New approaches for scaling innovations in health, care and support for adults
The biggest innovation challenge we now face is how to move new ideas to core business in ways that improve people’s lives and support a more sustainable health and care system for the future.
This was the whole-system change articulated by Realising the value and Total transformation of care and support . If we are to realise this vision, it is time to take a step change in our approach. There are number of system-wide change methodologies that have the potential to help break this innovation glass ceiling. We wish to draw on four of the approaches that show the most promise, to develop, test, compare and share the very best ways to bring new person- and communitycentred approaches to scale.
The question you need to ask is, how do you create an environment and permissions framework, so that people can think and feel differently and try things out without bureaucracy, but so that there is some structure and safety?Kathy Clarke, North Yorkshire Council
People powered results and other design-led approaches.
These approaches bring innovation and scaling which have been successfully used by other sectors into public services. Nesta has developed a 100-day approach to change with the Rapid Results Institute. It supports professionals across the local health and care system – including the local voluntary and community sector – to connect and create shared purpose around key goals, such as reducing unnecessary hospital admissions for people who are frail. These connections build shared motivation across individual institutions and give permission to frontline staff to solve problems with people who use services. They enable the whole system to act as more than the sum of its parts and create momentum for change in ways that may otherwise never happen. This approach could be used in combination with any of the others to catalyse more rapid action.
The co-production approach
Co-production involves people who use services and their families being an equal part of change conversations from the start. It aims to achieve system and culture change through involving different perspectives to those usually asked to lead change and by being open to different sets of priorities. We have outlined a structured approach to considering five key kinds of council and NHS activity which need reform. Leaders are often nervous about having open conversations with local people concerning difficult decisions, but in the small number of areas that have taken this risk, they have often been surprised by local citizens’ pragmatism and appetite for radical change.
The asset-based area approach
This starts from the premise that radical change will always be limited within deficit-based systems. Piloting innovations without realigning the system around new goals and values can lead to repeated promising experiments which survive only as long as their temporary funding. Asset-based approaches take a different starting point (‘What does a good life look like?’ rather than ‘What changes shall we make to our services?’) in order to redefine local relationships (‘What are we all willing to do to make this a good place to live?’) and different solutions. The chief executive of Wigan, Donna Hall, argues that the Wigan Deal is an existing example of doing this. Thurrock is working on the Six (plus) innovations model , led by Martin Routledge of Community Circles and Helen Sanderson of Helen Sanderson Associates.
Trial new outcomes-based payment mechanisms and integrator models to bring together and align a range of communitybased approaches
Effective social prescribing programmes invest in the infrastructure to support and work with a range of community groups and resources. Accountable care organisations can align both statutory and voluntary provider organisations around shared goals and outcomes, using ‘alliance contracting’ and other approaches. The organisation Social Finance has developed a model in which an ‘integrator’ organisation acts as bridge and broker between state and community providers.