Creating a Learning Culture: Exploring Adult Social Care Practitioners’ Perceptions of Organisational Learning through Feedback

Populations around the world are rapidly ageing and more people are living with multiple long-term conditions. There is an urgent need for evidence about high quality, cost-effective, and integrated systems of health and social care. Health research funders are now also prioritising research in adult social care and wider local authority settings, e.g. housing services.Developing the evidence base for adult social care should include implementing randomised controlled trials, where appropriate. Within the UK, the clinical trial is the established road map for evaluating interventions in the National Health Service (NHS). However, adult social care and local authorities are relatively uncharted territory for trials. BATH-OUT-2 is one of the first clinical trials currently underway within adult social care and housing adaptations services in six English local authorities. It provides an opportunity to explore how the clinical trial road map fares in these settings.Whilst setting up BATH-OUT-2, we encountered challenges with securing funding for the trial, lack of non-NHS intervention costs, using research and support costs as intended, gaining approvals, identifying additional trial sites, and including people who lack the mental capacity to provide informed consent. Overall, our experience has been like navigating uncharted territory with a borrowed map. In the UK, the clinical trial road map was developed for medical settings. Its key features are integrated within the NHS landscape but have been largely absent, unfamiliar, inaccessible, or irrelevant in social care and wider local authority terrain. Navigating the set-up of a clinical trial outside the NHS has been a complicated and disorientating journey.BATH-OUT-2 highlights how local authorities generally and adult social care specifically are a relatively new and certainly different type of setting for trials. Whilst this poses a challenge for conducting trials, it also presents an opportunity to question longstanding assumptions within trials practices, reimagine the conventional clinical trial road map, and take it in new directions. As the UK research landscape moves forward and becomes better primed for randomised evaluations in local authorities, we propose several suggestions for building on recent progress and advancing trials within adult social care and across health and care systems.

Background/Aims Promoting the wellbeing of service users is a core focus in occupational therapy and adult social care. Despite a professional, policy and legal mandate to provide evidence of the effectiveness of occupational therapy interventions in adult social care, few local authority teams in England use standardised outcome measures to assess the impact of interventions on wellbeing. One local authority's occupational therapy service in England sought to address this by introducing the Adult Social Care Outcomes Toolkit. This study explored the Adult Social Care Outcomes Toolkit's clinical utility (usefulness) in this setting. As the Adult Social Care Outcomes Toolkit has multiple translations, this research is relevant to international practice. Methods This qualitative study collated the views and experiences of occupational therapy staff using the Adult Social Care Outcomes Toolkit in practice. Data from an online focus group were thematically analysed. Results Four themes were identified relating to: understanding the Adult Social Care Outcomes Toolkit; using it in daily practice; applying it to the local authority occupational therapy context; and the felt experience of using the Toolkit. Broadly, participants were keen to measure wellbeing, liked the Adult Social Care Outcomes Toolkit in principle and noted its relevance to occupational therapy practice in adult social care. Some concerns were raised about the Adult Social Care Outcomes Toolkit's complexity and completion times. Conclusions This first known study of using the Adult Social Care Outcomes Toolkit in occupational therapy practice in adult social care provides key insights into its clinical utility. Findings may be of interest to practitioners, commissioners and service providers. Implications for practice The Adult Social Care Outcomes Toolkit has potential for use as an outcome measure in social care occupational therapy, though there are some barriers to use in practice. Alternative versions of the instrument offer solutions, though some limitations may remain. This novel study highlights the importance of clinician feedback and thorough consideration of an outcome measure's clinical utility.

Earlier this year, the Scottish Parliament passed the Public Bodies (Joint Working) (Scotland) Act 2014, which establishes a framework to ensure health and social care services in Scotland are planned, resourced and delivered jointly by Health Boards and Local Authorities, working with nonstatutory partners to improve outcomes for people using services, their carers and families. The Act sets out a core set of principles and the legislative framework for integrating health and social care. Health Boards and Local Authorities will establish integrated partnership arrangements, called Integration Authorities, which will deliver national outcomes for health and wellbeing from a pooled budget for health and social care services. Integration Authorities will set up locality arrangements with local professional leadership of service planning. The Act places a heavy emphasis on the importance of effective strategic commissioning of services underpinned by a good, shared understanding of the population’s needs, and informed by professional and local community input. The new law applies to adult health and social care services – Health Boards and Local Authorities can also include children’s health and social care services, criminal justice social work, housing support etc. in their integrated arrangements if they agree to do so locally. The legislation includes a strong role for the third and independent sectors, clinicians, social workers, other professionals, and local communities. What will the reforms look like? Two models of integration are available for Health Boards and Local Authorities to choose from: delegation of functions and resources between Health Boards and Local Authorities. delegation of functions and resources by Health Boards and Local Authorities to a body corporate. An integrated budget will be established in each partnership to support delivery of integrated functions, which will cover at least adult social care, adult community health care, and aspects of adult hospital care that are most amenable to service redesign in support of prevention and better outcomes. Ministers will establish in Regulations which functions (and therefore budgets) must be included in the integrated arrangement. International Journal of Integrated Care – Volume 15, 27 May – URN:NBN:NL:UI:10-1-117032 – http://www.ijic.org/ 15th International Conference on Integrated Care, Edinburgh, UK, March 25-27, 2015 2 Each partnership will establish locality planning arrangements at sub-partnership level, which will provide a forum for local professional leadership of service planning. Each partnership will put in place a joint strategic commissioning plan for functions and budgets under its control – the joint strategic commissioning plan will be widely consulted upon with nonstatutory partners, patient and service user representatives, etc. Where the body corporate model is used, a chief officer must be appointed by the partnership to provide a single point of management for the integrated budget and integrated service delivery. In the delegation between partners model, this single point of management falls to the Chief Executive of the “lead” agency (i.e., the partner to whom functions and resources are delegated). The Act focuses on the importance of effective joint strategic planning and commissioning of services. This approach builds on the wealth of evidence for successful integration of health and social care from elsewhere in the UK and further afield, which demonstrates that, while no single organisational approach is required to deliver improvement, the following characteristics are consistently displayed by successful systems: Local planning systems focus on population need, rather than historic structures. Health and social care systems plan together for older people, for example – or for adults with chronic obstructive pulmonary disorder, or for children with complex needs, or for any other care group that is a local priority – rather than planning separately in terms of “health” provision and “social care” provision. Resources across health and social care are pooled to support delivery of the population-based plan. Resources reflect population need, and are managed to follow patient/service user need in order to deliver maximum benefit. This approach eliminates the risk of cost shunting, which can permit financial gain from poor performance on the part of one partner, at the cost of the other. Mechanisms are in place to ensure the opportunity for leadership by local clinicians and professionals from across health and social care, particularly GPs, in planning service provision. Clinical buy-in and leadership of integration is fundamental to improving outcomes. Strong, effective, consistent local leadership retains a relentless focus on outcomes for patients and service users.

SPN Position Statement: Transition of Pediatric Patients Into Adult Care

PurposeHealth and social care services should demonstrate the quality of their interventions for commissioners, patients and carers, plus it is a requirement for occupational therapists to measure and record outcomes. Use of the “Therapy Outcome Measure” (TOMs) standardised tool was implemented by an occupational therapy adult social care service to demonstrate outcomes from April 2020, following integration to a community NHS Trust.Design/methodology/approachThe aim was to demonstrate occupational therapy outcomes in adult social care through a local audit of the TOMs. The objective was to determine if clients improved following occupational therapy intervention in the four domains of impairment, activity, participation and wellbeing/carer wellbeing. 70 cases were purposively sampled over a 2-month timeframe, extracting data from the local electronic recording system.FindingsOccupational therapy in adult social care clearly makes an impact with their client group and carers. Evidence from the dataset demonstrates clinically significant change, as 93% of clients seen by adult social care occupational therapy staff showed an improvement in at least one TOMs domain during their whole episode of care. 79% of activity scores, 20% of participation scores and 50% of wellbeing scores improved following intervention. 79% of carer wellbeing scores improved following occupational therapy.Research limitations/implicationsThe audit did not collect data on uptake from the separate teams (equipment, housing, STAR and adult social care work) in occupational therapy adult social care. Potential sampling bias occurred as cases with completed scores only were purposively sampled. Sampling was not random which prevented data gathering on uptake of TOMs across the separate teams. Additionally, the audit results can only be applied to the setting from which the data was collected, so has limited external validity.Originality/valueThese novel findings illustrate the valuable and unique impact of occupational therapy in this adult social care setting. The integration of adult social care into an NHS Community Trust has supported the service to measure outcomes, by utilising the same standardised tool in use by allied health professions across the Trust.

ObjectivesTo describe adult care and support patterns across Wales, examining variations by socio-demographic characteristics, impairments and health conditions, and deprivation. This study aims to identify disparities in care provision across individuals and areas to inform equitable service delivery and improve outcomes for adults receiving local authority (LA) care and support. MethodsThe Adults Receiving Care and Support (ARCS) census became a mandatory data return to the Welsh Government in April 2023. The CARE Lab is a data partnership between ADR Wales, Welsh Government, Swansea University, London School of Economics, Disability Wales, Social Care Wales and Cardiff University, integrating data from adult social care, children’s social care, health care and the 2021 Census. This initiative advances the understanding of adults receiving LA care and support, enabling detailed analysis of socio-demographic factors and inequalities. The findings will support service planning, policy evaluation, and strategies to reduce disparities in care provision across Wales. ResultsWe will present highlights related to the initial 2023/24 ARCS standalone data collection, offering a detailed profile of adults with care and support plans. Analysis includes demographic breakdowns, intersections of socio-demographic factors, and variations in care durations. Additionally, it examines whether individuals had active care or support on the census date. Insights reveal patterns of care provision and identify areas of potential inequality or unmet need. These findings serve as a baseline for future comparisons and analyses, supporting targeted interventions to address disparities in adult social care services, and enable planning for future research for the CARE Lab and other researchers interested in the ARCS data, and suggestions towards the future primary data collection of the ARCS data. ConclusionThis study will be the first UK study to explore adult social care at a national level using individual-level population-scale linked data sources. Findings will inform future data collection improvements, provide actionable insights for policy and practice, and offer an early snapshot of the population receiving LA care and support.

Background Efforts to build and foster adult social care research in England have historically encountered more challenges to its growth and expansion compared with health research, with a sector facing significant barriers in facilitating research activity due to a lack of resourcing, poor valuation or understanding of the profile of social care research. The landscape for supporting the social care workforce to use, engage in and undertake research in adult social care has been rather bleak, but in recent years there has been recognition of the need to foster a social care workforce research community. The National Institute for Health and Care Research in England have committed to investing in social care research capacity by funding six adult social care partnerships, with one based in Southeast England. Setting up Communities of Practice (COPs) offers a model to build a shared learning space to foster a social care research community. Process developing COPs: Three online networking events were held in the first year of the project to engage managers and practitioners from the local authority and from the wider adult social care sector, taking place in July and November 2021, and March 2022. Two COPs were identified, following an ordering and thematising process of feedback from the networking events, of: (a) Supporting people with complex needs throughout the lifespan, and (b) Enhancing, diversifying and sustaining the social care workforce. Whilst it would be premature to identify their long-term impacts, the COPs have provided a space for regular communication, knowledge sharing and networking between members. Conclusions The COP framework offers a collaborative approach to initiating research from the grass-roots level in adult social care. This paper focuses on how the COP model offers great promise for knowledge-exchange providing a forum to generate and disseminate knowledge around social care in two COP domains.

Efforts to build and foster adult social care research in England have historically encountered more challenges to its growth and expansion compared with health research, with a sector facing significant barriers in facilitating research activity due to a lack of resourcing, poor valuation or understanding of the profile of social care research. The landscape for supporting research in adult social care has been rather bleak, but in recent years there has been recognition of the need to foster a research community. The National Institute for Health and Care Research in England have committed to investing in social care research capacity by funding six adult social care partnerships, with one based in Southeast England. Three large online networking events were held in the first year of the project to engage managers and practitioners from the local authority and from the wider adult social care sector. These took place in July and November 2021, with a last event in March 2022. Two COPs were identified, following an ordering and thematising process of feedback from the networking events, of: (a) Supporting people with complex needs throughout the lifespan, and (b) Enhancing, diversifying and sustaining the social care workforce. Whilst it would be premature to identify their long-term impacts, through the facilitation of 20 COP meetings held so far, alongside the engagement platforms and enrichment resources, these have provided a space for regular communication in the sector, knowledge sharing and networking between COP members. The COP framework offers a collaborative approach to initiating research from the grass-roots level in adult social care. This paper focuses on how the COP model offers great promise for knowledge-exchange providing a forum to generate and disseminate knowledge around social care in our two COP domains.

Despite calls for greater use of research and an appetite to do so within adult social care, a gap persists between research and practice. To explore views of adult social care staff about research and its application to everyday practice. To understand how these might impact upon research use capacity-building initiatives within adult social care organisations. Thematic analysis of semi-structured qualitative interviews with 25 staff members working within the adult social care departments of three English local authorities. Participants characterised research as feeling separate from practice. They reflected on their use of it in relation to pressures affecting adult social care and identified a lack of relevant research. Research benefiting service users, supporting individual practice or informing organisational decision-making was considered useful. However, research could also be viewed as a luxury where its findings were felt to represent an 'ideal' rather than real world of practice or did not accord with practice knowledge or local experience. While participants feel positively towards research, there remains a gap between these perceptions and its use in practice. There remains a need to improve research relevance and accessibility and to clarify its role in decision-making in social care, including where there is no evidence, where evidence challenges existing practice, or where the evidence base is growing. Collaborative partnerships between adult social care organisations, researchers and service users could help to narrow the research-practice gap and support the routine translation of research to practice.

PurposeThe purpose of this paper is to provide an overview of the process of commissioning adult social care services in England. It reflects the literature on commissioning at the strategic level followed by a section on operational or micro-commissioning. The rest of the paper focusses on the emergence of ideas about outcomes-based commissioning (OBC) in the field of adult social care and ends with critical consideration of the effectiveness of OBC in adult social care as applied to support and care provided in extra care housing.Design/methodology/approachThe review of strategic and operational commissioning in adult social care in England (and Scotland in brief) is based on both policy documents and a review of the literature, as are the sources addressing OBC in adult social care particularly in extra care housing settings.FindingsThe core of this paper focusses on the challenges to the implementation of OBC in adult social care in the context of provision for residents in extra care housing. Of central importance are the impact of the squeeze on funding, increasing costs as a result of demographic change and the introduction of a national living wage plus the focus on the needs of service users through the idea of person-centred care and resistance to change on the part of adult social care staff and workers in other relevant settings.Originality/valueAddressing the implementation of OBC in adult social care in England in the context of extra care housing.

ObjectivesSocial Care Wales have conducted a national research priority-setting exercise as part of the Social Care thematic area within ADR Wales. We would like to present the results and engage in discussions with researchers about how we can develop the research priority areas identified from this exercise into future research activity. MethodsOur priority-setting exercise involved individuals from organisations that routinely collect data, people with lived experience of care and support, social care practitioners, third sector partners, researchers and policy makers. We used different methods of engagement, including surveys, focus groups, workshops and interviews to identify a list of research themes for linked data research. We analysed these themes to determine whether they could be explored using linked data research. The final stage of the priority-setting process involved an independently led workshop to develop a consensus for the top 10 research priorities for linked data research within adult social care ResultsThe priority-setting exercise resulted in 10 research priorities for linked data research within adult social care. These priorities also formed the basis of the team's data acquisition activities. As an ambassador within the adult social care sector, Social Care Wales has been promoting the use of linked data research within adult social care. And developing relationships with data owners across Wales, to encourage them to share data within the SAIL Databank. We would like to work with researchers to discuss these research priorities, data availability and collaborations for future research activities. ConclusionOur priority-setting exercise and ongoing data acquisition activities aim to advance linked data research within adult social care and have a strong focus on public involvement and engagement. Our team hope to present their ongoing and planned work at the conference, using this as an opportunity to engage with the research community.

PurposeThis paper aims to whether current public expenditure on adult social care services might be associated with the number of delayed days of care attributable to the social care system in England.Design/methodology/approachPanel econometric models on data from local authorities with adult social care responsibilities in England between 2013–2014 and 2018–2019.FindingsAfter controlling for other organisational sources of inefficiency, the level of demand in the area and the income poverty amongst the resident older population, this paper finds that a 4.5% reduction in current spending per head on adult social care per older person in one year is associated with an increase by 0.01 delayed days per head the following year.Social implicationsGiven the costs of adverse outcomes of delayed transfers of care reported in the literature, this paper suggests that budgetary constraints to adult social care services would represent a false economy of public funds.Originality/valueThis is the first paper that models the association between public spending on adult social care and delayed transfers of care due to issues originating in the social care system in England.

The idea of ‘co-production’ has been promoted by both New Labour and Coalition governments as a means to help ‘transform’ adult social care. With its emphasis on active citizenship, community support networks, voluntary effort and power sharing, the idea might have been expected to have been received more enthusiastically by those expected to put it into practice and benefit from it. However, unlike other ‘big ideas’ intended to ‘transform’ adult social care, such as ‘personal budgets’, co-production has gained comparatively little traction with either local authorities or service users. Despite the publication of much promotional literature in recent years, co-production has not yet become a significant part of either official or lay discourse on adult social care. It is concluded that apart from definitional problems and conceptual ambiguity, the inability of successive governments to effectively deploy common techniques of meta-governance might also be contributory factors to its sluggish take up.

Evolving occupational health needs for the adult social care workforce due to changing migration patterns: a cross-sectional study

ContextFamily and Group Conferencing (FGC) is a strengths-based approach to social work, originating from New Zealand and now used internationally. Previous research on FGC has focused largely on the context of children’s services but, FGC also aligns with the principle of the Care Act in England to prevent, reduce or delay the need for long-term (and potentially costly) adult care services. Limited previous research has tended to explore potential cost savings associated with FGC, without accounting for the cost of the intervention itself, risking biased results.ObjectiveThis paper aims to identify resource use and associated monetary costs associated with FGC services in English adult social care and mental health settings.MethodsFramework development was informed by previously published work establishing programme theory for FGC, extended by expert opinion and published sources of monetary costs. The framework used scenario-based analysis and a bottom-up costing approach, with sensitivity analysis.ResultsEstimated costs of conducting a standard full FGC (excluding referral) range from £1,455 to £2,043 (adjusted from 2022–2023–2025 prices) from a local authority and National Health Service (NHS) perspective. Costs can vary depending on the involvement of an advocate or interpreter, network size and the complexity of issues being addressed. We report overall costs with and without resource use specifically related to referral.DiscussionHigher staff costs account for slightly higher intervention costs in an NHS mental health setting, compared to adult social care settings.ConclusionReallocating scarce public resources with the intention of preventing, reducing or delaying use of costly future care must be evidence-based as pressures build to meet acute needs. Accurate per-case costing of FGC is a necessary preliminary step towards exploring the cost-effectiveness of FGC. A full economic evaluation will account for costs, outcomes, and alternative options (uses of limited resources).