Routes to scale – lessons from experience - Innovative models of health, care and support for adults

For this research, we interviewed a range of stakeholders involved in trying to build and grow successful and sustainable innovations in health, care and support. We also spoke to commissioners and funders with experience of enabling, shaping and supporting new innovations. We learned about:

• different routes to scale
• the challenges people encountered
• the factors that have enabled them to bring new models to scale.

This research has identified several routes to scale, although these are not necessarily mutually exclusive, and can happen at the same time in more than one place.

Spreading across boundaries

Several innovations have sought to spread their models to other areas, with varying degrees of success. ‘Lifting and shifting’ innovations can follow different routes, though these are not mutually exclusive.

• Organisational growth: this enables innovators to maintain control and influence on the delivery and impact of their model
• Licensing and affiliation: this can enable innovators to retain some quality control, while harnessing local expertise and resources to adapt to local context, where appropriate
• Partnerships: these can enable innovators to access skills and resources, and reach people, volunteers and markets that may not otherwise be accessible. Although more complex, partnerships can be a good approach where people are also likely to be using some mainstream services and where integration and coordination will create demand and improve people’s experiences
• Replication through delivery networks: this can scale a new way of working which can be delivered by, or incorporated into, practices of existing organisations and networks.

In choosing the right approach, it is important to consider the right balance between local coproduction and being faithful to an emerging model. Enabling people to design and adapt local programmes, based on the core features of an external innovation, is likely to increase the degree to which they value those programmes and engage personally with them. Focusing on outcomes and goals, core values and essential practices, with room for local creativity and ownership can get the balance right.

Case study: North London Cares

North London Cares is a community network of young professionals and older neighbours helping one another in a rapidly changing city. Founded in 2011, its objectives are to:

• reduce isolation and loneliness among older people and young professionals alike
• improve the connection, confidence, skills, resilience and power of all participants so that neighbours can feel part of a changing city rather than left behind by it
• bring people together to reduce the gaps across social, generational, digital, cultural and attitudinal divides.

Independent evaluations have shown that North London Cares has reduced loneliness and increased the wellbeing of those involved, with 73 per cent of older neighbours reporting feeling less isolated as a result of participating in its activities.

In 2014, South London Cares was founded. In 2017 the model expanded into Manchester and there are plans for branches elsewhere.

Key factors supporting scaling up

• Provision of advice from experts in business growth and finance, e.g. in managing risk and developing effective governance arrangements
• Co-production – always listening to the people involved, responding to their needs and drawing on their ideas
• When moving your model into a new area, understanding it will be very different, and will need a unique approach which reflects local circumstances
• Recruiting, developing and retaining people with strong values, ideas and energy.

When we started to build South London Cares, after the success of North London Cares, we couldn’t just take the model and plant it across the river. We needed a whole new set of people with local community experience and local community ties, who were excited to do this kind of work, and with new ideas on what would make it successful.

Alex Smith, North London Cares

Case study: Age UK’s Personalised Integrated Care

Age UK’s Personalised Integrated Care programme operates across England and brings together voluntary organisations and health and care services in local areas; providing an innovative combination of medical and non-medical personalised support for older people living with multiple long-term conditions who are at risk of recurring hospital admissions. The programme was originally piloted in Cornwall, and has grown significantly, operating across several local areas.

The process begins with a conversation between the person and the voluntary sector coordinator, who helps them to identify their goals and coordinate a management plan. Trained volunteers provide support to help the individual become better connected to their community, be more physically and socially active and subsequently have better health outcomes. Practical support, navigation and coordination are provided to boost self-confidence and selfreliance, reducing adult social care spend and primary/community health benefits.

Scaling up

The programme was first trailled in Cornwall in 2013. In 2015, it was extended to eight new sites, each aiming to support a further 500 to 1,000 older people a year. These sites are Portsmouth, North Tyneside, Ashford and Canterbury, East Lancashire, Blackburn with Darwen, Redbridge, Barking and Havering, Sheffield, Guildford and Waverley.

In 2017, South Gloucestershire, North Kent, South Kent, Croydon and Northamptonshire were added.

Key factors supporting scaling up

• Undertake robust evaluations of the impact of the programme, and utilise this evidence to convince other commissioners and funders
• Ensure that the initiative is aligned to current and emerging policy drives, such as the development of integrated personcentred care
• Select areas for adopting the model that have strong existing partnerships