Title: Improving choices for care: a strategic research initiative on implementation of the care act 2014
Funder: Department of Health and Social Care

Abstract: The proposal is for research to examine the Care Act 2014 implementation support programme. In order to meet the tender brief s requirements to identify what works and provide examples of effective practice in terms of implementation and potentially transferable lessons the proposed study supplements the evidence on policy implementation with evidence on service improvement . The aim is to assess the impact of the national and regional partnership programme on local implementation by: identifying key lessons from evidence and practice evaluating the impact and effectiveness of support arrangements understanding implementation issues at local level developing a framework for successful improvement developing transferable knowledge We propose to undertake an analysis of the partnership support programme and how it has facilitated local transformational change and service improvement. This is a mixed-methods case study design with the data collection undertaken at macro, meso and micro levels. The proposed research has three strands: Strand 1: Identifying &ldquo;effective practice&rdquo; We will synthesise findings and lessons from three related streams of literature to help structure a theoretical and conceptual framework for our investigations: the literature on policy implementation; on service improvement; and the available evidence from the impact of different approaches to policy implementation support domestically and internationally. We will construct an evidence matrix of approaches to supporting implementation of national policy and programmes and consequent service improvements identifying supporting evidence in relation to the methods used, the context in which they are used, and what kinds of outcomes are identifiable. Strand 2: Analysing the partnership support programme This strand will involve a detailed analysis of the Care Act partnership approach &ndash; its impact on local authority planning, decision-making processes and service delivery with data collection and analysis at three levels: Macro: At national and regional levels we will examine the roles and functions of the key support mechanisms and structures in order to identify the key elements of the partnership approach and the respective support mechanisms of the reform programme board, programme management office and work-streams and regional leads. We will use a mixed-methods approach involving interviews and document analysis to examine process and impacts. Meso: To examine how local policy and decision-making are influenced by and respond to the national support programme we will conduct in-depth research in two County and two Unitary councils and two Metropolitan/London Boroughs in England. We will undertake interviews with senior directors and councillors as well as observe strategy meetings and analyse key documentation. Micro: To identify the degree to which various national, regional and local support initiatives have helped facilitate and deliver local service improvement. This will involve interviews with staff and user representatives to understand how service improvements are being enacted. Strand 3: Developing a framework for service improvement support by synthesising the findings from the two previous strands to understand multi-level coherence between the macro, meso and micro levels for service improvement support that is well placed to bring about sustainable change for the Care Act and also other policies. Dissemination: We will adopt an iterative approach to the research providing regular feedback. We will provide a report at the end of year one on the evidence matrix and an initial analysis of early findings. We will utilise social media forums and dissemination opportunities and in year two run a national workshop to present our initial findings and provide a validation platform of key learning, and produce a final report. The research team is exceptionally strong in terms of its experience in, and institutional commitment to, conducting research to inform health and social care policy and practice; developing underpinning methods; and engaging with stakeholders.

Lay abstract: The difference between formulating a policy and making it work in practice, the policy-implementation gap , has long been recognised as a problem by policy makers and those responsible for putting policy into practice. To date, little attention has been paid to identifying the best ways of improving successful implementation in practice. The Department of Health, together with other central and local government organisations and professional bodies, developed a partnership programme for the Care Act 2014 involving innovative implementation support systems at national and regional levels to ensure local areas were well-placed to deliver the changes required. This project will evaluate the extent to which these support arrangements have been successful. We will identify those elements that supported successful implementation and explore how they can be replicated for other major government policy programmes and initiatives. We will review what has been done previously in other national programmes to assess their respective strengths and weaknesses. We will consider what constitutes good practice across a range of centrally driven national programmes designed to support the introduction of new social care related policy initiatives. We will also undertake research in a number of local authorities to examine the experiences and impact of the Care Act implementation support arrangements. We will examine evidence at four levels &ndash; national, regional, local strategic and local frontline, including the views of users and carers &ndash; in order to build a comprehensive picture of what works under what circumstances when viewed by policy makers, local service providers and the users of services and their carers. Finally, we will pull all this evidence and learning together to develop guidance for central and local governments for supporting new policy initiatives in social care and health. We are especially keen to establish links between the Care Act support and the early experience of NHS Improvement &ndash; the new NHS agency for supporting service improvement in the healthcare sector. We recognise that any framework will have to be adapted to specific contexts and issues, but anticipate that the components will serve as a guide to governments on actions most likely to bring about favourable results.

Research activity codes: 8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE