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PRP (39-01-06) Understanding best practice in adult social work interventions for people with complex needs

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Published: 14 May 2024

Version: 1.0 - May 2024

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Timetable and Budget

DescriptionDeadline/Limit
Deadline for Stage 1 Applications 18 June 2024, 1pm
Notification of outcome of Stage 1 Applications September 2024
Deadline for Stage 2 Applications 22 October 2024, 1pm
Notification of outcome of Stage 2 Applications February-March 2025
Earliest potential project start March 2025
Project duration 12-24 Months
Budget Up to £400,000

Introduction

The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a multi-phased research project. The project will aim to understand variation and best practice in adult social work interventions for people with complex needs.
The multi-phased research project will consist of:

  • a development phase which will focus on scoping, assessing the feasibility of and recommending possible approaches for a main phase study;
  • a main phase study which will take forward the approach identified during the development phase.

At this stage, we anticipate commissioning a development phase study (costing up to £400,000), that will inform a subsequent main study.

Background

Social work involves a range of interventions intended to help people, including those with complex needs, maintain independence and social functioning and improve their overall health and well being.

Social workers provide an essential contribution to Local Authorities in fulfilling their statutory functions under the Care Act, Mental Capacity Act, Mental Health Act and ensuring that people’s rights are protected in line with the Human Rights ActThe Care and Support Statutory Guidance recognises the importance of social workers in all aspects of care, including conducting care assessments, making safeguarding enquiries, arranging care, and their role in preventing and reducing needs for care and support. Recent research has highlighted the diversity of expertise that social workers as a population bring to adult social care [1].

Adults with complex needs are those who need a high level of support with many aspects of their daily life and rely on a range of health and social care services [2]. This may be because of illness, disability, or broader life circumstances and may be present from birth or develop over the course of a person’s life. At the end of 2022/23, over 800,000 adults were accessing long term care support in the community in England [3].

Social workers play a key role in ensuring that people with complex needs experience a thorough assessment of their needs and eligibility for care. Social workers also coordinate resulting care to address the person’s support needs, which can be wide ranging and often changing. A lack of appropriate support has been found to result in escalations, crises, and admissions to hospital [4].

The evidence on links between social work practice and health and care outcomes is limited, particularly quantitative evidence, with NICE publishing research recommendations in this area [5]. Social work activities are highly contextualised, with research needed to understand the effectiveness of different interventions in order to explore what works, and in which circumstances, for adults with complex needs. These interventions may be multidisciplinary, meaning they involve other professionals outside of social workers. Previous research has explored how social workers can best support older people and carers [6].

This research seeks to strengthen the evidence base to better understand the impact social workers and varying social work activities have on improving lives for adults, with complex needs, and ultimately what impact social workers have on health and care outcomes [7,8,9]. It is recognised that the coverage of this call is broad, and we invite applicants to outline which population groups they would like to focus on. More widely, there is a particular interest in the impact of social workers for adults with complex needs, particularly older adults within this group.

Research Priorities

The overarching aim of this research is to begin to understand the current variation in adult social work practice for people with complex needs, and the effectiveness of these different social work interventions. Given the complexity of the area, to support the scoping and to understand what is feasible we are commissioning a development phase, which will then be followed by a separate main phase study informed by the findings from the development phase.

The research questions to be considered are cross-cutting across this development phase and the future main stage study. We recognise that due to the nature of this development phase, that research questions may be added to or amended.

The key research questions are:

  • What approaches do social workers and social services use to support people with complex needs?
    • What approaches do social workers and social services use as preventative measures with people with complex needs, to help prevent escalation or admission to hospital or residential care?
    • What approaches do social workers and social services use to support people with complex needs when needs are escalating
    • What relational approaches do social workers and social services use to promote social inclusion of people with complex needs?
  • What factors do social workers consider when deciding how to best provide support to people with complex needs? How does this vary between individuals and local authorities?
  • What training and development and support arrangements are required for the workforce to provide effective social work support to people with complex needs?
  • What impact do social work approaches have on a) the well being of people with complex needs, b) their health and care outcomes in terms of hospital admissions or admission to residential care, and c) the cost of care provision?

We anticipate the development phase will consist of the following work packages:

  • An initial review of the evidence base on current variation in social work practice and the impact of social work activities for adults with complex needs.
  • Qualitative primary data collection that explores current social work practice. We are particularly interested in understanding how social workers currently make decisions on how to support people with complex needs, including preventative practices and interventions when needs are escalating.
  • Scoping of data availability. Exploration into data availability and what data and methods are suitable to measure differences in health and care outcomes for people with complex needs (e.g., data on hospital admissions). The outcomes of interest include health and care outcomes for those with complex needs, including measures of wellbeing, as well as the cost of social work interventions and social care support.
  • Development and identification of future research, including an assessment into the feasibility of an evaluation of social work practice as a secondary study (e.g. comparing outcomes with a control group not receiving social work services).

We acknowledge that the research scope for the subsequent main phase may need to be narrowed, and we encourage applicants to outline how they propose this is done. The development phase will be used to inform future priority research areas. At this stage, groups of particular policy interest include:

  • Older adults with complex needs, including physical disability/ frailty/ capacity issues arising from cognitive decline.
  • Adults with learning disabilities and/or autism with multiple needs, including early onset dementia.

Eligibility

Eligibility rules for the NIHR Policy Research Programme are explained in the Standard Information for Applicants and these apply to all calls unless otherwise stated in the individual research specification. 

Technical requirements/Expertise required

Required:

  • Knowledge and experience of conducting research in social care and social work.
  • Expertise in qualitative research and evidence reviews.

Outputs

Throughout the project teams would be expected to have regular meetings with colleagues at the Department of Health and Social Care (DHSC), including the Chief Social Worker, to discuss emerging findings. This is crucial to ensure that research informs future policy.

The team would be expected to share interim findings from the evidence review, in the form of a report suitable for non-technical policy audiences. Full findings from the qualitative element and the evidence review combined should take the form of a report written to a publishable standard and suitable for non-technical policy audiences (e.g. with a clear executive summary and conclusions / key findings).

The key output of the final work package, which addresses the development and identification of a future main-stage study, including the feasibility of an evaluation of social work practice as a secondary study, should consist of a report detailing the recommended approach or options for the design of such future research. This report should be in an accessible format for policy, and should incorporate the findings of the exploration into what data and methods are suitable to measure differences in health and care outcomes for people with complex needs.

We would expect presentations of findings to technical and non-technical audiences at each of these reporting stages. Additional briefing notes or updates may be requested by the Department.

Budget and Duration

We anticipate the research to be delivered within a cost of £200-£400k. The research will be conducted over a period of 12-24 months.

Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.

Management arrangements

A research advisory group including, but not limited to, representatives of DHSC, other stakeholders, and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:

  • Provide regular feedback on progress
  • Produce timely reports to the advisory group
  • Produce a final report for sign off

Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.

Guidance on Health and Care Inequalities and associated data collection within NIHR PRP Research:

Health and care Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We ask that you please clearly identify in the research plan section of the application whether your application has an inequalities component or theme as well as how this research hopes to impact inequalities or not. Please also detail the core set of inequality breakdown data that will be collected, if applicable. More information on this request can be found in the Standard information for applicants.

Improving Data Access Pilot

The NIHR are working together with the Data Access & Partnerships Team in NHS England (NHSE) to better align NHSE requirements for data access with NIHR commissioningprocesses.

This funding call will include a pilot to support researchers in making data access requests by identifying any potential issues and resource impact earlier in the process. If your research will require access to NHSE data, please find further details of the pilot on the Data Access Pilot Guidance Webpage.

References and key documents

  • [1] Willis, P., Lloyd, L., Hammond, J. Milne, A., Nelson-Becker, H., Perry, E., Ray, M., Richards, S., Tanner, D. (2022). Casting Light on the Distinctive Contribution of Social Work in Multidisciplinary Teams for Older People, The British Journal of Social Work, (52), 1, pp. 480–497. Available online at Casting Light on the Distinctive Contribution of Social Work in Multidisciplinary Teams for Older People | The British Journal of Social Work | Oxford Academic (oup.com)
  • [2] Social work with adults experiencing complex needs. London: National Institute for Health and Care Excellence (NICE); 2022 May 26. (NICE Guideline, No. 216.) Available from: Social work with adults experiencing complex needs - NCBI Bookshelf 
  • [3] Adult Social Care Activity and Finance Report, England, 2022-23 [Internet]. NHS Digital. 2023 [cited 2023 Dec 12]. Available from: Adult Social Care Activity and Finance Report, England, 2022-23 - NHS Digital 
  • [4] Mullen EJ, Shuluk J. Outcomes of social work intervention in the context of evidence-based practice. Journal of Social Work. 2010 Dec 5;11(1):49–63.
  • [5] Mehmeti A, Francis J, Dworzynski K, Lloyd-Evans B. Social work with adults experiencing complex needs: Summary of NICE guidance. BMJ [Internet]. 2022 Jun 20;377:o1077. Available from: Social work with adults experiencing complex needs | NICE 
  • [6] Tanner D, Milne P, Nosowska G, Glasby J, Beedell P, Noszlopy L, et al. Social Work with Older People Research - Research findings [Internet]. Social Work with Older People Research. 2023 [cited 2023 Dec 15]. Available from: Social Work with Older People
  • [7] McGregor J, Mercer SW, Harris FM. Health benefits of primary care social work for adults with complex health and social needs: a systematic review. Health & Social Care in the Community. 2016 Apr 5;26(1):1–13.
  • [8] National Institute for Health and Care Excellence . Social work with adults experiencing complex needs (NG216) [Internet]. 2016 [cited 2023 Dec 12]. Available from: Recommendations for research | Social work with adults experiencing complex needs | Guidance | NICE