What matters is what works – but who decides?

In this blog, IMPACT’s Obert Tawodzera and Jon Glasby reflect on the results of a national survey of people involved in adult social care, and its implications for IMPACT’s work

IMPACT has been fortunate to receive up to £15m over nearly 7 years, to design and deliver a new UK centre for implementing evidence in adult social care.  To make sure that we use this funding to make as big a difference as possible, we asked people across adult social care and across the UK:

  • What they think influences what actually happens in adult social care
  • The extent to which evidence affects what happens
  • Whose voices should be heard when we try to make changes to services
  • What support people feel they need to make improvements on the ground
  • The ways in which IMPACT should prioritise its work and the topics it should focus on

Rather than produce a very ‘type-set’ and designed document, we have simply put the underlying findings out into the public domain in a PDF, so that everyone who contributed can see what we found, and in case it helps other people think through and work on these issues. 

Significant survey results

The main use of the survey has been to shape IMPACT’s overall design, its early work plan and the practical projects which it will be piloting in 2022 and into 2023.  In particular, five main things struck us as significant:

2021 has been a year like no other – and yet 2,165 people took the time to complete the survey in order to help shape our thinking.  We think this might be one of the largest surveys of its kind that there’s ever been – and we’re really pleased that nearly half of respondents were people who currently draw on care and support, carers or front-line practitioners.  It’s also crucial to IMPACT’s mission that responses broadly reflect the overall populations of the four nations of the UK, reflect the nature of the adult social care workforce in terms of gender and come from people from a range of diverse backgrounds and with different protected characteristics. 

Of course, this didn’t happen by accident – and we’ve worked incredibly hard with partners to make the survey as accessible to everyone as possible.  Even with all this, we’ll need to continue to strive to make sure that IMPACT engages across the sector, in all its diversity – and we’ll need to be particularly careful to make sure that we are inclusive to people from black and minority ethnic communities and from particular faith communities.  While we’re pleased that our respondents reflect the workforce in terms of gender, this also raises important questions about the nature of care, and how we get more men involved in care work.

People have told us that adult social care feels incredibly fragmented with a lack of shared spaces for people to come together to work on key issues – and we agree.  However, the responses to our survey are remarkably consistent (across the different nations of the UK, and across all the different groups of people taking part – from people drawing on care and support to Directors of Social Services, from front-line practitioners to commissioners, and from carers to service providers).  We might not always agree on exactly what should happen next, but we seem in significant accord as to how things currently are and the priorities for the future.  Going forwards, we hope that IMPACT can have a ‘convening role’ – helping to bring people together and join things up, and the survey suggests that there are lots of opportunities here.

Most people believe that social care is shaped primarily by factors such as funding, national politics and local policy – not by evidence of what works.  Key barriers to greater use of evidence include lack of funding, time and thinking space; a lack of priority given to social care in wider society; and a lack of shared vision.  Going forwards, people don’t necessarily want more evidence or training to better understand the evidence that there is.  Instead, they want to see funding to involve people who draw on care and support, carers and practitioners; practical support to make changes to social care on the ground; and opportunities for people to work on practical changes together.  These are all built into the delivery models that IMPACT will be testing during 2022, and central to our thinking.

Most people believe that ‘evidence’ should include people’s lived experiences of drawing on care and support/carers and the practice knowledge of social care staff, alongside different types of research.  Our broader engagement suggests that these might helpfully be seen as three different ways of knowing the world that IMPACT should bring together to triangulate, supporting people from different backgrounds to work meaningfully together on common challenges and, hopefully, on common solutions.  This might sound like a bit of a dull philosophical debate, but it’s actually crucial.  Deep down, it’s really a question about which voices get heard when we try to make improvements to adult social care, and who decides.  Our respondents are clear that research, lived experience and practice knowledge all really matter, and are important sources of expertise and learning in their own right.

There was widespread support for the principles which IMPACT has set out to help design its overall work programme (making a real difference to people, tackling inequalities, making good use of scarce resources, and having enough evidence to work with).  We have used these to shape our 2022 work programme, and will embed them across all our work as we develop our plans for 2023-2027.  Key topics for IMPACT to focus on included assets-based and person-centred approaches; prevention and well-being; support for carers; and supporting people who work in adult social care – and these are all built into our plans.

Next steps

Over the coming months, we’ll be doing more to understand and share what people have been telling us in our survey, testing out how to implement these ideas and beliefs in practice.  However, everyone we’ve talked to has been very clear: IMPACT needs to value and integrate different types of research, lived experience and practice knowledge; it needs to provide practical support to make changes on the ground, in the realities of local services and people’s lives; it needs to support the participation of people who draw on care and support, carers and front-line workers; and it needs to bring people from different backgrounds and different parts of the system together to co-create change.

Obert Tawodzera and Jon Glasby

February 2022

Acknowledgements: This project is funded by the Economic and Social Research Council (ESRC) through UKRI’s Strategic Priorities Fund (SPF) and the Health Foundation.