Innovation in social care: it’s the how as much as the what

Catherine Needham

People with personal budgets need to have something to buy. For some people the money will be spent on a personal assistant. But there will be lots of people who don’t have a big enough budget to employ someone, or don’t want to take on employer responsibilities. For them a more attractive option may be to buy some support from within the community. What budget-holders probably don’t have in mind is buying care slots from a big domiciliary care agency employing a high turnover workforce on zero hour contracts, replicating the local authority offer. The transformational stories that have spread about personal budgets have been based on people thinking much more creatively about the kinds of choices that budget-holders might want to make. Of course some people might want short visits from agency carers; plenty of self-funders already opt for that. But local commissioners of care services, particularly as they become market-shapers, need to ensure that 15 minute services aren’t simply chosen because there is nothing else to buy or nothing else that can be afforded.

One way to get more cost-effective and innovative services could be for commissioners to stimulate the growth of micro-providers: very small local care providers who keep costs low through minimal bureaucracy but who can find innovative ways to offer support. The Putting People First consortium has endorsed these micro-enterprises (employing 5 people or fewer) as a key element of the move to personalisation: ‘Micro social care and support enterprises established and managed by local people are in a good position to deliver individualised services and are vital elements of a diverse market’.

But is it true that very small organisations are more innovative and cost-effective than larger ones? The University of Birmingham is leading a project to evaluate the contribution that these micro enterprises make, testing if they outperform larger care providers in delivering services to users that are valued; innovative; personalised and cost-effective. We will be speaking to people who use services, and to carers, in micro, small, medium and large care providers, as well as to the providers themselves and the local authorities in which they are based.

The existing literature on scale and innovation is ambiguous: small organisations can be more versatile and lean, intimately knowing their customer-base and innovating quickly. On the other hand, large organisations have the inhouse expertise and the financial security to be experimental, utilising economies of scale. However existing studies have rarely looked at micro-providers (with 5 or fewer staff), as opposed to small organisations (classed as having 6-25 staff). Micro organisations may magnify the benefits of smallness, providing very personalised support to just a few people, and drawing on the ‘natural networks’ of the community to keep costs low. However micros may be more fragile than small providers, heavily dependent on one or two staff, and unable to participate in local tendering processes that are more accessible for small organisations.

A central issue for the research team is the extent to which micro-enterprises can become a new core offering for social care, or whether they offer creativity at the margins, for people who have the resources or imagination to step outside the domiciliary or residential mainstream. This links to the question of what kind of innovation is on offer from micro-providers: is it a what innovation, i.e. a new kind of support. Or is a how innovation: delivering ostensibly traditional services such as residential and domiciliary care in more personalised ways, being better attuned to what kind of support is being asked for, and developing more relational forms of support which utilise the assets of those being supported.

Some of the micro-enterprises supported by the national body Community Catalysts are very much offering what innovations. There is no obvious ‘old world’ equivalent of an animal-human therapy service or a bike-powered smoothie business, just two of the diverse services which Community Catalysts helped to get started. What innovations hit the headlines and help to generate excitement about how personalisation can break the mould of social care service-land. However it is the scope for process-based how innovations that constitute the most radical challenge to the mainstream of social care. People will continue to need help getting out of bed, getting washed and dressed; for some people residential care will continue to be the best place to get this support. If micro-enterprises are an affordable way to get the personalised, responsive, dignified,  domiciliary and residential support that we would all wish for our families, that will be a radical finding from the project.

For more details about the project please see the website or contact Catherine directly.

Catherine Needham is Reader in Public Policy and Public Management at the Health Services Management Centre, University of Birmingham, and is developing research around public service reform and policy innovation. Her recent work has focused on co-production and personalization, examining how those approaches are interpreted and applied in frontline practice. Her most recent book, published by the Policy Press in 2011, is entitled, Personalising Public Services: Understanding the Personalisation Narrative. Follow Catherine on Twitter: @DrCNeedham.

Planning and the new (new) localism – what chance of success?

Nancy Holman

Planning in a time of austerity is never easy – budgets are cut, needs are great and regulation can be seen as stifling growth.  In England we are in just such a position and in the midst of a reformulation of planning that is on the one hand meant to deliver growth and on the other designed to empower communities. Most of these reforms are being couched in the language of localism with community participation at the forefront of policy.

However, these reforms raise a series of questions that have yet to be answered: Who will get involved in local planning? Will localism foster increased NIMBYism? And most importantly, can the localism agenda actually engender action toward policy implementation? My article, co-authored with Yvonne Rydin, examines these dilemmas through the lens of social capital and offers key insights into this latest governmental foray into local social relations.

Who will get involved?

The Localism Act provides communities with an opportunity to come together and formulate their own neighbourhood plans thereby shaping their locale.  Key to this is engaging people in sufficient, meaningful and constructive participation. Social capital suggests that this can be kindled when like-minded communities come together over locally salient issues thereby creating networks of mutual trust and reciprocity.  However, this scenario is not without problems as in order for it to work communities must believe that the benefits of participation are not offset by the opportunity costs of participating. In addition, the strong ties of bonding social capital that emerge from participative exercises can in turn foster more insular and exclusionary localities outweighing any strategic benefits to greater community involvement.

Will localism foster NIMBYism?

Even if the localism agenda fosters communities burgeoning with social capital and a zeal for participation, a real fear, from the government’s perspective, is that these communities will be those best able to resist growth, which runs counter to the Coalition’s aspiration for localist planning.  Countless studies, from the location of mobile homes in post-Katrina New Orleans to LULUs (Locally Unwanted Land Uses) in Japan, have shown that strong social capital is associated with heightened abilities to avoid unwanted development.  Whilst the government has put in place a number of measures like the New Homes Bonus to incentivise local communities to grow the jury is still out on how well this will work.

Will the agenda actually engender policy action?

As the old adage goes, “Almost anyone can write a plan, the difficult part is putting into action”. Critically, there is nothing in the new system of Neighbourhood Plans that makes them more proactive and action oriented in terms of bringing land and development forward to achieve plan outcomes. Here, social capital tells us that, if communities wish to see their plans implemented they must situate themselves in networks that extend beyond local bonding ties into a bracing matrix tailored to the needs of the development activity so that they may access additional resources and investments.  This means that there is scope to ‘shape’ networks to deliver more effective planning.

So, what might be the outcomes of government reform?  As it stands, the rhetoric of localism is in danger of delivering only failed promises and thwarted desires for local communities.  However, planners could regain a key role under the new agenda by focussing on how they could actively build the networks of specific forms of social capital needed to achieve participation, frame localist planning in broader terms by injecting much needed planning skills into the neighbourhood planning exercise, and deliver development that meets community needs by considering the necessary resources and engaging with those who have the power to deliver such change.

A full account of this research is available in my recent article with Yvonne Rydin: ‘What can social capital tell us about planning under localism?Local Government Studies. 39 (1), 79-88.


Nancy Holman is the Director of Planning Studies at the London School of Economics and Political Science. Her work deals primarily with issues of governance and local planning including sustainable development, heritage conservation and community participation. She has often used social network analysis to explore the complex relationships in the multi-level, multi-actor partnerships present in modern governing arrangements.

Could a lack of trust between professionals undermine health and social care integration?

Catherine Mangan

The latest guidance on the health and social care integration transformation fund emphasises the need for ‘genuine commitment to partnership and recognition of the challenges’ to ensure success. We all know that successful integration will rely on genuine, positive relationships between health and social care professionals in the system. But are we taking these positive relationships for granted?

The early findings from iMPOWER’s Home Truths programme suggests that we are, and that we face some fundamental challenges around levels of understanding, and, ultimately, levels of trust between professionals in the health and social care sectors.

The original Home Truths report was published in September 2012 and suggested that GPs were inflating demand for residential care because they didn’t understand the alternatives and that by failing to address this issue, local authorities were failing to manage demand for residential care. Since then, six geographical areas have been working with iMPOWER to explore these issues further, with the University of Birmingham acting as a critical friend.  The sites have conducted surveys of GPs and older people, interviews and data analysis; culminating in an action plan. This week sees the launch of the interim evaluation report on the work of the six sites. The initial findings make for interesting, albeit uncomfortable reading:

  • Over half of GPs rated their relationship with adult social care as poor or unsatisfactory. 41% of GPs felt they could make a better assessment than social workers about a patient’s need for residential care.
  • On a more positive note, 92% of GPs wanted closer links with Adult Social Care staff to better understand local service offers and 76% of GPs said they could be helped to do more to intervene earlier to delay or avoid the need for residential care admissions.  A third of GPs felt that at least some of their patients who had gone into residential care had been admitted before they needed to be.
  • GPs lack knowledge and understanding about social care and prevention type services. Half of GPs who took part in the surveys knew nothing about telecare services (even though they were available in their area), whilst a third knew nothing about the available exercise classes or social support networks. Even where GPs do know about social care services there is a strong perception that these services are not good quality.

Sites also discovered that GPs have a significant influence on older people’s decision-making about care options, with the survey of older people showing that after family, most older people would turn to their GP for advice.  This is perhaps made even more significant by the finding that older people don’t pre- plan their entry into residential care, so may be turning to GPs in a moment of crisis.

For the sites these findings made difficult reading, but most of those involved admitted they had a ‘gut feeling’ about the problems. They have started to address the issues by developing a variety of approaches which aim to:

  • Improve communication about social care referrals
  • Improve access to information about social care services
  • Train GPs and consultants about social care services and processes
  • Embed joint working between social workers and GPs
  • Influence the influencers of older people’s decisions about care

For the sites involved, the Home Truths programme has acted a useful catalyst and provided a focus around which health and social care professionals can begin to converge. The work has acted as a first step in understanding and addressing the relational challenges of integration that lie ahead.

We suggest that all Health and Well Being Boards would benefit from thinking about how these issues might apply within their health and social care systems and ensure that alongside structural plans for integration, fundamental issues around trust and understanding are recognised and addressed.

The Home Truths evaluation report will be launched today at the NCAS conference #ncas and will be available at

Portrait of OPM staff member

Catherine Mangan is a Senior Fellow at INLOGOV.  Her interests include public sector re-design, outcomes based commissioning and behaviour change.  Prior to joining INLOGOV she managed the organisational development and change work for a not-for-profit consultancy, specialising in supporting local government; and has also worked for the Local Government Association, and as Deputy Director of the County Councils Network.  She specialises in adult social care, children’s services and partnerships.

It’s been 30 years coming, but Clause 38 is still really bad news

Chris Game

Sometimes you hear “All things”, but the ancient proverb and the modern Guinness advert agree that it’s “Good things come to those who wait”. Unfortunately, bad things do as well, and for local government Clause 38 of the Local Audit and Accountability Bill is a bad thing that’s been waiting to happen for 30 years and now finally has.

Full badness details will follow, but first, please excuse some personalised scene-setting. The LAA Bill is through the Lords and should get its Commons Second Reading later this month. Its main and originally entire purpose, embodied in Clauses 1 to 37, is to complete the Audit Commission’s abolition and introduce from 2017 a new regime for local authorities and other public bodies to appoint their own auditors. Yes, it is controversial, but a controversy best pursued by more knowledgeable others.

The sole concern here is Clause 38, one of two added by Communities Secretary Eric Pickles and the DCLG long after MPs’ scrutiny of the draft Bill had been completed. It comprises Ministers’ intention to turn the Code of Recommended Practice on Local Authority Publicity from guidelines with which councils are currently recommended to comply, into a statutory document with which they must comply.

There are several wrongs here, quite apart from Ministers’ extraordinary Humpty Dumpty attempt – “when I use a word, it means just what I choose it to mean” – to label it an exercise in ‘localism’, because it seeks to protect the interests of local newspaper publishers against those of elected local authorities. The story starts, though, in the adventitiously appropriate year of 1984.

Then, as now, Ministers were in a lather because a handful of mainly London councils were doing things they didn’t like: some admittedly dubious, but most provocatively ‘political propaganda on the rates’ – when the phrase, unlike when their successors use it today, at least made literal sense. The then Pickles, Patrick Jenkin, played to his party conference audience by announcing what would become the Widdicombe Committee of Inquiry into the Conduct of Local Authority Business, designed to do a hatchet job on those pesky Labour boroughs.

It didn’t work out quite like that – partly, I like to think (as one of the researchers), because of the Committee’s commissioning and use of an extensive programme of independent research, and partly through refusing in its main report to deliver the censorious denunciations of local government practice for which Ministers were apparently looking.

That main, research-based Widdicombe Report, though, was preceded by a quick-and-dirty, research-free interim report on local authority publicity. The Committee members didn’t want to play, and used the opportunity to rehearse their views that local authorities were more than a sum of their services, and had a duty to inform the public both of their own functions and on local government matters generally.

They delivered a divided report, but the majority verdict calling for a prohibition of publicity designed to support a political party was enough for Ministers to produce a statutory political publicity ban, based not on content, which was Widdicombe’s concern, but intent – indeed, possible intent: any material which appeared designed to affect, “or can reasonably be regarded as likely to affect”, support for a political party, cause or campaign.  Remember those conjectural words; there’s more coming up.

The only constraint on the Government in the 1983-87 Parliament were the Lords, and here they removed “likely to affect”, and a good deal else besides, and refused to agree to any code of practice being more than advisory. But the reprieve was short-lived and by 1988 there was a new Act with an even more restrictive definition of legitimate publicity, embedded in a Code of Recommended Practice to which authorities were required to “have regard”.

There have been various interim revisions of the Code, but none that have changed its fundamental character: a set of recommended principles and ultimately voluntary practices, written and scrutinised as such, with none of the forensic drafting rigour that would have been brought to a document intended for legal enforcement. But change “have regard” into “must comply” and you change everything, and that’s what the Government is doing in Clause 38.

I’ll look first at the Publicity Code itself, then at the proposed means of enforcement. The Code’s most recent revision in 2011 was driven jointly by the Newspaper Society – arguing (without much support from hard evidence) that council publications, rather than the internet and broadband, were the crucial threats to local newspapers’ sales and advertising revenues – and a receptive Eric Pickles, two of whose favourite hate taunts are ‘propaganda on the rates’ in the form of ‘town hall Pravdas’ or council newssheets.

Up front in the Code are seven key principles: that publicity by local authorities should be lawful, cost effective, objective, even-handed, and appropriate, should have regard to equality and diversity, and be issued with care during periods of heightened sensitivity.

Even here there are examples of the real slackness and imprecision with which the Code is, and will remain, littered. What do ‘have regard’ and ‘care’ mean? How tall does sensitivity have to grow? And another of those conjectural phrases we saw earlier: objectivity is infringed by “anything likely to be perceived by readers as constituting a political statement, or being a commentary on contentious areas of public policy”. Whether or not you think it reasonable for a political body to make a political statement or an observation on a contentious policy, what kind of yardstick is the likely perception of all, or most, or some, or a vexatious handful, of your readers?

To repeat: in a voluntary code, already overseen by numerous laws, auditors, and the Advertising Standards Authority, these vaguenesses are merely irritating and a potential get-out. In a statutory code, they can cost potentially serious money.

Probably the code’s most contentious provisions are that, where councils do publish “newsletters, newssheets or similar communications”, they should not be issued more frequently than quarterly, or “seek to emulate commercial newspapers in style or content”.

The majority of council newspapers are now quarterly, although even a monthly publication – an appropriate and cost effective frequency, one might argue, for keeping residents fully informed of service developments and changes, consultations, forthcoming council business, councillors’ surgeries, traffic orders and planning notices – could hardly be said to be emulating the style of commercial newspapers, whatever that might be guessed to mean.

What we have, then, is one more example of Ministers’ typical modus operandi in their dealings with local government. They see something they don’t like being done by a few London boroughs on their proverbial doorstep – in this case, distributing a weekly newspaper (Tower Hamlets) or fortnightly magazine (Newham). Then, instead of letting residents decide for themselves whether they approve of how their money’s being spent, they outlaw it with ill-prepared legislation applying to every principal and parish council in England – in the name of localism.

Which brings us to the enforcement debate. Clause 38 allows the Secretary of State to direct one, some or all authorities to comply with part or all of the Code, whether there are grounds for believing they are currently breaking it or not.

How, though, do you judge either compliance or non-compliance with a code as casually drafted as this one? Even in the apparently straightforward case of council publications, there’s no definition even of ‘newsletter’ or ‘newssheet’ or when either metamorphoses into a newspaper, let alone of what emulating commercial newspapers in style and content entails.

“Contentious issues” – like HS2, a third runway at Heathrow, large housing developments, cuts to police and fire services, hospital closures, welfare reforms – are, well, even more contentious.

At present, if an authority feels it or its residents would be severely adversely affected by a government policy, it can “have regard” to the principles of the Code, but still judge the matter sufficiently important for it to explain its opposition in a way that will certainly be perceived by at least some readers “as constituting a political statement, or being a commentary on contentious areas of public policy” – because that’s what it’s intended to be.

LGA Chairman, Sir Merrick Cockell, picks HS2, and specifically the cross-party 51M alliance of 19 local authorities opposed to it, as a topical issue that highlights the almost laughable irrationality of the Government’s proposals. The authorities have already challenged the Government’s policy in the High Court, may carry on the fight in the Supreme Court, and will surely petition Parliament for amendments to any eventual legislation. Yet, if they attempt publicly to explain their case and how they’re spending residents’ and taxpayers’ money, they would in future risk being individually and/or collectively prevented, on the grounds of infringing the Code.

It seems that, after nearly 30 years’ waiting, Pickles and his colleagues are about to achieve what their Thatcherite predecessors never quite managed: the power to gag any council’s questioning of any Government policy. It would have been bad legislation then, but in today’s hugely different political climate, it looks, if anything, even worse.

Chris Game - pic

Chris Game is a Visiting Lecturer at INLOGOV interested in the politics of local government; local elections, electoral reform and other electoral behaviour; party politics; political leadership and management; member-officer relations; central-local relations; use of consumer and opinion research in local government; the modernisation agenda and the implementation of executive local government.

Leading a Council: insights from Warwickshire

Izzi Seccombe

May 2nd 2013 was a greatly significant day. Not only was I appointed leader of Warwickshire County Council, but, as the first female leader, I felt incredibly proud and honoured to be steering our county borough into the future.

Being leader of such a wide-ranging organisation as Warwickshire County Council is both a privilege and a challenge. On assuming position in May 2013 I quickly learned the importance of co-operation and conversation with both opposition leaders and the district councils, not least because we are an administration that lacks overall control.

Underpinning this administration’s vision are two key pillars; a desire to ensure integrity of services within a constrained budget and an aspiration to drive forward Warwickshire as a centre of economic excellence.

The first pillar is perhaps the trickiest. As leader of an administration which holds no absolute control, careful consideration has to be made into the effects and impacts of key decisions that have ‘domino effects’ for external organisations and the populations we serve as elected members. It is with this in mind that the ‘shaping the future’ programme was born. Engaging with communities is vital and I hope that as many people as possible will participate in this conversation. These are our services and it is vital our values are in line with those of the communities we represent.

As already mentioned, the task of delivering our services for the most vulnerable within a constrained budget is a great one. The transformation of services should involve the integration of the ‘3rd sector’ into traditional approaches, simultaneously maintaining our services and bringing communities closer together. In doing so, we provide an answer to the great demands placed on health and social care (for example) by demographic changes in society.

The second pillar of our administration focuses on economic development and growth. Creating and maintaining valuable jobs is vital in enhancing our economic capabilities. Jaguar Land Rover is but one example where innovation and investment enhance our economy and our outlook for the future. Linked to this, the procurement of skills of our young people within a changing labour market is also an important asset in ensuring economic development. Apprenticeships are increasing; engaging members of society with their local economies, equipping them with valuable skills needed to succeed.

One of the key elements of developing a strong, stable economy is the confidence it gives to our population that they will have jobs that will be sustainable. The role the county needs to play here is in matching the skills of our young people to the job needs within Warwickshire. The Warwickshire economy, has, by and large faired reasonably well through this difficult period. We are now poised to develop a thriving economy for the future.

It is essential for the wellbeing of generations ahead that Warwickshire plays the pivotal part now in shaping our future in this area.


Councillor Izzi Seccombe became the first female leader of Warwickshire County Council in May 2013. She was elected as Councillor for Stour and the Vale in 2001, and prior to becoming leader was Cabinet Member for Children, Young People and Families from 2005 to 2010.

If I asked you to describe a 21st century public servant, what would you say?

Catherine Mangan

I read with interest the recent announcement from Birmingham City Council that they did not intend to recruit a replacement chief executive, but would instead create a ‘lead officer’ role. A few years ago it would have been unthinkable not to have a chief executive at the head of a council.  Now, with councils debating what their role is, and the need to seize an opportunity to make savings, more and more councils are making the decision to remove the chief executive post entirely.

Arguments about whether this is a good idea or not have been much debated in the local government world, but I’m interested in what this says to those seeking a career in local government, and the wider public service.   If the very pinnacle of public service, a council chief executive, is no longer a relevant role, what does this mean for the wider workforce?  As the ‘how and what’ of local government changes, so too must the workforce.  How can public servants ensure they remain relevant, and ready for the future challenges?   What does a public servant in the 21st century look like?  How do those of us who provide development support to the workforce best work with them to give them the skills to achieve?

These are questions we will be exploring through a new knowledge exchange project in partnership with Birmingham City Council, funded through the ESRC.  Over the next year we will examine the recent literature, carry out interviews with key stakeholders and create an on line resource to support public servants seeking support and development.   We aim to address key questions such as:

What is the range of different roles of the twenty first century public servant?  As people’s roles expand to encompass the whole person in a system, they can no longer dispense professional judgement in isolation. They need to be negotiators, brokers, story-tellers and resource weavers. Perhaps no longer a social worker but a care navigator.

What are the competencies and skills that public servants require to achieve these roles?  What do you need to be good at to be an effective family support worker?  Probably an ability to empathise, engage, motivate and inspire.  Along with the skills to get things done.   What might that look like in a professional development plan? How do we best support people to develop those roles and skills?  Skills for the 21st century public servant may not be those that can be developed through traditional training; we need to think imaginatively about supporting peer learning, sharing knowledge about what works; facilitating networks of learning.

And as the career path becomes more complex and less certain; with roles spanning organisations and sectors, how can central and local government better support and promote public service as a career?

We are looking forward to exploring the ideas and issues raised by these questions, and want to hear what those of you working in or supporting the public sector have to say.   If you’d like to know more about the project, or contribute in any way, contact us.  We’d love to hear your views.

Portrait of OPM staff member

Catherine Mangan is a Senior Fellow at INLOGOV.  Her interests include public sector re-design, outcomes based commissioning and behaviour change.  She is currently leading the 21st century public servant project, in partnership with Catherine Durose and Catherine Needham. She can be contacted about the project via email, or on Twitter – and you can join the conversation: #21CPS.