Evidence in Social Welfare Policy & Practice

Evidence in social care: filling in the gaps

Jo Moriarty

7 December 2012

Outline

Discussing need for good evidence in social care

Some of the challenges in disseminating evidence in the social care sector

Need to think beyond academic users to general public – especially people using services and carers

Mainly focusing on support for adults7 December 2012

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Why we need evidence

1. Cost2. Numbers of people using

social care3. Size of the workforce

Expenditure on social welfare

£17 billion spent on adult social care in 2010-11 (NHS-IC, 2012)

Excludes amounts spent by people paying for their own care

Excludes expenditure on social security and housing supporting people with social care needs

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Almost 2 million service users

1.46 million adults in England whose care wholly or partly funded by their local council in 2011-12 (NHS-IC, 2012)

Harder to estimate self funders› Around 440,000 self

funders (Institute of Public Care, 2011)

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Image from Swansea council website

‘What about the workers?’

At least 2 million people work in social care in the UK (Moriarty, 2010)

29.56 economically active people in UK (ONS Labour Market Statistics, 2012)

› 7 per cent of labour force (Hussein, 2012)

NHS headcount 1,182,933 in August 2012 (NHS-IC, 2012)

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Workforce composition 1,603,000 people

work in adult social care in England (Eborall et al., 2010)

Divided between larger direct care workforce and smaller numbers of professional and managerial posts

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Where are we now?

1. Progress in terms of the evidence base

2. Why do we need to improve access to social care evidence

Better than in the past!

Jacobs et al asked to ‘describe the state of social care services for older people at the turn of the 21st century’ (2009)

› Retrieved 7000 references› 234 articles in peer reviewed

journals› Most were descriptive› Methodological quality varied › Few RCTs/quasi experimental

studies7 December 2012

Concluded….

‘The review has also identified weaknesses in the evidence base, both in terms of gaps and in respect of the quality of published studies; in these areas, policy and practice appears to have advanced without research evidence’ (p526)

‘Without an adequate evidence base, however, policy makers and commissioners will struggle to ensure that service improvements can be made with finite resources’ (p527)

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Role of the NIHR SSCR

National Institute for Health Research School for Social Care Research (NIHR SSCR) launched in 2009

Aims to improve the evidence base for adult social care practice in England

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http://www2.lse.ac.uk/LSEHealthAndSocialCare/aboutUs/NIHRSSCR/home.aspx

www.sscr.nihr.ac.uk

Challenges in disseminating research evidence….(1)

DIVERSITY of sector Only 12 per cent of people working in adult

social care work for a local council Overwhelming majority in private sector

› Ranges from large private equity companies to small ‘mom and pop’ care homes

› 40,626 establishments (Eborall et al, 2010)

About 25 per cent in voluntary sector (Eborall et al, 2010)

Policy of personalisation has led to increasing numbers of self employed people – no precise numbers

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Some challenges….(2)

Training is longstanding issue Professional qualifying training

› Social workers› Occupational therapists› Nurses working in care homes

BUT access to continuing professional development is variable

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Enrolments on social work post qualifying awards 2006-2011

0

2000

4000

6000

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CPD and social workers

Amounts to just under 12k enrolments

Represents about 14 per cent of those working in statutory social work with children and adults (Moriarty, 2012)

Although need to take account of those holding predecessor awards and undertaking other types of CPD, most CPD is probably self directed

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Limited access to research evidence

NHS offers opportunity for staff to register for Athens password› Only comparatively small number of social

workers in NHS benefit from this Much larger numbers working for

local authorities› Cuts in local authority training budgets› Cuts in local authority research staff

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The direct care workforce

Less than a third of the workforce have a NVQ 3 qualification or equivalent (Hussein & Manthorpe, 2012)

› Lower levels of training in dementia care workforce, although supporting people with very complex needs

› New framework is QCF

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Training for the direct care workforce

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‘There is induction training when you first start, which covers medication and how to fill I the sheets what you can and can’t give. Moving and handling. Using hoists and slide sheets and everything. Obviously personal care. Food hygiene. Just across the board really with a bit of everything…It lasts for a week, four days, sorry. Once you’ve done the indoor training, if you like, you then go out for four shadow shifts with another carer [care worker]…. If you need any more help or you don’t feel that you are ready to go out on your own, one of the supervisors would perhaps come out with you until you are comfortable that you can do it on your own’. (LoCS interviewee)

Service users and carers

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Picture accompanying Daily Telegraph article by Max Pemberton in June 2009

‘I sometimes think people don’t recognise that they are carers themselves, even though they maybe kind of know they are, but they are so busy just doing that role that they don’t always see themselves as that person’ (WORKER 2)

Difficulties accessing information

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‘Again, it’s finding a starting point and access to information. It is very limited. There is probably a lot of information out there, but you’ve got to know where to go and look for it’ (CARER12)

’There is no information. It’s like treading through treacle (CARER1)

Carers are looking for evidence

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‘I go through all sorts of information. I will go onto a government site and then find out the information and then go and try and pare it down…. And then when I get fed up and then I will go onto the Carer Centre to see if they’ve picked up on it. You often see White Paper predictions and that and you think…How is it going to come down to us?... Is it going to work for carers?’ (CARER1)

Need range of information

‘Well, we had someone whose husband had had a stroke. And again they are mid 50s and they were happily living their lives and been working and everything and then suddenly had this stroke. Their whole lives were turned upside down and because of the stroke as well he had some brain damage. And so now this gentleman unfortunately is in residential care and the lady has to start and rebuild her own life now and start thinking how she is going to manage on her own (WORKER6)

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‘At the click of a mouse’

BCD Associates (2011) showed how hard it was for older people to find out about care homes from council websites

Looked at information for carers – especially carers’ registers - similarly variable

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Issues

Evidence is there but differential access› Between different types of worker› Between different people using services

and carers Carers from black and minority ethnic groups

seem to have greater problems accessing information (e.g. Adamson, 2001)

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‘Digital divide’

16-24 25-34 35-44 45-54 55-64 65-74 75+0

20

40

60

80

100

Ever used internet

Source: ONS, Statistical bulletin: Internet Access Quarterly Update, 2012 Q1

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Quality

1. Need to link evidence with improvements in service quality

Report from regulator

‘Overall CQC is finding that the increasing complexity of conditions and greater co-morbidities experienced by people are impacting on the ability of care providers to deliver person-centred care that meets individuals’ needs. It is also seeing increasing pressures on staff, both in terms of the skills required to care for people with more complex conditions and in terms of staff numbers’

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Conclusions

Evidence base for social care is increasing

Covers topics that are important and relevant to people’s lives

Particular need for resources such as British Library Social Welfare Portal and Social Care Institute for Excellence for groups unable to access other resources

Need strategy that will help reach these groups

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Disclaimer

The preparation of some of the material in this presentation was made possible by a grant from the National Institute for Health Research (NIHR) School for Social Care Research on social care practice with carers. 

We acknowledge the contribution of the Policy Research Programme at the Department of Health for its support for the Unit

The views expressed in this presentation are those of the author and not necessarily those of the NIHR School for Social Care Research or the Department of Health

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