Relationships and meetings of the mind

IMPACT and The Health Foundation logos

Earlier this year, IMPACT’s Co-production Advisory Group had the pleasure of meeting and engaging with The Health Foundation Inclusion Panel. This created an opportunity for IMPACT to focus on building relationships between organisations. Early in the process we agreed this would be a two-way engagement and we would focus on the theme of co-production. The detail of what that would look like took a little longer to decide.

Co-producing an event

We agreed to co-produce the preparation and delivery of our co-production themed event, involving two members of each group plus the coordinator of each group. Narrowing down such a big topic is challenging – it can be time consuming and a little messy, but this is time well spent. As co-production means different things to different people, it involves accommodation and relationship building, seeing things from alternative perspectives and not being prescriptive. Not being prescriptive means that it can take time to tease out the theme and agree on questions to address and perhaps working in a way that’s different from what we are used to.

Happy to say I’m quite reassured it’s come a long way. I didn’t think you would get there, well done guys!  Testament to real coproduction in action.

Isaac Samuels, member of the Co-production Advisory Group

Building relationships for a successful approach

Cohesiveness, trust, and building relationships takes time for groups. This applies internally to groups and in external engagement. This is an ongoing challenge when time to co-produce, plan and deliver is limited or restricted by the reality of projects and work programmes.

A takeaway for me was the importance of building relationships to ensure effective co-production.

Ann Marie Penman, member of the Co-production Advisory Group

As a fledgling group meeting, engaging, sharing and learning with an established group was insightful. We are at different points in our journeys – we are starting out on our journey and the Health Foundation Inclusion Panel is working out its path for a sustainable and productive future. The experience of meeting a more established group reinforced the point that relationships, group trust and dynamic takes time to build. The sense of family and community from the well-established Health Foundation Inclusion Panel was palpable. This was inspiring and settled us as a group that we are right to spend time on building relationships and trust within our group.

In the practical sense, the process of co-producing the joint event has prompted us to try this approach in our preparation and meeting delivery. Until this point, we were somewhat self-critical of our own approach – a ‘knowing’ that we weren’t quite there but not quite sure how to get where we want to be.

Reflections

I am very proud of our work as the Co-production Advisory Group in 2022, particularly our ability and willingness as a group to be flexible, listen to each other, to feedback and most importantly to act upon it. Building relationships involves building trust and confidence. This takes time. A key takeaway from this meeting is co-producing the preparation, delivery and follow up. We are implementing this approach in our workplan for 2023.

Karen McCormick, Lived Experience Engagement Lead 

My own reflections were about how important it is to consider the whole process in effective co-production. That is, thinking about before, during and after i.e. how do we make sure we give the opportunity of involvement to everyone, how do we bring people together in a suitable space (physical and otherwise) and how are people kept involved and updated afterwards? A lot of our discussions focused on the being together part, but I think it’s important not to lose site of the ‘before’ and ‘after’.

Ann Marie Penman, member of the Co-production Advisory Group 

Relationship building extends beyond the relationship between two groups. Bringing in another group can somewhat shift the dynamic within our own groups. Sharing lived experiences and a passion for co-production with another group was empowering for members of IMPACT’s Co-production Advisory Group, a sense of shared purpose, a healthy respect and acknowledgement of the perspective of others.

Working with the NIHR Delivery Research Programme

A paper setting out a framework for collaboration between NIHR Health and Social Care Delivery Research (HSDR) and IMPACT was discussed at the HSDR Programme Oversight Committee in April 2022. The principles for closer working to promote and enhance social care research were welcomed by the HSDR Programme Director and committee. The Committee endorsed the approach, setting out how this informal collaboration might work and key touchpoints where there would be mutual benefit in close working to maximise HSDR outputs and reach wider social care audiences. This was seen as an exciting opportunity for the Programme.

It was agreed that information on current studies in the pipeline could be shared regularly with Jon Glasby and staff at IMPACT, perhaps on a quarterly basis. It was suggested that pilot work would be done with early engagement with teams and projects on linked studies on family group conferencing and support for people with learning disabilities/autism leaving long-stay hospitals which are likely to be of great interest to social care practitioners and service users. 

Jon Glasby is also linked into other parts of NIHR, including the School for Social Care Research, Research for Social Care programme and the NIHR Centre for Engagement and Dissemination. Developing ways of working with HSDR programme may be a useful pilot arrangement which could be the model for other parts of NIHR.

This paper was then discussed at the IMPACT Leadership Team meeting in June 2022.  With a few minor changes in wording or emphasis, IMPACT would be keen to pursue all the opportunities below as a way of supporting NIHR as it extends its social care expertise and presence, and as a way of supporting a number of IMPACT’s key objectives.

Frameworks for working with NIHR

Background

IMPACT is the UK centre funded by the ESRC and Health Foundation to implement evidence in adult social care.  Following a scoping phase with surveys and Assemblies to identify pressing topics and ways of working, the new centre will enter a steady state for five years from 2023-27. After this, the aspiration is that the centre, or key elements of its work, becomes a more permanent feature of the social care landscape (future business model tbc).

NIHR Health and Social Care Delivery Research (HSDR) Programme is a national funding programme awarding more than £20m a year for research on the quality and organisation of services in health and social care. Projects relevant to social care range from evidence synthesis on strengths-based approaches to social work to ambitious evaluations of family group conferences for vulnerable adults. 

Suggested areas for joint working and synergy

  • Anticipating research pipeline and maximising funded outputs

HSDR has a number of projects underway in the area of adult social care. This includes £7m+ investment in local adult social care research partnerships around the country, projects on self-neglect, care workforce and support for older carers. In the first instance, this could be a pilot for one or two research teams and projects to work with IMPACT, with IMPACT delivery staff working to implement findings from these studies. This would need to depend on their being an appropriate ‘fit’ between forthcoming research and IMPACT’s priorities for 2023-25 (to be submitted to IMPACT’s funders in September 2022). NIHR studies would also need to be working with a similar definition of evidence (which IMPACT defines in terms of insights from different types of research, the lived experience of people drawing on care and support and carers, and the practice knowledge of social care staff).

  • Identifying gaps/research needs

IMPACT’s broad and deep engagement will help to identify priority areas for future research. This is already evident from outputs from the survey/Assemblies which highlighted the importance of research in areas like prevention and wellbeing, asset-based approaches, carers’ health and wellbeing, and support for people who work in social care. Having chosen a series of key topics for its forthcoming work programme, IMPACT also goes through a ‘triage’ process to make sure that there is enough evidence with which to work, and checking for gaps – in either research, lived experience or practice knowledge. HSDR could work with IMPACT and constituent partners to work up briefs in priority areas, identifying important areas of research interest and important gaps in knowledge and framing calls in ways that will resonate with social care researchers and communities. 

  • Building capacity and sharing expertise

Consider opportunities to develop and strengthen capacity and community in adult social care research. Some approaches for embedded research and capacity building are being tested in the new HSDR adult social care partnership research awards, as well as particular opportunities through NIHR Academy Incubator for Social Care. There may be other opportunities – for instance, shadowing or sharing resources around review and research methods through the rapid evaluation and synthesis centres. This is a key priority for IMPACT as one of its four objectives is around building capacity in the workforce, and there may be scope to explore for IMPACT to support the local stakeholders with whom it is working on the ground to encourage stronger applications for existing NIHR capacity building schemes and helping to create a pipeline of credible candidates for these opportunities.

HSDR would also benefit from the expertise and networks of IMPACT to strengthen funding committee and reviewer base to make the right decisions with the right expertise for new projects.

Next steps

  • IMPACT and HSDR Programme staff to meet to take forward above areas for development – with quarterly meetings suggested going forwards
  • There is a particular opportunity to build in 1-2 topics from current NIHR projects into the draft work programme which IMPACT submits to funders in September 2022
  • IMPACT and HSDR to explore scope to publish a statement about this relationship/ways of working

Black History, Forgiveness and Adult Social Care

Our Digital Communications Officer, Munpreet, does a few things in her spare time, from volunteering at her Gurudwara, to working on both educational books and community-led building sites. Recently, as part of her volunteer work, she travelled to Ghana as part of a delegation launching the Peace Charter for Forgiveness and Reconciliation in Africa. The group she travelled with also visited Cape Coast Castle, near Accra, Ghana. This castle historically held thousands of African men, women, and children in captivity before sending them across the ocean to become slaves in the western world. 

As October is Black History Month, Munpreet has shared some of the things she learnt from this visit and how it relates to our approach within the adult social care sector. 

What has this visit taught me about forgiveness and care?

When I visited the castle, I didn’t know what to expect. The guide walked us through the dungeons and cellars in which our group of 40 felt confined, uncomfortable and at times scared; only to learn that previously these same walls had been home to over 200 individuals at any one time. 

As we were a delegation for peace, we asked the guide how the Ghanaian people have addressed forgiveness for the atrocities that occurred. He responded, “If we do not forgive, we will still be stuck within our own pain and suffering. Forgiveness is the only way we can heal.” He also shared that the local Chiefs of the time had been responsible for some of the harm that was done, as they had willingly handed over their prisoners of war without questioning the circumstances they were going into. As an acknowledgement of this complicit behaviour within the local history, our guide pointed out a plaque which the current Chiefs had placed on the castle walls, pledging to never let such injustices occur again. 

How does this apply to the UK today? 

During the Coronavirus pandemic, I volunteered at a vaccination centre. I saw many individuals from the African community arrive to be vaccinated, most of whom shared that within their communities there was a fear that the vaccine was designed to harm them. 

At the time I couldn’t understand this feeling of persecution and mistrust. However, having visited the castle it is now as clear as day. I understand that there are deep-rooted traumas that have been passed down within these communities that may not be overtly apparent to us. Yet, it is this history that can influence the way in which these same communities engage with larger health and social care services. 

It, therefore, becomes the responsibility of those delivering care to ensure they listen attentively, build trust, and create safety and security for those they are supporting. 

How can we use this knowledge within IMPACT? 

IMPACT is currently conducting a facilitator project on Direct Payments within the BME community. The project came as a result of IMPACT assembly discussions and is based on the recognition that those from BME communities do not access the support that is offered to them. I discussed my trip with the project Facilitator, Marie, to understand how this learning could be applied to the project going forward. 

The take-away points from the conversation were: 

  • We need to take time to understand the personal/familial or community history that might be influencing someone’s behaviour 
  • We need to make an active effort to build trust with all communities so that they feel valued, heard, and supported. 

Within IMPACT we understand that there are many issues that cannot be solved overnight. However, discussions and sharing of knowledge such as this gives us the opportunity to broaden our horizons and become aware of perspectives we may not have previously considered. 

Thinking about 2023

In 2022, we’ve been getting up and running as a national centre and testing our four delivery models via a series of pilot projects across different parts of the UK.  In 2023, we want to work in even more places and cover a broader range of topics.  We’re still working on the detail of this, but we hope to be able to go out to the sector in late 2022 with an ‘expression of interest’ – looking for partner organisations who might be interested in hosting future projects. 

Topics for 2023

The topics for 2023 would be based on the priorities which came out of our national survey and from our Assemblies.  In particular, we’ll focus on topics which:

  1. Make a real difference
  2. Tackle inequalities
  3. Make good use of scarce resources
  4. Have enough evidence for us to work with (where there isn’t enough evidence we’re trying to make sure that we feed this back to partner organisations so that they can try to fill these gaps as quickly as possible)

This is likely to include topics such as:

  • Prevention and well-being
  • Assets-based and person-centred care
  • Carers’ health and well-being
  • Support for people who work in social care

Identifying Partner Organisations

When we identify sites that might want to work with us, we want to get a real mix (e.g. in terms of geography, and the nature and needs of the local population).  We also want to make sure that we don’t just work with organisations that usually volunteer for these opportunities – but with a wide range of people.  This might include small, innovative community organisations; user- and carer-led organisations; and services that are really struggling and wouldn’t usually be able to think about taking part in something like this.

To help people plan, we’ll be clear about the funding and support we can provide, but also about the things we’ll need in return (for example, we’ll want sites that are committed to co-production and to sharing learning with others). 

Expressing interest

There will be more information later in the year – but please start thinking about whether your organisation might be interested in expressing an interest. You can sign up to our newsletter and follow us on social media (Twitter, LinkedIn) to be among the first to find out more.

A Co-production Charter

The beginning of the journey of the Co-Production Advisory Group

A key element of IMPACT, the UK evidence centre for adult social care, is the commitment to co-production in all aspects of its work. The first step towards this commitment involved the Co-Production Advisory Group, and their group Charter.

The Co-Production Advisory Group’s role is to develop, support, monitor and review IMPACT’s co-production activity, producing an annual report for the Leadership Team on progress made during the year, areas of good practice and areas for further development. This work is supported by the Lived Experience Engagement Lead, Karen McCormick.

“Quite often when new groups come together for the very first time, it can be a challenge to gel. We are all a little bit nervous and perhaps unsure of each other’s circumstances. However, this was not the case with IMPACT’s new Co-Production Advisory Group. They are an animated, confident and lively bunch – this bodes well for us as a group.” Karen explained.

Creating a Charter

A charter is a nice way to document how we intend to collaborate together and our guiding principles.  It’s a way of acknowledging the work we have to do, such as project objectives and the parameters we have to work within, but also allowing space for members of the group to have their say on how we approach it and work together.  

“My approach to starting a charter is to include the knowns, leaving space for the unknowns and being open to the aspirations.” Karen tells us.

“The knowns are the practical things such as structures, definitions, the fact that we need to have 3 meetings this year and produce and annual report. The unknowns are things like the topics we are going to discuss and the schedule for this. Unknowns are also things like the shared vision for the work of the group, the strengths and assets of the group and the language we use and barriers to participation.  Suggestions around practical tips for working together online, communicating and engaging are also included in the early version.

“These were collated into a draft charter (a working document) and presented as suggestions to get us started at the induction meeting – the first coming together of the co-production advisory group – all subject to change through engagement and agreement among members of the group. Ideally with more time, we would come with a blank page but we have a lot of work to do in a short space of time.”

A Living Document

It is intended that the charter will be a living document. Just like charting any course, it will need revision – the group will have waypoints, needing to check where they are and if they are heading in the intended direction. It is hoped that by the end of the first working year together all members of the co-production advisory group respect the journey, and recognise each other and themselves as valued members of the crew.

IMPACT on the Care Matters Podcast

We are pleased to bring you a two-part episode of the Care Matters Podcast, produced by the ESRC Centre for Care and CIRCLE, and focussing on the work of IMPACT (IMProving Adult Care Together), the new UK centre for implementing evidence in adult social care. IMPACT is funded by the ESRC and the Health Foundation, with £15m over nearly 7 years.

Improving Adult Care Together: Part 1
Improving Adult Care Together: Part 2

“We believe that good care isn’t about services, but about having a life – and that evidence can play a key part in achieving this vision.”

However, for this to be meaningful, ‘evidence’ has to include insights from different types of research, from the lived experience of people who draw on care and support and carers, and from the practice knowledge of people working in adult social care.  As IMPACT gets up and running, people from across social care have told us that they don’t really need ‘more evidence’ – but that they are crying out for practical support on the ground to make a difference in the realities of front-line services, support to fund the participation of people whose voices are seldom heard, and shared spaces/facilitation to come together to work on shared problems and shared solutions.

We’ll be building all these principles into a series of delivery models and projects which we’ll be piloting from 2022, and then rolling out across the UK from 2023.  As we start this work, these two linked podcasts involve conversations between people from different parts of the UK and from different parts of the social care ‘system’, exploring some of the key challenges and opportunities, and reflecting on what these mean for our work together to bring about positive changes on the ground.  You can find out more about how to get involved, but please listen to and share these podcasts as a way of continuing the conversation about how we get better care and support for all of us, how we see social care as a form of social and economic investment that we make in ourselves as a society, and how we work together to make a difference.

Our host and guests

Host

Jon Glasby

Jon is a qualified social worker by background and works as a Professor of Health and Social Care at the University of Birmingham.  He is the Director of IMPACT.

Jon Glasby Profile

Part 1

Karen McCormick 

Karen is a parent to a young adult with an intellectual disability who draws on social care. In order to give her daughter more choice and control over her life, they have opted for a personal budget. The process of establishing her daughter’s self-direction arrangement to employ her own personal assistants motivated Karen to found inCharge Ltd in 2020.  She believes that technology can play an enabling role in the self-directed care process.  Karen contributed to the work of the Northern Ireland IMPACT assembly in the design phase through her lived experience contributions to the temporary co-production advisory panel and is now Lived Experience Engagement Lead for IMPACT. 

inCharge HQ Website
inCharge Twitter
Karen’s Linkedin
Karen’s Twitter

Terry Davies 

Terry is an IMPACT Assembly member for Wales and is a person of lived experience, employed by West Wales Action for Mental Health.

West Wales Action for Mental Health Website

Obert Tawodzera 

Obert is a Research Fellow at the University of Birmingham and IMPACT’s Project Officer. He completed his PhD at Sheffield University and was part of the Sustainable Care programme led by Professor Sue Yeandle. Prior to doing his PhD, Obert worked as a care worker for adults with learning difficulties. His desire and passion to see change which is underpinned by inclusion and equality is what drives his commitment to research in adult social care.

Professor Sue Yeandle Profile

Part 2

Clenton Farquharson MBE

Clenton is a disabled person with lived experience who draws upon health and social care. Clenton employs his own Personal Assistance, and he looks after his mum’s personal budget which his mum uses for her own personal assistance.

He is Chair of the Think Local Act Personal (click here to learn more) programme board, and a member of the Coalition for Personalised Care. He is also a member of the Social Care Sector COVID-19 Stakeholder Group which will ensure that concerted and determined action continues to be taken to reduce the risk of transmission of COVID-19 in the sector, both for those who rely on care and support and the social care workforce.

Clenton was named in Disability News Services’ list of influential disabled people and listed in the top 50 of HSJ’s most influential Black, Asian and minority ethnic people in health. He was also voted top social care leader in the recent Social Care Top 30 awards hosted by Care Talk magazine.

Visit Think Local Act Personal
Social Care Top 30 Awards

Karen Hedge

As National Director for Scottish Care (click here to learn more), Karen is working to shape the future of social care but is frustrated by the failure of traditional research to move beyond the ‘proof of concept’ stage. She believes IMPACT offers an exciting opportunity to reconsider our approach to evidence implementation by recognising the value and capability of the social care sector. Creating the conditions for real collaboration, critically including those who work in and access care and support, will allow us to move not only to research implementation but embedding. She brings over 20 years of sector experience from frontline to Board level and a passion for evidencing impact in outcomes for people.

Scottish Care Website

The Care Matters Podcast

Care Matters Podcast Producer: Dan Williamson

Dan is the Digital and Communications Coordinator at the ESRC-funded Centre for Care and produces the Care Matters podcast, as well as creating animations, videos, various other digital outputs and maintaining the Centre for Care website and social media platforms. Before joining the Centre for International Research on Care, Labour and Equalities (CIRCLE) at the University of Sheffield, Dan worked for many years at a telecare company, training healthcare professionals and patients with long-term conditions how to operate state-of-the-art remote monitoring devices.

The Care Matters Podcast Series: care is a complex and important issue that affects everyone at some point in their life. The CARE MATTERS podcast welcomes experts in the field and those giving or receiving care to discuss crucial issues in social care, as we collectively attempt to make a positive difference to how care is experienced and provided.

IMPACT’s National Survey

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.