We do a lot of research about adult social care at Lagom. We work in other sectors too, but social care is a niche we’re very happy to operate in.
We’ve worked with the Department of Health and Social Care on big strategic issues, Skills for Care on services used by the social care workforce, and with those closer to the front line (e.g. Kirklees Council) responsible for the ways care is delivered in communities.
As it happens, before joining Lagom, I worked for the Department of Health (albeit before it added the “& Care”), so I have a long professional association with social care, as well as my own personal experiences of the care system.
But I’ve learned much more about the issues facing people working and receiving adult social care by doing Lagom research projects over the last few years.
The discovery projects and services that we work on are often very different from one another, but there are some recurring themes and patterns.
This blog post draws out what I’ve learned about some of the common issues we see when we do our research.
1. People care about care
People involved in adult social care really care about care. They know it’s difficult, and they know it’s important.
This is true of people we speak to who are involved in policy making, who know that the provision of social care is one of the trickiest issues facing society and governments as demand increases.
It’s true of people we meet who provide care, who are usually incredibly committed to their roles and responsibilities, and are highly engaged in finding ways to tackle the problems they face.
And it is true of the people receiving care, whose daily lives are dependent on the system and services working.
I think this is one of the reasons doing research in social care is so rewarding.
2. People are time-poor
It’s fairly common when we do research into public services to find users that are relatively time-poor. Lorry drivers are busy; NHS librarians have multiple demands on their time; trainees are getting on with their training.
But people in the adult social care sector seem to be particularly time-poor. Providing care is time consuming, and the people we need to speak to often simply don’t have much (any) spare time.
This might affect their ability to take up a service. So the recommendations we make often have to account for this.
And it affects their ability to take part in our research, which we also need to find ways to accommodate.
So while users might be highly engaged (see above), and willing to take part in our research, they can struggle to make the time for a 45 minute interview, or a 90 minute workshop, or even a 10 minute survey.
3. Some parts of the sector are far less well understood
When thinking about adult social care it is easy to default to thinking about the sector as being represented by some of its better known parts, like residential care homes.
But social care is a hugely diverse sector. And while residential care is quite well understood, the way care is provided in people’s homes, by small and large businesses or the self-employed, is just as important, but much less visible.
Government has an excellent source of data about adult social care in England in ASC-WDS. But ASC-WDS only covers about 50% of the sector.
Some parts of the sector, like individual employers and the personal assistants they employ, do not provide data about their services in the same ways, and are far less well understood by policy makers and the public.
4. The less understood parts of the sector may be the most in need of support
Some of those working to provide care in the less well understood parts of the sector may not regard themselves as part of a care system.
But they are likely to be faced with the same issues as those working in the better understood parts of the sector. They may need the same support around skills, pay and career progression.
In fact, the problems they face may be heightened because they don’t have access to the same support as others in more highly structured parts of the sector.
5. Assumptions about (digital) skills are often wrong
It’s easy to fall into some fairly lazy stereotyping when thinking about the adult social care sector.
For example, we often hear from stakeholders in our research that people working in social care lack digital skills.
But when we plot participants in our research on the digital inclusion scale, we rarely find any marked deficiency of digital skills in the adult social care sector, compared to other workforces.
Our findings tend to be much more nuanced. For example we might find issues around access to technology, or connectivity, that are particular to a care service, rather than a lack of digital skills amongst its users.
6. Issues are not the same across the UK
Like health, social care is a devolved issue. And while it is tempting to assume that the issues facing the provision of care might be common across the UK (and beyond), there are often significant differences.
For example, the data held by government about those providing care is not the same in England as in other parts of the UK. England has ASC-WDS. But Wales, Scotland and Northern Ireland all have established registers of those working in care, with close to 100% coverage.
This affects understanding of the sector. It affects the possibilities to provide digital services. And it affects our ability to conduct research.
Moreover, the provision of care differs by region within nations, as well as by nation. So, for example, I’ve learned that it is a big mistake to assume that the issues facing the delivery of care in the South West of England are similar to those faced in the North East.
7. Initiatives are not on the same scale in care as in health
It is common to think about the provision of health and care as being somehow equivalent. But the organisation of adult social care, and the resources available to it, are simply not equivalent to the NHS.
And our research rarely reveals that health and care are (yet) fully integrated services.
We have worked with both Health Education England and Skills for Care recently. On the face of it, they might be regarded as similar organisations. But while they are similar in mission, they have very different levels of resource to work with.
The department I used to work for has added “& Care” to its logo since I left, but that doesn’t mean there is parity in the initiatives that it funds across health and care.
So, for example, the campaign to recruit and retain staff in social care, doesn’t match the levels of the campaign to recruit nurses into the NHS, albeit the scale and urgency of the challenge may be similar.
Note: I tend to be the service designer on Lagom projects rather than the person conducting the user research. Our researchers might write quite a different blog to this one, based on their experience of doing the user research (I’m sure Adam could follow this up with “70 things I’ve learned about care by doing field research in social care”. This might be one in a series.)