometimes accidents like that happen don't they for maybe for a reason or if you believe it's for a reason i believe it's for a reason yeah so and um the combination of your work experience with with older people and your research how do you think those two combined helps each other and your understanding of of the problems faced by by uh the older generation yeah that's a good question michelle because certainly way way back when uh when i was a social worker a lot of my colleagues didn't didn't appeal to research they didn't look at research evidence and i was a little bit of a champion in the hospital you know you must look at this this is this tells you you know if you assess people in a certain way or if you help them in a certain way this is the evidence that it could work or these are the accounts but you know both qualitative and uh numerical that these things could work and so i was a bit of a champion for research and i i've always thought since then um good research can inform practice in a really applied way so part of my job now at the university of manchester is building capacity of people like social workers social care workers home care workers for example to look at the research to be helped in getting involved in research and recruiting uh their colleagues to research studies um because the generation of that sort of evidence for social care for example is very much you know way behind our nhs evidence and hs clinicians do research all the time and they're informed by research and guidelines are informed by research so i think it really uh informs the way that you do things and the way that you could change the way you do things if you see what i mean yeah a lot of established practices going on um that kind of go have gone on by accident in a way i've been championed by a specific person but are not really probably not really effective and they've never been tested so i think we need to test things out not least because our health and social care systems at least in the uk you know it's public money that's involved in running them so we need to really test them out to see which approaches are more effective than than others because there's a finite pool of resources so you have to use resources effectively i think i think you all that too to the public so i'm very strong on that that we should use research to inform practice yeah and you need you need both practice and theory and research to go hand in hand and in order to mutually reinforce each other definitely yeah so um going into well um how you met ian and you were introduced to the easy care tool and now which is now the the act assessment tool um what's the what would you say is the main thing that draws you towards this tool i think obviously ian's a geriatrician by trade and i'm a social worker we we might look at things slightly differently um so clinicians tend to look at um what's missing i suppose you know what what's missing from a person what what they need to you know the gap that needs to be filled whereas social workers tend to look at what the strengths of the person what the vulnerabilities to risks and harm the two of those sides of the same coin i think i think the difference between those perspectives is a little bit overplayed i think i think um both people like myself and clinicians probably look at older people in the same way but i think the language is probably different so what interests me about the act um tool is that it it does combine both those perspectives it's not um what you call purely a clinical tool for assessment it contains items that are about vulnerabilities you know social social participation aspects that can um lessen risk or be used to promote the strengths of older older people and the the focus of the tool is is very person centered so it starts from where the older person is rather than parachutes the clinical perceptions to the assessment encounter straight away so the tool starts with the older person and that's that's that's of interest to me as a social worker because that's where we used to start in our assessments um and my experience of act obviously is colored by the work myself and he ended previous previously on that um single assessment process policy which was which was the government's attempt really to bring these assessment perspectives together it wasn't entirely successful but i think that's got a lot to do with resource and changes of government etc you know in policy often these policies just um go by the wayside so to speak because a new government comes in and they want to do something different so it's very short-term ism you know from from a policy point of view um and that's what interests me about the sct tool it was it was nominated as one of the tools to within that policy because it brought all these perspectives together so that's um that's where i come into it i think yeah and um what do you think about the importance of the element of self-assessing for an older person i think it's very very important because that's person-centeredness isn't it you should start from where the older person is their perceptions and their views on on their own strengths and vulnerabilities but there are difficulties with the concept and that's what the demonstration project threw up i think um older people can kind of internalize um society's views and there's a lot of evidence for that about um you know what we're what we're supposed to be capable of as we get older so um there's a lot of aegis views around that the sort of in the culture i think um and older people can internalize those so to to ask them to assess themselves it isn't it's not a simple process really because if you're asking somebody to assess themselves it depends on their perceptions of their circumstances which may be colored by the general in the societal culture so that people may not actually be able to identify difficulties because they're they're just expecting to have difficulties you can see what i mean because you know i'm older i'm 80 so i couldn't expect to forget things or not be able to get up on my chair properly like i used to do and people just sort of internalize that and then it gets it gets sort of worse they realize they can't do things and it's because they've just accepted the views of others um so to to ask them to assess themselves a little bit sort of naive sometimes i think policies attempt to do that because of that but on the whole it should be upheld people should be able to have a view about their own difficulties but actually ask them to assess everything sometimes you need a third party viewpoint which is what you know clinical assessment's all about isn't it somebody with the knowledge and skills to tease things out and we made people realize that they have got difficulties or even strengths that they didn't know they had if that makes sense yeah yeah so yeah it's more i mean it's always the case that one's own self-perception is highly dependent on you know external perception and external judgment and external biases towards towards you and categorization putting you into a group of people yeah yeah yeah that's completely understandable so so would it be then a case of combining the self-assessment with with the third party you mentioned i think so an act attempts to do that i think it starts from the older person then it brings in um you know empirically justified items you know that from research that we know um cause vulnerabilities in older people you know cognitive impairment things like that we know that happens and the person assessing themselves may not have that um knowledge about their own difficulties because they've never thought of it before because or because as i've said they've been internalized society's norms about what they can and should be able to do at the age that they are at the moment so there's a constant tension in assessment i think between somebody assessing everything themselves and the professional assessing them in a kind of objectifying way taking this sort of responsibility off them those are the two ends of the spectrum there's a constant tension i think between those two sides in assessing people so i'm interested to know um throughout your career have you seen a change or an evolution in the way that in society's views regarding older people i have and this is particularly uh around dementia i think and cognitive impairment um that's changed dramatically in the past 20 years i think and a kind of metaphor is with uh perhaps with cancer you know we we didn't used to even say the word cancer uh 30 40 years ago but all that's changed now and research has helped in that and good good health care has helped in that yeah now people in um you know obviously a cancer diagnosis is still a horrendous thing but there is help and people sort of embrace that help and they embrace the research and talk about the condition and that's happening with dementia now certainly over the past decade so we've certainly in the uk we've had various initiatives in demand sure there's a prime minister's challenge on dementia which has been longer now through successive governments there there's been a lot of um [Music] resource put into dementia support research and i don't i don't just mean drug trials but personal support approaches how effective they are and charities like the alzheimer's society have been great promoting a kind of more positive view of dementia and there are carers groups there are national family carers groups and national groups of people with dementia themselves who are promoting a kind of message you know you can live well or live as well as you can with dementia and this is how you do it this is how i do it as an older person so you know that's the sort of hard end of older people's difficulties i think obviously not not all older people um suffer with cognitive impairment or dementia but but prevalence does increase as one gets older so it is linked to aging it's not necessarily a part of the aging but it's linked uh there's been a definite sea change in in views about that conditions and that's at the hard end but more generally there has been a little bit of a sea change in how we view older people but i think it varies by country and certainly in the uk i think there's still a lot of air just kind of assumptions and language especially in the media and [Music] there's a view that um older ages necessarily means frailty you know definitely means frailty not which is actually statistically not true it's only a very small proportion of the older population who experience really um you know profound frailty that needs a clinician's help more most older people are managing it as well as they can and need that little bit of help i think as as one gets older so there are a lot of sort of language um kind of aberrations i suppose yeah about people in the culture certainly in the uk differs by country some countries are kind of better at promoting older age than than certainly the uk is but we're ahead of some countries so we have a long way to go yeah i think yeah i mean stereotypes in general but in this case specific to the older population will depend on that country's history and and social cultural situation would be very interesting to to come to do a comparative study so um just to finish off in relation to your plans to conduct studies with the act assessment i know you're still in the planning stages but can you just explain what the plans are what the objectives are just any information you might have yeah i've been working with ian and colleagues um for a few months now we're we're planning um a research program really a research study in a big research study if we if we can apply for funding for that to look at a ct assessment but look at it across different settings because as i as i um explained earlier michelle about my career it's kind of cross settings you know between nhs social care primary care i've been involved in as well gp practices so we're going to look at a ct assessment to look at if it can be implemented basically across multiple settings so in primary care [Music] nhs what we call secondary care which is community teams that support older people and social care which is quite important social care is quite separate from the nhs in the uk so they'd need their own principles and their own ways of viewing set to help them with their assessments they do separate assessments from the nhs so that's an interesting area whether the set tool could be implemented within social care which is principally organized around local authorities local municipalities rather than a national system which are our health care system is so we're looking to do that and what we're looking to do first of all principally is looking at looking at the acceptability and feasibility of set assessments for older people in in a particular setting first because we've got to test it out somewhere so we're going to test it out in one of our local nhs trusts that i've worked with before and principally we're going to look at whether the assessment is acceptable and test it out a little bit see how long it takes professionals to to you know assess older people but also we're going to try and link it with what we call an information prescription which is basically a tool that's already been created in some other areas um by by a company um a business uh that can be linked to the set assessment tool and it's basically um a prescribed list if you will of different community organizations different sources of help that could help the older person um mitigate the vulnerabilities and risks that the aact assessment has identified if you if you do what i mean so it's linking it electronically i suppose to the set assessment to this information prescription and that's a kind of new novel area and we're hoping that both combined could support the older people so we're not we're not just merely using the act assessment to identify difficulties problems vulnerabilities and strengths we're hoping to link that identification with well what do we do now what does the older person do now um well we're linking them naturally to be sources of help and the way that information prescription works is is basically it's a digital application um like kct and and it basically would use the results i guess the findings of the act assessment in individual order people and then they would get a message on mobile phone or the device here's some organizations that your assessments identified could be helpful to you here's some contact details we can help you contact them if you want you know through the through the um healthcare trust so it's linking assessment and what we do after assessment together so that's that's one of the ideas because i've certainly learned from my mental health practice as well as a social worker it's it's okay assessing somebody and you've identified difficulties that perhaps they didn't even know were there before and that's great that's what that's what the job of assessment is but what do you do then it's not really effective unless you actually address those difficulties in some way it's all identifying difficulties but might be quite scary if somebody's had say um 10 difficulties identify that they didn't know about before and then you don't do anything about them you don't link them with any sources of help it would leave the person a little bit um vulnerable i think yeah don't ask to identify what the problems are and then a different task to then address it normally in clinical practice and in certainly in social work those two things are quite separate so the social worker would identify difficulties but then they would be passed somewhere else and sometimes that passing somewhere else they call it care planning sometimes that breaks down and the organizations don't get the message and that that's when a package of care as we call it breaks down because there's been no communication there this this information prescription would do all that automatically we're all together yeah and bring all together for the help and the person the older person will be in charge of that because they would receive the information and then be helped to organize themselves organize their relatives to get the sources of help to them professionals are still important in that and they could be brought in so we're going to look at how that would work know how the link would work both technically and kind of operationally i suppose how how that could be organized in practice and then sort of test that as a kind of feasibility um yeah so that's the sort of idea it's in the planning stage at the moment we've had a lot of discussions um of course what what's kind of um stopping it from happening more quickly is just the situation we're in i think the whole the whole corporate situation um it's been quite difficult for the healthcare agencies to um commit time to to planning research recently certainly over the past five months because there's a lot of staff absences etc so it's a difficult time to do research but we're pushing ahead because it's we think it's a good idea yeah and uh do you think do you have a rough idea of maybe one that will be able to happen or to just completely it's dependent on that but it's also dependent on research funding streams and they they're kind of announced every so often throughout the year so this idea would have to fit a particular research stream to give it a lot of chance of success i think so we're kind of bound by that and but also obviously the staffing as i said in the um healthcare organizations i mean we're planning it this year we're hoping to submit an application uh you know later on this year in the summer for example and then unfortunately you have to wait for the decision and wait for the research fund to decide on that so it often takes too too long actually it takes too long to to set a research project up but we're hoping if we set it up properly it's got more chance of success i think okay okay well um thank you very much i don't know if there's anything else you would like to add no it's very interesting talking to you michelle and very um sort of interesting for me to just recap on what i've done so far with act and honey and it's it's been a long journey that we've been on but we we continue to um talk to each other and try our best to uh get all these things into motion yes well i do hope um you know this project will be able to happen soon it does sound very very interesting and uh thank you so much for your time thank you a lot for sharing your personal experience and professional background and everything thank you okay thank you okay me too bye bye
2022-03-18