How can social care professionals grow the best services?
Even in these especially grim times for social care, all of us – I hope – are still able to celebrate examples of good services. Only last week, I was learning about how Penrose – a charity for which I am a trustee – had used a tiny grant to create a garden with a difference, a community hub giving people friendship, skills and improved mental wellbeing. But like so many brilliant community projects of its kind, it’s a small-scale operation and faces a struggle to grow.
However, it made me think: if we can still innovate and create great new services, why do we struggle so much to grow these further – to take them to scale? We can all point to examples of good practice, but rarely it seems can we provide examples that have grown to reach much larger populations. Isn’t it time to revisit this issue in social care, and ask the question: are we doing enough to scale up what works?
Obstructing schemes that seek to grow are an array of formidable barriers: the difficulties of accessing investment; the inward-looking culture of some areas that dismisses the potential of services developed elsewhere; and risk aversion, along with some short-sightedness among commissioners.
But some have defied these barriers to provide us with compelling insights into how to scale up. First, those that succeed are often adept at clearly articulating the ingredients of what makes their initiative work. This makes it easier for them to sell the idea to funders or others who want to adopt it. Oomph Wellness, for example, a social enterprise that trains staff to deliver exercise classes to care home residents, has developed a simple theory of change that captures how it makes a difference. Oomph reports a 260% increase in the number of classes it runs year-on-year.
Initiatives that successfully grow have worked hard to evaluate their impact. Good evaluations can help in two ways: they can demonstrate that a scheme works or saves money and they can help show others how the scheme has been implemented.
Shared Lives Plus, for example, which employs a family-based model of care, has used cost-benefit evaluations to demonstrate the huge savings it can make on the public purse, along with amazing outcomes. With more local authorities convinced of the benefits it can bring, Shared Lives continues to grow rapidly every year. Similarly, North London Cares, a volunteer-led initiative helping isolated older people, has recently used evaluation evidence to convince backers to help it open a south London branch.
In an effort to grow beyond initial pilot sites, schemes that succeed in scaling up often do so by involving local people. Living Well Cornwall, for instance, a model of community-based coordinated care for “at risk” older people, has expanded rapidly from a small pilot area to cover large parts of the county. It has done this not by imposing a new model from the outside, but by involving local stakeholders in a co-design process that ensures the best of the Living Well model can be adapted to local circumstances. Also, teams and local governance structures are built from the ground up so that the model is locally owned and led.
Finally, experienced scalers of good practice tend to be great at working in partnership, realising early on that growing “what works” requires supportive networks. Certainly this is a theme running through the story of the Casserole Club, a volunteer-led provider of meals to those who can’t cook for themselves. In addition to a range of more typical funders, Casserole Club’s tie-ups with the likes of Waitrose have greatly boosted its growth.
So scaling up in social care can be done, although it is not without enormous challenges. But the next time you come across a brilliant initiative, please ask: what can we do to help scale it up?
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