Case Study: Using a rapid review to develop support for minoritised informal adult carers

The service evidence need

Bradford Adult Social Care Commissioning Team (ASCCT) wanted to develop a new strategy for unpaid carers, with a particular focus on addressing inequalities and improving support for minoritised unpaid adult carers. To develop the new strategy, the team wanted to develop their understanding of the research evidence base on how best to support minoritised informal carers.

Working with the Bradford Health Determinants Research Collaboration’s (HDRC) Evidence into Policy and Practice Hub (Hub), the ASCCT identified the need for a rapid review and agreed the following research aim:

To rapidly identify and summarise evidence on key factors that affect access to support for minoritised informal (unpaid) adult carers which can be addressed at local policy level.

University of York research colleagues, working as embedded researchers in the Hub, completed a rapid review of over 300 research articles and reports and produced a research report briefing for the ASCCT. They also worked with ASCCT colleagues to support reflection on existing support mechanisms for unpaid carers, and to support review and refinement of engagement and consultation processes.

Key findings

The research identified examples of opportunities for local action and produced a ten-point checklist to guide council officers in the development of policy and practice.

1. Recognise diversity within minoritised groups.
2. Ensure support is socio-culturally appropriate.
3. Recognise different understandings of care and carer coping strategies within local policy development and support service design.
4. Ensure gendered hierarchies and inequalities in care work are considered when developing support.
5. Identify racism and discrimination and ‘design it out’ of services.

6.Ensure access to social networks for support, influence and voice.

7. Address exclusions that adult carers with additional communication needs face.
8. Identify and mitigate socio-economic inequalities.
9. Ensure representation of minoritised adult carers in systems of support
10. Ensure there is a ‘whole system approach’ to support carers, including attention to improving data systems and evaluation.

Impact on policy and practice: how the research was used

The research findings have been used in four main ways to:

• Enhance engagement and consultation processes. Based on the findings and through further work with the embedded researchers, the ASCC team have considered ways to amend questions to refine their regular surveys conducted with carers. This involved providing detailed feedback on the unpaid carers survey conducted in November 2023 and offering ongoing guidance for improvement over the subsequent six months. The review also informed potential questions for in-depth community conversations with specific groups of unpaid carers in Bradford to help the Adult Social Care Team address gaps in survey data. A workshop and analysis session were developed to assist the Team in analysing the insights from these conversations.
• Develop the key themes and priorities of the new strategy. The key findings from both the rapid review and engagement and consultation process have been used to develop the new strategy’s priorities and produce an action plan which meets the support needs of minoritised carers.
• Change procurement and service provision. Because of the insights gained from the review and consultation processes, changes to procurement practices, funding and service provision have been made to better support minoritised carers’ needs.
• Develop research capacity. The ASCC team has developed ongoing working relationships with the embedded researcher team and developed research skills within the ASCCT, setting a foundation for stronger research and internal capacity building.

“Understanding how people from different communities view carer support will allow us to change how services are promoted and provided. We have identified the need to target the identification of carers upon the diverse ethnic groups in Bradford and focus providing information on the support available to these communities.”

-ASCCT

Lessons learned

Be led by policy and practice demands. This builds in relevance and use value.

Be prepared to move beyond research roles . Knowledge mobilisation and supporting use in practice requires a wide range of skills. Embedded researchers have to learn how to mobilise research and work in complex political, policy and practice contexts.

Embedded researchers can help develop capacity in local authorities . Collaborating with embedded researchers can develop officer skills and support their understanding of how to use research and evidence in policy and practice.

Becoming embedded takes time. This requires a lot of development work in building relationships, developing trust, and being prepared to become immersed in policy and practice networks.

Evidence needs to be where policy is made. Evidence is used in ‘the everyday work’ of officer and partnership groups. District wide plans set high level priorities but this is not where most policy is made. Map out key stakeholders and policy to practice journeys.

Speak for the evidence. The independence of research and academic expertise supports officers in making arguments for policy.

Developing local authority capacity offers potential for cost savings. For example, the Health Foundation estimates a rapid review to cost between £30,000 to £40,000. Commissioning research is expensive and may not have the flexibility of an embedded research model. Also, there are the potential costs savings to be made from developing more effective policy and practice and improving health outcomes.