Title: Shifting Shapes: How can local care markets support quality and choice for all?
Funder: Department of Health and Social Care

Abstract: Background: Whilst local authorities have long had a role in supporting local care services, the Care Act 2014 has placed a duty on local authorities to promote diversity and quality in the market of care and support providers. This stems from a recognition that the current market of social care services will not adapt to offer more person-centred and diverse services without local authority intervention1. Local authorities as market-shapers need to ensure the provision of effective local information services as well as a wide choice of high-quality and cost-effective care providers which are sustainable in a context of shrinking budgets. The detailed project aims given above can be summarised as the aim to assess care market diversity and sustainability, nationally and in eight case study local authorities, through: Mapping local care markets to assess types and sizes of care provider, and levels of self-funding. Identifying local authority market-shaping activities in relation to the provision of information and services. Evaluating the experiences of people using services (both self-funders and those receiving local authority funding). Measuring the cost-effectiveness of market-shaping activities of local authorities. Improving local market-shaping behaviours through peer support. Research Plan and Methods of Investigation: A national survey of local authorities, national and local stakeholder interviews and secondary data analysis will be used for national and local mapping of care markets. Local research will be undertaken in eight case study local authorities, purposively sampled to have different care market profiles. The project will also undertake qualitative interviews with people who run and use care services, as well as carers. This qualitative data will allow an assessment of the quality of information and care services, the sorts of choices people can and want to be able to make within their localities, and will enable a linking of care outcomes to the cost-effectiveness of providers. The Research Team brings academic rigour but also the ability to translate findings into practice for front-line services and to support positive service change. Needham, Allen, Hall, Glasby, McKay and Brant worked together on ESRC-funded research evaluating micro-enterprises in social care. Goranitis is a Research Fellow in health economics at the University of Birmingham, specialising in the economic evaluation of health and social care interventions. Further guidance on economic evaluation will be provided by Professor Tracy Roberts, in an (unfunded) advisory capacity. Glasby has led and contributed to many large research grants. McKay has extensive experience of undertaking large-scale quantitative analysis of secondary and primary data. Mangan and Glasby were commissioned by the DH, LGA, TLAP and ADASS to develop Commissioning for Better Outcomes2, to guide Care Act implementation. Brant is a service user co-applicant with experience of co-producing research. Henwood is a consultant with extensive experience of researching personalisation and self-funders experiences. Carr has worked with DH, SCIE and TLAP on the implementation and evaluation of personalisation reforms, particularly for older people and mental health services. Potential impact/influence on the relevant policy field, users, carers and wider stakeholders: This is a mixed methods study with a national overview and detailed local case studies, which combines quantitative and economic expertise with qualitative research, with a strong role for people with experience of using services. As such it has the breadth and rigour to generate findings which national policy makers can use in developing effective market-shaping resources, with clear benefits for users, carers and providers. The final six months of the project are implementation-focused, using a peer review methodology to share research around the eight sites and within regions, which should facilitate rapid take-up of findings and more effective markets for local people.

Lay abstract: Under the Care Act 2014 local authorities have a responsibility to ensure that there is a wide variety of good quality care services available for people who need them. Older people, people with disabilities, people using mental health services and carers need information about what services are available. Those services should be person-centred and high quality. Cost-effectiveness is also important: providers of information and services should offer value for money; local authorities should be spending money effectively to support a wide range of good quality providers. This is particularly vital given the context of an overall reduction in spending on social care. This project will assess how far choice and good quality are available, looking at national information on the diversity of the care market, and then focusing in depth on what support and services are available in eight local authorities. It will look at existing information on people's experiences of care services, and also interview people who design, support, run and use care services to find out whether services are diverse, good quality, and easily accessible. Some people who use care services pay some or all of the costs of care (and are called self-funders), whereas other people's costs are paid for by the local authority because they do not have enough money to pay for care themselves. The research will include both of these groups, recognising that they may have different experiences of care. Talking to users and carers is likely to be particularly effective when other service users and carers do the interviews, as they can often establish a rapport with interviewees. The project will include service users and carers as co-researchers, involved in designing the research, doing the interviews, identifying key findings and telling people about the research findings. Standards of good practice in conducting research will be followed as required by the Social Care Research Ethics Committee. The research will comply with the University of Birmingham policies on the conduct of research and the Data Protection Act. Interim and final reports will be publicly available.

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