A realist evaluative comparison of local authority adult social care commissioning for older people in England

There is now an expectation that social care- the configuration of social arrangements intended to respond to the care needs of older and disabled people - will be high on the list of priorities for social policy improvement in a post-crisis England (Dunn et al., 2020). Social care services are now largely externally 'commissioned' in line with strategic aims related to statutory functions to meet needs, prevent future needs and promote the wellbeing of the local population (Knapp et al., 2001). It is this 'strategic commissioning' function for which I hope to develop a realist framework for comparative evaluation and to illustrate its utility by comparing the strategic commissioning interventions of two local authorities in England.

Social scientists often deal with systems in which there are a number of interacting structures and mechanisms (Gorski, 2013). One such system is the 'social care system' with its complex interaction of structures: state, market, family and community and the social norms and motivations underpinning and emerging from these interactions (Daly and Lewis, 2000). My method will attempt to combine two approaches: realist evaluation (Pawson and Tilley, 1997) and critical realist comparison (Bergene, 2007). It will attempt to clarify, refine and test the programme theory of adult social care commisioning as well as comparing the approach of one local authority with another. It will seek to answer the questions:

1. Which components of adult social care commissioning are linked to outcomes?
2. How these components are linked to outcomes?
3. What are contextual mechanisms impacting the mechanisms identified, resulting in variation in effectiveness

My evaluations will follow three phases:

Development of programme theory: Review of national legislation and policy, review of local policy and initial, exploratory interviews with a cross-section of social care system stakeholders. This stage is intended to clarify the purpose (the theory) of commissioning according to participants in the system. These findings will be contextualised in a literature review, critically analysing the normative motivation of commissioning activity in adult social care as well as the salience of contextual mechanisms.

Data collection: Descriptive statistical data regarding the context of commissioning, the collected data regarding commissioned service activity and theory-relevant outcome data; Qualitative interview data from in depth interviews carried out with 50 participants to explore the components of commissioning linked to outcome delivery and the contextual mechanisms enabling and constraining delivery.

Analysis: I will integrate our various data into a single framework, following Gale et al (2013) and their framework analysis approach to explore the CMO configuration in each case and to compare them.

Bergene, A. (2007) 'Towards a critical realist comparative methodology: Context-sensitive theoretical comparison', Journal of critical realism, 6(1), pp. 5-27.
Daly, M. and Lewis, J. (2000) 'The concept of social care and the analysis of contemporary welfare states', The British journal of sociology, 51(2), pp. 281-298.
Dunn, P., Allen, L., Humphries, R. and Alderwick, H. (2020) 'Briefing: Adult social care and COVID-19', Assessing the policy response in England so far. London: The Health Foundation.
Gale, N. K., Heath, G., Cameron, E., Rashid, S. and Redwood, S. (2013) 'Using the framework method for the analysis of qualitative data in multi-disciplinary health research', BMC medical research methodology, 13(1), pp. 1-8.
Gorski, P. S. (2013) 'What is critical realism? And why should you care?', Contemporary sociology, 42(5), pp. 658-670.
Knapp, M., Hardy, B. and Forder, J. (2001) 'Commissioning for quality: ten years of social care markets in England', Journal of social policy, 30(2), pp. 283-306.
Pawson, R. and Tilley, N. (1997) Realistic evaluation. sage.