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Scaling innovation in social care

Rapid pragmatic evidence review: summary report

Published June 2020

SCIE undertook a rapid pragmatic literature review of publications since 2015 to provide a baseline understanding of the evidence on scaling innovation in adult social care. We were specifically interested in significant or large-scale change, and searched for examples of good practice and factors which hinder and facilitate scaling of innovations.

Examples of scaling innovation

We found few reports of specific innovations in adult social care which had scaled significantly in the time period covered by this review. We extended the remit to include health and children’s social care, but there were still relatively few published examples of single innovations which had scaled significantly in the time period covered. Across all three fields there were a number of reviews of scaling innovation which were published after 2015, but drew on examples prior to 2015. This review is based on evidence from those reviews as well as the smaller number of studies of individual innovations and innovation programmes.

What facilitates or hinders scaling of innovations in adult social care?

Across the literature we found that common themes to do with scaling innovations had been identified. Following Albury et al. (2015) we divided the themes into those which are closely related to the innovation or change itself, and are (to some extent) within the power of the innovator to influence; and those which are external to the innovation, to do with the wider context or system, and are harder for the innovator to influence directly. This latter category may be particularly relevant for commissioners, funders, policy-makers and others who wish to drive or facilitate the scaling of innovation.

Factors at the level of the innovation

  • The importance of evidence for demonstrating efficacy and building demand.
  • Maintaining effectiveness while adapting to context.
  • Scaling is iterative and requires reflective learning.
  • The need to acknowledge and engage with complexity.
  • Scaling is different from innovating and may require different leadership/teams.
  • Leadership is necessary, but it is important to scale groups or teams rather than lone champions.
  • Acknowledging that change takes time and commitment.
  • Engagement and co-production with people who use services is key.
  • The need to plan for scaling.
  • Having a clear vision and building shared understanding.
  • Having adequate resources, both financial and human.
  • The impact of recruitment and turnover of staff.
  • Professional and management risk aversion.
  • Reluctance in the sector for partnership working.

Factors external to the innovation

  • Acknowledging that social (and health) care is an inherently difficult environment for innovating and scaling.
  • The need to provide funding to support scale and spread.
  • The importance of networks for spreading innovations and sharing knowledge.
  • The importance of support from leadership and management.
  • The need to allow time for scaling and embedding.
  • The use of policy and financial levers to encourage adoption.
  • The need to capitalise on national and local priorities.
  • The importance of commissioning for sustainable spread.

We suggest that all of these factors are important for scaling innovations and large-scale change in adult social care, but there are seven which are of particular relevance in the context of adult social care, and which innovators and those wishing to encourage scaling of innovations in adult social care should pay particular attention to.

Models and frameworks for planning and understanding scaling

The review identified a number of frameworks or models for scaling and spreading innovations. These models may help innovators and supporters of innovation by providing a framework for planning and understanding scaling which incorporates the factors identified above. The review identified four in particular that have potential for further exploration and use in adult social care because they explicitly engage with the complexity and difficulty of scaling innovations in contexts like this.

To see illustrations of these models, please download the full PDF.


The evidence reviewed suggests that all the factors identified are important for successful scaling of innovations. Innovations in social care may need to pay additional attention to seven factors which are of specific relevance to social care:

  • Acknowledging and engaging with complexity
  • Social care is an inherently difficult environment for innovating and scaling
  • Having adequate resources and funding to support scale and spread
  • Recruitment and turnover of staff
  • Risk aversion
  • Engagement and co-production with people who use services
  • The importance of evidence for demonstrating efficacy and building demand.

Using of one of the models identified above, or a similar framework, can help innovators to identify potential areas of difficulty when planning and designing an innovation. Use of formal models also allows innovators to record and analyse progress in a systematic way which can help increase scale and spread.

About the Social Care Innovation Network

The Department of Health and Social Care is funding SCIE, Think Local Act Personal (TLAP) and Shared Lives Plus to develop the Innovation Network to help local areas take innovative approaches to social care which work.

The Innovation Network will bring together:

  • innovative providers
  • commissioners
  • interested citizens

The Network will support them and local authority commissioners, local partners, care providers and others to test new ideas and share learning and support with others.

A complicated problem is one which has many parts and can be hard to solve, but is systematically and consistently addressable with the right rules and processes. Complex problems involve unknowns and factors which interrelate in unpredictable ways, and consequently cannot be reduced to rules and processes.