Social care research and impact: too long a hidden relation of health
14th March 2022
Authors: Julie Bayley, Lincoln Impact Literacy Institute, University of Lincoln, Lincoln, UK, and Mo Ray, School of Health and Social Care, University of Lincoln, Lincoln, UK.
The COVID pandemic has, amongst many other things, shone a light on the challenges of social care. Much like its health counterpart, social care has had monumental upheaval, navigating continued flexing of rules and ongoing staff shortages, whilst desperately trying to keep everyone safe.
For health, astronomically expedited timescales to create and administer vaccines have been rightly heralded as not only a route out of the pandemic, but a testament to researchers whose specialisms give humanity a way forward. Regular 8pm applause through the first lockdown reminded the NHS of how appreciated they were, and rainbows in the windows of houses expressed colourful gratitude to the bravery and dedication of our healthcare workforce.
Yet without diminishing the worthiness of these endeavours, they also illuminated the contrast in attitudes to social care. Whilst pans were drummed and bells rung for the healthcare, social care was rarely mentioned in the news except for stories focusing on the tragically high infection and death rates of care home residents and of families being kept away from relatives isolated in care homes. Whilst both health and social care shared the challenges of staff sickness, bereft families and ongoing difficulties sourcing PPE, social care was rarely the topic of applause or children’s pictures. Moreover, social care provided outside of formal settings, particularly via family members, was absent from many dialogues, with individuals turning to forums in attempts to understand how they could maintain their loved ones’ care without breaching rules or unsteadying their loved ones’ routines.
COVID has illuminated some of these key differences between the health and social care sectors, and by extension the challenges we have driving social care research. Fundamentally, social care and health, are inextricably linked. Health services will always struggle to achieve, for example, effective and timely discharges from hospital without an appropriately resourced and funded care service. The complexity of social care remains poorly understood and under-researched in an environment which has traditionally been dominated by health models.
A core challenge for social care is that the environment in which research is cascaded and used is far less cohesive than in health. Notwithstanding the challenges of communicating research within a busy health system, the health sector does at least have centralised structures (e.g. Clinical Commissioning Groups) by which to integrate research, and evidence-based practice weaved into clinical training and practice. Patient groups are routinely gathered for research projects, with Public and Patient Involvement an increasingly central expectation for applications to pass reviewers’ thresholds to recommend award.[i] Models of research impact – exploring how research translates from exploration to widespread use – often reflect scriptable journeys through Randomised Control Trials and into NICE Guidance, highly intensive processes in which the scale of data essentially necessitates change to practice. Research and evidence-based practice are requirements in both professional and service development, and the sector is essentially wired up to be expectant of, and duty-bound to act upon, changes in light of research evidence.
In contrast, the social care sector is far more dispersed and absent of the routine networks and structures so commonplace in the NHS. Social care ranges from high cost, privately funded specialist residential care for dementia, community-based services provided by voluntary and faith-based organisations, through to invisible care provided by family members. Care may be formally logged (e.g. via a formal care plan) or may be undertaken without any involvement from statutory social care/social work services. There are far fewer obligations to drive research-led change, meaning that whilst there is not an absence of social care research, priority is naturally focused towards more urgent issues rather than the ‘bonuses’ brought to bear by research. The combined effect is a sector bound conceptually together with healthcare yet sharing little of the infrastructure or strategic mandates to meaningfully drive research into use.
The pandemic has perhaps illuminated divisions that many within the sector already knew. Ongoing ramifications about effective PPE and managing infection control will run on in both health and social care for some time. Yet perhaps this is also an opportunity to draw from these contrasts to recognise the different challenges faced within social care, and in so doing reminding all in the research ecosystem that contemporary social care poses a range of important questions which are distinct from health and which are contextualised by a complex shape and structure.
Social care research needs social care to be lifted from the shadows. We need to find better, more effective and more suitable ways to connect research with potential users, reprogramming our default thinking about how research finds its way to use. We need to recognise the challenges faced by a lack of operational capacity to use research, confounded by poor access and little strategic persuasion to normalise research within social care. We need to explode the assumption that social care equates to residential care and accurately reflect the scale of care taking place at home and the vital role of non-funded, family member provision. Only if we reset our thinking on the complementarity but difference between health and social care can we truly build research into practice.
[i] INVOLVE (2015,) Public involvement in research: values and principles framework. INVOLVE: Eastleigh. Available at https://www.invo.org.uk/wp-content/uploads/2017/08/Values-Principles-framework-Jan2016.pdf