December 4, 2025 • 22 mins
Care Ecosystem: Research update and next steps
Professor Catherine Needham and Dr. Emily Burn (Centre for Care, University of Birmingham) update us on the progress so far in their cross-cutting research theme at the Centre for Care, which looks at what makes social care a complex, adaptive ecosystem and how understanding this help improve care outcomes for all.
They reflect on their previous research with the Local Government Information Unit on Scotland’s proposed National Care Service, we get an overview on what a Care Ecosystem is, and we hear about future plans for the research theme as they continue to "watch the ripples" with our other teams.
Related linksThe images discussed in this episode of a 'Flourishing Care Ecosystem' can be found on the 'Care as a Complex, Adaptive Ecosystem' research theme page here: https://centreforcare.ac.uk/topics/care-as-a-complex-adaptive-ecosystem/
Read about Catherine and Emily's work with the Local Government Information Unit here: https://centreforcare.ac.uk/commentary/2025/01/developing-a-national-care-service/
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Learn more about our research on the Centre for Care website here: https://centreforcare.ac.uk/
The CARE MATTERS Podcast is produced by Dan Williamson at the Centre for Care and CIRCLE.
---Intro/outro music: Music: https://www.purple-planet.com is licensed under CC BY-SA 3.0
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:05):
The Care Matters podcast is
brought to you by the ESRC centrefor Care and CIRCLE, (the centre
for International Researchon Care, Labour and Equalities).
In this series, our researcherswelcome experts in the field
and those giving or receiving careto discuss crucial issues in social care.
(00:27):
As we collectively attemptto make a positive difference to how care
is experienced and provided.
Hello
and welcometo another episode of Care Matters.
My name is Dan Williamson.
I'm the digital and communicationscoordinator for circle
(00:48):
and the centre for care.
I'm also the producer of the Care Matterspodcast.
Today, I'm very pleased to be joinedby two centre for care
colleagues, ProfessorCatherine Needham and Doctor Emily Burn
who are basedat the University of Birmingham.
Hi, Catherine.
Hi there.
And hi, Emily.
(01:09):
Hi there.
Catherine and Emily work on our CareEcosystems research theme,
which explores what makes social carea complex, adaptive ecosystem.
And how can understanding this helpimprove care outcomes for all.
Today we're going to be catching upon this research so far
and looking forwardto what 2026 has in store for this team.
(01:33):
Catherine, we'll start with you first.
An ecosystem is a metaphor for nature,which we often use in social science
when talking about somethingwhich is complex and interlinked,
and when no one is controlof the whole thing.
What do we mean when we talk aboutthe term care ecosystem?
Yeah.
(01:54):
So we use the term ecosystemto try and convey
the complexity of, social care.
So I think it's quite common now
to talk about complex adaptive systemsand complexity in public services.
And that's really helpfulbecause that helps us understand
that some of the issuesthat public services help us with,
(02:14):
things like health and housingand social care are interrelated.
So you cannot address somebody's healthneeds and leave them in poor housing.
And people are not gonna be able to studyif they're, got,
difficult circumstances at home,in social care, which we focus on.
You know, as people,we want people to be able to access
(02:35):
good quality,affordable and tailored support.
Then we recognise that has to be partof a, a kind of holistic offer,
making sure that people are livingin the right circumstances that they got,
they can get outand do the things they want to do in life.
So, so thinking about thissort of interrelationship
between differentelements of people's lives,
(02:55):
and also, I think
recognising thatthere is a sort of complexity to that.
So to say something is complex is notthe same thing as to say it's complicated.
So complicated issues
have got lots of elements, sothat can be hard to get our head around.
But they operate on the basis of,cause and effect chains.
So we might say thatsomething like building
(03:15):
a new hospital is complicated,but it's not complex.
If you've got the right materials
and you put them up in the right waywith the right engineers,
you'll get a hospital.
What goes on in the hospital,the kind of interplay of staff
and buildings and patients and families.
That is a complex system.
(03:36):
And so we want to kind ofbring that to, to social care.
So what does sort of complexity, mean?
And thinking about kind of ecosystemis a good way to convey that.
So I think there's sort of three thingswe might say,
benefit us if we think about social careas a complex ecosystem.
So firstly, it's about being holistic.
(03:58):
So rather than sayingwe're going to focus on unpaid carers
or we're going to focus on providers,or we're going to focus on,
the workforce,or even people in receipt of care.
We want to sort ofthink about all of those things together.
So think about, holistically,how those experience
so that the interdependenciesbetween those shape our understanding
(04:18):
of the whole social care system.
I think another advantageof thinking about a complex
ecosystem is related to what we might callkind of boundary issues,
and the fact that there aren't clearboundaries, it's not kind of
very clear where sort of social care ends,because it kind of goes over
into the things that we do in our familiesand in our communities.
(04:39):
You know,social care is a sort of quite complex
interaction of things that the statedoes, things that the market
does, things that our families do,and then things we do in the community.
So we need to kind of recognisethat it's not clear
necessarilywhere the end of kind of social care is.
And so we have to be alert to thatwhen we're trying to study it.
(05:01):
And then I think the the third reasonwhy it's useful
to talk about kind of complexityin a complex ecosystem
is because in complexity theory,we understand that you can't intervene
in a systemand expect to predict predictable results.
You can't kind of pull a leverif you're like in local government,
you're a commissioner.
You sort of redesign, a home care contract.
(05:22):
You can't necessarily understandhow that will play out in
what is a very complexlandscape of delivery of care.
So some things might be predictable,some things not.
But if, for example, there'slots of things outside your control,
so it's the wages of social care workersgo up.
Or there's a change in the visarequirements for international workers.
(05:42):
These are both thingsthat we've we've seen recently.
This then starts to reshapewhat's possible for you within your own
local space.
And so, being understandingthat sort of difficulty around
kind of cause andeffect is part of complexity.
So given
that interesting complexity,we were just starting to think about,
well, how can we kind of conveythe sense of a complex ecosystem
(06:05):
in a way that doesn't itselfbecome so difficult to explain that
it's actually, really hard toto convey the idea.
And so in the end,we decided to do that with an image.
And you can see that image, on our,website.
And the image is really tryingto show the,
using the metaphor of a natural ecosystem
(06:26):
and all the kind of interdependenciesof that to show the interplay
between the bits of social care,which are quite
sort of visible in the sensethat they are building things.
They are formal state services.
So things like a care home or, domiciliary care or
the kind of a hospital, because we knowthat health and care are so interrelated.
(06:47):
Those are the kind of visiblebits of the system,
but actually they're completely predicatedon what are often
the kind of more invisible bits ofwhat kind of communities and families do
to give people a sense of meaningand purpose and a good life.
And we know that a kind of a goodlife is really what social care is about,
about helping people to access the thingsthat they enjoy doing.
(07:07):
And that were, you know,give them a real sense of,
of, of enjoying life and flourishing.
So we don't just want to thinkthat social care, as somebody who comes in
to get you out of bed and wash out, helpsyou with food, it's really about seeing
that as a, as a sort of jumping offpoint into what gives people a good life.
And we think this sort of ecosystem
(07:27):
conveys that broader sense of a good life,but also the interdependencies.
So the things that are sort of abovethe soil line and are visible
are all dependent on a kind of abundantsupply of family and community
who can really support people in the waysthey want to be supported.
So we need all of this,and it's all interrelated.
And we felt that the concept of anecosystem is of metaphor, of an ecosystem.
(07:52):
And the image, really conveyed what ourunderstanding of the care ecosystem is.
Thanks, Catherine.
That's great.
And as you say,the image of a flourishing care
ecosystem is available to viewat the UK's centre for Care
Act UK, and I will include a link
to this in the descriptionfor this episode.
(08:16):
Let's now look at what you've learnedfrom your research at the centre for care.
What do we knownow about the care ecosystem?
So this is a work
in progress, and we'll talk to youabout some of the work that we've done.
And we'll hopefully come back today, dateand tell you
when our projects have finished.
But I think one of the first thingsthat we really had to wrestle with was,
(08:38):
how do you study an ecosystem?
Because of what I've said so far,
is that the notionthat the boundaries aren't clear.
So everything is sort of in view.
You can't can study causal effects,
maybe in the way that we might likenormally is doing an AI research study.
So I thinkone of the things we've been doing
is really trying to get a handleon how we might study an ecosystem,
(08:59):
and we've been doing that in dialoguewith, lived experience partners.
To sort of really think aboutwhat might make a meaningful set
of inquiries into the care ecosystem.
So we've done thatin a number of different ways.
So we've been involvedin some of the dialogue
around, sort of redesigningthe whole care ecosystem.
(09:21):
So the at the national level.
So that's relating to, say,the National Care Service plans
in England and Wales and Scotland,and we're trying to be part of that.
So dialogue too, so that we can helpmake the case for needing to think
holistically about carerather than intervening in these very
discreet ways and not thinking throughthe consequences of doing so.
(09:46):
We've
also beenlooking in within local authorities.
So within local government,
at some of the waysthey're trying to make changes
in the care, services and thinking
again, holistically about whatthat might mean for the care ecosystem.
So, doing some work in onelocal authority,
looking at changes to its homecare service
(10:08):
and thinking aboutif you're moving it to a more,
sort of patch based modelwhere, it's more locality based.
So each care providerwould be based on a particular locality.
There's potentially lots of great things,might come from that.
And we need to sort of to follow throughwhether, you know, whether that does help
(10:28):
get better outcomes for people,maybe get them discharged quick, more
quickly from hospitalbecause it's really clear
which agency is responsiblefor that postcode.
Whether it helps, it's more efficientbecause the workers,
the care workers can dowalking round between houses
because they're all locatedin the same place.
So lots of reasonswhy that might be a great idea.
(10:48):
What one of the things we're doing istalking to providers, talking to the to,
people in that area to really understandwhat how has this played out?
Because we think, really the only wayyou can study a Carrick system
is by kind of watching the ripples.
So we're watchinga particular intervention and,
and seeing how that changes,
(11:08):
speaking to peopleover a period of time to say last,
you know,
we came to see a year ago when you werejust starting on this intervention,
what's happened,what the things that were expected,
what wasn't expected, what happenedwhen there was a national change
to the visa regime,which is totally out of your control?
How did that
then start to reshape thingsso that we can be thinking holistic about,
(11:29):
you know, when you make an intervention,
how does that affect the systemas a whole?
So, that's really all kind of,our focus is to think about
specific changesand then how they, spread out to affect
the, local, national, care systems.
And then also, you know, thinking aboutsome of the more international elements,
(11:50):
given that so much of our care workforcecomes from overseas, recognising that
all these different levels of the careecosystem are interrelated.
And that that's another elementto that we need to bring in.
Thanks.
And what an interesting metaphorwatching the ripples is when thinking
about the care ecosystem, it makes senseof how interlinked social care can be.
(12:12):
Emily,perhaps now you can tell us what is next
for the care ecosystems theme.
Yeah. Of course.
I suppose just, Just building
on what Catherine saidthereabouts of how we can apply.
So this idea of the social care ecosystemto different levels
say we will be working at the levelof the local authority.
(12:33):
Like Catherine said, looking at changesto the way the local authorities
commission home care.
So looking at this patch based approachand also sort of zooming out more,
to instance of changesare being made at a national level.
And so those implicationsof national policies
say we'll be working with colleaguesat the centre for care
(12:55):
and with it.
And so
to understand sort of shiftsin the immigration system over the last
18 months have been sort of great changes,sort of in terms of
as the international workforceand being unable to bring their dependents
with them, but also the sense that nowproviders need to prioritise is employing
(13:15):
people who are already in the countryon their health and care visa.
And so really trying to understandthe implications of that on the way
that providers so work to recruit their, their workforce.
Also of the wider effects of thatwithin local care ecosystems.
I are also looking at thethe policy of the Care
(13:38):
Quality Commission that have introducedlocal authority Surance.
And so this is a processby which care quality
Commission is going into local authoritiesand assessing
how well they are discharging their duties
under the Care Act 2014.
And say we are trying to explore sort ofsome of the assumptions behind that,
(13:59):
that policy changeand so how it's then kind of assumed
and proposed that
that will lead to potential improvementswithin the social care system
and then really working on the ground,working in, local authorities
just to try and understandhow likely voters have responded
to this policy changeand also how those changes
(14:19):
have potentially affected the,the social care ecosystem, as well.
So again, it's workings or but at those,those multiple levels.
And that's really sort of what we see asa strength of the, the ecosystem concept.
Thereis this ability to kind of home in and out
on, on different different levels.
Thanks, Emily.
We'll stick with you again here.
(14:40):
As I wanted to ask you about researchyou published in 2024 with the Local
Government Information Unit on Scotland'sproposed National Care Service.
Could you reflect on thisfor our audiences, please?
Yeah. Of course.
So we were
commissioned by the local governmentInformation Unit to try and understand
the implications of the plans to introducea national care service in Scotland
(15:05):
and say the National Care Service Bill,
it was introduced in 2020.
And the aim is really to improve thequality and consistency of care services.
And so throughout that consultationperiod, proposals that policy did
did evolve throughout time.
But initially the proposals really removedresponsibility for social care
(15:27):
from local government and obviouslywould have quite massive implications
for the way that that local authoritiesin Scotland, which function
so, as I said,so those proposals did evolve,
and it did sort of get to the pointwhere local authorities
would maintain their responsibilityfor social care over
those allotted so disquietingconsternation about those proposals.
(15:49):
And they were dropped in January 2025.
But we worked with the Local GovernmentInformation Unit, so throughout that
that consultation process, as these, proposals evolved to try and understand
the implications of the introductionof the National Care Service,
unlike authorities.
And so we undertook, documentary analysis
(16:10):
and also interviewed20 stakeholders as well,
just to get their sense of of what whatthose changes would mean for them.
And so the findings have told usthat the reforms,
proposed reforms were so very vagueand what they were trying to do.
So the legislation was establishedas a piece of framework legislation,
(16:31):
with those details of the ideabeing that the details
would be fleshed out at a later date.
But that often meant that peoplewe interviewed said, well,
we sort of struggled to understand
what the implications of these reformswould be for us.
But really sort of a key thingwas just this idea
that the National Care Service was seenas a kind of a top down initiative
(16:51):
that was focussed on structural reformand structural reorganisation.
And there were just a great questionsabout the way that,
whether this emphasis on structuralreform would really address
some of the challengeswithin the social care system.
And so is a real sort of,criticism about this idea
of only focusing on structurereform and structural reorganisation,
(17:15):
rather than thinking aboutsort of those of relationships
that, within the local social careecosystem, and how those relationships
kind of affect the designand delivery of social care services.
So we also had
that kind of the reformssort of were being layered on
to previous reformsto integrate health and social care.
(17:37):
And really, there hadn't been a chance
to let these reforms help that inand to have have an effect.
And so there's kind of this sensethat, you know, we're being sort of pulled
on this idea of them,this route of structural reorganisation.
But actually there needs to be a greateraccountability, the relationships
and dynamics of it in the local level.
(17:57):
When it comes to the social careecosystem,
as I would suggest that these findingshave kind of a relevance for,
ongoing discussions around the, potential generation
of a national care servicewithin England and Wales.
So it's kind of the sense that,
you know, we can't really thinkthat we can achieve transformation
without there being sort of a greateremphasis on this relational work.
(18:21):
And just thinking of transformation,perhaps, of structural reorganisation
is kind of questionhow effective that will be.
And so really
that's that's kind of a key finding thatwe think we can kind of take into that.
So discussions are ongoing around thedevelopment of the National Care Service
and in England, and sort of the workthat's ongoing in Wales as well.
Thanks for that, Emily.
(18:42):
Before we wrap the episode up,
I'd like to invite either of youto let our audiences know
anything about the themewe haven't touched on yet.
Regarding your future plans?
Yeah.
I mean,I think as we're pulling it all together,
and just really trying to thatholistic thinking, I think
one of the questions that we keep comingback to is, how do we support people
working in complex systemsto solve, to manage complexity?
(19:06):
Because, you know, the wholeI guess, point about complex is it
sort of is unmanageable, whether it's onit's unknowable, it's unmanageable.
And people obviously need, to find ways
to, to soup, to, keep going in that context.
So part of what we will be doing throughthe kind of conversations
that we're having with people
working in social care and commissionersand policymakers, is was thinking about
(19:29):
what are some of the kind of thethe tools that will help policymakers
and local practitioners to to keep goingin the context of complexity?
You know, and we know from other workthat,
you know, the things that really help,humility, and being able
to sort of tolerate uncertaintythat they know that uncertainty
and lack of full informationisn't a kind of, error.
(19:52):
It is just the nature of workingin these really complex systems.
You know, it's about being ableto collaborate and partner
with other organisations,across the ecosystem.
It's about being able to share generouslyand understand that when, you know,
you may invest as a local authority,
you may invest something and the benefitsmay come to another organisation.
(20:13):
You know,maybe there'll be benefits for the NHS.
And we know in cash tight systemsthat can be really hard.
So it's sort of, you know, helping, some of the people working
in those systems to, to really understandwhat complexity means, but also how they,
as professionals working in those systems,can really kind of make the most of it.
(20:33):
Because, you know,we do think that complex systems
also have a dynamism and, and energy and,
you know, we shouldn't see complexityas something to be designed out.
It is something really just to try to.
And it's a bit like surfing a wave,I suppose.
It's kind of, you know, if you can kind offind your own way to go with it,
then I think it can bea, you know, a really powerful way
(20:54):
to think holisticallyand to support people holistically.
You know, to
to listen to people holisticallybecause people do not live
their lives in these little service silosthat we create for them.
You know, peoplebring the whole souls into the room.
But we aren't very good as a public.
So this is a kind of bring out and listento to what people needs are holistically
(21:15):
and kind of what their skillsand assets are holistically either.
So it's about really thinking,you know, if we understand and agree
with this notion that public servicesand social care is complex, then,
how do we equip peopleto really thrive in those systems?
Brilliant. Thanks, Catherine.
That's perfect. And thanks, Emily.
I've really enjoyed hearingabout what you've been doing
(21:36):
on the Care Ecosystems teamand what to expect next.
Sure. Our audiences have to.
I'm looking forwardto having you back on in the future.
Thanks, Tom. Thanks very much, Dan.
And thanks to our audiencesfor joining me on
this episode of the Calmatters podcast.
You can listen to all of our episodeson our website at w
(21:57):
w w Dot centre for caretaker UK.
The Care Matters podcast is
brought to you by the ESRC centrefor Care and CIRCLE, (the centre
for International Researchon Care, Labour and Equalities).
In this series, our researcherswelcome experts in the field
and those giving or receiving careto discuss crucial issues in social care.
(00:27):
As we collectively attemptto make a positive difference to how care
is experienced and provided.
Hello
and welcometo another episode of Care Matters.
My name is Dan Williamson.
I'm the digital and communicationscoordinator for circle
(00:48):
and the centre for care.
I'm also the producer of the Care Matterspodcast.
Today, I'm very pleased to be joinedby two centre for care
colleagues, ProfessorCatherine Needham and Doctor Emily Burn
who are basedat the University of Birmingham.
Hi, Catherine.
Hi there.
And hi, Emily.
(01:09):
Hi there.
Catherine and Emily work on our CareEcosystems research theme,
which explores what makes social carea complex, adaptive ecosystem.
And how can understanding this helpimprove care outcomes for all.
Today we're going to be catching upon this research so far
and looking forwardto what 2026 has in store for this team.
(01:33):
Catherine, we'll start with you first.
An ecosystem is a metaphor for nature,which we often use in social science
when talking about somethingwhich is complex and interlinked,
and when no one is controlof the whole thing.
What do we mean when we talk aboutthe term care ecosystem?
Yeah.
(01:54):
So we use the term ecosystemto try and convey
the complexity of, social care.
So I think it's quite common now
to talk about complex adaptive systemsand complexity in public services.
And that's really helpfulbecause that helps us understand
that some of the issuesthat public services help us with,
(02:14):
things like health and housingand social care are interrelated.
So you cannot address somebody's healthneeds and leave them in poor housing.
And people are not gonna be able to studyif they're, got,
difficult circumstances at home,in social care, which we focus on.
You know, as people,we want people to be able to access
(02:35):
good quality,affordable and tailored support.
Then we recognise that has to be partof a, a kind of holistic offer,
making sure that people are livingin the right circumstances that they got,
they can get outand do the things they want to do in life.
So, so thinking about thissort of interrelationship
between differentelements of people's lives,
(02:55):
and also, I think
recognising thatthere is a sort of complexity to that.
So to say something is complex is notthe same thing as to say it's complicated.
So complicated issues
have got lots of elements, sothat can be hard to get our head around.
But they operate on the basis of,cause and effect chains.
So we might say thatsomething like building
(03:15):
a new hospital is complicated,but it's not complex.
If you've got the right materials
and you put them up in the right waywith the right engineers,
you'll get a hospital.
What goes on in the hospital,the kind of interplay of staff
and buildings and patients and families.
That is a complex system.
(03:36):
And so we want to kind ofbring that to, to social care.
So what does sort of complexity, mean?
And thinking about kind of ecosystemis a good way to convey that.
So I think there's sort of three thingswe might say,
benefit us if we think about social careas a complex ecosystem.
So firstly, it's about being holistic.
(03:58):
So rather than sayingwe're going to focus on unpaid carers
or we're going to focus on providers,or we're going to focus on,
the workforce,or even people in receipt of care.
We want to sort ofthink about all of those things together.
So think about, holistically,how those experience
so that the interdependenciesbetween those shape our understanding
(04:18):
of the whole social care system.
I think another advantageof thinking about a complex
ecosystem is related to what we might callkind of boundary issues,
and the fact that there aren't clearboundaries, it's not kind of
very clear where sort of social care ends,because it kind of goes over
into the things that we do in our familiesand in our communities.
(04:39):
You know,social care is a sort of quite complex
interaction of things that the statedoes, things that the market
does, things that our families do,and then things we do in the community.
So we need to kind of recognisethat it's not clear
necessarilywhere the end of kind of social care is.
And so we have to be alert to thatwhen we're trying to study it.
(05:01):
And then I think the the third reasonwhy it's useful
to talk about kind of complexityin a complex ecosystem
is because in complexity theory,we understand that you can't intervene
in a systemand expect to predict predictable results.
You can't kind of pull a leverif you're like in local government,
you're a commissioner.
You sort of redesign, a home care contract.
(05:22):
You can't necessarily understandhow that will play out in
what is a very complexlandscape of delivery of care.
So some things might be predictable,some things not.
But if, for example, there'slots of things outside your control,
so it's the wages of social care workersgo up.
Or there's a change in the visarequirements for international workers.
(05:42):
These are both thingsthat we've we've seen recently.
This then starts to reshapewhat's possible for you within your own
local space.
And so, being understandingthat sort of difficulty around
kind of cause andeffect is part of complexity.
So given
that interesting complexity,we were just starting to think about,
well, how can we kind of conveythe sense of a complex ecosystem
(06:05):
in a way that doesn't itselfbecome so difficult to explain that
it's actually, really hard toto convey the idea.
And so in the end,we decided to do that with an image.
And you can see that image, on our,website.
And the image is really tryingto show the,
using the metaphor of a natural ecosystem
(06:26):
and all the kind of interdependenciesof that to show the interplay
between the bits of social care,which are quite
sort of visible in the sensethat they are building things.
They are formal state services.
So things like a care home or, domiciliary care or
the kind of a hospital, because we knowthat health and care are so interrelated.
(06:47):
Those are the kind of visiblebits of the system,
but actually they're completely predicatedon what are often
the kind of more invisible bits ofwhat kind of communities and families do
to give people a sense of meaningand purpose and a good life.
And we know that a kind of a goodlife is really what social care is about,
about helping people to access the thingsthat they enjoy doing.
(07:07):
And that were, you know,give them a real sense of,
of, of enjoying life and flourishing.
So we don't just want to thinkthat social care, as somebody who comes in
to get you out of bed and wash out, helpsyou with food, it's really about seeing
that as a, as a sort of jumping offpoint into what gives people a good life.
And we think this sort of ecosystem
(07:27):
conveys that broader sense of a good life,but also the interdependencies.
So the things that are sort of abovethe soil line and are visible
are all dependent on a kind of abundantsupply of family and community
who can really support people in the waysthey want to be supported.
So we need all of this,and it's all interrelated.
And we felt that the concept of anecosystem is of metaphor, of an ecosystem.
(07:52):
And the image, really conveyed what ourunderstanding of the care ecosystem is.
Thanks, Catherine.
That's great.
And as you say,the image of a flourishing care
ecosystem is available to viewat the UK's centre for Care
Act UK, and I will include a link
to this in the descriptionfor this episode.
(08:16):
Let's now look at what you've learnedfrom your research at the centre for care.
What do we knownow about the care ecosystem?
So this is a work
in progress, and we'll talk to youabout some of the work that we've done.
And we'll hopefully come back today, dateand tell you
when our projects have finished.
But I think one of the first thingsthat we really had to wrestle with was,
(08:38):
how do you study an ecosystem?
Because of what I've said so far,
is that the notionthat the boundaries aren't clear.
So everything is sort of in view.
You can't can study causal effects,
maybe in the way that we might likenormally is doing an AI research study.
So I thinkone of the things we've been doing
is really trying to get a handleon how we might study an ecosystem,
(08:59):
and we've been doing that in dialoguewith, lived experience partners.
To sort of really think aboutwhat might make a meaningful set
of inquiries into the care ecosystem.
So we've done thatin a number of different ways.
So we've been involvedin some of the dialogue
around, sort of redesigningthe whole care ecosystem.
(09:21):
So the at the national level.
So that's relating to, say,the National Care Service plans
in England and Wales and Scotland,and we're trying to be part of that.
So dialogue too, so that we can helpmake the case for needing to think
holistically about carerather than intervening in these very
discreet ways and not thinking throughthe consequences of doing so.
(09:46):
We've
also beenlooking in within local authorities.
So within local government,
at some of the waysthey're trying to make changes
in the care, services and thinking
again, holistically about whatthat might mean for the care ecosystem.
So, doing some work in onelocal authority,
looking at changes to its homecare service
(10:08):
and thinking aboutif you're moving it to a more,
sort of patch based modelwhere, it's more locality based.
So each care providerwould be based on a particular locality.
There's potentially lots of great things,might come from that.
And we need to sort of to follow throughwhether, you know, whether that does help
(10:28):
get better outcomes for people,maybe get them discharged quick, more
quickly from hospitalbecause it's really clear
which agency is responsiblefor that postcode.
Whether it helps, it's more efficientbecause the workers,
the care workers can dowalking round between houses
because they're all locatedin the same place.
So lots of reasonswhy that might be a great idea.
(10:48):
What one of the things we're doing istalking to providers, talking to the to,
people in that area to really understandwhat how has this played out?
Because we think, really the only wayyou can study a Carrick system
is by kind of watching the ripples.
So we're watchinga particular intervention and,
and seeing how that changes,
(11:08):
speaking to peopleover a period of time to say last,
you know,
we came to see a year ago when you werejust starting on this intervention,
what's happened,what the things that were expected,
what wasn't expected, what happenedwhen there was a national change
to the visa regime,which is totally out of your control?
How did that
then start to reshape thingsso that we can be thinking holistic about,
(11:29):
you know, when you make an intervention,
how does that affect the systemas a whole?
So, that's really all kind of,our focus is to think about
specific changesand then how they, spread out to affect
the, local, national, care systems.
And then also, you know, thinking aboutsome of the more international elements,
(11:50):
given that so much of our care workforcecomes from overseas, recognising that
all these different levels of the careecosystem are interrelated.
And that that's another elementto that we need to bring in.
Thanks.
And what an interesting metaphorwatching the ripples is when thinking
about the care ecosystem, it makes senseof how interlinked social care can be.
(12:12):
Emily,perhaps now you can tell us what is next
for the care ecosystems theme.
Yeah. Of course.
I suppose just, Just building
on what Catherine saidthereabouts of how we can apply.
So this idea of the social care ecosystemto different levels
say we will be working at the levelof the local authority.
(12:33):
Like Catherine said, looking at changesto the way the local authorities
commission home care.
So looking at this patch based approachand also sort of zooming out more,
to instance of changesare being made at a national level.
And so those implicationsof national policies
say we'll be working with colleaguesat the centre for care
(12:55):
and with it.
And so
to understand sort of shiftsin the immigration system over the last
18 months have been sort of great changes,sort of in terms of
as the international workforceand being unable to bring their dependents
with them, but also the sense that nowproviders need to prioritise is employing
(13:15):
people who are already in the countryon their health and care visa.
And so really trying to understandthe implications of that on the way
that providers so work to recruit their, their workforce.
Also of the wider effects of thatwithin local care ecosystems.
I are also looking at thethe policy of the Care
(13:38):
Quality Commission that have introducedlocal authority Surance.
And so this is a processby which care quality
Commission is going into local authoritiesand assessing
how well they are discharging their duties
under the Care Act 2014.
And say we are trying to explore sort ofsome of the assumptions behind that,
(13:59):
that policy changeand so how it's then kind of assumed
and proposed that
that will lead to potential improvementswithin the social care system
and then really working on the ground,working in, local authorities
just to try and understandhow likely voters have responded
to this policy changeand also how those changes
(14:19):
have potentially affected the,the social care ecosystem, as well.
So again, it's workings or but at those,those multiple levels.
And that's really sort of what we see asa strength of the, the ecosystem concept.
Thereis this ability to kind of home in and out
on, on different different levels.
Thanks, Emily.
We'll stick with you again here.
(14:40):
As I wanted to ask you about researchyou published in 2024 with the Local
Government Information Unit on Scotland'sproposed National Care Service.
Could you reflect on thisfor our audiences, please?
Yeah. Of course.
So we were
commissioned by the local governmentInformation Unit to try and understand
the implications of the plans to introducea national care service in Scotland
(15:05):
and say the National Care Service Bill,
it was introduced in 2020.
And the aim is really to improve thequality and consistency of care services.
And so throughout that consultationperiod, proposals that policy did
did evolve throughout time.
But initially the proposals really removedresponsibility for social care
(15:27):
from local government and obviouslywould have quite massive implications
for the way that that local authoritiesin Scotland, which function
so, as I said,so those proposals did evolve,
and it did sort of get to the pointwhere local authorities
would maintain their responsibilityfor social care over
those allotted so disquietingconsternation about those proposals.
(15:49):
And they were dropped in January 2025.
But we worked with the Local GovernmentInformation Unit, so throughout that
that consultation process, as these, proposals evolved to try and understand
the implications of the introductionof the National Care Service,
unlike authorities.
And so we undertook, documentary analysis
(16:10):
and also interviewed20 stakeholders as well,
just to get their sense of of what whatthose changes would mean for them.
And so the findings have told usthat the reforms,
proposed reforms were so very vagueand what they were trying to do.
So the legislation was establishedas a piece of framework legislation,
(16:31):
with those details of the ideabeing that the details
would be fleshed out at a later date.
But that often meant that peoplewe interviewed said, well,
we sort of struggled to understand
what the implications of these reformswould be for us.
But really sort of a key thingwas just this idea
that the National Care Service was seenas a kind of a top down initiative
(16:51):
that was focussed on structural reformand structural reorganisation.
And there were just a great questionsabout the way that,
whether this emphasis on structuralreform would really address
some of the challengeswithin the social care system.
And so is a real sort of,criticism about this idea
of only focusing on structurereform and structural reorganisation,
(17:15):
rather than thinking aboutsort of those of relationships
that, within the local social careecosystem, and how those relationships
kind of affect the designand delivery of social care services.
So we also had
that kind of the reformssort of were being layered on
to previous reformsto integrate health and social care.
(17:37):
And really, there hadn't been a chance
to let these reforms help that inand to have have an effect.
And so there's kind of this sensethat, you know, we're being sort of pulled
on this idea of them,this route of structural reorganisation.
But actually there needs to be a greateraccountability, the relationships
and dynamics of it in the local level.
(17:57):
When it comes to the social careecosystem,
as I would suggest that these findingshave kind of a relevance for,
ongoing discussions around the, potential generation
of a national care servicewithin England and Wales.
So it's kind of the sense that,
you know, we can't really thinkthat we can achieve transformation
without there being sort of a greateremphasis on this relational work.
(18:21):
And just thinking of transformation,perhaps, of structural reorganisation
is kind of questionhow effective that will be.
And so really
that's that's kind of a key finding thatwe think we can kind of take into that.
So discussions are ongoing around thedevelopment of the National Care Service
and in England, and sort of the workthat's ongoing in Wales as well.
Thanks for that, Emily.
(18:42):
Before we wrap the episode up,
I'd like to invite either of youto let our audiences know
anything about the themewe haven't touched on yet.
Regarding your future plans?
Yeah.
I mean,I think as we're pulling it all together,
and just really trying to thatholistic thinking, I think
one of the questions that we keep comingback to is, how do we support people
working in complex systemsto solve, to manage complexity?
(19:06):
Because, you know, the wholeI guess, point about complex is it
sort of is unmanageable, whether it's onit's unknowable, it's unmanageable.
And people obviously need, to find ways
to, to soup, to, keep going in that context.
So part of what we will be doing throughthe kind of conversations
that we're having with people
working in social care and commissionersand policymakers, is was thinking about
(19:29):
what are some of the kind of thethe tools that will help policymakers
and local practitioners to to keep goingin the context of complexity?
You know, and we know from other workthat,
you know, the things that really help,humility, and being able
to sort of tolerate uncertaintythat they know that uncertainty
and lack of full informationisn't a kind of, error.
(19:52):
It is just the nature of workingin these really complex systems.
You know, it's about being ableto collaborate and partner
with other organisations,across the ecosystem.
It's about being able to share generouslyand understand that when, you know,
you may invest as a local authority,
you may invest something and the benefitsmay come to another organisation.
(20:13):
You know,maybe there'll be benefits for the NHS.
And we know in cash tight systemsthat can be really hard.
So it's sort of, you know, helping, some of the people working
in those systems to, to really understandwhat complexity means, but also how they,
as professionals working in those systems,can really kind of make the most of it.
(20:33):
Because, you know,we do think that complex systems
also have a dynamism and, and energy and,
you know, we shouldn't see complexityas something to be designed out.
It is something really just to try to.
And it's a bit like surfing a wave,I suppose.
It's kind of, you know, if you can kind offind your own way to go with it,
then I think it can bea, you know, a really powerful way
(20:54):
to think holisticallyand to support people holistically.
You know, to
to listen to people holisticallybecause people do not live
their lives in these little service silosthat we create for them.
You know, peoplebring the whole souls into the room.
But we aren't very good as a public.
So this is a kind of bring out and listento to what people needs are holistically
(21:15):
and kind of what their skillsand assets are holistically either.
So it's about really thinking,you know, if we understand and agree
with this notion that public servicesand social care is complex, then,
how do we equip peopleto really thrive in those systems?
Brilliant. Thanks, Catherine.
That's perfect. And thanks, Emily.
I've really enjoyed hearingabout what you've been doing
(21:36):
on the Care Ecosystems teamand what to expect next.
Sure. Our audiences have to.
I'm looking forwardto having you back on in the future.
Thanks, Tom. Thanks very much, Dan.
And thanks to our audiencesfor joining me on
this episode of the Calmatters podcast.
You can listen to all of our episodeson our website at w
(21:57):
w w Dot centre for caretaker UK.
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