Why a holistic approach to public health and social care needs a wider evidence base … and how Social Policy and Practice can help

SPP screenshot2016 has been described as “make or break time for the NHS”, and with pressures on finances increasing, social care and public health are in the spotlight. Around £1 in every £5 of NHS spending is estimated to be the result of ill health attributable to the big five risk factors of smoking, alcohol, poor diet, obesity and inactivity. Investing in prevention, and understanding the complex wider community and social factors that lead to poor health, is therefore important. In cash-strapped local authorities however, investment in preventative projects can be sidelined in the face of tackling acute issues.

Prevention and behaviour change are linked

Recent health policy has included an expectation that individuals should take greater responsibility for their own health. But where we are talking about behaviour change, there is no quick fix. Glib use of the term ‘nudge’ to promote change can suggest that laziness is the only issue. However, research such as that by the King’s Fund has highlighted that motivation and confidence are essential if people are to successfully modify their health behaviours.

Practitioners within the field of both public health and social care need help understanding what works – but as two great recent blogs from the Alliance for Useful Evidence noted, change can be achieved in multiple ways and evidence shouldn’t be used to prove a service works but as part of a journey of improvement and learning.

We talk about the “caring professions”, but it seems that it can be difficult to maintain a focus on the ‘person not the patient’ when budgets are being cut. Well-reported issues such as the rise in the use of 15-minute home care appointments are just one symptom of this. More generally, making time to consider alternative approaches or learn from good practice elsewhere can be hard. That is where having access to a trusted database can help.

Trusted source of research and ideas

The Alliance for Useful Evidence, most recently in its practice guide to using research evidence, has highlighted the importance of using trusted sources rather than “haphazard online searches”. One of these resources is Social Policy and Practice, a database which we have contributed to for twelve years.

“SPP is useful for any professional working in the field of social care or social work who can’t get easy access to a university library.” Alliance for Useful Evidence, 2016

The partners who contribute to the database – Centre for Policy on Ageing, Idox Information Service, National Children’s Bureau, the NSPCC and the Social Care Institute for Excellence – are all committed to sharing their focused collections with the wider world of researchers and to influence policy and practice.

Social Policy and Practice is the UK’s only national social science database embracing social care, social policy, social services, and public policy. It boasts over 400,000 references to papers, books and reports and about 30% of the total content is grey literature.

Social Policy and Practice has been identified by the National Institute for Health and Care Excellence (NICE) as a key resource for those involved in research into health and social care. And importantly, it supports the ability to take a holistic approach to improving outcomes, by covering social issues such as poor housing, regeneration, active ageing, resilience and capacity building.


Find out more about the development of the Social Policy and Practice database in this article from CILIP Update. Update is the leading publication for the library, information and knowledge management community and they’ve given us permission to share this article.

If you are interested in using the Social Policy and Practice (SPP) database for evidence and research in health and social care, please visit www.spandp.net for more information and to request a free trial.

Read some of our other blogs on evidence use in public policy:

Fairness Commissions: tackling poverty and inequality in the UK

by Stacey Dingwall

Next month, Brighton and Hove will become the latest council area to publish the report of its Fairness Commission. Established in 2015, Brighton and Hove’s is one of 24 Fairness Commissions set up in the last five years across the UK, in areas ranging from Dundee to Plymouth.

What are Fairness Commissions?

Fairness Commissions began to come together in 2010, in the wake of rising inequality in the UK. Inspired by the publication of The Spirit Level: Why More Equal Societies Almost Always Do Better by Kate Pickett and Richard Wilkinson (the founders of The Equality Trust), local authorities came together with academics, trade unions, and third and private sector partners to draw  up recommendations for ways of tackling inequality and poverty in their local area.

Similar to a parliamentary select committee, Commissions begin their work by gathering evidence from the public, which is then analysed and synthesised into a final report containing recommendations to the local authority. Typically, this process lasts for a year.

In their report on Fairness Commissions published in July 2015, the New Economics Foundation outlined the typical stages of holding a commission:

  • Scope: decide what and whom you are targeting with the commission.
  • Language: decide what to call the commission and define its purpose.
  • Resource: decide on a proportionate budget and allocation of staff time.
  • Leadership: invite commissioners to participate and appoint chairs.
  • Communication: start talking about the commission locally and invite people to participate.
  • Participation: gather evidence and solutions through a range of methods.
  • Analysis: develop recommendations based on the evidence and possible solutions.
  • Recommendations: make recommendations for change to the relevant organisations.
  • Implementation: put the recommendations into action.
  • Evaluation: monitor progress, measure change, and report on it.

Fairness in London – the Tower Hamlets story

Two key reports have been published by Commissions in London: one by the pan-city London Fairness Commission and another by the Tower Hamlets Fairness Commission. Inequality between the East and West of the City dates back to Victorian times and while Tower Hamlets has seen some improvements, most notably due to investment in education, this gap still persists. Although home to the global financial hub Canary Wharf, a major contributor to the borough’s £6 billion a year economy, 49% of Tower Hamlets’ residents live in poverty – the highest proportion in the entire country. Despite ever increasing house prices and rents in London – an average income of £75,000 was required to privately rent in the borough in 2012 – a fifth of its residents earn under £15,000 a year.

These figures, alongside evidence of stark health inequalities and the impact of welfare reform, formed the basis of the Fairness Commission’s inquiry in 2012-13. Speaking to residents, the Commissioners found a distrust of the big business that now dominates the borough, partly due its perceived contribution to the gentrification of the area. Residents whose families had lived in Tower Hamlets for generations spoke of feeling like they existed in a “parallel world” and that opportunities in the borough were inaccessible to them. The Commission’s final report made a total of 16 recommendations, for local and national government and the third sector, aimed at bringing the local community back together and making Tower Hamlets a fairer place to live.

Fairness and inequality – the political agenda

The London Fairness Commission was one of the organisations who made recommendations to the new Mayor of London ahead of his election on the 5th of May. In a poll conducted one week prior to polling, the Commission found that three out of four respondents believed that the income gap between those on the highest incomes and those on the lowest incomes had increased over the last five years, and that the majority would welcome the introduction of an annual London Fairness Index to test whether the city is a fair one in which to live.

The Index was one of the key recommendations in the Commission’s final report, which described the city as a ‘ticking time bomb’. Housing, transport and childcare were identified as the three biggest issues facing London, and the Commission made a number of recommendations on how to address these, including:

  • a binding London minimum wage of £9.70 per hour;
  • setting ‘affordable rents’ at 30% of household income rather than 80% of market rent; and
  • suspending the right to buy scheme for five years while supply is increased.

Reducing inequalities was also a key feature of the Scottish Parliament elections, with First Minister Nicola Sturgeon pledging that the SNP would “use every power” to tackle poverty and inequality in the country. Sturgeon also detailed plans to implement the recommendations of the Independent Advisor on Poverty and Inequality, publish a Fairer Scotland Action Plan, and reintroduce the socioeconomic duty for public bodies to consider the impact that their decisions will have on narrowing inequalities.

With the UK government committed to continuing their austerity programme, and persistent evidence that the UK is one of the least equal of the world’s developed countries, it’s clear that reducing inequality and striving for fairness will, and must, remain high on the political agenda for the foreseeable future.


Read more from our blog on poverty and inequality in the UK:

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Overworked and under-resourced – ‘mission impossible’ for social workers?

By Heather Cameron

A year on from my previous blog on the emotional pressures facing social workers, have the headlines improved any?

Going by a new Guardian survey of social workers, it would seem that the answer is a resounding no.

The Social Lives Survey revealed that while the majority of social workers enjoy their job, two-thirds say they can’t focus on what really matters and only a quarter feel their workload is manageable. Almost 80% work overtime every day, and 86% don’t get paid for doing so.

Heavy and increasingly complex caseloads was the most common reason given for stress among social workers in last year’s Community Care survey.

Unmanageable caseloads

Unison surveyed social work staff from across the UK about their work at the end of a day in April 2014. Just over half (52%) said their caseload size was affected by covering for staff shortages and nearly three quarters highlighted that there was no formal system in place to help manage their caseloads and ensure they are at a safe level. A significant minority (42%) noted that they left work with serious concerns, the main reason for which was being unable to complete paperwork, followed by being unable to speak to other agencies or professionals involved.

Similarly, in May 2012 the British Association of Social Workers published the findings of its State of social work survey which indicated that 77% of the social workers surveyed said their caseloads were unmanageable. One child protection social worker said “the team I work in currently is working at dangerous caseload levels in terms of child protection work”.

The emotional impact of the challenges of social work were highlighted by a number of respondents, as one mental health social worker described:

It makes me so sad that this job seems only to be possible if you sacrifice your own health and wellbeing

The subsequent inquiry into the state of social work report by the All Parliamentary Working Group at the end of 2013 also emphasised the extent of stress among social workers who are overloaded and under-resourced. It heard from a local authority social worker who said:

 “the more cases we have, the more corners we have to cut, and the more corners we have to cut the more we have significant numbers of children for whom we haven’t had the time to do a thorough assessment”.

Another social worker said that as a result of budget cuts, “the conditions for child-centred practice and safe working are being eroded”.

Impact of austerity

A little over two years on from the inquiry, it would seem there is no let up on the impact of austerity on the social work profession.

A huge majority (92%) of social workers who took part in the Guardian’s survey highlighted that spending cuts are affecting services and putting more pressure on care professionals. And it was felt by 88% of respondents that social work isn’t as high on the political agenda as other public services.

With further cuts to hit local authorities from April this year, following the government’s announcement of a 6.7% funding cut for councils, things may get worse before they get better.

To help offset the impact on social care, local authorities will be able to raise an extra £2 billion through a 2% Council Tax precept and the £1.5 billion Better Care Fund.

Nevertheless, it has been argued that this will not be enough to address the immediate social care crisis or to prevent an estimated £3.5 billion funding shortfall by the end of the decade.

‘Bad press’

As well as spending cuts increasing pressure on social workers, the negative perception of the profession was also raised by the Guardian’s survey:

“The government and media need to stop portraying social workers as child-snatchers and do-gooders. They should sometimes focus on the lives we have saved and positively changed.”

It was suggested that newspapers should also focus on the pressures put on social workers rather than always on when things go wrong, and the government should be supportive of the role and address the lack of recognition and support at the national level.

Way forward?

Perhaps the rest of the UK should be looking to Wales for good practice, where the happiest social workers reside.

In Wales there are lower caseloads, more support from managers and better integration with health. According to one social worker, “it’s a better place to be a social worker. Social work is recognised and valued; in England I don’t think it is.”

Social services in Wales have also been more protected from cuts than elsewhere. And you don’t see the same negative language about social workers in Wales as you do in some parts of the media in England, according to the Welsh Government’s minister for Health and Social Services.


Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Further reading: if you liked this blog post, you might also want to read Heather’s other article on engaging fathers with social work.

Budget cuts hit research in councils’ adult social care departments

 

By Morwen Johnson

The news that budget pressures have affected councils’ ability to carry out research in adult social care won’t come as any surprise to those working in the sector. Councils have cut £4.6bn from adult social care budgets since 2009-10, equivalent to almost a third of net real terms spend, according to Adass. And with research seen as non-essential, it will always lose out in favour of frontline services and care packages.

A recent survey carried out by the Social Services Research Group (SSRG) and commissioned by the Personal Social Services Research Unit (PSSRU), highlighted the scale of the problem though, finding that there were fewer staff to do research, and those who were left had fewer resources and less support.

Dr Chris Rainey, one of the report authors commented: “In-house research is critical to finding out what, how and why services are delivered and what difference they make. The survey points to the need to reinvest in local research capacity to ensure sound evidence is used”.

Barriers to the use of research

As well as low capacity to undertake their own research on local needs, the survey also identified restrictions on training and professional development.

Like other professions, those working in public health and social services face barriers to keeping up with the latest evidence and commentary. This includes lack of time but also the accessibility of much research (both in terms of knowing it is out there and being able to understand how research relates to practice).

The report highlighted the risk that “reliance on internet-based training and information … may result in a lack of exposure to critical debate and an over-reliance on ‘received wisdom’”.

What our members say

The findings reflect our own experience in meeting the information needs of council staff. We’ve a number of adult social care departments who use our Information Service and once staff realise the time savings we offer, they become champions of the service to colleagues. As our team is made up of information professionals and researchers, we offer experience that can be lacking internally. Resources include peer-reviewed journals, grey literature, books and practice-based case studies and evaluations – which won’t be found by searching Google.

Staff also use us for CPD purposes – nowadays spending on event and conference attendance is unlikely to be approved, but our briefings and current awareness services can help keep them up-to-date with essential topics. We also have a lot of resources on general management issues, such as managing teams, benchmarking, performance, equalities and communication.

“From time to time, we review this service and our last review showed that those who use it regularly either in a corporate capacity or in our major strategic services value it highly, describing it as quick, easy, and comprehensive. It gives staff access to a wide range of information and keeps them up-to-date across many areas that are of direct relevance.”

“I recently completed a Post Graduate course and used it as my first reference point at the beginning of each module. The service saved me a lot of time in searching for articles and books and the staff were extremely helpful. The library is well stocked and I didn’t need to purchase any books for the course.”

“Having access to the on-demand research service is a real plus, and most of our staff see real advantage to that. It saves them time in the long run and frees them up to do the day job.

The threat of short-termism

With resources in social care departments likely to remain very tight, but with practitioners under more pressure to deliver than ever, the question is how can local authorities retain and enhance the evidence base it needs to make decisions effectively?

And how can practitioners engage with the research and analysis on key developments in policy that affect social care services, such as demographic change, housing need, and independent living?

It’s worth remembering that local authority social services researchers were introduced as a result of a recommendation of the 1968 Seebohm Report. This report stressed the need for research and evaluation to be ‘a continuous process, accepted as a familiar and permanent feature of any department or agency concerned with social provision.”

But as we approach another Spending Review, it’s likely that adult social care services will face more cuts. This is despite national organisations representing the sector issuing a statement in October arguing that the sustainability of the sector has now reached a ‘crunch’ point.

Focusing on efficiency savings and short-term interventions may seem the only option at the moment, but we risk just patching up problems rather than delivering services which take a holistic and long-term view of outcomes. And that’s why recognising the value of research and evidence should be a key part of decision-making in every part of the public sector.


We are currently offering a free trial of our service for local authorities. Contact us for more information.

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Top 5 trends for public sector technology

The Word 'Digital' on metal

Image from Flickr user Ged Carroll via Creative Commons

By Steven McGinty

At the Idox Information Service, we like to keep up to date with the latest developments in public sector technology. Whether it’s what new digital services are on the market or which direction the government is heading in, we like to monitor everything that could potentially have an impact on our customers, as well as, of course, ourselves.

With the pace of change though, sometimes it’s a good idea to stand still and reflect. Therefore, we’ve decided to sit down, analyse the trends of the day, and produce our very own list of top 5 public sector tech trends.

Here’s what we’ve come up with:

Government as a platform

The recent election win by the Conservatives provides a certain level of continuity for the Government Digital Service (GDS). Over recent years they have been heavily involved in the implementation of ‘government as a platform’. They describe it as:

“a common core infrastructure of shared digital systems, technology and processes on which it’s easy to build brilliant, user-centric government services”.

The most high profile example of the government as a platform approach is the GOV.UK website. In 15 months the government has shifted from having over 300 government agency and arm’s length body websites to having information delivered through just one single website.

The GDS has also introduced GOV.UK Verify, a platform that allows citizens to prove who they are when using government services. At the moment, several government departments have signed up, including HM Revenue and Customs (HMRC), the Department for Environment, Food & Rural Affairs (DEFRA) and Department for Business, Innovation & Skills (BIS).

It is likely that government as a platform will continue, with new government departments and agencies moving onto GOV.UK and GOV.UK Verify. The Chancellor, George Osborne, also announced a greater role for the GDS in working with local government. The result could be a greater use of government as a platform principles in local government.

Government austerity

The issue of tackling the budget deficit was a major theme of the last election. It’s widely accepted that savings will have to be made if the government is to reach its goal of running a surplus by the end of the parliament.  The Local Government Association highlight that local authorities may be particularly affected, estimating cuts of approximately 9% next year. Although it will be interesting to see if a recent warning against further cuts, which has come from Conservative Councillors, will make a difference.

Either way, this will have an impact for technology. It could mean that councils will be looking to find technical solutions to create efficiency savings. We have also seen local authorities working more closely together and sharing services in order to drive down costs.

Data driven decisions (analytics)

The public sector has been using data collected from a variety of channels to provide more efficient and effective public services. Government services are being moved online and users are being encouraged to make this their first port of call.

For instance, Essex County Council has been using analytical and diagnostic methods from the commercial sector to map the ‘customer journey’. They applied this approach to the booking of Adult Learning courses, which requires customers to interact with a number of systems.

‘Open government’

In January, the Speaker’s Digital Democracy Commission published a report on how technology can be used to improve democracy in the UK. Some of the main proposals include:

  • Ensuring that Parliament is fully interactive and digital by 2020;
  • Introducing secure online voting for citizens by 2020;
  • Making sure that published information is freely available in formats suitable for re-use;
  • Using new technologies and social media to help explain the role of the Houses of Commons and increase public engagement.

Health and social care

Health and social care is a key area for technology. The policy of health and social care integration means that technical solutions are required to manage and share information.  Although this has been an issue for decades, the demand for greater savings has meant that this has become a real issue. It will also be necessary to meet new legislative requirements, such as the reporting requirements introduced through the Care Act.


Further Reading:

We regularly write about public sector technology, and how technology based solutions can help drive improvements in public sector service delivery. Other recent blogs include:

A bleak future for UK arts funding?

5349310766_ea97e0ee88_bBy Stacey Dingwall

At the moment, it seems like hardly a week goes by without the announcement of cuts to funding for arts organisations across the country. In July 2014, it was announced that, due to changes in the way it distributes its funding, Arts Council England would be reducing the amount of annual funding it provides to the English National Opera by 29%. On top of this, 33 organisations were informed that their funding would be stopped altogether, and 670 that the amount they receive would be frozen for the time being.

Cuts across the regions

The picture is similar across the country. In October, it was revealed that Arts Council Wales’ 2015/16 budget would be reduced by £300,000 on the previous year. The Arts Council of Northern Ireland is facing an 11.2% reduction in its own budget for the year ahead. And in Scotland, more than half of the organisations, including the Scottish Youth Theatre, who applied to Creative Scotland for long-term funding at the end of 2014 had their bids turned down.

Reactions to these announcements have been widely negative, from the public, leading arts figures and the organisations themselves. Accepting a theatre award last week, the actor David Tennant argued that providing funding to the UK creative industries is an “investment” rather than an “expense”, and that “the arts bring in so much more money to this economy than they take out”.

This was backed up a couple of days later in a report published by the Warwick Commission, Enriching Britain: Culture, Creativity and Growth, after a year-long examination of the UK creative arts sector. According to the Commission, the sector represents 5% of the total UK economy, valued at £76.9 billion.

Despite this, the sector presently receives just 0.3% of public spend annually, a figure which many involved in the sector expect will only decrease; new analysis carried out for the London School of Economics has predicted that English local council spending on the arts could fall by as much as 33% over the next five years. In real terms, this would represents a fall in funding of £750 million between 2014 and 2019, making arts the fourth hardest hit service during that period, behind planning, transport and housing.

Unfair distribution?

Aside from the actual amount of funding provided to the arts, another key issue is its distribution across the regions. In October 2014, the House of Commons Culture, Media and Sport Committee published the report of its enquiry into the work of Arts Council England, which criticised the “clear funding imbalance” in favour of London in the Council’s distribution of grants and aid.

Many have argued that this has been an issue for some time; a 2013 report, Rebalancing Our Cultural Capital, argued that of the £320 million allocated by Arts Council England in 2012/13, £20 per capita went to London, with only £3.60 per head given to the rest of England.

Separate analysis of Arts Council England’s national investment plans for 2015-2018 by GPS Culture, Hard Facts to Swallow, placed the overall balance of investment from the Council’s grant-in-aid and lottery income streams over this period at 4.1:1 in London’s favour. According to this analysis, £689 million (43.4%) will be invested in the London arts scene, providing a per capita return of £81.87 per head of population (php); £900 million will be provided for arts in the rest of England, generating a per capita return of £19.80 php.

Things can only get….worse?

Should there be a change in government at the upcoming general election, it doesn’t look like this will improve the funding situation for the arts. In January this year, the Labour Party was criticised for ‘bragging’ that it wouldn’t reverse the arts funding cuts announced by the coalition government, should it gain office in May. Although she has criticised cuts to arts funding imposed by the current government in the past, the deputy Labour leader Harriet Harman indicated that as “this government has failed on living standards and failed on the deficit”, a future Labour Government would be unable to reverse all of their decisions made regarding cuts going forward, including on arts.

In the meantime, many UK arts organisations are turning to an alternative means of financing their projects: crowdfunding. The last few years have seen many filmmakers and musicians across the world turn to platforms such as Kickstarter to get their projects off the ground, and last year The Art Fund launched its own platform, Art Happens, to help UK museums and galleries raise money for creative projects. Through this, it is intended that British museums will be able to continue to present the innovative projects which they, and the entire UK arts sector, are globally renowned for.


This article was originally published on 3 March on the Idox Grantfinder expert blog.

We are Europe’s leading provider of grants and policy information and have been providing support to UK organisations since 1985.

 

The Autumn Statement 2014

Pound coin

By Alex Thomas

Chancellor George Osborne’s 2014 Autumn Statement was delivered at 12.30 GMT today in the House of Commons. The Autumn Statement is an opportunity for the Chancellor to update MPs on the Government’s plans for the economy based on the latest forecasts from the Independent Officer for Budget Responsibility (OBR).

As many predicted the chancellor committed to further tightening public finances within the statement. He went on to say that if the Conservatives remain in government after the May General Election there will be substantial savings in public spending. Continue reading

A local crisis? Local authorities and the housing crisis

Miniature red and green houses against a white background.By Alex Addyman

England needs to provide between 200,000 and 250,000 homes each year to meet the current housing shortage. The role of local authorities in meeting this shortfall was recognised in the Autumn Statement and has been progressed through some recent policy initiatives. This blog considers some of these initiatives and questions whether local authorities have the capacity to deliver them. Continue reading

Why local authorities should support community organisations delivering local services

3d Community puzzle

by Stephen Lochore

I recently posted about how local authorities can support their communities, and in particular local community groups, at a time when their ability to directly deliver local services is diminishing.  My post touched on the danger of assuming that local groups will be able to step-in to deliver services.  Research into issues such as community resilience, community development and co-production suggests a number of concerns about the role of voluntary and community organisations (VCOs) in delivering local public services. Continue reading

8 ways local authorities can support community empowerment in an age of austerity

community signby Stephen Lochore

Austerity measures implemented by the UK Government since 2010 have reduced funding for some public services and aspects of welfare.  Although local government has attempted to absorb real-term reductions in funding, for example by sharing corporate functions, the scale of the cuts is reducing direct delivery in some service areas.  Discretionary community-level support services have been disproportionately affected by austerity measures. Continue reading