Social care – looking back, looking forward

Author Helen Mthiyane
Posted 2020.07.17

Our chair and presenters from the HSR UK 2020 plenary 'A Crisis in Adult Social Care? Learning from Across the UK' summarise key themes from their presentations, and questions from the audience.

In a week where Simon Stevens underlined the need for urgent reform, we were pleased to shine a light on social care at the HSR UK 2020 conference earlier this month (the plenary session can be watched here). We heard from researchers with different perspectives – Patrick Hall on what we can learn from comparative systems in different parts of the UK (and Europe); David Bell showing how the double crises of social care and COVID-19 formed a perfect storm; and Reena Devi on participatory research with care homes to support and foster improvement and innovation.

These were different lenses but some common threads emerged. Many vulnerabilities are longstanding, but exposed by the recent pandemic.  In the memorable words of Warren Buffet quoted by David Bell, “when the tide goes out, you see who has been swimming naked”. In terms of adult social care this relates to the fragility of provision, with chronic underfunding, an unstable care home market, and long standing challenges with recruiting and retaining the care workforce. At the same time, many decision-makers are acting in the dark, with a serious lack of complete, routine, comparable information on needs, activities, health status, costs and outcomes. It was good to hear of NIHR funded work ongoing to provide an overdue care home core minimum dataset to help future planning and research. But also we heard how the low policy salience has led to political paralysis, with successive administrations failing to act on well recognised problems. The recent COVID-19 crisis highlighted the lack of parity between NHS and social care, although there are more than double the number of residents in care homes as hospital patients. Looking at different policy and funding systems in place, Patrick Hall showed us a variety of approaches to the same challenges across Europe, with England’s model of means-tested local authority social care by no means the norm. 

We had a lively (virtual) Q&A session. While older adults have suffered disproportionately from the outbreak and in the wider crisis of adult social care, we also discussed social care support for people of working ages with complex needs and disabilities. There were questions about the vulnerabilities of people with learning disability and what is still unknown about their risk and outcomes in the pandemic. We are not just talking about care homes and institutions. There were questions too about home care services. Analysis of excess deaths post-COVID suggests that recent decline in hospital and care home mortality rates is not mirrored in homes and community settings. And the hidden iceberg of sustained and often invisible unpaid care by family and others remains a gap in policy and public narratives.

Other participants raised issues about the use of language and the need to avoid medical models when looking at the way forward for social care. Reena Devi showed how we can’t assume that what works well in healthcare settings will also work well in social care. For example, the phrase ‘quality improvement’, widely used in healthcare, is received differently by care homes and others, implying performance regimens and failure.

To resolve these challenges requires political will and focus. But there were also signs of optimism in models of embedded research, such as the one outlined by Reena Devi where researchers identify what matters to people living or working in care homes, translate this into research questions and search for evidence based answers. And from bottom-up to top-down, we saw the benefits of macro-level analysis in Patrick Hall’s overview of approaches taken by other countries facing similar challenges. Indeed, the potential for research to make a difference is evident in David Bell’s work over many years influencing Scottish policy and practice on longterm care. Most recently, he has been leading a team from Scotland coordinating a report on COVID-19 and long-term care in the UK as a whole which will soon be published at  

Our debate highlighted areas where more research is needed in social care, including pressing issues post-COVID on recovery, social isolation and effects on vulnerable population and groups. One participant raised an interesting question of the natural experiment of exceptional measures to speed and support discharges from hospital during the COVID emergency – were there any takehomes from this for normal times? Another participant wondered if other responses, such as Northern Ireland’s deployment of health staff to care homes or cash grants to care staff in Wales have had any sustained impact on staff turnover or morale?  How do we spread innovation and best evidence on coping with COVID and other pressing issues in such a dispersed sector? Many research funders from ESRC to NIHR to the Health Foundation are prioritising work and putting out new calls and programmes in social care research. It has never been a better time for research to address the many and urgent questions on approaches to support the most vulnerable in new ways.


Tara Lamont is a Senior Scientific Adviser (Evidence Use) at the Wessex Institute and an HSR UK board member @TaraJLamont

Professor David Bell is a Professor of Economics at the University of Stirling @DavidNFBell

Dr Reena Devi is a Senior Research Fellow at the School of Healthcare, Faculty of Medicine & Health, University of Leeds @_DrReenaDevi

Patrick Hall is a Research Fellow at the Health Services Management Centre, University of Birmingham