Moving on from 20th Century models: advice for the social care Green Paper team from the Six Innovations group


A Green Paper on social care was announced a few months ago. The current government has said that it will “…address system wide issues to improve the quality of care.” We very much hope that whatever the result of the election, a review of social care will be picked up and followed through. In truth, there has been no shortage of policy and prescription in this area in recent years. Yet if we look at the landscape of supports and services around the country, it remains dominated by models and approaches that are not serving people and communities well enough but which have been ‘business as usual’ for decades. These models are underpinned by commissioning, investment and ownership approaches which effectively institutionalise them and make it very difficult for any innovation to get a serious foothold.

The dire financial position of social care has led to an enormous and finally successful joint effort by many organisations and voices to begin to break through to media and political consciousness. There is a big risk, however, that the awareness and attention gets channelled narrowly – towards discussion about sustaining markets, or about people selling their homes to pay for support. The recent injection of cash will be largely spent on the former, and political attention seems now to be mostly on the latter.

Several of us are involved in local or regional reviews of support models; such as approaches to care at home. Too often, though, the debates and proposals are about marginal changes which might take up substantial resources but not really make much difference. Changes like these still leave people poorly-served and don’t address working conditions for staff.

And yet, as we are trying to show with our Six Innovations initiative, there are approaches with the potential to effect really worthwhile change if they could move beyond the margins and into the mainstream. We feel strongly that any post-election policy initiative worth its salt needs to pay real attention to the issue of how to rapidly introduce, test, refine and embed worthwhile innovation.

So what are the barriers and enablers that the anticipated Green Paper might pay attention to? In his recent blog, Alex Fox offered a list that our organisations have identified through our work in many localities. One key barrier is the lack of investment in and support for innovation, and another is the “evidence catch-22” faced by new models; in which organisations are being asked for robust evidence before they have yet had a chance to effectively generate it at scale.

The recent Communities and Local Government report on Adult Social Care pointed to a mixed picture. Although some councils are responding to pressures through innovation, most are retrenching. The report also suggested an innovation fund:

We found that funding constraints and demographic pressures are acting as a driver for some councils to innovate and change the way they deliver care. However, due to budget pressures, most councils are in panic mode and are not ready to rethink the way they do things. We recommend that the Government should create an innovation fund to encourage and give councils the capacity to consider how innovative approaches could be applied in their local area, including alternative models of care, such as the Shared Lives scheme.

We strongly support this idea. We have seen the local impact such funds can have – for example as part of the “Wigan Deal”. If the Green Paper were to propose such a development, however, we would advise that it not be disbursed via the traditional allocation mechanisms. If one problem is that the majority of councils are struggling to innovate, simply giving the cash to local commissioners won’t work in too many cases. We saw this, for example, with the £520m allocated via the Putting People First policy in 2008-11. Some councils used the funding for real transformative change, but most didn’t. We suggest that:

  • First, funds are targeted towards real innovation – not for more, increasingly large, institutions or to be seized by powerful organisations on preferred provider lists.
  • Second, the funding is overseen or disbursed from central to local by intermediaries with a strong focus on new models and approaches – for example Power to Change or Cooperatives UK.
  • Third, that there is strong involvement in local decision-making about use of the funds by those using local social care and by community groups.
  • Fourth, that encouragement and support for promising models is maintained during the period in which they are building the evidence base for their growth.

It shouldn’t be necessary for an innovation to be subject to a multi-year random control trial before getting initial support. These unreasonable barriers to initial entry are unrealistic and damage the chances of real innovation ever happening, and, in any case, they sit in stark contrast to the shaky evidence base of many traditional models.

What do you think? We’d be interested in other ideas about how this next period of policy development could have a real impact. Surely now is not the time to simply prop up a creaking system when so much more is possible?

Martin Routledge

Note: The Six Innovations are: Community Circles, Local Area Co-ordination Network, Wellbeing Teams, Shared Lives Plus, Homeshare UK and Community Catalysts.