Last week, the Care Quality Commission's annual State of Care report once again revealed the enormous challenges faced by social care – a sector at 'full stretch' according to CQC. Against this backdrop, making a case for more innovation could be seen as somewhat flippant or even naive. The counter argument is: ‘What about just keeping what we have got already functioning?’
But innovation is, more than ever, what we do need, and not necessarily by technological breakthroughs or big ideas that totally reimagine-care giving. In most cases, new and better ways of delivering relationship-based care, brought to many more people, will be sufficient.
Thankfully, pockets of innovation do exist in social care and have done for many years. In the area of personalisation, for instance, what are now mainstream approaches to personalised care were first pioneered in social care. Today, we are seeing models of care emerge, such as Homeshare, care navigation and community circles, that not only create better, more person-centred outcomes, but reduce costs to the state.
Failing to benefit?
But here's the difficulty: most innovations such as these remain relatively small scale, with innovators struggling to take their ideas to a mass market. This can mean that overall, large parts of the sector fail to benefit from these innovations. Champions of innovative ideas can then be faced with a plethora of hurdles: lack of investment in new ideas and technology, commissioning that is focused on short-term fixes, overbearing procurement and regulation, and high staff turnover.
What can be done to overcome this situation? In a focused piece of research to inform the Department of Health and Cabinet Office thinking on social care reforms, SCIE has started to explore what conditions are needed to foster innovation.
Conditions one to five
First, you need strong and purposeful leaders. The Wigan Deal, for instance, has transformed how care is experienced and has reduced demand for formal care packages. Here you see visionary and committed system leaders across statutory services, willing to take risks and to back each other up.
Second, to support committed and purposeful leaders, you need the right capabilities including skills in accessing new forms of finance, branding, marketing and sales, and using evidence to demonstrate that your ideas work and developing successful business models. Do we need a leadership programme for the next generation of social care innovators?
Third, you need to ensure that service users are critically involved in shaping innovations. At an event we held with the innovation charity Nesta, Sue Bott, from Disability Rights UK – and a person with lived experience – told us that some of the most successful innovators have been disabled people, who have pioneered innovations in independent living and direct payments. But she also told us that it was only when people start working on an equal basis with likeminded local authorities that significant change was brought about. We call this co-production.
Fourth, you need investment to make this happen. Creating anything new and bringing it to scale costs money, and if all your funding is tied up in maintaining services that are at breaking point, it is immensely difficult to release funding to seed innovation. For real innovation to take place at scale, the total amount of money going into social care needs to increase dramatically. In the absence of a new funding settlement, we at least need a pot of money made available to support the best ideas. Such a thing exists in children's social care; now we need one for adult care.
Fifth, we need to tackle the paucity of good data and evidence in this sector. Stakeholders told us it is very difficult to convince commissioners to invest in untried innovations without good evidence. We need to create a sector-wide capability for evaluating interventions and for helping local innovators access and use data. Again this will exist soon in children's social care, in the form of a What Works Centre, which SCIE are helping to set up.
From Jersey to Manchester
Finally we need to share good news better in cases where innovation does exist. SCIE's publication on the asset-based place comes with a host of examples of people – like Alex Smith of North London Cares – who developed an idea about reducing social isolation by encouraging people from different generations to share social experiences, and took it to scale across London and Manchester. Or Joe Dickinson, a postal worker in Jersey, who set up a scheme involving postal workers making short visits to residents which involves conversations covering health and wellbeing topics, giving isolated people peace of mind. We need more sharing of successful innovation.
The findings of the CQC State of Care report can mean that the challenges of getting innovation off the ground are considerable. How do you set up something new with little money and a pressurised workforce? But for the same reasons, innovation is more important than ever; traditional models of care are unlikely to give us a route out of this challenging state. For innovation to flourish, we need to find better ways to help people bring good ideas to life. The keys to success are good leadership, co-production, more intelligent use of funding, support with evidence generation and skills development.
Ewan King is director of business development and delivery at the Social Care Institute for Excellence (SCIE)