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.

Putting the cart before the horse (yet again)

As government makes plans to increase funding for social care, is this a déjà vu at what could be yet another major missed opportunity

During the pandemic, the longstanding neglect of adult social care has been even more tragically exposed than before – and lots of people have been debating how things need to be different in future.  While it’s great that so many people are at least talking about social care, it tends only to be the bits that touch the NHS (essentially care homes and services for older people), rather than social care in all its diversity and in its own right.  Moreover, the recent funding debates have been so narrow as to be embarrassing.

As we wrote for the Local Government Association (when, tired of waiting, it produced its own Green Paper on Adult Social Care in 2018): “All too often the funding of adult social care is seen as an economic and a technical issue: what’s the best mechanism for raising the funding we need?  While this is important, the more fundamental questions are personal, political and philosophical: what kind of life do we want to have together as a society?  How much do we value disabled and older people with care needs?  What sort of support would we want available to any of us if we needed care?  How much do we really vale this and how much might we be prepared to pay for whatever quality of life we decide we want?

With the NHS, we recognise that none of us can predict in advance who might need to access health services, that care should be based on clinical need rather than ability to pay, and that we’re better off as a society when we all contribute to the cost of the service and all benefit when we need it.  With social care, unfortunately, we have a system that few people understand, that is only really available for people with very significant needs and very low incomes, and that few people think about until they find themselves trying to access it in a crisis – never a good time to be finding out about something for the first time.

Since the late 1990s there have been at least 12 major reviews, vision statement and Green/White Papers – and we’ve failed to implement the funding recommendations of any of them.  Despite Boris Johnson’s claim to have a plan for social care when he became Prime Minister in 2019, and despite all the recent debate around funding models, it’s hard to imagine that this might be 13th time lucky.  While the devil is in the detail, many people feel that an increase in National Insurance is much less equitable than funding social care from general taxation, disproportionately affecting younger people and those on low incomes.  It’s also possible that any cap could be set at too high a level to make much difference, preventing people from preparing for future care costs because the sums involved are simply too large to contemplate.  What emerges might also be a health and social care fund, focusing initially on the NHS backlog following COVID, before any new money gets anywhere near social care.

However, while even a limited cap might have some positive impact, this still seems a major case of putting the cart before the horse.  A cap is a start and would help to at least soften one of the worst and most cruel cliff edges in our welfare system.  However, by itself, all it would do is change who pays: it wouldn’t necessarily mean that even an extra penny was available to spend on more or better care or to improve the terms and conditions of low-paid, exhausted and demoralised workers.  Even worse, it would do nothing to change the nature of current services – so all we’d have is a row about who pays, and potentially no discussion of what we want social care to help us achieve in our lives, what principles it should be based on and how future care should be organised and delivered.  Fortunately there are excellent attempts to do just this – from Social Care Future and the Alzheimer’s Society, to the ‘community conversations’ facilitated by Engage Britain or the forthcoming Archbishop’s Commission on Reimaging Care

Although very different in their nature and origins, all these initiatives seem likely to point in a similar direction.  As an example, I’m the Director of IMPACT (‘Improving Adult Care Together’), a new UK centre for implementing evidence in adult social care, and we see social care not as a basic safety net that we have to provide to meet minimum public expectations, but as a form of social and economic investment that helps us to be full citizens, live chosen lifestyles and have a better life together as a society.  Our strapline (suggested by someone who draws on care and support themselves) is that “good care isn’t just about ‘services’, it’s about having a life”.  This has much in common with the vision developed by Social Care Future“we all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing the things that matter to us.”  Unfortunately, the current debate about social care funding seems about as far away as one can get from these visions for people’s lives – and it’s hard not feel an exhausting sense of déjà vu at what could be yet another major missed opportunity.

Our previous work on the nature and costs of social care reform is published in the Journal of Social Policy, setting out different spending scenarios depending on the level of reform that is pursued, and identifying a ‘lost decade’ between 2010 and 2020 when social care reform arguable stalled, and in many ways went backwards.

Are you involved in adult social care? IMPACT, a new UK centre for implementing evidence in adult social care, want to hear from you. The Centre are particularly interested in hearing from: people who use care and support services, user-led and community organisations, groups that work with people whose voices are seldom heard, people who look after someone else – ‘carers’, people who work in social care and people from black and minority ethnic communities.