Title: Determining Best Preventative Social Care Practice in the Contexts of Older People Receiving Care and Support at Home and Those Living with Dementia
Funder: Health and Care Research Wales (Welsh Government)

Abstract: This proposal will develop and disseminate a theoretical toolkit guiding prevention work in the context of social care. This will be achieved by exploring how key stakeholders currently conceptualise prevention work, and how prevention interventions are delivered and received in two distinct but overlapping priority areas: i) People living with dementia; and ii) older people receiving care and support at home. BACKGROUND Prevention is central to recent social care policy with strategies filtered through regional partnership boards (RPBs) in Wales, or integrated care systems (ICS) in England. Initiatives commonly focus on cost savings, with work undertaken in social care being variable, conflicted and reliant on public health narratives [1]. Most recently, the evaluation of the Social Services and Well-being (Wales) Act highlighted the deficit of a prevention model focussed on the realities of social care and experiences of service users / carers [2]. In a context of reduced social care budgets, there is an imperative to spend wisely. It is a false economy to hastily invest based on an incomplete picture of what preventative social care is, how it happens, and the conditions by which it happens successfully. RESEARCH QUESTIONS i) How, and in what ways, do professional staff and carers involved with prevention activity in the two priority areas perceive their work to fit, or not, within governmental definitions, e.g. primary, secondary, tertiary prevention? ii) How are prevention activities regarded by the service users receiving them? In what ways, if any, is their self-perceived well-being associated with this? iii) How might complexity theory - the study and analysis of complex systems - offer insights into the translation of prevention planning to reality? PLAN OF INVESTIGATION Within an ethnographic case study approach, six interlinked research phases will be carried out: 1. Database interrogation, document analysis and qualitative interviews with RPB / ICS professionals will identify existing / planned prevention activity in the two priority areas. 2. Observations within RPB and ICS board meetings / related activity, shadowing and interviewing around collaborative activities and those within their ‘home’ organisations (e.g. councils etc.) 3. Interviews and observations with carers involved in delivering prevention initiatives, as well as the service users receiving them will explore their perspectives on preventative social care. 4. Synthesis of data, qualitative analysis and development of the initial theoretical toolkit. 5. Participants from Phases 2 and 3 will be re-interviewed to validate findings and the initial theoretical toolkit. 6. Additional data from Phase 5 will be analysed and a further iteration of the theoretical toolkit will be developed. SUMMARY OF BENEFITS The key benefit will be new knowledge and guidance, in the form of a theoretical toolkit, enabling organisations involved in delivering prevention work to invest prudently, maximising the benefits of their investment. This will be available to policy-makers, RPBs, ICS and stakeholders in other sectors with a view to influencing policy. While the pre-eminent focus will be on the priority areas, the aim is to identify characteristics and principles applicable to all preventative social care enabling more effective interventions and a sounder footing for investment decisions.

Lay abstract: BACKGROUND AND AIMS Prevention is core to recent Welsh and UK social care policy. Regional partnership boards (RPBs) in Wales and integrated care systems (ICS) in England play a key role in outlining how prevention is interpreted and implemented. Yet the work undertaken can be variable and reliant on public health definitions (e.g. ’primary’ prevention to intervene before any health effects occur) rather than those of social care. With prevention aiming to reduce dependence on services, it is important that spending decisions are made wisely. It is false economy to invest in social care prevention without clarity on what it is and how it happens successfully. We will address these knowledge gaps by developing a theoretical toolkit for best practice, supporting decision-making on future social care prevention investment. Research will examine how prevention is interpreted and implemented across regions, and how it is regarded by service users, carers and a range of professionals enacting its agenda. The focus will be on two Welsh and UK government priority areas: i) those living with dementia, and ii) older people receiving care and support at home. RESEARCH QUESTIONS Research questions include how those involved in delivering prevention work (e.g. local authority staff, GP teams, health board staff, third sector, private sector, carers) perceive their work to fit within existing government definitions of prevention (if at all), and how older people receiving preventative social care regard such initiatives. DESIGN AND METHODS The study adopts a case study approach with six RPBs and ICS situated across Wales and England over six phases of research: 1. Identifying existing or planned prevention activity in the two priority areas through existing databases (e.g. DEWIS), document analysis and qualitative interviews with RPB / ICS professionals. 2. Observing RPB and ICS board meetings, collaborative activities, and prevention work within ‘home’ organisations, as well as interviewing those involved, to identify how the prevention agenda is interpreted and implemented. 3. Interviewing and observing carers involved in delivering prevention initiatives, as well as the service users receiving them to explore their perspectives on preventative social care. 4. Analysing qualitative data and developing the toolkit (initial version). 5. Re-interviewing participants from Phases 2 and 3 to validate findings. 6. Analysing additional data from Phase 5 and developing a further iteration of the toolkit. PUBLIC INVOLVEMENT The project is dependent on the inclusion of service users and carers as participants, but also arbiters of data interpretation and project outcomes. As such, phases 4, 5 and 6 are structured to allow feedback from participants at the analytical stage. Additionally, Swansea University research centres such as Centre for Ageing and Dementia Research will provide access to public involvement networks for co-developing interview schedules and information sheets. DISSEMINATION We will invite social and health care professionals, third sector groups, primary care representatives, paid and unpaid carers, and service users to a set of workshops. These will outline study findings and the preventative social care toolkit, offering new perspectives on best practice. We will communicate findings to academic communities through papers for academic journals, and by presenting at selected academic conferences.

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