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Staff Profile

Dr Vanessa Davey

Research Associate

Background
Vanessa is a Research Associate at the Population Health Science Institute, Faculty of Medical Sciences, Newcastle University.

Education and qualifications

2019 - PhD in Social Policy - London School of Economics & Political Science
2001 - MSc in Health Policy Planning & Financing (Health Economics) - London School of Economics & Political Science/ London School of Hygiene and Tropical Medicine
1998 -  Nursing Science – University of the West of England

Areas of Expertise

  • Long-term care in the community
  • Home Care
  • Direct Payments/ Self-directed Care
  • Involving people that draw on care and support in designing services 
  • Social care commissioning
  • Social care contractual regimes
  • Integrated care
  • Unpaid care

Background

Vanessa began her career as a nurse in the NHS before completing an MSc in Health Policy Planning & Financing (LSE, 2001) and, later, a PhD in Social Policy (LSE 2019).

Between these times, she worked at the Personal Social Services Research Unit at the London School of Economics and Political Science (now the Care Policy Evaluation Centre), at the RE-FiT research group linked to an intermediate care hospital (Barcelona, Spain) and as a consultant researcher, before joining the Population Health Sciences Institute at the University of Newcastle (May 2022).

Vanessa’s main expertise is in understanding how long-term care policies for older people work, or how they can be improved. Specifically, how different models of care influence the experience of receiving care and the outcomes of care for person receiving care and their caregivers.

During her time at LSE, Vanessa worked on projects focused on the role of institutional mechanisms for improving long-term care services. This covered aspects such as the role of contracts and commissioning, incentives, performance regimes, quality assurance mechanisms, and collaboration between health and social care.

Vanessa’s experience at LSE led to a PhD on the role and function of direct payments to older people, drawing on a “production of welfare approach” (Knapp 1984). This considers the care system as a factory that produces a range of welfare outcomes such as increasing quality of life, increasing the length of time that a person can live in their own home, and reducing carer stress. In this the ‘inputs’ potentially contributing to outcomes, include, both resource inputs which can be clearly expressed in monetary terms and non-resource inputs. For instance, along with staff time which can be clearly budgeted, aspects like relational continuity and staff attitudes, which do not have an identifiable price, can also influence outcomes. More broadly the production of welfare approach recognises that in a mixed economy, care outcomes are also influenced by market conditions.

This model also identifies numerous other potentially influential factors including ‘quasi-inputs’ which can affect welfare outcomes including the specific attributes of the person receiving care, and unpaid carer characteristics, such as capacity to navigating the health & social care system, ‘intermediate outputs’ such as the types, quantities and attributes of care received (including flexibility).

Drawing on this framework, Vanessa’s PhD used qualitative and quantitative methods to explore factors impacting on the outcomes of direct payments (DPs) to older people from a broad perspective with particular focus on the role of unpaid caregivers, intermediary services to support direct payments use and the nature of support purchased with direct payments.

Research

Current work:

Vanessa is working on the DACHA-DOM project to explore the potential of a national Minimum Data Set for home care building on research done in care homes by the main DACHA study.

In England, there are over 8000 registered home care agencies, providing support to almost one million older people in their own homes, yet there is no systematic approach to sharing data on people who use home care. This is a key reason why so little is known about the population of people receiving support in their homes and about how they access other services and transition between services (such as a home care setting to a care home setting).

If key information about people receiving care were routinely collected, stored, updated and shared with relevant agencies, such information could be used to plan care and support for older people, including by government departments, and regulatory organisations, such as the Care Quality Commission. It could provide a vital link between information on resources and outcomes.

Key objectives of DACHA-DOM are to: 1) design a template (or Minimum Data Set (MDS) for key information about people receiving homecare (e.g. characteristics, needs, outcomes. 2) explore support for, and feasibility of, implementing an MDS for homecare in the UK.

DACHA-DOM is funded by the National Institute for Health and Care Research (NIHR).

 

Recent work:

Innovative models of home care

Project for the provincial council of Barcelona on ‘Innovative models of home care for older people’, based on experiences in England and Catalonia (Spain), involving interviews with experts in the field and a review of academic and grey literature. Report (in Spanish and Catalan – forthcoming) includes chapters on direct payments and individual service funds; community microenterprises and local area coordination; wellbeing teams and outcomes-based commissioning based on examples from local authorities in England; plus neighbourhood-based care in the city of Barcelona; free choice of home care in Mataró, and a partnership between a local authority and a social enterprise to provide home care in the municipality of Arbúcies.

Co-designing measures to promote remote physical activity in frail older community-dwellers

 The purpose of this study was to detect barriers and facilitators, as well as to prioritize action items to increase the digital component of a physical exercise program targeted at older adults with mild frailty living in the community. This was undertaken via a participatory process, with different relevant stakeholders: older adults and caregivers, health, social care and third sector professionals, applying co-design principles. This programme of work was funded by La Caixa Foundation and Barcelona Science.

Rapid response work to COVID-19 pandemic

Involved in various projects to document the impact of the COVID-19 pandemic in Spain in collaboration with LTCcovid.org. This included reporting on the emerging crisis in nursing homes, the impact on community-based services and early policy and practice measures taken.


Previous work:

Older people’s involvement in commissioning

Project funded by the Joseph Rowntree Foundation to investigate the extent of older people’s participation at different levels of social care commissioning. This work began with a literature review to investigate the extent of older people’s participation at different levels of social care commissioning (individual, locality, contracting and strategic). The review was followed by case study work with local authorities to identify factors limiting the capacity for user influence and involvement at each commissioning level.

Unit costs of Direct Payments Support Services

Despite policy emphasis on self-directed support, via personal budgets and direct payments, very little information has been available on the costs of providing direct payment support. Where it is available, costs are typically estimated by dividing annual expenditure by the number of users supported. Such ‘top-down’ methods provide a helpful start, but they do not reflect the different support activities provided, and so do not pick up the different levels of resources provided to users or the different ways of spending those resources.

Vanessa has developed various methods of calculating direct payments support costs derived from ‘bottom-up’ methods. Firstly, using data from a national survey of organisations that provide direct payment support (Davey et al., 2008). Secondly, through working with three direct payments support organisations in collaboration with a software designer to develop a program to record staff activity including all client related (direct and indirect), and non-client related activity to provide more accurate picture of support costs, and explore the association between client characteristics, support package size, types of support required (e.g. recruitment, administrative, PA management) and service use.

Evaluation of the Direct Payments Development Fund and its role in promoting direct payments to older people

Mixed-methods evaluation of direct payments implementation with a focus on direct payments uptake by older people (with or without the support of an unpaid carer) funded by the Department of Health and Social Care. Case study work in ten local authority sites including qualitative interviews with older people receiving direct payments, interviews with care managers, local authority commissioners, direct payments coordinators and representatives from direct payments support schemes. This project also involved a national survey of local authorities and organisations providing direct payments support, as well as secondary analysis of survey data and information available from government sources.

Integrated commissioning for older people’s services

Qualitative project funded by the Department of Health and Social Care to explore factors hindering and facilitating developments in integrated commissioning between health and social care exploring implementation of 1999 Care Act ‘flexibilities’ identified in article 31 which established three mechanisms for health and social care integration. (These have since been followed by changes in the Health & Social Care Act 2012 and the Health & Care Act 2022)

The work involved qualitative semi-structured interviews with commissioners in six local authorities and analysis of local policy documents. Specific areas mapped were the extent and nature of joint commissioning for older people; planning procedures and process; and strategic activity and decision-making (including the range of activities involved in commissioning), leading to a learning event for commissioners and other stakeholders and other outputs.


Publications