I, along with my colleagues from the Research Design Service (RDS) South East and RDS South West, recently attended the 5th International Clinical Trials Methodology Conference, which was held this year in Brighton. In addition to attending various talks and sessions, we were involved in one of the conference’s debates – a new item on the programme. The debates were held to encourage discussion around potentially conflicting areas and the conference organisers were keen to play up the potentially antagonistic views held by the speakers on either side of the debate’s motion in a fun and playful way. For our debate, RDS SE Director Jörg Huber decided to focus one of the NIHR’s more recent research priorities – social care research – and to facilitate discussion on whether research in this area is ready to make use of the methodologies employed by clinical trials in health research. The debate was very good-natured and we purposely played up the potentially opposing points of view.
Helen Weatherly, from the Centre for Health Economics at the University of York, took the first position: that the social care evidence base could be enhanced by using the methodologies of clinical trials. She argued that reductions in public expenditure on social care amidst increasing costs meant that the area was ripe for robust research to identify effective and cost-effective interventions. This position is underlined by the work of funders such as NIHR in establishing social care research bodies such as the NIHR School for Social Care Research and funding streams such as the NIHR Research for Social Care call. Given this need for high-quality research, and provided investment is there for researchers and research infrastructure, is social care research really that different to health care research? Indeed there are many similarities – both cover broad-span, complex interventions for which guidance on research methodologies and design already exists – the MRC guidance, for example. Trial design offers technical and ethical advantages in demonstrating the effectiveness of interventions and the methods of trials have been developed in a culture that has been able to embed research in its practice. There are challenges, of course, and we do need to be mindful of the differences of the social care environment, the training and education needs of social care practitioners, and the need to raise awareness of the value of involvement in research. However, there remains value to utlilising the clinical health care research methods in social care research and this is something for which we should strive.
Rosemary Greenwood, from RDS South West and the University of Bristol, and Ann-Marie Towers, from RDS South East and the University of Kent, argued for the second position: that social care research is not yet ready to employ the methodologies of clinical health research. They argued that social care research is still at far too early a stage for such an approach; that even getting a PICO right for a social care research project is fraught with difficulty. How do you get an ‘unbiased’ group? How can you randomize care homes to interventions which *they* are going to have to pay for? This latter is a crucial point – who is going to pay for these novel social care interventions? Social care interventions require co-production, but the resources for this co-production simply hasn’t existed until very recently. We first need to concentrate on using the available research funding to develop such interventions before we even consider evaluating their effectiveness in randomised controlled trials. And, in the meantime, considerable work needs to be done to the social care sector as a whole – from workforce capacity and training to research management infrastructure and incentivisation – for delivering such trials. We also need to figure out the pathways to impact with social care research, especially given the multiple providers of social care and an ever-changing policy backdrop.
We had great engagement from the floor. Issues raised included highlighting that we need to figure out where children’s social care fits into this picture, as current NIHR funding initiatives focus solely on adult social care. And that we really need to be talking about ‘health *and* social care’, as they’re often indivisible from a clinical perspective. Points were also made about the challenges involved with engaging different providers from different sectors with different economic and finance models.
It was a fascinating debate with excellent points from all sides – thank you so much to our excellent speakers! Ultimately, I think we all really do agree that both opportunities and challenges exist as we design and fund social care research and that we must work through these issues together. Social care research is undoubtedly a priority for funding by the NIHR and rightly so. But, as with all NIHR-funded research, it must be of high quality and utilize appropriate research methods. Research questions need to be clearly defined and centred around service users, with outcomes leading to tangible changes to practice which will benefit both the care system itself and the lives and experiences of those who use it. The research methodologies employed to answer these research questions therefore need to be appropriate to producing the right kinds of data. It may very well be the case that these methods will be those already being employed successfully in health care research, but they equally may be entirely different. We need to be aware of, and sensitive to, the different professional and research environments and open to the potential need to adapt or develop new methodologies that may be better suited to the social care arena.
Social care research is here to stay. And your local Research Design Service is here to help you design your research study and apply for funding.