A Caring Society - How can grassroots innovation flourish to tackle the care problem?
The provision of social care presents a huge challenge for society. More and more people will need care in future – but current approaches to commissioning and delivering care are already creaking under the pressure.
Across the sector, there are pockets of innovation as local authorities, social entrepreneurs and technology entrepreneurs try to find new ways to meet demand and improve the quality of care people receive. But moving beyond pilots can be hardgoing. Established systems, ingrained culture and hard-to-shift mindsets are just some of the barriers to the transformational change that’s needed.
In the third roundtable of our Caring Society programme – led by Hellen Bowey (CEO and Co-Founder of Alcove), Brendan Martin (MD of Buurtzorg Britain & Ireland and Public World), Devika Wood (Co-Founder and Chief Development Officer of Vida) and Paul Najsarek (Chief Executive of Ealing Council), people from across the public and private sectors came together to try to understand what needs to change to enable innovation to flourish and create new models for how we care for each other as a society.
Let’s rethink care models around relationships, not transactions
Despite widespread public debate, much of the care system still operates on a ‘time and task’ model. Employed under this model, carers must view their work almost as a transaction and have little opportunity to develop and deliver people-focused care.
A different way of employing and organising carers – such as the neighbourhood care model used by Dutch homecare organisation Buurtzorg – can provide much better outcomes. Under Buurtzorg’s innovative model, carers are organised as self-managed teams and have the freedom to work with clients to understand how best to meet their needs.
Balancing control and safety is fundamental
Giving carers the freedom to develop people-focused solutions rather than execute prescribed tasks raises complex issues around safety and control. The ideal is to create an environment where committed carers with the right qualifications can exercise their professional autonomy and their intrinsic motivation to do their jobs well. But how do you protect vulnerable people from situations where this ideal scenario doesn’t play out? It’s a paradox that’s not easy to resolve.
Technology can simultaneously enable autonomy and ensure safeguarding. The digital care service developed by Alcove, for example, incorporates not just in-home sensors to monitor patients, a wearable assistance device, and smartphone and tablet apps. It also incorporates digital tools to monitor the activity of care workers.
Technology will be essential to tackle carer shortages
With two million more care workers required in the UK by 2024, local authorities and individuals may find they have no choice but to turn to technology for the support they need. But while telecare solutions can help family, friends, carers and local authority professionals keep an eye on vulnerable people living independently, they are not a solution in themselves. The human component is still vital.
Similarly, assistive technology also has the potential to make a big difference for people who need help, but robots cannot replace human interaction and kindness completely.
It can still be a challenge for entrepreneurs and private companies to talk to councils about how technology can help meet future demand for care. Many technology businesses say if they try to talk to social care commissioners about digital, they are often pushed back.
We need more flexibility around employment models
Traditional employment models can get in the way of matching demand with capacity and can hinder efforts to deliver more personal, relationship-based care. CQC rules, for example, prevent agencies from using self-employed carers, even though agencies often need to use a mix of contract types to get the flexibility they need.
Homecare innovator Vida uses a mixed employment model in conjunction with bespoke software to create and manage personalised care packages for different clients. Vida’s algorithms find the best match between available carers and the needs of individual clients – enabling the company simultaneously to promote a personalised service and to make best use of carer capacity.
How can we create the conditions for innovation?
In local authorities, there’s rarely time and resource available to think about innovation in the system and understand what the pipeline innovation in the local area might look like. What’s more,
local authorities can be hampered in their desire to innovate and be creative around the care services they provide simply by the nature of the systems within which they exist.
There’s also a more specific challenge about discussing and envisioning innovation. There’s no language or taxonomy for thinking about innovation and the social care system. No way of describing what good looks like in terms of councils providing the conditions for innovation.
Money still matters
All too often the debate around the future of social care comes down to the need to meet growing demand in the context of limited resources. Our Caring Society series aims to open the debate up – but there are still financial components working against innovation.
One challenge is that it can take time to realise benefits from new approaches – and local authorities facing budget restrictions don’t have the luxury of waiting for several budget rounds before innovation yields results.
On a connected note, it can be difficult for local authorities to capture the savings from investments they make. For example, the impact of setting up and funding self-managed teams may be seen in a reduction in hospital admissions or a fall in demand for GP appointments. When no benefits accrue to the local authority, there’s little financial incentive for them to try a new approach.
Why we should be optimists
Our debate reveals the complex challenges around how to innovate and create a caring society. But it also highlights commitment, vision and energy on the part of those taking part in the conversation. Forward-thinking authorities are working hard to rethink their care models, while social and technology entrepreneurs are developing solutions with the potential to improve the quality of care for millions. This is no time to be pessimists. Let’s look to the future with optimism.