Adult Social Care in rural and coastal areas – the issues, emerging evidence and process mapping models

We focus on developing the evidence base to support better local and national policy making for adult social care (ASC) in rural and coastal communities (R&CCs). Research in this area has been more neglected compared to R&CC health care. We have balanced methods which are necessarily exploratory and case study based, developing a better understanding of complexity in context, with process tracing evaluation of interventions making efficient use of existing evidence and local understanding to develop robust sensemaking frameworks to guide ASC planning more generally in R&CCs.

Living in R&CCs can bring benefits to people, which is why many are drawn to live there, but demographic patterns and the geographic profiles of R&CCs present increasing challenges to delivering ASC in them. Some of the positive aspects of living in these areas, such as rurality, may become barriers to effective delivery when people start to need ASC.

Workforce shortages, for example, are more significant in R&CCS than in their many urban/inland areas, and national initiatives to address workforce issues in R&CCs have focused on health care. National data provide insights into the challenges of ASC in R&CCs, but may obscure important details e.g. about inequalities and context. More fine-grain understanding of ASC in R&CCs, drawing in local expertise of living with support needs and of planning and delivering care, is required.

Our overall goal it to address the question What are the key issues in the delivery of high-quality adult social care in rural and coastal communities, how does this fit with a local systems view, and what does local and related evidence tell us about potential solutions to help national and local policy making in such communities more generally? Underpinning this is a complexity/systems perspective on delivering care, relationally understanding issues of agency and emergence.

In workpack (WP) 1 we address the question by a scoping review of literature and interviews with a snowball sample of key national leaders to develop a national (England) overview of the issues of ASC in R&CCs. In WP 2 we will work in 3 case study sites, Devon, Cumbria, and Herefordshore & Worcestershire, each with their own assemblages of assets and challenges, mapping ASC and key issues in each site and developing in-depth undestanding of contexts, systems, challenges and possible solutions.

This includes interviews and worshops to bring local expertise to the forefront of understanding contexts. Through case studies we can explore in detail local issues and those crosscutting the localities. An established framework for understanding the delivery of health and care in rural areas will guide our data collection and analysis, allowing comparison across sites and lessons for R&CCs more widely.

In WP3 we will undertake process tracing evaluation (PTE) of a sample of ASC interventions designed to address R&CCs challenges in the sites to understand not only whether they work, but also how and why (in context). PTE provides a structure for developing and logically testing hypotheses for why things do/not work in contexts.

against theory and evidence

A key area of investigation across all aspects of the study will be the relationships between ASC and addressing equality, diversity and inclusion in ASC in the sites and more widely in R&CCs.

Public engagement and plans for knowledge exchange underpin all WPs and help to prepare a pathway to impact, drawn together in WP4.