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

现在人们期望，社会关怀--旨在满足老年人和残疾人护理需求的社会安排的配置--将成为后危机时代英格兰社会政策改进的优先事项之一(Dunn等人，2020年)。目前，社会护理服务主要由外部“委托”，以符合与法定职能相关的战略目标，以满足需求、预防未来需求并促进当地人口的福祉(Knapp等人，2001年)。正是这种“战略委托”职能，我希望为其制定一个比较评估的现实主义框架，并通过比较英国两个地方当局的战略委托干预措施来说明其效用。社会科学家经常处理的系统中有许多相互作用的结构和机制(Gorski，2013)。一个这样的系统是“社会照顾系统”，它具有复杂的结构相互作用：国家、市场、家庭和社区，以及支撑和产生这些相互作用的社会规范和动机(Daly和Lewis，2000)。我的方法将尝试结合两种方法：现实主义评估(Pawson and Tilley，1997)和批判现实主义比较(Bergene，2007)。它将试图澄清、提炼和测试成人社会照顾委员会的方案理论，以及比较一个地方当局与另一个地方当局的做法。它将寻求回答以下问题：1.成人社会护理委托的哪些组成部分与成果有关？2.这些组成部分如何与成果挂钩？3.什么背景机制影响已确定的机制，导致有效性的差异我的评价将分三个阶段进行：方案理论的发展：审查国家立法和政策，审查地方政策，以及与社会保健系统各阶层利益攸关方进行初步的探索性访谈。根据系统参与者的说法，这一阶段旨在阐明调试的目的(理论)。这些发现将在一篇文献综述中进行背景分析，批判性地分析成人社会护理中委托活动的规范动机以及背景机制的重要性。数据收集：关于委托背景的描述性统计数据，收集的关于委托服务活动的数据和与理论相关的结果数据；对50名参与者进行的深入访谈的定性访谈数据，以探索与成果交付相关的委托组件以及促成和约束交付的背景机制。分析：我将按照Gale等人(2013)及其框架分析方法将我们的各种数据整合到一个框架中，以探索每个案例中的CMO配置并进行比较。《走向批判现实主义比较方法论：语境敏感的理论比较》，《批判现实主义期刊》，6(1)，第5-27页。Daly，M.和Lewis，J.(2000)：《社会关怀的概念和当代福利国家的分析》，《英国社会学杂志》，51(2)，第281-298页。Dunn，P.，Allen，L.，Humphries，R.和Alderwick，H.(2020年)：《简报：成人社会关怀和新冠肺炎》，评估到目前为止英格兰的政策反应。伦敦：健康基金会.Gale，N.K.，Heath，G.，Cameron，E.，Rashid，S.和Redwood，S.(2013)《使用框架方法分析多学科健康研究中的定性数据》，BMC医学研究方法论，13(1)，第1-8页，P.S.(2013)：什么是关键现实主义？《为什么要关心？》，《当代社会学》，42(5)页，第658-670页。Knapp，M.，Hardy，B.和Forder，J.(2001)《质量委托：英格兰十年的社会关怀市场》，《社会政策杂志》，30(2)，第283-306页。塞奇。

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 effectivenessMy 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.