Monthly Archives: April 2012

Forging social care policy amid the white heat of a White Paper

By Martin Knapp

With the Government’s White Paper on Social Care expected soon, all eyes are turned to an area of just a few hundred square metres inWestminster. There, three major Government departments (Health, Treasury, Number 10) will be negotiating (perhaps fighting out) what policies will be included. Whilst we await details, we can expect the White Paper to cover future funding arrangements for long-term care and to set out what needs to be done to improve the delivery, quality and regulation of care and support. Proposals for better integration of health and social care are certain to feature.

The widely welcomed recommendations of the Dilnot Commission report from July 2011, setting out options for financing long-term care, would commit the Government to higher spending at precisely a time when budgets are being cut across the public sector. Many of the other suggestions outlined by the Coalition within months of coming to power – in its vision statement for social care published in November 2010 – might need to be reined in given the economic climate.

So how far can researchers help policy makers in this field? Can we help to deliver improvements in areas, such as the provision and financing of long-term care, that have challenged many of us before us?

PIRU’s role is building a platform of evidence to help the Department of Health to develop the Government’s proposals. We have, for example, been reviewing the evidence on levers that might be pulled to improve the quality of social care. Our literature review suggests that investment in staff training can offer some returns. Likewise, focussing on commissioning may make a difference. We are examining possible financial incentives. However, the evidence base is less than comprehensive in each of these areas.

We are also reviewing research from abroad and in this country on the ways and benefits of achieving closer integration between health and social care. It’s a debate with a long history. However, no country has achieved satisfactory integration of these sectors – each has different challenges. Indeed, even when we look at other countries that have successfully moved further than us on this issue, the picture is clouded by other variables. For example, health and social care systems offer a number of different interfaces with welfare benefits and housing systems. So there are no easy answers.

A familiar plea from the academic community in such circumstances is to call for further research. More realistic advice amid the white heat of Government policy making is to advocate that considerable care be taken in the implementation process. Where evidence is lacking, it will be vital to make sure that consultation is thorough and combined with sound modelling of the impacts of change.

Martin Knapp is Professor of Social Policy, Director of the Personal Social Services Research Unit at the London School of Economics and Political Science, and Director of the NIHR School for Social Care Research.


Desperately seeking the Steve Jobs of healthcare modelling

by James Barlow  

We know that health services need a shake-up. How else can we meet ever increasing demand while holding down costs and improving quality and productivity? But shake-ups, involving novel combinations of technology, services and infrastructure, can do a lot of damage – and still fail to achieve their goals.

Pilots can help but may not reflect the resource-constrained realities of mainstream roll-out. We need better ways to link up the context, process, costs and outcomes of potential innovations at different system levels.

Simulation models can do just this, allowing experimentation with different courses of action in a safe, quick and cheap way. They often temper perspectives that tend to over-estimate the reliability of prediction and bring uncertainty out in the open.

Such models for healthcare planning have been developed since the 1960s, improving communication between diverse stakeholders by creating a shared representation of the whole system. Latterly, powerful computers plus improved graphics and animation have helped, increasing both the potential and accessibility of models. Yet, despite success stories and academic endorsement, the technique has yet to catch on with many clinicians, health managers and policy-makers.

What’s the hold-up? As in many fields that require the adoption of sophisticated communications technology, it’s the ‘Steve Jobs’ problem. Simulation modelling needs to be a lot easier for the non-technically minded, so it feels like a dream, not a scary nightmare. In short, models and their results should be accessible to stakeholders with no or limited experience of modelling.

The pressure is mounting for this development. There is an increasing push on academia, the health services and the health care consultancy industry to ensure that appropriate analytical tools are created, driven partly by the new Cumberland Initiative ( But policy makers, though accustomed to simulation modelling at a Whitehall level, have yet to recognise fully its potential more locally.

We need all these sectors to back a step-change in presentation and usability now if simulation modelling is to become truly embedded in healthcare decision-making at all levels. Sadly, we can’t recruit into healthcare planning the current generation of 10 year olds who would probably find all of this technology more intuitive and easier to use than do their parents. We also cannot afford to delay important changes in service delivery until those 10 year olds find themselves running the NHS.

James Barlow is Professor of Technology and Innovation Management at Imperial College London. He is a co-investigator with PIRU and Co-Director of the Health and Care Infrastructure Research and Innovation Centre.