There is widespread consensus that innovation in adult social care is a good thing. Social care providers, policymakers and others all express an appetite for learning how to innovate successfully and sustainably. However, there is a lack of evidence available about how to scale-up or spread innovation, as a 2020 review by the Economic and Social Research Council (ESRC)-funded Supporting Adult Social Care Innovation (SASCI) project found. As members of the Lived Experience Reference Group, we ourselves have seen that this evidence gap may be a key reason why innovation is not being adopted as quickly as it should, although there has been an increased research focus on this over the last decade.
What is “innovation” anyway?
One of the reasons why there has been a continuing evidence gap and limited scaling of innovation in adult social care is because the term itself is not widely understood. “Innovation” can mean many different things to different people. At the Health and Adult Social Care Commissioners’ Conference (December 2023) in Derbyshire, there was confusion amongst Local Authority Commissioners about what the term means. Given their critical role in designing, delivering, monitoring and evaluating innovative local care and support services, this is concerning.
Many local commissioners see innovation as invention: that it has to be something completely new to the world. However, this assumption is wrong. Innovation can also involve using something in a different way to its original purpose. Two examples illustrate this:
- Using a Ring Doorbell and Alexa to transform safety in the home: One of this blog’s authors used to leave their front door unlocked if visitors were expected. A friend adapted and re-purposed their Ring Doorbell, by connecting it to Alexa. This means that they can now ask Alexa to unlock their front door, transforming personal safety in the home.
- Using a drumkit as physiotherapy: A friend had a stroke and found it difficult to draw on standard physiotherapy. He asked his local authority if he could use part of his social care personal budget to buy a drumkit. This helped him to build up his muscle strength and control, while also relieving stress and frustration, and he was soon strong enough to propel his wheelchair himself. He didn’t need the local authority to pay £1,500 a month on a personal assistant, when a £350 drumkit helped him be independent. His life improved in a very individualised way.
What makes social care innovations successful?
While many people think of successful innovation in terms of spread and scale, these are not always the most important criteria. We encourage people to think of more nuanced definitions of success. We consider an innovation successful when it meets the needs, wants, and wishes of the individual or group it’s aimed at supporting. Social care innovation is successful when it enables people who draw on care and support, and their carers, to live the lives they want for longer. Success may be changing the working lives of the social care workforce for the better. Success may mean embracing complexity or being radical and transformational.
Sometimes, success means keeping an innovation local. For example, a local innovation for Chinese older people may be transferable to different areas, but that does not mean it should necessarily be scaled up nationally.
A balance needs to be struck between providing the flexibility to ensure an innovation is appropriate and personalised, and providing clear and consistent rules so that people can draw on innovations in fair and inclusive ways. Self-directed care and support payments are an example of a national innovation that is not working because the flexibility of the ‘offer’ differs depending on where you live. When innovations become national there is the danger that they become inflexible and access becomes unequal.
Successful innovations are those which are co-produced with the people who are intended to benefit from them; these are the innovations which will stand the test of time. However, many in the social care sector are still struggling with what co-production with people with lived experience of care and support means, and how to do it well.Better infrastructures are needed to connect organisations to people and make this possible.
The dangers of short-term funding for innovation
A key challenge for innovating successfully is the limited cycles of funding. Often, only small innovation projects are funded for short periods of time. This “projectitis” problem resonates with what we’ve seen: pockets of social care innovation rarely make it into the mainstream. When the funding ends, a project usually folds, and the project workers or volunteers leave. This negatively impacts on the people who benefitted from the innovation, as well as those providing it. Short-lived innovations can leave people who draw on care and support disappointed, cynical, and demotivated. We can be left with a feeling that in the wider scheme of things, we don’t count – or worse, that we count as a cost.
To remedy this, money should be spent on making sure innovative projects develop sustainably so that they can reach the people they intend to support. Councils must find robust evidence to help them decide what to spend money on, and transparency is needed about why public funding for certain social care projects stops. This is especially true when commissioners are faced with shrinking budgets, and are reluctant to spend substantially on innovation.
The importance of diverse and inclusive collaboration in innovation and in research
Existing evidence shows us that collaboration, leadership, culture, knowledge, and resources are all required to innovate. However, there is little evidence about how organisations can promote diverse and inclusive collaboration, leadership and culture. This is a symptom of broader issues that have been raised: there is very little evidence on developing innovation in general, and even fewer cases of co-produced innovations. Another issue in the research base is that knowledge and evidence from people who draw on care and support is often absent or given less status and value than evidence from other sources. However, we know from experience that evidence is stronger if equality, diversity, and inclusion are prioritised in research design and delivery.
Historically, innovation has come from grassroots movements, such as the deaf and disability movements. In these cases, successful innovations were developed by micro-providers and activists responding to what local people want. If innovation comes from community organisations and workers collaborating with those who draw on care and support to make changes and find solutions, it makes sense for research to look at grassroots innovation. However, the existing evidence does not seem to examine grassroots innovations, or document how inclusive, diverse, and collaborative approaches to innovating can be promoted.
Key reflections
Overall, reviewing the existing literature reveals many gaps in understanding about what social care innovation is, what success looks like, what funding is needed, and who should be involved. As people with lived experience engaging with the social care system, this has highlighted important messages for commissioners, policymakers, researchers, and people who draw on social care and support.
Messages for commissioners:
- Innovation is not the same as invention; it can be the adaptation of small everyday things in ways that improve life.
- It is important for innovators to see people as individuals who have strengths and preferences and keep them at the centre of decision-making about their own care and support.
Messages for policymakers:
- Innovation needs financial support: legislation and policy are insufficient to drive change unless they are backed with adequate long-term funding and supportive leadership.
- When an innovation is scaled up to the national level it must be done in a way that is fair and flexible.
Messages for researchers and research funders:
- There is a lack of research into how organisations can improve their ability to innovate in ways that support equity, diversity, inclusion, and intersectionality – this needs to change. We need more stories about innovation with people with lived experience of care and support.
- Evidence reviews should routinely and explicitly highlight whether equality, diversity and inclusivity principles have been incorporated into studies, and if not, this should be called out.
- Get involved, if you can, with your local social services and social care organisations to share your views on care and support.
Find out more about our Supporting Adult Social Care Innovation research project by visiting our website. The support of the Economic and Social Research Council (ESRC) is gratefully acknowledged (ES/T001364/1). This blog was coordinated and edited by Jacquetta Holder and Annabel Fenton.
About the authors
Dr Clenton Farquharson CBE
I am a member of the Advisory group for the Supporting Adult Social Care Innovation (SASCI) research programme at the Care Policy and Evaluation Centre (CPEC) at the London School of Economics and a member of the SASCI Lived Experience Reference. I advocate for inclusion and equality in health and social care. Through my work with Think Local Act Personal (TLAP), where I am Associate Director, and my work with SCIE, the NHS Assembly, and the NHS Quality Board, I am committed to systemic transformation.
Drawing from personal experiences, I speak out against discrimination, aiming to break down barriers, amplify marginalised voices, and create an equitable society. When I'm not championing change, I'm exploring the globe with my family, while keeping a close eye on Birmingham City FC’s fixtures.
Sandra Paget
I am the Public Involvement Advisor for the Supporting Adult Social Care Innovation (SASCI) research programme at the Care Policy and Evaluation Centre (CPEC) at the London School of Economics, and a member of the SASCI Lived Experience Reference. I have been very pleased to participate in this project. At the age of 76 and having lived with a progressive neuro muscular condition since the age of three years old, I have seen many changes in health and social care. By working with researchers, I help to focus research on why some things have not changed for people and hope to increase understanding about what helps make change happen. I hope the results of this project will kickstart a conversation within adult social care to embrace innovations.
Jennifer Pearl
If you have the right support, anything is possible. I believe in using the lived experience of disability in shaping services. I am a member of the Lived Experience Reference group at the SASCI research programme (Supporting Adult Social Care Innovation) at the Care Policy and Evaluation Centre (CPEC) at the London School of Economics. I am on the National Co Production Advisory Group (NCAG) of Think Local Act Personal, where at national and local level we co-produce services. I am also a project advisor at the Kent University for their research project on cost benefit of domiciliary care. I work as an Expert by Experience for the Care Quality Commission. I am also Co Chair of Inclusion Barnet. When everything comes together I can literally fly a microlight or race at Silverstone.
Paula Sardhina
I am a member of the Lived Experience Reference Group at the SASCI research programme (Supporting Adult Social Care Innovation) at the Care Policy and Evaluation Centre (CPEC) at the London School of Economics and Political Science (LSE). I am on the National Co Production Advisory Group (NCAG) of Think Local Act Personal (TLAP), where at national and local level we co-produce services. Life has its challenges but by being listened to and given the right support those challenges become more manageable. I have a voice that is heard, I feel valued and I’m able to live the life that works for me.