Vanora Hundley, Deputy Dean for Research & Professional Practice, Faculty of Health and Social Sciences, Bournemouth University;
Phil Richardson, Executive Director, NHS Dorset Clinical Commissioning Group and Visiting Professor, Bournemouth University;
Jane Murphy, Professor of Nutrition, Faculty of Health and Social Sciences, Bournemouth University;
Lee-Ann Fenge, Professor of Social Care, Faculty of Health and Social Sciences, Bournemouth University and CRN Wessex Specialty Lead for Social Care.
Research is important, and the role that health and social care providers have played in finding solutions to the challenges of the pandemic is evident. Vaccine success has been very much in the news, but it is supported by an array of new treatments (e.g. antivirals) and models of care (e.g. home oximetry) that would not have been possible without collaboration and partnership working. The pandemic encouraged us to put aside our discipline and methodological differences to address the challenges at hand, but we argue that inclusive research, research that brings together health and care, is still a long way off.
The Integrated Care System (ICS) provides an opportunity to systematise research to embed it as everyone’s business. It can be a vehicle to bring together people with a shared interest in research and innovation. Research Active Dorset (RAD) has enabled practitioners and leaders from the NHS and social care to collaborate with the University, Wessex Academic Health Science Network, Clinical Research Network and digital colleagues with an ambition to create a living laboratory. Our Dorset community has established a sound approach to collaborative working, allowing Dorset to be one of four national hubs for innovation and harness the ability to quickly mobilise as a key national centre for vaccine research. Wessex Health Partners combining RAD with teams in Hampshire and the Isle of Wight has built on this strength to create a force for research and innovation with the potential for global reach. This is important because the single focus needs to be on the health of the population. It’s not about clinical trials, or patient recruitment. Our reimagined approach to health and social care is evidence based, needs-led and ICS prioritised to focus on research and innovation as a means to deliver better health for the local population.
Research has been dominated by physical medical health, with most research funding spent within acute NHS Trusts. The model is broken and does not acknowledge the role that social care plays in framing the wider understanding of how social problems undermine health and wellbeing. The traditional focus on payment by patient recruitment is no longer fit for purpose. The need for a more integrated approach has been recognised by the National Institute of Health Research (NIHR), which has supported the inclusion of social care with new roles and targeted funding streams; however there is more to do. In the UK, health service research is viewed as a ‘core function’ planned through research and development (R&D) supported by organisational approaches to build research capacity development. This approach needs to be supported and replicated across social care with increased interest in understanding what works and why (data and analytics to create new innovations). We must consider the wider determinants of health and wellbeing and how these contribute to helping people leading healthier lives. Whether that is in cancer, where a high proportion of treatment is delivered through research, mental health in the workplace, or the social impact of poor housing. We need to make it our business, everyone’s business; working with people in the community, who should be offered the opportunity to be part of making their lives better. We must make the same offer to the professionals that work in this space. This requires a business model, informed by our approach, that challenges the imagination; not one that drives transactional funding decisions.
The social care sector, the voices of its workforce and those who use its services are seldom heard in research. We need to redesign services in partnership with citizens and communities, particularly marginalised groups, and re-evaluate the worth of social care. There is a need to raise the funding, profile and status of social care for meaningful integration. Power disparities between social care and health care may emphasise medical rather than holistic social models of care resulting in tensions. A commitment to social justice within the wider ICS may promote increased understanding of oppressive structures and practices. This includes consideration of societal narratives which can marginalise certain groups, organisational narratives which may highlight risks rather than strengths and professional narratives which reinforce stereotypes.
Supporting disciplines that are underrepresented in research can be achieved through collaborative projects. In Dorset, to improve health and social care outcomes, equity and accessibility for the older population the DONOR project (Digital cOachiNg fOr fRailty) will investigate how a digital approach could be used alongside support from health coaches and social prescribers to help lifestyle management of frailty in its early stages. This research offers a new digital approach combined with a coach, to improve health and live well by accessing person-centred advice and care, reducing the burden on health and social care services. Led by Bournemouth University, it brings together partners including the Dorset CCG, NHS Trusts, PCNs, Wessex AHSN, charity (Help and Care) and University of Southampton. It is one of eight new projects to have been awarded a share of £1.2 million by the NIHR Applied Research Collaboration (ARC) Wessex.
By making access to research and the ability to participate possible we can remove perceived barriers and make it open for all. The ICS gives us a pathway to do this. The Social Care Institute Excellence (SCIE)’s research mindedness criteria (2012) include being prepared to challenge inequality and oppression in all aspects of the research process. The voices of service users and participants from all fields must be included appropriately, for example, through peer models of research which provide ‘insider links’ into communities (Vaughn et al. 2018), and through inclusive participatory research methodologies. We want people to live the best lives they can.
We propose that research should be viewed as a social movement. It’s a place to inspire and be inspired. Permission to make strides in unlocking the value that exists within a community. The opportunity to unleash talent and to be humble. It is the time to ask not what we do in research, but to shout about the difference we make on practice and people’s lives.
SCIE (2012) Research mindedness in social work and social care. Available from: Research mindedness: Research in social care and social work (scie.org.uk)
Vaughn, L.M., Whetstone, C., Boards, A., Busch, M.D., Magnusson, M. and Määttä, S. (2018) Partnering with insiders: A review of peer models across community‐engaged research, education and social care. Health & social care in the community, 26(6), pp.769-786.