Reflections on Reimagining Social Care

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Those familiar with social care policy and practice will also be familiar with the terms ‘change’, ‘modernisation’ and ‘transformation’, all of which suggest a continuous momentum forward, perhaps without time to stop and reflect. Despite this, it’s more important than ever to consider the wide range of evidence available in social care to inform policy and practice. So, the new report from Research in Practice for Adults (RiPfA) provides a helpful and timely pause for thought, as it looks at the evidence in order to ‘reimagine’ social care.

The report is a bumper edition of analysis and commentary from experts in the field, covering

  • Safeguarding adults from abuse
  • Evidence-based prevention and independence in adult social care
  • Involving people, co-production and advocacy
  • The adult social care workforce in England

These are some of the most pressing and challenging areas in adult social care, and the report authors grapple with the evidence in order to reimagine what these aspects of social care could be.

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The authors examine the evidence to reimagine how social care could be.

What if adult safeguarding were evidence based?

Social Care Elf blogger Lindsey Pike and Adi Cooper draw on research and practice experience to examine and rethink adult safeguarding. After considering the research evidence (including that on user involvement as there is currently little research regarding user perspectives on adult safeguarding) on what people want from safeguarding, abuse prevention and the implications for regulation, Lindsey concludes that

People who use services want to feel in control of the situation when involved in safeguarding.

Risk aversion, partly driven by safeguarding concerns, can limit users’ options and result in situations where, for example, they prefer ‘abusive’ friends to social isolation. A risk enablement approach is therefore key.

Adi provides a commentary informed by extensive practitioner expertise, highlighting the need for continuing action research and a focus on the following areas in adult safeguarding:

  • personalisation
  • prevention
  • regulation
  • workforce multi-agency working.

What could a new model of prevention and independence for older people look like?

Social Care Elf blogger Robin Miller tackles the complex evidence base associated with prevention and independence for older people, with John Bolton providing a commentary from the practice perspective. Robin honestly describes the evidence base as being ‘messy, contested and occasionally contradictory’, although slowly improving, and he attempts to pin down the often elusive concepts of ‘wellbeing’, ‘prevention’ and ‘independence’ for older people.

Central to his investigation is what research shows could work and the views of older people. The evidence shows that a new model needs to maintain a tricky balance to ensure older people get the support the need to maintain independence:

Older people often value social engagement more highly than formal services – so the quality of contact and support from family and friends, as well as paid staff, is critical. Yet such support is hard to organise and often falls below council priority levels. Nor should it be an issue for adult care services alone – health, housing, leisure and other public services have a role here.

On the other hand, formal interventions at the secondary and tertiary level can help promote people’s independence if delivered, resourced and targeted effectively.

John Bolton offers an expert commentary from the perspective of local authorities that are expected to deliver savings through prevention and the promotion of independence for older people, with commissioners who will be concerned with what works and best value. So what does the evidence-base offer for local authority decision-making in this area? John concludes that the evidence needs to be appropriate for the local circumstances:

Many councils are now looking to establish the right performance systems to look to understand which of their services produces the best outcomes for people in need of help and which do not. Those councils who are starting on the journey should focus on either those interventions that assist people in helping them to stay outside of the formal care system or with those short term recovery and rehabilitation services that enable people to regain their independence.

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The report tackles some thorny and complex social care challenges.

What difference does service user involvement and co-production make?

Service user involvement, advocacy and now co-production are terms that have become established in the social care lexicon, but what’s the evidence on the difference they can make to social care? Rich Watts and Peter Beresford unpick the evidence, the challenges and gains for co-production, service user involvement and advocacy, offering a robust critique of the concepts and evidence. Drawing on evidence and policy, Rich untangles co-production and service user involvement, concluding that co-production is not about consultation or more tokenistic types of involvement, but rather

Co-production ‘requires a different sort of relationship between people using services and professionals, whereby power is more equally shared, with the goal of improving users’ quality of life.

For Peter, to achieve this in reality means that the

definition, policy and practice is strongly in the hands of service users and our organisations, and where we as people who use services play an equal role in their conceptualisation and associated action for change.

Both Rich and Peter examine the barriers posed by structures, expectations, practices and processes as well personal barriers around confidence and lack of training and support. They also provide evidence on the clear benefits of service user involvement, co-production and advocacy. Peter emphasises the importance of experiential knowledge as evidence and concludes that significant gains have been made

while it is important to be aware of the problems identified by service users in relation to user involvement, it would be a mistake to ignore the gains. These are particularly evident in relation to user involvement in professional education, where social work has been at the vanguard.

There have also been groundbreaking developments in social care research involving and controlled by service users, despite barriers that continue to be faced. Also, new ideas like ‘independent living’ and ‘mad studies’, initiated by and involving service users on equal terms, are highlighting new directions for the future.

How do we create a person-centred social care workforce?

Helen Donnellan and Social Care Elf blogger Jo Moriarty critique the evidence on the social care workforce and explore some of the complex contemporary challenges for those providing and working in social care services.

They identify key tensions between a workforce whose job is to provide personalised care and support and yet is subject to the market and employment practices associated with a low-wage sector. The focus throughout the discussion is on the person at the receiving end of the care and support, with a major evidence-based practice improvement point being

As well as tackling problems like endemic low pay and widespread zero hours contracts, there is a need for development pathways to open up practice opportunities for experienced care workers. User views about what they want from care staff also suggest a strong need for values-based (rather than skills-based) recruitment processes.

Jo considers what the social care workforce and practice would look like if based on evidence concerning what people using services say they want and what is effective. She concludes that ‘this feels like the right time to give a different model of care and support a chance’. The headings from her contribution summarise very nicely how things could be

  • More tea, fewer tasks! (the Social Care Elf is particularly keen on this one)
  • Going out and going to bed
  • Personalisation should mean more than help with personal care
  • Markets and neighbourhoods.
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The Social Care Elf is pleased that there’s evidence for more tea and fewer tasks.

Summary

You may not hear this very often about a report on social care evidence, but this publication is actually quite exciting, and that’s not because several Social Care Elves contributed (declare bias). The authors draw on diverse evidence sources to create a different kind of knowledge base for social care – one that is inclusive, discursive and reflective – a bit like reimagined social care research and practice could be.

Links

Beresford P, Bolton J, Cooper A, Donnellan H, Miller R, Moriarty J, Pike L, Watts R and Walden D (ed) (2015) Evidence Review: Reimagining Social Care. Dartington: Research in Practice for Adults

Beresford P, Bolton J, Cooper A, Donnellan H, Miller R, Moriarty J, Pike L, Watts R and Walden D (ed) (2015) Executive Summary. Evidence Review: Reimagining Social Care. Dartington: Research in Practice for Adults [Full Text]

Read more from the report authors in the Reimagining Adult Social Care blog series.

Photo credits

Bill Selak via Compfight

Luciano Bello via Compfight

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Sarah Carr

Sarah Carr

Sarah is Associate Professor of Mental Health Research at Middlesex University. Sarah also runs an independent mental health and social care knowledge consultancy. She has a background as a senior research and policy analyst in mental health and social care, with a focus on service user participation, personalisation and equality issues, having formerly worked for the Social Care Institute for Excellence (SCIE). She is an Honorary Senior Lecturer at Institute for Applied Social Science at the University of Birmingham, an Honorary Visiting Fellow, Social Policy and Social Work at the University of York and a Fellow of the Royal Society of Arts. Co-chair of the National Survivor and User Network (NSUN) and a member of the editorial boards of the journals Disability and Society and Lancet Psychiatry, Sarah has a particular interest in social care and mental health issues and is a long term user of services.

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