Adult Social Care – where’s the evidence?

Jo Moriarty Nov 2014bJo Moriarty and Martin Stevens are Senior Research Fellows at the Social Care Workforce Research Unit. (1,192 words)

People often talk about the absence of a social care evidence base, but ‘patchy’ is a far better description. Until we arMartin Stevense more explicit about this, it will be difficult to make progress in achieving evidence based policy and practice. We took part in two Meet the Researcher sessions at an event jointly organised by Research in Practice for Adults (RIPfA), the British Association of Social Workers (BASW) and the Association of Directors of Adult Social Services (ADASS). They were part of a day-long seminar designed to bring Directors and Assistant Directors of Adult Social Care and researchers together to discuss current and future adult social care research. Continue reading

Imagining the future – the social care workforce

Dr Martin StevensMartin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit at the Policy Institute at King’s. (1,593 words)

A new report from the Centre for Workforce Intelligence: Forecasting the Adult Social Care Workforce to 2035 was launched at an event on the 27 July. This report asks some key questions and offers some possible answers. What will social care look like in 2035? Who will be doing the work?  How many people will be needed to keep care and support services going? Social care seems to like such forecasts, a previous report by Skills for Care in 2011 estimated that the number of jobs in the adult social care sector would need to grow from around 1.6 million in 2010, to 2.8 million in 2025 in order to meet projected demand for social care support. Only last year the Centre for Workforce Intelligence (2015) forecasted a 33 per cent growth in demand by 2030. Continue reading

Supporting parents with learning disabilities – passing on practice experiences

Dr Martin StevensDr Martin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit. (1,037 words)

There is increasing interest in supporting parents with learning disabilities, as evidenced by the good turnout at the Social Care Workforce Research Unit’s most recent practice seminar on 24 June. Our seminar series focusing on learning disabilities covers a wide range of topics, but this one on parents with learning disabilities reflected the relevance of the subject to practitioners working in both adult and children’s services. Sandra Baum, the seminar presenter, estimated that most (two-thirds) child and family social workers have a parent with learning disabilities on their case loads. Dr  Baum is head of learning disabilities psychological services and associate clinical director (LD) at Oxleas NHS Foundation Trust.

Dr Sandra BaumIn addition to co-authoring many articles and key guidance books, Sandra (pictured right) has substantial practice experience. Her work involves assessments, which include IQ tests alongside functional assessment of Daily Living Skills. She acknowledged that there is a serious question about the usefulness of IQ tests in assessing parents’ suitability. If the IQ score is over 55 (as it often would be), Continue reading

Risk, Safeguarding and Personal Budgets: exploring relationships and identifying good practice

Martin StevensDr Martin Stevens is Senior Research Fellow at the Social Care Workforce Research Unit in the Policy Institute at King’s. (900 words)

Published today are our findings from this timely NIHR-SSCR funded study, which aimed to provide evidence about the impact of using different forms of Personal Budgets on risks of abuse, to explore practice responses to the increased emphasis on using Personal Budgets and the experiences of Personal Budget holders who had been the subject of a safeguarding referral (suspected abuse or neglect). This collaborative research (undertaken by researchers from King’s, the University of York and Coventry University) was driven by our awareness of contradictory perceptions held by practitioners and other researchers. We had heard views that people on Direct Payments (one main form of Personal Budgets) were more at risk of abuse than other social care users, but on the other hand that the increased control offered by Direct Payments was a protective factor. In order to provide some evidence to address these contradictions, we re-analysed national and local data on safeguarding referrals and take-up of the different forms of Personal Budget. Continue reading

Risks and barriers to organisations conducting research

by Martin Stevens, Senior Research Fellow at the Social Care Workforce Research Unit at King’s College London. (2,114 words)

The Health Research Authority (HRA) is currently consulting on various aspects of research regulation in health and social care in preparation for replacing the Research Governance Framework (RGF). The Social Care Workforce Research Unit (SCWRU) has had a long involvement with the implementation of Research Governance in social care and has made a response to part of this consultation. The HRA is currently asking ‘What are the risks to research because of perceived risks of research? and has published a report explaining its proposed approach. There is much with which we agree in the consultation report, specifically:

  • the focus on clear and consistent definitions of terms;
  • the emphasis on collaboration;
  • the promotion of sound arrangements between the different organisations involved in research;
  • the promotion of a quality research culture, within research organisations and also in care organisations; and,
  • the need for more explicit support for a high quality research culture.

However, despite the focus on good collaboration and the need to involve all stakeholders, the document needs to better reflect the experiences of social care researchers, and those responsible for research governance in local authorities. Continue reading

Where next for integration and funding?

John Woolham

John Woolham

Martin Stevens

Martin Stevens

It is estimated that the NHS faces a shortfall of at least £30 billion a year within a decade and possibly a deficit as high as £50 billion. Martin Stevens of King’s and John Woolham of Coventry University report on an event last month where experts debated funding and integration in health and social care. (1,369 words)

At a SSRG-SSCR event on Integration and Funding of Health and Social Care held at the LSE on 18 June José-Luis Fernandez of LSE opened with a statistical review of the decline of social care service provision since the 1980s, which had become especially marked since 2008-09 with the contraction in public spending—despite increases in the numbers of older people over this period. While this could in small part be due to better targeting and more effective services, his conclusion was that there was a great deal of unmet need in the community. Continue reading

Personalisation of adult social care – do we have to decide between choice or quality?

Martin Stevens, Research Fellow at the Social Care Workforce Research Unit at King’s, discusses personalisation and the risks associated with an exaggerated concentration on choice in the context of adult social care.

Personalisation of adult social care (and other publicly funded services) is still an important goal of government policy and local practice. The claims about the benefits of personalisation are well known—choice and control produces better outcomes and is achieved primarily through an up-front allocation of resources to individuals to make decisions about what to purchase and from whom. ‘Think Local Act Personal’ is a sector partnership of voluntary and statutory organisations, which offers advice and information to councils and professionals in implementing personalisation and is a leading proponent of personalisation, particularly in relation to personal budgets.

The roots of personalisation lie in two strands of philosophical and political thought. First is a view that markets are the best way (if not the only way) of providing services. Second is an emancipatory perspective that identified professionally organised services as oppressive and restrictive, leading to a campaign for greater control. This was led by young disabled people.

John Clarke and his colleagues (2008) have raised three concerns over the value of emphasising choice in this context. First, they argued that focusing on increasing choice favours those with the best ability to exercise it (or with the most supportive networks), thus increasing inequality. Second, they maintained that a focus on choice ignores the complexities of power relationships and fails to recognise the public interest in decisions about public services, such as social care. Findings from the IBSEN study (evaluating the pilot individual budget sites) also supported this critique (see Stevens et al. 2011). While there has been great emphasis on increasing choice of provider within a market, this has possibly been at the expense of exploring the best ways to support people to exercise choice and control over their lives. Similarly, less attention has been paid to ensuring the quality of the support provided. Some commentators have therefore questioned the extent to which personalised funding should be the sole means of arranging services, arguing for the need for maintaining some collective provision (see Needham 2012).

This is not to argue against choice, but to caution against the adoption of choice as a goal in itself, separate from other aims of improving outcomes. It can be argued that personalisation policy has become focused on the means of choosing services, and how money is spent, rather than the kinds of support that is valued, although Think Local Act Personal has produced some guidance for people using direct payments to employ personal assistants.

The financial recession has led to several years of public sector spending restraint, which has coincided with a strengthening political will towards marketisation. This has become a dominant driver of personalisation. It has exacerbated the emphasis of choice over quality. In practice terms, this presents difficulties for social workers and others working to support people making choices about the use of public money allocated for their support, as there are fewer ‘levers’ to pull in terms of ensuring quality of service and outcomes. Where abuse is suspected, a safeguarding team can investigate and attempt to improve the quality of support if necessary, but this is a safety net approach. It is interesting that two recent evaluations have not emphasised the value of choice in contributing to outcomes, but have highlighted the importance of quality of support (these evaluations were launched at a joint King’s College London and Ipsos MORI event on 25 September (Personalised support services for disabled people: What can we learn?).

Great emphasis has also been placed on the support that disabled people and carers may need to use direct payments. User-led organisations can provide this support and are valued where this happens—see Think Local Act Personal’s guidance document: Best practice in direct payments support – a guide for commissioners. However, there is also a case to be made for professional support for this kind of decision making. Good relationships with individual disabled or older people may be one way of ensuring the availability of advice about the best kinds of support and how to assess the quality of care. Similarly, engagement with organisations of disabled or older people may help to identify concerns and lead to policy and practice questions being addressed. While this support does not necessarily need to be provided by social workers, their value as people trained in understanding the significance of major psycho-social decisions and (hopefully) a good knowledge of the different kinds of support, should not be dismissed.

Dr Stevens is Research Fellow at the Social Care Workforce Research Unit at King’s College London. Recent work includes the Jobs First Evaluation (launched at the 25 September event mentioned in this post). Current work includes Models of safeguarding: a study comparing specialist and non-specialist safeguarding teams for adults.

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References:

Clarke, J., Newman, J. and Westmarland, L. (2008) The antagonisms of choice: New Labour and the reform of public services, Social Policy and Society, 7: 2, 245–53.

Needham, C. (2013) Personalized commissioning, public spaces: the limits of the market in English social care services, BMC Health Services Research 13 (Suppl 1): S5 9 pages.

Stevens, M., Glendinning, C., Jacobs, S., Moran, N., Challis, D., Manthorpe, J., Fernández, J-L., Jones, K., Knapp, M., Netten, A., Wilberforce, M. (2011) Assessing the role of increasing choice in English social care services, Journal of Social Policy. 40(2), 257–274.

 

Are direct payments a form of activation policy?

Martin Stevens

by Martin Stevens

It was Jo Moriarty, a colleague here at SCWRU, who introduced me to the idea of labour activation, pointing out its relevance to Jobs First, the evaluation report of which I am just now drafting.

Is it right to see the Jobs First initiative as a labour activation policy in relation to people with learning disabilities? More than that, might the policy drive toward personalisation bear the imprint of an ‘activation ethos’?

Labour Activation Policies have a long history, at least back to the 16th Century, when those overseeing the poor were involved in ‘sending vagrants to work’ (Patrick, 2012:6). These days, we can talk about four key facets: increasing market involvement in providing services; individualisation or personalisation of response to each individual; integration of different forms of support (e.g. the merging of welfare benefit organisations and Job Centres into Jobcentre Plus); and an uneasy balance between coercion and support. This last is illustrated in the varying degree to which policies support people to get jobs that fit their qualifications and previous experience or apply pressure for people to take any job, to get off welfare benefits.

These topics were the focus of the Workshop on integrated employment and activation policies in a multilevel welfare system, in Milan at the end of August, where Jobs First had its first academic outing. The workshop aimed to explore facets of European Activation Policies, involving academic speakers from across Europe. One message from the Workshop was that some form of labour market activation had been almost universally accepted in Europe. Consequently, there are many kinds of interventions to support or coerce young people and unemployed people to get paid jobs.

Jobs First shares the first three elements of activation: an increased emphasis on using personal budgets to purchase supported employment services from independent sector organisations; an individualistic approach; and increased links between adult social care and Jobcentre Plus. However, there are no directly coercive elements, in relation to loss of benefits. Having said that, some participants referred to the reduction of public spending on support for leisure as creating pressure to get jobs.

Of perhaps wider interest in relation to social care is the application of activation to personalisation. Direct Payments can also be said to share three elements of activation policies. First, they create more reliance on markets and individualisation of service. Second, they put more responsibility on individuals and their families to manage their own support. Third, there are ongoing efforts at integration with health (e.g. the Personal Health Budgets project) or through combining funding streams (as is being trialled in the Right to Control, trailblazer sites). There is no direct analogue for coercion, although the government’s strong preference for direct payments, puts pressure on local agencies to increase their use. The key link is perhaps the focus on individuals to bear responsibility to be active co-producers of welfare. So is this a useful way to think about personalisation?

Patrick, R. (2012) ‘Work as the primary ‘duty’ of the responsible citizen: a critique of this work-centric approach’ People, Place and Policy Online 6(1), 5-15.

Dr Martin Stevens is Research Fellow at the Social Care Workforce Research Unit at King’s College London. With Jess Harris he is currently writing the final report for the evaluation of Jobs First (an initiative encouraging the employment of people with learning disabilities) for the Department of Health.

 

How should research evidence be used to improve adult social care policy and practice?

Martin Stevens

by Martin Stevens

This question has bothered me since I started as a social services research officer in 1992. Attending the NIHR School for Social Care Research (SSCR) Workshop: Maximising Research Impact in Adult Social Care last week was a chance to ponder this question and, more usefully, to hear other people’s ponderings. The event was very well attended, with a mix of academic (including Jo Moriarty, Jess Harris and me from the Social Care Workforce Research Unit) and local authority staff, with a small number of people who use services and carers. First up was a panel discussion, in which Martin Webber (York University); (Chris Rainey (West Sussex Social Services Research); and Deborah Rutter (Social Care Institute for Excellence – SCIE) gave short introductory accounts, followed by a long question and answer session. Three presentations followed: Sarah Carr (SCIE) emphasised the roles of service users and carers; George Julian (Research in Practice for Adults) gave some practical aspects using research evidence; and Jonathan Grant and Molly Morgan Jones (RAND Europe) presented various approaches to measuring research impact in social care.

Naturally, in the presentations and discussions, there was a sense of frustration about apparent lack of change over the years. Best metaphor of the day was from the Unit’s own Jess Harris, talking about the need to ‘bite people on the bottom’ when trying to encourage the use of research in policy. These feelings are understandable, the issues and barriers raised by all speakers – time, resources, attitudes of practitioners, managers and policy makers, levels of training, understanding of research methods, lack of good quality research presented in easy to understand formats, seem to have been around during my whole career as a researcher.

More positively, there was a welcome emphasis on dialogue and engagement of different stakeholders. This is valuable as there has often been a somewhat mechanical view of research evidence as a lever to change practice. This simplistic approach ignores important contextual factors, such as practitioners’ low level of discretion, making the direct application of research problematic. A focus on the need for dialogue and engagement, together with the idea of co-production, suggests an acceptance of the complexity of linking research evidence with policy and practice change.

However, I was left with three questions that need more attention in order to optimise the impact of research in policy and practice:

  • What is the most appropriate and proportionate impact we can expect from research compared to that from other influences (politics, values, professional and user knowledge), given the necessary uncertainty and contestability of research evidence in this sphere?
  • How should different kinds of evidence, which often arise from different assumptions about the nature of social world, be combined to make changes in policy and practice?
  • How can policy making be changed in order to make best use of research (in terms of timescales, but also increasing the influence of people using services, carers, practitioners and researchers)?

Dr Martin Stevens is Research Fellow at the Social Care Workforce Research Unit at King’s College London. With Jess Harris he is currently writing the final report for the evaluation of Jobs First (an initiative encouraging the employment of people with learning disabilities) for the Department of Health. He is also Principal Investigator in a study examining the vetting and barring of workers in the sector.