Evaluating social care prevention in England: challenges and opportunities

Marczak J, Wistow G, Fernandez J

Journal of Long-term Care 2019, December, 206—217

Available online 4 Dec 2019

Abstract

Context
The Care Act 2014 placed a statutory duty on adult social care (ASC) to prevent and delay the development of needs for care and support. There is little clarity about how to translate this national obligation into effective local practice.

Objectives
This exploratory study sought to lay the foundations for understanding approaches to this new duty by identifying: emerging local understandings of prevention; associated implementation strate­gies; and the potential for designing evaluation frameworks.

Methods
Local perspectives were secured through: in-depth interviews in six English local authorities; reviews of local strategy, implementation documents and reviews of data sources; and methods for evaluating local initiatives in sampled authorities.

Findings
Our findings indicate important differences between and within local authorities in conceptuali­sations of prevention. Although willingness to commission services was strongly linked to the availability of evidence on what works in prevention, council conducted limited local evaluations. We also found limited collaboration between ASC and Health in developing joint prevention approaches, in part due to differ­ences in conceptualisation and also constraints arising from different priorities and information systems.

Limitations
The exploratory nature of the study and the small sample size limits the generalisability of its findings. Overall, the number of local authorities and respondents allowed us to explore a range of local views, opinions and practices related to the prevention agenda in a variety of contexts, however the findings are not generalisable to all English local authorities.

Implications
Our study suggests that the limited local evidence about prevention, combined with finan­cial austerity, may lead to disproportionate investment in a small number of interventions where existing evidence suggests cost-savings potential, which, in turn, may impact authorities’ ability to fulfil their statutory duties related to preventing and delaying the needs for care and support. In this connection, we highlight the potential for developing local evaluation strategies utilising existing but largely unexploited local administrative data collections.