Embedding a local innovation in health, care and support for adults

This happens when a local innovation is successful beyond pilot funding to become core funded. Some providers have made this transition, but the challenges for many innovations are considerable. It is important for emerging networks to be able to continue to coproduce and refine core values and practices, as has happened with the UK-wide Shared Lives and Homeshare networks and is beginning to happen with the Local Area Coordination Network.

I frequently meet visionary senior leaders who assume that key systems such as referral, care pathways and procurement processes will align around the goals they articulate. This only happens when those leaders are willing to follow through on the detail: this is a willingness to step outside of being “strategic” at times.

Alex Fox, Chief Executive, Shared Lives Plus

Case study: Shared Lives

Shared Lives is a model in which adults either live with or regularly visit their chosen carer, who is trained and managed by a local Shared Lives scheme. Shared Lives has grown slowly and organically over 40 years, from an association formed from local initiatives which coalesced around a set of values and core practices, to a regulated care and health model used by 14,000 people from an increasing range of groups. These include adults with learning disabilities, people leaving hospital and women fleeing domestic abuse.

The model exists in nearly every area, but some have small, local schemes, while the biggest schemes support hundreds of people. The Greater Manchester devolved region is now taking a Greater Manchester-wide approach to developing its 10 local schemes. NHS England and seven clinical commissioning groups are investing in taking the model from social care into the NHS.

Key factors supporting scaling up

• It is regulated but flexible enough to allow different local authorities to adapt it to particular groups, and to enable individuals to define what family life looks like for them.
• The CQC inspection regime and national membership network (Shared Lives Plus) mean that all participants can join communities of practice and benefit from research programmes, alongside a single quality framework, outcome measuring tool and tax regime
• Shared Lives has an evidence base which clearly demonstrates the economic benefits of the model versus other forms of care. The Care Quality Commission consistently highlights Shared Lives as the most consistently high performing of all kinds of regulated care. This in turn gives local authorities the incentive to grow the model.