Continuities and differences in a Norwegian welfare service context

Health and Social Care Delivery Research (HSDR) Programme is part of the National Institute for Health and Care Research (NIHR). As such, it aims to contribute to the NIHR's mission of improving the health and wealth of the nation by funding evaluative research projects that have the potential to improve the quality, accessibility and organisation of health and social care services by providing useful outputs for decision-makers, staff, service users, academic, and public audiences. More information about the programme can be found on the NIHR website. A logic model is a visual way of showing how an activity, programme or intervention is expected to work and bring about the benefits and changes it intends to achieve. By summarising the core elements, a logic model can be used to support programme planning, implementation, and evaluation. NIHR logic models presentin a linear flow diagramthe key activities, outputs, outcomes and impacts of each funding programme as a series of logical steps.

The authors investigated the impact of organizational justice on social workers' intention to leave Korean social service agencies. Specifically, this study concentrated on the moderating effect of organizational justice on the relationship between burnout and intention to leave. The authors surveyed 218 front-line social workers from 51 social welfare service centers in Korea. Data were collected from a sample of social workers indentified through a multistage cluster sampling process. The authors used a linear mixed model to analyze the multilevel data structure. This study had three major findings. First, higher levels of burnout of individual social workers corresponded to increased intention to leave. Second, higher levels of organizational justice of social welfare service centers corresponded to decreased intention to leave. Finally, and most important, the organizational justice of social welfare service centers moderated the impact of burnout on individual social workers' intention to leave. On the basis of these results, the authors discuss the importance of organizational justice to social service agencies. KEY WORDS: burnout; intention to leave; moderating effect; organizational justice ********** Within a human service agency, the primary workforce is social workers (Sung, 1993). Frequent turnover among social workers causes practical problems for social work agencies in terms of service discontinuance and loss of skilled practitioners (Carmeli & Weisberg, 2006; Loewenberg, 1979). Given the high costs of social worker turnover, finding effective strategies to reduce turnover rates has been a great concern and challenge in social work settings (Abu-Bader, 2000; Curry, McCarragher, & Dellmann-Jenkins, 2005; Vandervort, Pott Gozalez, & Coulborn Failer, 2008). Previous literature has consistently demonstrated that intention to leave is one of the strongest predictors and an immediate precursor of social worker turnover (Harrington, Bean, Pintello, & Mathew, 2001; Vandervort et al., 2008). A number of social work administrators and professionals have attempted to determine the factors that affect social workers' intention to leave social service agencies (Chiu & Lai, 1997; Ulrish et al., 2007). Several studies have revealed associations between the psychological and demographic characteristics of individual social workers and their intention to leave (Drake & Yamada, 1996; Harrington et al., 2001). Generally, the results of these studies have determined that burnout of social workers significantly increased their intention to leave (Drake & Yamada, 1996; Harrington et al., 2001). These studies, however, have focused primarily on individual factors of social workers as the predictors of intention to leave, ignoring the influence of the social-environmental context of social work agencies. Currently, organizational theory emphasizes the leverage effect of organizational factors on intention to leave among organizational members (Acker, 2004; DePanfilis & Zlotnik, 2008). As George and Jones (1996) pointed out, the impact of individual factors on turnover may be moderated by other organizational factors, such as a supportive organizational climate. Current organizational research has shown increasing interest in organizational justice as a potential factor that creates benefits for both organizations and their individual members (Judge & Colquitt, 2004; Lain, Schaubroeck, & Aryee, 2002). Other fields--including education, public administration, and business--have investigated the dynamic between organizational justice and the intention to leave or turnover rates among organizational members. Prior studies conducted in these fields have indicated that enhancing organizational justice is an efficient strategy to decrease intention to leave or reduce turnover rates and, therefore, increase service quality and clients' satisfaction (DeConinck & Bachmann, 2005; Foley, Ngo, & Wong, 2005; Kickul, Lester, & Finkl, 2002; Parker & Kohlmeyer, 2005). …

Self-report questionnaires can enable health and social care organisations to understand better a person’s views about their health and well-being, allowing them to provide effective, safe, individualised integrated care. Outcomes are the results from care and/or treatments people have received whilst in clinical or other care settings. Some outcomes, such as symptoms, quality of life and aspects of physical, mental, and social functioning can only be captured directly from the person themselves. These are called patient-reported outcomes (PROs) in healthcare settings, and this information is usually collected using electronic questionnaires that allow us to assess and measure these issues of individual importance. PROs can deliver person-centred care through individualised clinical assessments to support disease/treatment monitoring leading to improved patient–clinician communication which aids shared decision-making. At an organisational level, PROs are used to monitor provider performance, inform policy, and guide quality improvement. PROs in social care could be used similarly, to promote choice and autonomy, to ensure care meets a person’s goals for their health and wellbeing. At a service level, these self-report questionnaires could help identify unmet need and guarantee that measures of quality emphasise person-centred outcomes. PROs offer an opportunity to support effective integrated care in settings where individuals, particularly those with multiple long-term conditions, might receive both health and social care services. The National Institute for Health and Care Research Applied Research Collaborative West Midlands (NIHR ARC WM) leads a programme of research exploring the use and implementation of PROs in integrated care. A Priority Setting Group was established comprising people with lived experience of health and social care(n=3), experts in health, social care and PROs methodology (n=4) and representatives from a charity to support independent living (n=2), who identified the need to undertake a scoping review to explore the evidence on the use of PROs in adult social care. The scoping review, which included searches of 6 databases (years 2010-2023), identified 159 articles reporting on the international use of 216 PRO measures in social or integrated care. PROs were primarily used as research tools, but 5% studies reported PROs as part of an intervention; 23.9% papers focused on PROs use with participants in long-term residential care, with less published evidence of PROs use for those receiving supported living services (5.7%) and social day care services (3.1%). Only 3 articles (1.9%) referred to PROs in the context of the provision of integrated health and social services. The review highlighted a lack of coherence in purpose of use and poor reporting of implementation factors that could optimise PROs use to achieve potential identified benefits in these populations. Findings informed a mixed methods study (qualitative interviews and structured survey), designed in consultation with the NIHR ARC WM Public Advisory Group (n=18), to explore current and potential use of PROs in integrated care settings, involving persons with lived experience, carers and professionals across health, social care, voluntary and charitable organisations. Results will inform guidance on key considerations to optimise PROs use in integrated care.

Each chapter concludes with Summary and Selected References. I. INTRODUCTION. 1. What Is Social Work? Social Welfare. Social Work. Distinguishing Characteristics of Social Work. Sociology and Social Work. Psychiatry and Social Work. Psychology and Social Work. Counseling and Social Work. Social Work in the World Today. 2. The Evolution of Social Welfare and Social Work in the United States. Echoes of the Past. European Roots. Beginnings in the United States. Public Assistance and Social Welfare Emerge. Services of Volunteers. Social Workers Appear. 3. Education for Social Work. Social Work Education. Council on Social Work Education. II. SOCIAL WORK PRACTICE. 4. Generalist Practice and Introductory Theory. Need for a Theoretical Framework. Introductory Inner and Outer Forces Paradigm. Additional Model Definition. The Life Cycle and the Inner and Outer Forces Model. Social Functioning. Levels of Social Functioning. A Base for Generalist Social Work Practice. 5. Social Work Practice with Individuals. Work with the Individual: A Generalist Approach. Social Casework Defined. History of Social Casework. Trends in Casework. The Practice Framework. Methods of Social Casework. Problems in Social Casework. The Casework Process. The Multi-Systems Approach. 6. Social Work Practice with Groups. Historical Developments. Group Work Defined. Group Work Models. Formation of Groups. Selection of Group Members. Preparation of Group Members. Structuring the Group. Stages of Group. Group Work Settings. 7. Social Work Practice with Communities. What Is Community Organization? Beginnings of Community Social Work. Underlying Principles in Community Organization. Community Social Work Processes. Roles of the Community Organizer. Case Summaries. 8. Administration and Research. Administration. Research. III. SOCIAL WORK SERVICES. 9. Mental Health Services. Beginnings in Mental Health. Elements of the Mental Health Network. Essential Elements of Comprehensive Mental Health. Special Problems and Issues in Mental Health. 10. Social Work in Health Care. Definition of Social Work in Health Care. The Meaning of Illness. The Role of Social Work in Health Care. The Future of Social Work in the Health Care Services. Prevention and Social Work. 11. Social Work in the Schools. The Education Delivery System: New Approaches. Problems Plaguing the Public Schools. Beginnings in School Social Work. Social Work Practice in the Schools. Social Work Using a Group Approach. School Social Work and the Community. Working with Minorities. When the System Fails. 12. Social Security and Public Welfare. Government's Responsibility for Welfare. The Social Security Act. Aid to Families with Dependent Children. Government and Public Welfare. 13. Family and Child Welfare Services. Marriage and Family Counseling. Child Welfare Services. Home Care of Children. Foster Care of Children. Adoption Services. Protective Services. Child Sexual Abuse. 14. Correctional Services. The Social Problems of Delinquency and Crime. Social Work and Corrections. Social Work Practice in Corrections. Processes and Principles. Social Services and Case Examples. 15. Services for the Aged. Older Americans Act of 1965. White House Conference on Aging, 1971. Adequate Income. Appropriate Living Arrangements. Institutional Responsiveness and a New Attitude Toward Aging. Independence and Dignity. 16. Drug Abuse and Social Work. Misused Drugs and What They Do. Extent and Cost of Drug Abuse. Programs for Control, Prevention, and Treatment. Role of Social Work in Treatment. 17. Services with Minorities. Minority Problems. Social Services. Educational Developments. 18. Social Work in Rural Areas. Beginnings in Rural Social Work. Rural Social Work Practice. Roles of the Rural Social Worker. Rural Social Service Agencies. Distance Learning for Rural Social Work. 19. Case Management. Historical Developments. Case Management Defined. Case Management Research. IV. PROFESSIONAL DEVELOPMENT. 20. Social Work: A Maturing Profession. Criteria of a Profession. Historical Background. Social Work Today. 21. Social Work Prevention and Enrichment. Social Work Focus on Prevention. Problems Involved. Examples of Prevention. Implications of Prevention. Social Work Enrichment. 22. Social Work and the Future. Professional Maturation. Increase in Services. Professional Identification and Visibility. Licensing. Spirituality in Social Work Practice. Changing Continuum in Social Work Education. Development of the Role of Consultant. Status of Social Worker. Private Practice. Case Management. Advocacy Role. Improved Public Relations. Rural Social Work. Technology. Expansion of Leadership Roles. Increase in International Social Work. Prevention. Enrichment. Movement for Higher Quality. Name Index. Subject Index.

Gambling-related harms constitute a significant public health concern, with adverse effects ranging from financial difficulties to mental health disorders. Therefore, people experiencing gambling-related harm may need different kinds of health care and social services. This study examines the social and health care usage between gambling severity groups. We aim to examine whether people with recreational, risk or problem gambling use more social and health care services compared to non-gamblers, and what increases the probability to use social and health care services for people who gamble on different levels of risk for harms. The study used data from the population-based Healthy Finland survey (N=28,153, 46%) Results: Our results show that individuals with problem gambling more commonly experienced social and health vulnerabilities. Among individuals with problem gambling, 86% had utilized health care services, and 18% social care services during the past year, which was somewhat higher than among individuals who did not gamble. Among different gambling severity groups, it seemed, that the use of health care services is less common among men, younger individuals, people with excessive alcohol use and among those with higher income. Individuals in the problem gambling groups were 2.1 times more likely to utilize health care services than non-gambling group. Among individuals with problem gambling and low-risk gambling groups, the utilization of social services was more common among those with lower income, individuals experiencing psychological distress and long-standing illnesses. These results provide new knowledge on how people with different levels of risk for gambling harm use social and health services, and support to develop social and health services in responding to gambling problems.

Background: Ireland has national strategies and policies setting out the importance of integrated care and coordination of care and support between health and social care services, to enable children to get timely and appropriate care and support. Despite Government commitment to a coordinated approach, delivery of care and support to children continues to be inconsistent and fragmented. While children with complex needs are more likely to experience significant gaps and delays in the care and support they need, evidence shows that any child in need of care and support from a health or social care service is at risk of gaps and delays. The Health Information and Quality Authority (HIQA) and the Mental Health Commission (MHC) are the regulatory bodies for health and social care services, and mental health services, in Ireland. To promote and support greater integration and collaboration between health and social care services, HIQA and the MHC worked together to develop national standards for all health and social care services working with children. Throughout the standards development process, we collaborated with children and families with lived experience, and advocates and staff working in health and social care services. Methods: These evidence-based standards cover all health and social care services working with children, including healthcare, disability, mental health and children’s social services. They provide a shared framework for all services and aim to support them to work together in a coordinated and collaborative way to improve the experience and outcomes of children and families. The standards were informed by a literature review, and extensive stakeholder involvement including focus groups with 217 children, young people and families with lived experience, advocates, staff, inspectors, and policy-makers; and 130 responses to two public consultations. An Advisory Group representing key stakeholders and a Children’s Reference Group informed the standards. The Children’s Reference Group comprised of young people and family members with experience of health and social care to ensure active people involvement and engagement in design and implementation of the standards. Their input helped ensure the standards authentically reflected what children should expect from a health and social care service committed to child-centred care. Initiative: This is the first time a set of Irish national standards has been developed focused on the needs of all children across health and social care services. The standards are underpinned by the principles of a children’s rights-based approach, safety and wellbeing, responsiveness, and accountability. Presented in the child’s voice, they articulate what outcomes a child should expect and what a service needs to do to achieve these outcomes. Impact: These standards will help to drive quality, safety, consistency and coordination across health and social care services working with children, as all organisations and services will be operating to one set of consistent national standards. Although an important lever for change, we recognise that services will need tools to support implementation of the standards and we will work with the sector to identify and collaboratively develop relevant tools to support implementation of the standards in day-to-day practice.

BackgroundSince the 2000s, local governments have contracted out more and more social services to social work organizations in China. Social workers are thus experiencing the inconsistency between local governments' and clients' demands and the deviation from the professional duty of helping clients, which may result in conflicting and unclear roles in their jobs and further lead to burnout. Based on the Role Stress-burnout Model and the previous theoretical and field-work investigations, this study examined the effects of the government-client work interaction frequency gap on social workers' burnout as well as the mediating effects of role ambiguity and conflict and the moderating effects of the non-front-line work.MethodsA cross-sectional study of 2,643 front-line social workers and 2,599 supervisors or managers from 56 major cities all over China was conducted. Work burnout was measured by the 22-item three-dimension Maslach's Burnout Inventory Scale. Rizzo et al.'s 14-item scale measured role conflict and ambiguity. The government-client working interaction frequency gap was measured by the difference between the five-point level of work interaction frequency with governments minus the one with clients. Structural equation modeling was adopted to test the mediation and moderation models.ResultsResults showed that for the front-line social workers, besides directly reducing personal accomplishment, the government-client work interaction frequency gap could indirectly neutralize its alleviating effects on emotional exhaustion (Mediating effect ratio = −63.64 %), make its total effects on depersonalization significant (37.03%), and reduce personal accomplishment further (23.08%) through increasing social workers' feeling of role conflict. However, the above mediating effects of role conflict were not significant for social workers with extra management or supervision workload, revealing the moderating effects of non-front-line work.ConclusionsThis study revealed that front-line social workers in China who had more work interaction with governments and less with clients could have higher role conflict, increasing their burnout further. Therefore, social work educational programs should include adequate mental adjustment courses and practical emplacement to prepare students for the potential role conflict. Furthermore, higher-level governments should issue relevant regulations to form a collaborative rather than an employment relationship between local governments and social worker organizations.

This study offers theoretical explanations and distinctions associated with the phenomenon of conscience in social work. It uses the perspective of Roman-Catholic theology, or more precisely of the Roman-Catholic Church. It briefly reflects on an anthropology of conscience and then contemplates the essence of conscience and its relationship to the truth. In the reflection on the contradiction between Christian and secularized morality (given by the renowned Swiss Catholic theologian Hans Urs von Balthasar 1905-1988), it shows the importance of conscience in the value inconsistencies of the attitudes of today’s world. Finally, based on the impulses of the apostolic exhortation of Pope Francis Amoris laetitia (2016), it reflects on practical impulses concerning the place and importance of conscience in social work.

This article draws on yarning (reciprocal Indigenous storytelling) with 15 Aboriginal and Torres Strait Islander social service providers to explore the question of how we can support change in decoloniality and antioppressive practice in social work. The methodology foregrounds the voices and world views of Indigenous people in order to disrupt Western thought and to dialogue with and extend antioppressive social work theory, knowledge, and practice. The yarning (qualitative) data were collected in five agencies providing Indigenous social services in close conjunction with Indigenous communities, and produced three strong themes: neo-liberalism and funding challenges; working from a new model; and nurturing and sustaining long-term relationships. The findings present recommendations for decoloniality including decentring Western foundational concepts and practices; providing space for cultural practice(s); Indigenous yarning or the cocreation of new narratives; centring Indigenous ways of knowing, being and doing (cultural safety and cultural humility); collective and individual critical reflexivity; visioning for all; and connection to Country. The article ends with further reflections on Indigenous resilience and healing, reclaiming sovereignty, and nurturing resistance. IMPLICATIONS Neo-liberal funding policies slow and disrupt decolonising efforts in social service organisations. Decolonisation of social service practices and policies involves patient, long-term relationship building and close attention to ongoing flexible and respectful collaboration with Indigenous Peoples and communities at all levels. Critical reflexivity among frontline workers and across social service agencies can help maintain decolonising efforts and support new options for social work practice and policy.

The first cases of Coronavirus (COVID-19) were reported in Wuhan, China in December 2019. Globally millions of people have been diagnosed with the virus whilst thousands have died. As the virus kept spreading health and social care frontline workers (HSCFW) were faced with difficulties when discharging their duties. This paper was set out to explore the challenges faced by different frontline workers in health and social care during the COVID-19 pandemic. The research utilized an explorative qualitative approach. A total of forty (N = 40) in-depth one-to-one semi-structured interviews were undertaken with HSCFW who included support workers (n = 15), nurses (n = 15), and managers (N = 10). Health and social care workers were drawn from domiciliary care and care homes (with and without nursing services). All the interviews were done online. The data were thematically analyzed, and the emergent themes were supported by quotes from the interviews held with participants. Following data analysis the research study found that lack of pandemic preparedness, shortage of Personal Protective Equipment (PPE), anxiety and fear amongst professionals, challenges in enforcing social distancing, challenges in fulfilling social shielding responsibility, anxiety and fear amongst residents and service users, delay in testing, evolving PPE guidance and shortage of staff were challenges faced by frontline health and social care workers during COVID-19 pandemic. The results of the current study point to a need for adequate pandemic preparedness within the health and social care sector to protect both frontline workers and the individuals they look after.

Gambling-related harms constitute a significant public health concern, with adverse effects ranging from financial difficulties to mental health disorders. Therefore, people experiencing gambling-related harm may need different kinds of services. While previous studies have examined the prevalence and impacts of problematic gambling, less is known how individuals who gamble use social and health care services. This study examines the social and health care usage between gambling severity groups: (1) non-gambling, (2) recreational, (3) at risk and (4) problem gambling. We aim to examine whether people with risk or problematic gambling use more social and health care services compared to non-gamblers, and what increases the probability to use social and health care services with individuals in different groups. The study used data from the population-based Healthy Finland survey (N = 28,154, 49.3%). Health and social care use were measured with separate questions by asking if participants had used services in the past 12 months (yes/no). Our results show that among individuals with problem gambling, 86% had utilized health care services, and 18% social care services during the past year, which was somewhat higher than among individuals who did not gamble. Among different gambling severity groups, it seemed, that the use of health care services is less common among men, younger individuals, people with excessive alcohol use and among those with higher income. Among individuals with problem gambling and low-risk gambling, the utilization of social services was more common among those with lower income, individuals experiencing psychological distress and long-standing illnesses. These results provide new knowledge on how people with different levels of risk for gambling harm use social and health services, and support to develop social and health services in responding to gambling problems.Key messages• People who experience different levels of risk or problem gambling are already patients in health care, and we need to make sure, that gambling is recognized behind the service use.• With these results we can understand who of those experiencing gambling problems are not in health care services, and develop practices to increase help-seeking.

Managers are dependent on those with whom they work to behave and act in ways which promote organisational performance, and the experience of those who use the organisation’s services is primarily shaped by the front-line workers with whom they are in contact. But managers are often not present alongside front-line workers, and this is especially so within social work and social care services. For senior managers in particular, they may be located away from front-line teams and have only limited contact with front-line workers. The issue then arises of how to have an impact and influence even when geographically remote and unseen. Drawing on the author’s experience of front-line to senior management, this paper reflects on what works in managing and leading at a distance, focussing on enabling, empowering and facilitating front-line workers and re-balancing from an overwhelming focus on direction and control.

Managers are dependent on those with whom they work to behave and act in ways which promote organisational performance, and the experience of those who use the organisation’s services is primarily shaped by the front-line workers with whom they are in contact. But managers are often not present alongside front-line workers, and this is especially so within social work and social care services. For senior managers in particular, they may be located away from front-line teams and have only limited contact with front-line workers. The issue then arises of how to have an impact and influence even when geographically remote and unseen. Drawing on the author’s experience of front-line to senior management, this paper reflects on what works in managing and leading at a distance, focussing on enabling, empowering and facilitating front-line workers and re-balancing from an overwhelming focus on direction and control.

Policy PointsHospitals address population health needs and patients’ social determinants of health by offering social care services. Tax‐exempt hospitals are required to invest in community benefits, including social care services programs, though most community benefits spending is toward unreimbursed health care services.Tax‐exempt hospitals offer about 36% more social care services than for‐profit hospitals. Among tax‐exempt hospitals, those that allocate more resources to community benefits spending offer more types of social care services, but those in states with minimum community benefits spending requirements offer fewer social care services.Policymakers may consider specifically incentivizing community benefits expenditures toward particular social care services, including linking tax exemptions to implementation, utilization, and outcome targets, to more directly help patients.ContextDespite growing interest in identifying patients’ social needs, little is known about hospitals’ provision of services to address them. We identify social care services offered by US hospitals and determine whether hospital spending or state policies toward community benefits are associated with the provision of these services by tax‐exempt hospitals.MethodsNational secondary data about hospitals were collected from the American Hospital Association Annual Survey, with additional Internal Revenue Service (IRS) Form 990 data on community benefits spending from CommunityBenefitInsight.org and state‐level community benefits policies from HilltopInstitute.org. Descriptive statistics for types of social care services and hospital characteristics were calculated, with bivariate chi‐square and t‐tests comparing for‐profit and tax‐exempt hospitals. Multivariable Poisson regression was used to estimate associations between hospital characteristics and types of services offered and among tax‐exempt hospitals to estimate associations between social care services and community benefits spending and policies. Multivariable logistic regressions modeled associations between community benefits spending/policies and each type of social care services.FindingsPrivate US hospitals offered an average of 5.7 types of social care services in 2018. Tax‐exempt hospitals offered about 36% more social care services than for‐profit hospitals. Larger number of beds, health system affiliation, and having community partnerships are associated with more social care services, whereas rural hospitals and those managed under contract offered fewer social care services. Among tax‐exempt hospitals, greater community benefits spending is associated with offering more total (incidence rate ratio [IRR] = 1.10, p < 0.01) and patient‐focused social care services (IRR = 1.16, p < 0.01). Hospitals in states with minimum community benefits spending requirements offered significantly fewer social care services.ConclusionsAlthough tax‐exempt status and increased community benefits spending were associated with increased social care services provision, the observation that certain hospital characteristics and state minimum community benefits spending requirements were associated with fewer social care services suggests opportunities for policy reform to increase social care services implementation.

Background Community-based NHS and social care services offer a wide range of health and social care services, including General Practice, care homes, hospices, community pharmacies, district and community nursing, and mental health services, which provide care from birth to the end of life. However, despite being fundamental to plans for health and critical social care, community-based NHS health services are poorly understood compared to hospital-based services. A scoping exercise failed to identify any specific research examining the barriers and facilitators of community-based NHS and social care services. Objectives 1) To develop a qualitative framework using semi-structured interviews to explore the perspectives and experiences of the research staff and practitioners. 2) To explore how we can build research on community-based NHS and Social Care services using the perspectives and experiences of the research participants. 3) To make recommendations to clinicians, practitioners, policymakers, and funding organizations on how to build research in community-based NHS and Social Care Services. Methods With reference to the literature and input from the project team and key stakeholders, interviews will be conducted using a semi-structured topic guide. The interview guide will identify barriers and facilitators to researching community-based NHS health and social services. Outcomes The intended outcomes of this study could help in understanding and developing strategies to address workforce needs to increase the capacity and capability of research delivery. Further, to embed a research culture in community-based NHS and social care services by supporting collaborative work between primary, secondary, community, and social care to build research capacity and capability; reach underserved communities and increase local engagement and participation in research; and increase equality, diversity, and inclusion by adding research in community-based NHS and social care services where everyone lives.