As the NIHR announces new funding for social care research, our director Professor Martin Knapp explores how research can rise to the challenge of shaping social care services for the future.
Most readers will know someone who uses adult social care services. You may actually be that ‘someone’. Or you may be a carer. Many of the rest of you – if survey findings are accurate – will be seriously underestimating the likelihood that you will have social care needs yourself at some point.
Adult social care is the provision of personal and practical care and support that people may need due to ageing, illness, or disability, provided in a number of settings ranging from help in their own homes, to nursing homes, or in community settings such as day centres. Support is also provided to family and other carers. The likelihood that you might need these services is growing over time.
If only out of self-interest, therefore – although I hope that wouldn’t be the sole motivation – we will all want an adult social care system that is fit for purpose.
The system should be good at identifying social care needs in timely fashion, and responding to changes over time, and make sure it understands the preferences of individuals about how their needs are met and the personal strengths they bring to the care setting. It should recognise and support family and other unpaid carers. It should recognise people as individuals, engaging with them with respect and dignity. It should recruit, train and retain a skilled workforce. It should support that workforce with appropriate technology and other resources. It should recognise the enormous contributions that communities do and can make.
A high-performing social care system goes further. It ensures that every individual with social care needs – whatever their financial or family circumstances – has access to good quality support, and has a choice about what that support will be. A good social care system will also be funded fairly, and in a way that is sustainable over the long term.
And, importantly, it will be built on solid research evidence. That is why last week’s announcement by NIHR that it will fund a third phase of the School for Social Care Research (NIHR SSCR) is so welcome. Just under £20 million has been committed over 5 years to continue the work of the School. This includes £1.8 million specifically targeted on building research capacity.
Research helps. Note the careful choice of verb: not research ‘solves’ or ‘has all the answers’. Research is only one ingredient into decision-making. It offers evidence to be considered alongside other things. It helps decision-makers make difficult decisions.
Good research can address questions suggested by individual experience or prompted by wider contextual changes. Those latter might include population ageing, shifting societal priorities, cuts or boosts to public expenditure, technological innovation, breakthroughs in healthcare, changes in welfare benefit eligibility or housing policy, and even (whisper it quietly) possible workforce implications of Brexit.
So what does ‘good’ look like? Good research will include at least the following ingredients:
the views and opinions of people who use services and provide unpaid care, and also of service practitioners;
measures that show how progress is (or is not) being made in pursuit of personal and system-wide objectives; and
measures too of the resources required to achieve that progress.
Good research will likely draw on more than one academic discipline to find the best framework for interpreting data, whether qualitative or quantitative – ideally both.
It will endeavour to collect these data in a way that makes it possible to generalise from the findings to a wider context.
And it will, of course, be ethically sound and have the informed consent of participants.
NIHR School for Social Care Research
These are among the principles that have underpinned the work of the School since it was established. Since 2009, NIHR SSCR has funded 128 studies, published methods and scoping reviews, held a series of very successful annual conferences, and organised numerous other events.
In the new phase, there will be seven member universities: Birmingham, Bristol, Kent, Kings College London, Manchester, York, and the London School of Economics and Political Science, which will lead on coordination and management. I have the privilege of continuing as Director of the School.
What exactly gets researched by the School depends in part on our consultation: we listen to people who use services, carers, practitioners, managers, local authorities, organisations that provide services, third sector bodies and even other researchers!
Research themes might include:
Met and unmet needs; prevention
New approaches to care and social work practice, particularly user-led, carer-led and other innovations, including new technologies
Workforce development and retention, new ways of working
Issues for people who self-fund their care; supporting carers
Working with communities, such as through asset-based working, social prescribing, personalisation
Care market management, especially of quality
Diversity, inequality and marginalised communities, including how to tackle differences in access to care
Interfaces with other systems, especially housing, hospitals, primary care, employment.
None of this is set in stone. Indeed, the programme should evolve over time as new ideas and challenges emerge.
More than just NIHR SSCR
NIHR’s continuing commitment to SSCR is just part of a wider push to encourage and support research on adult social care. (NIHR does not fund research on child social care: this is the responsibility of the Department for Education.)
This is not a case of just adding the words ‘and social care’ every time an NIHR call or initiative mentions health research. The NIHR ‘push’ includes investing in research skills and researchers so that social care questions get suitably framed and answered. It is about making sure that commissioning panels and reviewers include people with expertise in social care. It is about working with local authorities and social care providers (the vast majority of which are in the private sector) to be ‘research-ready’ – indeed to be ‘research-hungry’. As the leading funder of social care research, NIHR has an enormous amount to contribute.
There are huge pressures on adult social care today. Needs and demands are rising, while public funding has been falling. There are growing numbers of self-funders, most of whom find it hard to understand the system. Many thousands of family and other unpaid carers face enormous challenges every day. Service providers often struggle to stay afloat.
The Government is expected to publish a Green Paper soon that will stimulate widespread debate about how social care should be funded, organised and accessed. NIHR-supported research can contribute enormously to this debate and to the future shaping of adult social care.
This blog first featured on the NIHR blog.