No, that wasn’t the title of today’s NIHR School for Social Care Research conference. But it encapsulates the message I took away with me. Social care research is only of value if it has an
No, that wasn’t the title of today’s NIHR School for Social Care Research conference. But it encapsulates the message I took away with me. Social care research is only of value if it has an impact on policy or practice – and it is researchers’ responsibility to ensure this happens.
Research grant applications expect researchers to define what the ‘outputs’ of their research will be, in addition to the ‘outcomes’ of their study, in order to receive funding. The output refers to a product such as a website or practice guidance which helps the research findings to directly influence policy or social care practice (this phrase incorporates social work practice, which is a small, albeit important, component of social care practice). In the case of the Connecting People study, for example, we are developing extensive practice guidance for implementing the Connecting People Intervention which we are currently refining in a Delphi Consultation. It is no longer sufficient to state that you will be writing a peer-reviewed journal article – an output needs to have ‘real world’ application.
Outputs take time to develop, disseminate and infiltrate the world of social care practice. The Connecting People Study was one of the first studies to be funded by the NIHR School for Social Care Research and the practice guidance is only now being finished off, some 18 months into the study. There is no quick turn-around in social care research and we must be patient to allow the outputs of studies to be developed as robustly as possible to ensure they have maximum impact on policy and practice.
Impact also depends on research design. Some studies will have more impact on policy and practice than others. Sticking my neck out a little here, I would suggest that scoping studies will have less impact than experimental studies evaluating the effectiveness of interventions. Both are necessary and equally ‘worthy’ (though some methodologists would no doubt suggest otherwise), but it is possible that well-designed experimental studies which can evaluate whether one service / intervention / way of working produces better outcomes for service users than a different service / intervention / way of working may impact more on policy or practice. Of course, experimental studies are rare in social care and social work as interventions are not as easy to define as in psychology or medicine, for example. But that should not stop us trying.
I am not suggesting that traditional hierarchies of evidence used to differentiate health research (which preference systematic reviews and randomised controlled trials above other forms of research) should be imported wholesale into social care. That would not be appropriate. My point is simply that we should measure the impact of the study by the research question it sets out to answer. It’s just that some questions are bigger than others.
We should also be mindful that rigorous research itself takes a long time. The two-year Connecting People study will be reporting later this year. The two years have been spent gaining the necessary ethical and research governance approvals, recruiting agencies in which to do the research, recruiting participants and undertaking data collection (in two six-month long phases), analysing the data, undertaking a Delphi Consultation on the practice guidance and writing a final report.
We will not expect to see much impact on policy and practice for at least another couple of years after the end of the study. There may be some immediate impact in the agencies which will be piloting the intervention from June onwards, but this will be relatively small scale. If the evaluation of the pilot finds that the intervention does not improve outcomes for service users, it will have no further impact. This will, of course, be very disappointing, but we must not forget that many studies have neutral or negative findings and don’t influence social care practice at all. However, if the pilot indicates that the intervention helps to improve participants’ social participation and/or well-being, it will be judged a success which will increase its potential impact on social care policy and practice.
If the pilot of the Connecting People Intervention produces positive findings, it will be up to agencies and practitioners to adopt this way of working. As was mentioned by several plenary speakers at today’s conference, including David Behan (Director General for Social Care, Local Government and Care Partnerships, Department of Health) and Andrea Sutcliffe (Chief Executive, Social Care Institute for Excellence), professional leadership is required to implement research findings in practice. It will be the responsibility of agencies to ensure their practice is informed by evidence and not regulators.
I have recently been heartened by speaking to social work and social care leads in the NHS Mental Health Trusts who will be piloting the Connecting People Intervention. These leads play a pivotal role within statutory mental health services as they both represent the social care perspective at high levels within their organisation (amidst the professional dominance of psychiatry and psychology) and have a responsibility for leading and inspiring the social care workforce. The leads I have spoken to recently are keen to participate in the study to help develop the evidence base for social care and social work practice in mental health services and to lead the professional development of their staff. We need to do more to develop professional leaders in social care and social work such as these, who are central to ensuring that research has a direct impact on frontline practice.
Finally, my quote of the day was provided by Andrea Sutcliffe, who referred to the constant re-organisation of services whenever integration of health and social care is being discussed: “Integration is not just about shuffling the deckchairs on the titanic”. When I asked her what the iceberg was and whether we were all doomed anyway, she suggested that we should not under-estimate the challenge provided by the current austere fiscal climate, which will strongly influence the future direction of social care. Worrying stuff. Though, framed more positively, we should aim to promote effective joint-working with a focus on improved outcomes for service users rather than obsess about the structure of organisations which deliver care.
The presentation I gave today (and a video of it – scary!) will be available on the NIHR School for Social Care website in due course. In the meantime, you can download the PPT slides here.