Area of Research: Adult Social Care
Section 1: Summary of main strands/themes for research
This Unit will seek to improve the evidence base for adult social care and social work policy, covering both economic and social research, including a wide range of topic areas and methodological approaches. There is a focus on building capacity and capability in policy research for adult social care which should be reflected in the scope and scale of this Policy Research Unit (PRU); we anticipate two units may be required.
The Unit/s will be required to develop a programme of research to ensure key evidence gaps are tackled. This will include generating evidence at the national/ macro policy level, considering social care and charging reforms and funding, understanding populations requiring or providing care and support, but there is also a need to understand how policy is implemented in, and impacting on, local authorities and those who need care and support and their families. Applicants will need to present a coherent proposal for a PRU, and it might be that they choose to focus either on macro level policy demand and impact or on understanding services and how they are experienced by those who need care and support. Populations of interest include older people with care and support needs; those who will need care and support in the future; working age people with current and future care needs; and condition specific needs such as dementia, physical disability, learning disability and those living with multiple long-term conditions.
The Unit will need to work closely with several of the other PRUs (see section 4) to develop and coordinate its programme of work. Social care is also a cross-cutting theme across PRUs, and we would expect the Adult Social Care PRU to support and coordinate this work.
Key themes we expect the Unit’s initial work plan to cover include:
Understanding the medium-term impacts and effects of charging and social care reform
- Including the effect on people’s behaviours, care planning, and financing of social care.
Understanding the number and needs of the population who need care and support services (and those who may do so in the future) and their care journeys
- Support the Department of Health and Social Care in developing methodology for the collection of characteristics data on adult social care recipients, both self-funded and local authority-funded, including their income.
- Analyse available data to:
- Increase understanding of the outcomes of using these services for diverse groups of people; and
- Understand needs in relation to NHS services and the relationship between health and social care needs.
- How people and their families make decisions on use of services, and the factors influencing these decisions, in the immediate, medium and longer term.
- Understanding how people fund their own care and how this might be changing considering Charging Reform.
Care and support for adults under 65
- Understanding the characteristics, future demand and preferences of adults under 65 who need care and support.
- Supporting choice and independence.
- Learning disability and neurodiverse conditions and improved models of care, including social work practice approaches, to support health and wellbeing.
Economics of social care systems, markets and commissioning
- Understanding the adult social care market: its structure, its viability in terms of investment and innovation, the role of fee rate and price in terms of sustaining investment and innovation.
- Understanding the underlying processes in provider failure, preparedness and ability to mount an emergency response.
- Drivers of spend in the future - demographic changes, changes in intensity of need, disability free life expectancy, wealth and income etc.
- Understanding different commissioning practices used by local authorities, including micro-commissioning at individual practitioner level and other commissioners of services, and how this influences outcomes and market shaping.
- Productivity in social care.
Quality and Improvement
- Informing work on measures of quality and outcomes, and systems for capturing data.
- Understanding access to care and care planning and the impacts of lack of access to care/unmet need.
- Assurance and oversight of the social care system to support good outcomes for people; role of person reported outcomes as a measure of quality.
- What works in supporting continuous improvement in social care commissioning and provision.
Innovation in social care delivery and new models of care
- Housing and care models and the role of housing in ASC; including provider markets and ability to innovate as well as outcomes and experiences of those living in these places.
- Markets, incentives and oversight and policy levers to support innovative models of care.
- Innovation in technology and data in social care.
- Personalisation.
Workforce
- Relationship between workforce inputs and service quality and outcomes, including pay and conditions, workforce satisfaction, availability and access to registered professionals, training, and productivity.
- The supply of care workers e.g. the current challenge of high turnover rates among care workers and the future challenge of increasing demand; recruitment, engagement and retention in adult social care.
Unpaid care
- The role individuals, people who need care, and their family/friends/informal carers can play in meeting care needs and the impacts/benefits this has both on the cared for and the carer.
- How best to support those providing unpaid care.
Understanding the effectiveness and cost-effectiveness of different social care interventions including:
- Home care (differentiating by different levels of intensity).
- Residential care (taking account of service user characteristics).
- Preventative services (i.e. services which can help delay or reduce the need for future social care provision including services to support unpaid carers).
- Reablement and intermediate care, including early support to help people to remain as independent as possible.
Social work practice
- Promoting independence in social care through strengths/asset-based approaches in the social work profession and in social care more generally.
- Further our understanding of effective social work with individuals / groups. What is effective for different people, who need care, in delivering better and safer outcomes, and at what cost?
- Adult safeguarding, including for different at-risk populations.
We are also interested in understanding and addressing inequalities in social care and social work practice, access, experience, and outcomes. Both as a topic itself and cross-cutting across the themes mentioned above.
It is difficult to predict the medium and longer run impacts of Covid-19 and interventions to address Covid-19 on the social care sector. The Unit may need to undertake work to support living with and recovery from Covid-19. This could include wider learning for the social care sector from the pandemic (e.g. system risk management or infection prevention control measures).
Section 2: Details of policy context and background
Adult social care comprises a wide range of personal and practical care and support for adults of all ages: older people and working age adults with physical disabilities, learning disabilities, physical and/or mental conditions, as well as support for their unpaid carers. The Department of Health and Social Care (DHSC) leads on the policy and legal framework for adult social care and is accountable for the outcomes achieved for the whole population (i.e. not just those receiving State support). The Department is also responsible for securing public funding for adult social care services. However, this sits within the overall funding system for local government for which the Department for Levelling Up, Housing and Communities is accountable.
Plans for Adult social care Charging Reform were announced in September 2021. The white paper, People at the Heart of Care, was then published in 2021 and sets out an ambitious 10-year vision for how support and care in England will be transformed. It builds on the changes outlined in the Care Act 2014 and puts people at its heart and revolves around 3 objectives:
- People have choice, control, and support to live independent lives.
- People can access outstanding quality and tailored care and support.
- People find adult social care fair and accessible.
In adult social care, compared to health, there is very little systematic evidence on the effectiveness or comparative cost-effectiveness of interventions, including the cost-effectiveness of approaches that could prevent or delay escalation of needs, such as providing support to individuals with lower levels of needs and to unpaid carers. This makes it difficult to assess the value-for-money of locally delivered social care services. This leads to a perspective that higher budgets equate to an improved service, when in fact this may not be the case. There is very little evidence to use to judge the level of efficiency savings that could be possible in the social care sector. This Unit will work alongside other research units to help address this gap.
Section 3: Justification for research topics
A research programme is required to help answer the themes set out in Section 1. These themes represent the scope of issues from which the final agreed programme will be built. Findings from this programme will provide the longer-term evidence base needed to support the Department’s key long-term goals, including the implementation and delivery of social care and charging reform, particularly in an environment of resource constraints.
Section 4: Other related research activity of which the Unit will need to be aware
There has already been significant research activity in adult social care. Applicants should be familiar with the existing research programme carried out by the current PRUs, and other policy research funded through the National Institute of Health and Care Research (NIHR) Policy Research Programme. The Unit will need to work closely with other PRUs to design a cohesive and complementary work programme across adult social care. The themes listed above therefore may not all be covered by this Unit alone and there is scope for joint working across units to deliver priority evidence requirements, in particular with the following units.
- Economics of Health and Care Systems;
- Economic Methods of Evaluation in Health and Social Care Interventions;
- Behavioural Science;
- Quality, Safety and Outcomes of Health and Social Care;
- Health and Social Care Systems and Commissioning; and
- Health and Social Care Workforce.
The work of these Unit/s will need to be set within the context of the wide-range of NHS activity including that of the National Institute for Health and Care Excellence (NICE) and the support for building the evidence-base through programmes of research such as the NIHR Research for Social Care Programme, the NIHR Health and Social Care Delivery Programme and other programmes, in particular the NIHR School for Social Care Research.
A James Lind Alliance Priority Setting Partnership was conducted for adult social work, and another for social care in Wales (while the PRU covers England, there might be some overlap in priority research questions). Not all of the priorities identified are policy research and some research is commissioned or underway to address these but could help inform Unit’s priorities.
Finally, future research should add to that carried out by other key players in this area such as Centre for Better Ageing, Pension Policy Institute, International Longevity Centre-UK and the Institute for Fiscal Studies.
Section 5: Other issues relevant to this programme of research
Evidence will be needed to feed in to key cross government reviews and periodic events such as the Spending Review. Having outputs to inform and share underlying detail and data in a timely fashion will be important for ensuring the work of the PRU is feeding into policy and analysis.
Short-term and timely desktop reviews (e.g. 4 to 6 week duration) on narrowly focused research questions are required to enable the Department to effectively scope out emerging policy areas to respond to Ministerial priorities and ideas.