Title: Implementing the Care Act 2014: Preventing, reducing or delaying needs for care and support in adult social care in England
Funder: Department of Health and Social Care

Abstract: Background The Care Act places new responsibilities on Local Authorities to reorient their activity so as to prevent, reduce or delay the need for social care services. Existing research indicates that Local Authorities have made some progress in thinking through and implementing models for preventative activity (Allen and Glasby, 2012), and there has been some evaluation of their impact and outcomes, including economic outcomes (Windle et al, 2011; Knapp et al, 2015). Initiatives include the upstream use of personal budgets (Carr, 2013), reablement (Francis et al, 2011) and whole family approaches (Tew et al, 2015) - now the focus of joint guidance to Local Authorities (DH et al, 2015). More fundamentally, this involves rethinking the ways in which Local Authorities engage with local communities and other stakeholders &ndash; both in terms of models of commissioning and provision (Newbigging and Heginbotham, 2010; Miller et al, 2013, 2014; Carr, 2014). Aim The overarching aim of this project is to establish the range of activities being undertaken by Local Authorities to prevent, reduce or delay the need for adult social care and to distil the evidence of outcomes and effectiveness - and associated costs and savings - to support the implementation of the Care Act. This will contribute to the evidence base for prevention in adult social care and enable Local Authorities to achieve better value for money. Research design and methods This is a multimethod study comprising five linked work packages (WPs): WP1 &ndash; literature and practice review to identify models relevant to prevention in social care and evidence of their effectiveness; WP2 - mapping of Local Authority implementation of preventative activity; WP3 &ndash; case study evaluations of initiatives (n=4) aiming to prevent the ongoing need for adult social care; WP4 - case study evaluations of initiatives (n=4) aiming to reduce or delay the need for social care services; WP5 &ndash; researching experience, outcomes and costs for samples of (potential) recipients and carers across both WP3 and WP4 case studies - using measures of capability (ICECAP) and triangulating these with interview data and an analysis of financial data relating to service use. Research team The team brings together substantial experience in researching Local Authority approaches to prevention (Glasby, Miller), upstream approaches to social care and health commissioning (Newbigging), and policy and practice initiatives aimed at prevention and the promotion of health and wellbeing - including personal budgets (Carr, Tew), whole family approaches and reablement (Tew), and care pathways for older people (Tanner). Alongside this, we have expertise in econometric analysis (Ercolani), and capability-based approaches in health economics (Kinghorn). The team includes people who have used care services, and together we have an established track record of engaging at a senior level with Local Authorities and NHS organisations, and relevant bodies such as ADASS, the LGA and Clinical Commissioning Groups. Potential impact As well as publishing our findings in peer reviewed Journals, we will also develop easy-access what works and how to on-line resources for use by Local Authorities to be available via ADASS and the University of Birmingham. We would maximise our impact within the sector through convening a seminar for an invited senior policy audience to be conducted under Chatham House rules and a wider Conference in conjunction with ADASS, Think Local Act Personal and Carers UK. At a local level, we will offer interactive feedback events for stakeholders within each of our case study Local Authorities to share and discuss both findings specific to the site and also the implications of our wider findings and what may be learned from the experience of other Case Study sites.

Lay abstract: The Care Act 2014 places a responsibility on Local Authorities to promote people s wellbeing and to prevent, reduce or delay their need for social care. This may involve acting to stop people s difficulties becoming more serious in the first place, but can also involve working with people (and their family and social networks) to maximise their ability to manage their difficulties and lead full and satisfying lives independent of social care services. Fundamentally, it involves using resources differently so as to help people to build sustainable lifestyles and support arrangements before difficulties become too serious. Previous research has shown that while Local Authorities have undertaken a range of different initiatives to address this agenda (e.g. promoting circles of support , use of technology, or imaginative use of personal budgets), the range, scope and impact of the various types of intervention is not well understood. This study aims to fill this gap by investigating what activity is being undertaken by Local Authorities and what difference this is making. We will first review the current evidence for interventions that can reduce, prevent or delay the need for social care and map what Local Authorities in England are currently doing. From this, we will explore, in depth, 8 examples of where different Local Authorities are implementing new ways of working - either to improve people s situations to the point where they would no longer have any ongoing need for care services, or to reduce or delay their need for social care. The research will be carried out in partnership with people with experience of using care services. In each example, we will examine what is being done differently, how this is being implemented, and whether or not this is making a difference in people s lives. We will also compare the financial costs associated with each initiative and any savings in terms of reduced use of social care and health services. The results will provide both a comprehensive picture of current practice and a more detailed evaluation of the impact and effectiveness of a range of approaches that are now being tried out.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE