How can evidence-based improvements to adult social care be applied to frontline services

At the COMPASS Jobs Fair earlier this month, Jon Glasby, Professor of Health and Social Care at the University of Birmingham, outlined the work and plans of the university’s new IMPACT centre, which is looking at ways of implementing evidence of good practice in adult social care.

“Impact stands for IMProving Adult Care Together,” Glasby said “and that isn't just about services. It's about having a life.”

The Centre is looking at different ways of integrating England’s health and social care services, drawing on evidence from Northern Ireland, which has had integrated services since the early 1970s.

“The centre wants to adapt a very broad and inclusive notion of what constitutes research, and what constitutes evidence. For us, evidence includes different types of research studies. It includes the lived experience of people who draw on care and support and their carers, and the practice knowledge of social care staff.

“We see those ways of knowing the world – research, practice, knowledge, lived experience – as all important in their own right.”

The centre is also looking at ways of building capacity and skills in the workforce, and of facilitating more productive relationships between people in different parts of the system.

“Building capacity isn't just a technical aspect of our work, I think there's some quite deep-rooted cultural aspects to that mission as well. And then also, which seems really important, it is about facilitating relationships.

“Adult Social Care seems to me very, very fragmented – there are different stakeholders, who tend not to come together very often, there are very few shared spaces, actually, for people to actually come together to meet each other and to talk things through.

“We saw that during the pandemic that kind of historic fragmentation of the sector [made] it really hard for people to work out how best to respond at a national level.

“I'm really conscious as director of the IMPACT Centre that we've got 15 million pounds to try and improve implementation of evidence and adult social care over seven years. And that's just not normally the sum of money that gets spent on Adult Social Care. It feels like a kind of once in a generation opportunity.”

So far the work has included meeting stakeholders across the adult care sector, and running an online survey.

More than 2000 people took part in the survey, giving their views on what shapes social care, the role of evidence in defining services, how evidence could be more usefully applied, and what centres such as IMPACT could do to help change frontline services and make a difference to people’s lives. Nearly half of the replies were from people drawing on caring support, carers or frontline practitioners.

“First of all, we got really strong support for this notion of evidence from different types of research, [including] lived experience and practice knowledge.

“There are particular forms of research that get listened to more often – the more quantitative and economic forms of research. Qualitative research is seen as less influential, and the lived experience of practice knowledge, even less so.

“People were really clear that they don't think evidence makes much difference to what happens in practice at the moment, the main things that people felt made a difference were money, national politics, and local politics.

“Good practice from other local authorities or care providers, internationally, or from other sectors was scored quite low in terms of what influenced what happens,” he said.

The survey asked what would make a difference. “First of all, people would really value practical support on the ground to bring about changes. There's a real sense that the sector has been through so much trauma and sadness as a result of COVID. And it's facing such significant service pressures, financial pressures…and a number of colleagues in our assemblies felt that it was a casualty also of austerity.”

“In one sense, we've always struggled with practical support in social care but when funding got really pressured, we did everything that we could to maintain frontline services. Things that were sacrificed were research, training, and some of the kind of evidence-into-practice posts that we had in some local authorities or in some providers.

“That's what we've really missed over the last ten years, [ways to] deliver practical support on the ground.

“One of our service users described it as not just talking about a job but rolling up your sleeves and getting your hands dirty.

“People also wanted to have some funding to enable the participation of people such as carers and frontline care workers who often couldn't take part in these debates without support.

“And then people also wanted opportunities to come together to work with people from different parts of the system and different backgrounds on practical solutions.

“We asked people in the survey about the sort of topic areas that we should be prioritising and people were really focused on prevention and wellbeing, on the health and wellbeing of carers, and on supporting people who work in care services.

“Respondents also talked about the needs of people who don't currently qualify for services. So people that may have unmet needs, or self-funders or be on the edge of being eligible for social care.

“They also fed back that our establishment phase shouldn't just be about getting set up as a national centre. Our credibility would come from delivery.”