Today (May 26th 2021) I attended a Zoom-based seminar on Social Care research run by the Research Design Service (South Central) of the National Institute for Health Research (NIHR). It was excellent. I will discuss it here. Anyone who wishes to see the slides can download then from this webpage here. The talks will also be available on YouTube in mid-June. The Research Design YouTube site is here. There are already many recorded meetings on the site, and if they are all as good as today’s, then they are well worth looking at. The main message for me was that social care and rehabilitation are almost indistinguishable, and face similar problems in research. Indeed the only research difference was that social care research is now where rehabilitation research was when I started in 1980. I hope that they can take advantage of our experience.
Social care is rehabilitation.
The speakers in this seminar all made the same points: social care is complex because of the fragmentation of budgets and organisations; there is a severe lack of resources and a great need for research; political indecision and unwillingness to act blights service delivery and development; and so. Change ‘social care’ to rehabilitation and every ‘sentence’ spoken would still have been true. I felt at home! (And, of course, I was at home; it was a virtual meeting on Zoom, one that was flawless in its organisation and use of technology.)
The first speaker, Luke Geoghegan from the British Association of Social Workers, drew attention to a problem I knew about but had under-rated. He pointed out that much (social work) research did not given any information about the context in which the research was carried out. Further, he pointed out that much (social work) research had within it multiple assumptions about the reader’s values, approach to clients, and understanding.
This is a pertinent, important point. I recognise it, sometimes, in papers submitted to Clinical Rehabilitation. One, trivial example concerns research from the UK. Authors refer to research being ‘carried out in a Trust’. Many readers in the UK might well be puzzled. Certainly no-one outside the UK would know what ‘a Trust’ means, and would not understand that a ‘Trust’ is actually a hospital.
His plea was to make all assumptions explicit. I agree, except that there is a practical problem. There are so many contextual factors that might influence research, and many others about the clinical context, that one could not cover them all. One he considered in his talk was the culture and values embedded within the services being researched. The culture and values probably also apply to the researchers, if they come from the service. Others contextual matters include the funding arrangements, where there are big differences between the United States and Europe, and a whole host of cultural assumptions held by the patients (clients) receiving services, which are personal, and cannot be described.
The second speaker was Andrew Dilnot, author of the Dilnot review of funding for social care. He primarily considered the elderly, pointing out that many more people now lived with several long-term conditions. However he raised a significant doubt, indirectly and possibly missed by some of the audience: the apparent increase in the number of patients with multiple long-term conditions may arise from changes in clinical data coding, and better data. For example, I have a ruptured tendon in one hand, and osteo-arthritis of the hip. Do I have two long-term conditions? I would not think so, but my medical record might.
A second point raised was that most of the cost of social care arose from a minority of people. In this context, I learned some fascinating facts. Winston Churchill was friends with William Beveridge (of the Beveridge report), and in 1943 Churchill committed the government to provide health and social care to all, saying that “the magic of averages come to the rescue of the masses“. He is referring to social insurance; taxation of all will mean that no-one has to worry, though most people will not need it. The magic happened for health, but it still has not occurred for Social Care. And the Tory party seems to have forgotten its pledge from 1943 and more recently in 2019.
His third point was that there is no ‘market’ for social care, and there is no explicit goal or outcome set – or measured – so that we can judge the success of social care.
The third speaker was Martin Knapp, whose slides were an excellent exposition of the complexity of service organisation and delivery. He stated that social care was distinguished from health care because ii focused on well-being, not health. Just as rehabilitation does. His slides, which are a beautiful presentation of the fragmented world faced by patients or social work clients, run through challenges that will resonate with all rehabilitation staff – and all people trying to find help for themselves or family members.
He also introduced me to a new journal (to me), the Journal of Long-Term Care. (here) It is an Open Access journal.
Third, he drew attention to the research resources of the National Institute for Health Research NIHR School for Social Care Research (SSCR) which is found here. They have a library of past webinars which would be an excellent start for any rehabilitation researcher – here.
The last talk was by Laura Mason, who went through research funding opportunities, especially for Social Care research. There is money. Last year around £850,000 was not allocated as there were insufficient applications of good quality. Read her slides, and you will also find more help in applying for research funds.
Well before I knew of this seminar, I have accidentally been writing about matters that would easily fall into Social Care, though I wrote them for a rehabilitation readership. I have stressed in several posts that rehabilitation necessarily is concerned with a person’s social functioning, suggesting that reducing loneliness might be a key outcome. (here) I have also highlighted the overlap of agencies concerned with important rehabilitation outcomes, suggesting rehabilitation is a ‘social service’. (here) Much of the social care budget goes to nursing homes, and I have also highlighted an NHS document on nursing homes and how it offers an opportunity to improve patient care and rehabilitation services. (here) I have also stressed the fragmented nature of services (here) but my diagrams obviously only show a part, now I have seen those of Martin Knapp.