Challenges and facilitators to scaling up in health, care and support innovation for adults
The people we interviewed told us about four key challenges.
- Financial pressures, which make it difficult for organisations and commissioners to fund new, innovative services at the same time as maintaining delivery and running down (decommissioning) low quality services. Although innovators may be able to access early stage investment or grant funding to develop and test their early ideas, it can be difficult to secure funding to grow and sustain impact.
- Lack of innovation and growth of skills and capability – such as strategic planning, marketing and market analysis, organisation and business case development – can mean that opportunities to address need and create demand are missed. Without understanding what is ‘core’ to success and what is negotiable, fidelity to the original values and intended ways of working can be lost and/or innovations can fail to adapt to local context.
- Inward looking organisational leadership teams , focused on short-term goals and local evidence and solutions, prevent organisations working together as partners to develop shared goals and learn about ‘what works’ from other places.
- Performance management and contracting systems . Our performance management systems are designed to manage the old models of care, not to incentivise new ones. They are institutionally-based, rather than focusing on people, pathways or localities. They reinforce silos and they are inherently conservative. The current contracting arrangements across health and social care promote perverse incentives, prioritising treatment over prevention, and rewarding activity rather than outcomes.
- Sustained engagement and co-production with stakeholders , including citizens, people who use care and support and carers. Stakeholders told us that when they engaged actively with local stakeholders and fully embraced the ideas, lived experience and expertise of people who use care, service changes were more readily accepted, and services were better tailored and more sustainable. Previous research by Nesta has found that innovators that have successfully scaled have been relentless in their ambition to improve outcomes for people and put strong emphasis on engaging their stakeholder communities.
The innovators who have been able to achieve the most change are disabled people. But they needed innovative people to work with, they couldn’t do it alone. It is about alliances, forging alliances. Need to formalise that.Sue Bott, Deputy Chief Executive, Disability Rights UK
- Ability to undertake high quality impact evaluations. Many of the most successful innovations have an ambition to ‘go big’ from the beginning. They value and act on feedback and intelligence to improve what they do and increase the number of people who benefit. Producing high quality evidence of impact, meeting the highest standards possible (Nesta Standards of Evidence), is increasingly seen as vital to convincing commissioners and other funders to invest in a new innovation. Commissioners and funders can help by being clear about their expectations and being willing to engage with evidence of impact from other areas.
It is important to make sure when you are testing new innovation that you are collecting high quality evaluation evidence and data, thinking ahead about how you will use this to make the case for further investment.Jane Townson, Chief Executive, Somerset Care
- A clear vision of the change being sought and the core features of the innovation that will achieve it. Stakeholders told us that when an innovation is easy to describe – its vision, how it works, and the difference it makes – it is easier to raise awareness, gain support and engage stakeholders in practical considerations of how to scale. Taking time to define and codify the ‘core features and benefits’ of the innovation can also reassure those interested in adopting it that the intended benefits are likely to be realised. By working together to develop clear referral routes through public services and community resources, innovators and commissioners can create demand for their innovation and a clearer pathway to scale and sustainability.
- Leadership. A ‘tight and loose’ leadership approach can help to create and maintain a clear shared vision and values, while enabling local teams to develop an approach that is adapted to local context and the needs of local people. For innovators, this can mean being open to different routes to scale and creating multiple pathways to reach new users. For commissioners and other providers, it can mean being open to new ideas and enabling teams to take the steps needed to make them a success, including where this requires developing new relationships, decommissioning or changing existing services, or giving up resources and control.
- Innovation funding. In some areas money has been diverted away from traditional services to nurture and develop innovations, especially in the voluntary sector. Stakeholders see this as essential to support emerging, and often small, local initiatives. However, it was only seen to be useful if local innovations were given a clear route map and support to move from innovation funding to core, longer-term, funding. By taking a more system-wide approach, it can be possible to use non-recurrent innovation funding to create additional capacity to ‘double run’ services. This demonstrates ‘proof of concept’ and shifts demand, before other services can be safely decommissioned.