In 1993, almost two decades after PSSRU was founded at the University of Kent, the Department of Health was undertaking its regular review of whether to continue our funding. One issue of concern was our location solely at the University of Kent, without direct links to the Department’s other major interests. In particular, while we had many successful ad hoc collaborations with clinicians, nurses and psychologists through my work on integrated care and case management, there was no formal connection with a medical school. They advised that such a link should be made. So in 1996, after assessing the options, I moved to Manchester to set up a new PSSRU branch within what was then the psychiatry department of the University’s medical school. At the same time, Martin Knapp launched a branch of PSSRU at the London School of Economics and Political Science, to provide a link with a major policy-related institution. This was the start of PSSRU as we know it today.

 

Manchester PSSRU was launched with just three of us: myself, another full-time academic and an administrator (and we are all still here). Relying on university funds to support the unit’s development plus a small budget from DH, part of our agenda was to bring in competitively sourced money to pursue the unit’s agenda. Gradually we had success, bringing in quite big sums on some occasions and recruiting and retaining good staff. We have grown to around 20 people, many of whom have been with us since 2000 or before. We are a genuinely multi-disciplinary group, with statisticians, psychologists, nurses, social workers, methods experts and two medics among us. Much of our project funding now comes through the National Institute for Health Research (NIHR), so we work at arm’s length from the Department of Health.  

 

The early years were really about saying “hello, we’re here and we’re doing something different”. It made sense to be in the psychiatry department because a lot of our work was on old age mental health and dementia. It was a good home: they were an interesting and supportive group of colleagues – and still are.

 

Among the projects that put us on the map was a randomised controlled trial of the impact of giving social care staff the opportunity to request a clinical assessment for an older person, before any decision was taken about whether or not they needed residential or nursing home care. Too often older people may appear to need a placement because of undetected morbidities of one kind or another, which may be temporary or treatable.  So we gave a group of social workers access to either a geriatrician or an old age psychiatrist for an immediate assessment of a person in their own home. A report designed for a social care practitioner was produced within 24 hours which could be used to make a better decision about the need for institutional care. We found this approach resulted in fewer care home and A&E admissions and quite a marked overall NHS cost saving. It was an exciting study that received a lot of attention. Unfortunately, it was never rolled out nationally, despite getting a special editorial in the journal Age and Ageing; these days various commissioning arrangements make this kind of collaborative enterprise more difficult to achieve than in 2004, when we published.

 

Another turning point for Manchester PSSRU came when the Department of Health started large programme grants. We managed to win what I think was the first social care led NIHR Programme Grant – approaching £2m for 2007/12 – to look at national trends and local delivery in old age mental health services. We explored the most appropriate and cost-effective ways of organising and delivering services for older people with mental health problems through a series of distinct, but interlinked, projects. There were a number of key findings: firstly that the integration of health and social care per se does not in itself necessarily produce better outcomes; secondly that although old age mental health is a significant input to residential and nursing homes more is required. Most controversially, we showed that implementation of the policy of shifting provision for very frail older people out of nursing home care and into the community had probably reached its limit, particularly for those with mental health needs. The number of nursing home beds now relative to community care provision is probably too low. That message is still not quite getting through.

 

Our current £2 million NIHR programme grant for 2013/18 is to lead work on effective home support in dementia care, including whether different types of home support combine together in better or worse ways and the effectiveness and cost-effectiveness of different models of support.

 

Since 1996 our unit has developed a distinct character within PSSRU as a whole. Unlike other branches, almost everything we do involves primary data, so we are continually going out and engaging with people – patients, service users, carers, and care organisations – and we have developed very strong links with the NHS and clinicians as well as local authorities, social care providers and care homes. Looking ahead, we have funding from the NHS to appoint another professor and significant grants still coming in so we’ll continue to focus on our key themes for older people and people with mental health problems: ageing, community- based and long-term care, dementia and the health and social care interface. Our location means we are well-placed for the latter. Being a social care enterprise that is seen as a valued part of a medical school is a real plus. I like to think we’ve acquired “well-accepted status”.

 

Interviewed by Teresa Poole