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

现在有一种期望，即社会护理--旨在应对老年人和残疾人护理需求的社会安排配置--将在危机后英格兰社会政策改进的优先事项清单上占有重要地位（Dunn等人，2020年）。社会护理服务现在主要是根据与法定职能有关的战略目标从外部“委托”提供的，以满足需求、预防未来需求和促进当地人口的福祉（克纳普等人，2001年）。正是这种“战略委托”的功能，我希望制定一个现实主义的框架进行比较评估，并说明其效用比较两个地方当局在英格兰的战略委托干预。社会科学家经常处理系统中有一些相互作用的结构和机制（Gorski，2013）。其中一个系统是“社会照顾系统”，其结构复杂，相互作用：国家、市场、家庭和社区，以及这些相互作用所支撑和产生的社会规范和动机（Daly和刘易斯，2000年）。我的方法将尝试结合联合收割机两种方法：现实主义评价（Pawson和蒂利，1997）和批判现实主义比较（Bergene，2007）。它将试图澄清，完善和测试成人社会护理委托的方案理论，以及比较一个地方当局与另一个地方当局的方法。它将试图回答以下问题：1。成人社会护理委托的哪些组成部分与结果有关？2.这些组成部分如何与成果挂钩？3.什么是上下文机制影响的机制确定，导致在effectivenessMy的评价将遵循三个阶段：发展的方案理论：审查国家立法和政策，审查当地政策和初步的，探索性的采访与社会保健系统的利益相关者的横截面。这一阶段旨在根据系统中的参与者阐明调试的目的（理论）。这些研究结果将在文献综述的背景下，批判性地分析委托活动在成人社会护理的规范性动机，以及上下文机制的显着性。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理论相关的结果数据;来自50名参与者的深入访谈的定性访谈数据，以探索与结果交付相关的委托组成部分以及实现和约束交付的背景机制。分析：我将把我们的各种数据整合到一个框架中，遵循Gale等人（2013）及其框架分析方法，探索每种情况下的CMO配置并进行比较。Bergene，A.（2007）“走向批判现实主义的比较方法：上下文敏感的理论比较”，批判现实主义杂志，6（1），页。5-27.Daly，M.和刘易斯，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），页。281- 298. Dunn，P.，艾伦，L.，汉弗莱斯河和Alderwick，H.（2020）“简报：成人社会关怀和COVID-19”，评估英格兰迄今为止的政策应对。伦敦：健康基金会。K.，希思，G.，卡梅隆，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，13（1），pp. 1- 8. Gorski，P. S.（2013）什么是批判现实主义？你为什么要在乎？”，《当代社会学》，42（5），页。658- 670. Knapp，M.，哈代，B. 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.和蒂利，N. 1997年，《现实评价》。圣人

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.