Discusses 'state of play, in terms of evidence in social care - where we have information, where there are gaps. Presentation from conference held at the British Library in December 2012 looking at evidence in social care.

1. 7 December 2012
Evidence in Social Welfare Policy & Practice

2.  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 adults
7 December 2012 2Evidence in Social Welfare Policy & Practice

3. 7 December 2012Evidence in Social Welfare Policy & Practice
3
1. Cost
2. Numbers of people using
social care
3. Size of the workforce

4.  £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
7 December 2012Evidence in Social Welfare Policy & Practice 4

5.  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)
7 December 2012Evidence in Social Welfare Policy & Practice 5
Image from Swansea council website

6.  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)
7 December 2012Evidence in Social Welfare Policy & Practice 6

7.  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
7 December 2012Evidence in Social Welfare Policy & Practice 7

8. 7 December 2012Evidence in Social Welfare Policy & Practice
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1. Progress in terms of the
evidence base
2. Why do we need to
improve access to social
care evidence

9.  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
studies
7 December 2012Evidence in Social Welfare Policy & Practice 9

10.  ‘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)
7 December 2012Evidence in Social Welfare Policy & Practice 10

11.  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
7 December 2012Evidence in Social Welfare Policy & Practice 11
http://www2.lse.ac.uk/LSEHealthA
ndSocialCare/aboutUs/NIHRSSCR/
home.aspx
www.sscr.nihr.ac.uk

12.  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
7 December 2012Evidence in Social Welfare Policy & Practice 12

13.  Training is longstanding issue
 Professional qualifying training
› Social workers
› Occupational therapists
› Nurses working in care homes
 BUT access to continuing professional
development is variable
7 December 2012Evidence in Social Welfare Policy & Practice 13

14. 0
1000
2000
3000
4000
5000
6000
7000
Combined
pathway
Leadership
and
management
Mental health Practice
education
Social work
with adults
Children,
young
people, their
families and
carers
7 December 2012Evidence in Social Welfare Policy & Practice 14

15.  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
7 December 2012Evidence in Social Welfare Policy & Practice 15

16.  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
7 December 2012Evidence in Social Welfare Policy & Practice 16

17.  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
7 December 2012Evidence in Social Welfare Policy & Practice 17

18. 7 December 2012Evidence in Social Welfare Policy & Practice 18
‘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)

19. 7 December 2012Evidence in Social Welfare Policy & Practice 19
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)

20. 7 December 2012Evidence in Social Welfare Policy & Practice 20
‘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)

21. 7 December 2012Evidence in Social Welfare Policy & Practice 21
‘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)

22.  ‘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)
7 December 2012Evidence in Social Welfare Policy & Practice 22

23.  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
7 December 2012Evidence in Social Welfare Policy & Practice 23

24.  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)
7 December 2012Evidence in Social Welfare Policy & Practice 24

25. 0
20
40
60
80
100
16-24 25-34 35-44 45-54 55-64 65-74 75+
Ever used internet
Source: ONS, Statistical bulletin: Internet Access Quarterly Update, 2012 Q1
7 December 2012 25Evidence in Social Welfare Policy & Practice

26. 7 December 2012Evidence in Social Welfare Policy & Practice
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1. Need to link evidence with
improvements in service
quality

27.  ‘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’
7 December 2012Evidence in Social Welfare Policy & Practice 27

28.  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
7 December 2012Evidence in Social Welfare Policy & Practice 28

29.  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
7 December 2012Evidence in Social Welfare Policy & Practice 29