Moving beyond the piloting – It’s time to grow social care innovations

By Ewan King

John Birdsall
For all the problems it faces, the social care sector has always shown that it can innovate. From personal budgets, which were pioneered in social care, through to shared lives schemes around the country, it’s a sector which can produce innovations.

The same cannot be said about its ability to grow these innovations – to bring them to scale, to use the jargon. Instead, innovative models have tended so stay small scale – at the margins rather than being core business. Forever trapped, it would seem, in a pilot phase.

It’s a longstanding issue. In 2010 the CQC wrote that ‘many councils are still at an early stage in transforming social care and developments are patchy, varying between different groups of people’. Even further back, in 2005, the adult social care Green Paper of the time acknowledged that whilst there were pockets of innovative practice, more effort was needed to ‘ensure that existing good practice is spread right across the system.’

Jeremy Hunt has also acknowledged this lack of progress in his recent speech on social care. He said that Government was duty bound to ‘encourage new models of care provision to expand at scale’.  This was, for me, the best part of his speech.

Luckily, there are no shortage of excellent models of care, which with support could be encouraged to grow.

John Birdsall
Local Area Coordination (LAC), a person-centred approach focused on prevention and co-production to help individuals lead better lives, has demonstrated that it can transform lives whilst reducing costs, most recently delivering ‘statistically significant improvements in health status, health confidence and personal wellbeing’ on the Isle of Wight. In Somerset, a group of locally based staff, working as Village Agents, have helped to reduce social isolation and support people to live independently by helping to connect people to one another and to community services.

People who need accommodation as well as support in their community have often borne the brunt of low quality care. For people who need this kind of support, Shared Lives –  a service that provides family-based support for older people and people with disabilities – continues to deliver high quality support, with 87% of all shared lives services in England rated good and 4% outstanding.

There is huge scope too, to invest in ways which support disabled people to live where they choose and receive the kind support they want. One example is award winning Bradbury Place, developed by the charity Enham Trust through co-production with residents and families, which provides 8 one and two bedroom wheelchair accessible apartments, catering for live-in care, couples and single occupancy.

For those just out of hospital who need support, new models of care like British Red Cross’s First Call, a 12-week volunteer led home support service, have shown that they can help people regain their confidence and community connections whilst saving the state money.

These examples point a way to the future, but we are yet to see the seismic shift necessary to take these models to scale. In our recent paper with Shared Lives, PPL and Nesta, we argue for a concerted and far reaching strategy to bring about the necessary change. We call for the Government to introduce an innovation scaling fund to test new approaches to scaling across local areas and support capacity building and coaching for social entrepreneurs and change-makers, including disabled entrepreneurs.

Locally, we call for a greater commitment from systems leaders to shift resources away from traditional models of services which deliver low quality care towards more innovative, community-orientated, high quality ways of delivering care. More money to support this transformation will be necessary, but as places which are delivering innovations at scale like Wigan, Bradford and Nottinghamshire have shown – it is by no means impossible to make progress.

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This year should mark the turning point for social care, where the disappointments about progress expressed in past Government policies become a thing of the past. In his speech on social care Jeremy Hunt quoted Ronald Reagan. I will quote another American President, Barack Obama who said:

“If you’re walking down the right path and you’re willing to keep walking, eventually you’ll make progress”
Ewan King is Director of Business Development and Delivery at the Social Care Institute for Excellence

@ewandking 

One thought on “Moving beyond the piloting – It’s time to grow social care innovations

  1. As a follow up, would it not now be important to ask the question as to why this is not happening, and then we can realise what the barriers are to moving from pilots to mainstream? There must be barriers to this forward movement, and unless they are identified and tackled, then how can we expect further development? It is shocking to see the effort used on innovative techniques, only to see them not continue.

    In my experience of working with the public sector on innovative and transformation, there are very good and clear reasons what the barriers, and more importantly why they exist. Here is my list off the top of my head.

    NHS:
    1. Structural and funding decisions are based on politics rather than value. The silo structure hampers innovation by providing departmental and budget barriers to end to end working.
    2. In many cases financial cuts target the areas of the NHS that provide prevention and good value. Cuts have damaged the ability for the NHS to be effective and efficient in the first place. Therefore innovation has no hope to go forward unless this basic competence is recreated. Staff – people are at the heart of innovation, and NHS staff have been abused as employees, so that their engagement and participation is non-existent.
    3. The value in the NHS is in the end to end workflows. Design these workflow to occur, rather than targeting silos.
    4. The majority of the cost of the NHS lies in people with needs that extend further than simple medical issues. `innovative examples have shown that such working goes against the current way of working of the structure of the NHS.
    5. The methods that leaders use to manage the NHS is driven by RAG reports, and short term cost management. Both of these stop any type of innovative end to end working.

    Local councils:
    1. Senior leaders are trapped in old style bureaucratic forms of management. Investment in modern leadership competence training is desperately required.
    2. Councils need to learn how to work with customer centric driven working. This means a change from strict enforcement driven procedures and treating everyone the same mentality. Due to this councils usually make social issues worse when working with people in need.
    3. Embrace end to end systemic thinking and working from the leadership level down. And operationalise it.
    4. Delegate daily operational individual decisions to front line staff. Train managers to understand how they do this.
    5. Re-examine the ridiculous fear based interpretation of the Data Protection act – perhaps renaming it the Data sharing acts and rewriting its text so that it still has the same principles but helps staff to share rather than scares managers into non-action.
    6. Employ public sector leaders that have the ability to lead.

    All of these have been designed in, and can be designed out.

    Like

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