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New Service Models Innovation Day

On Monday 21 November 2022, LOTI will host an innovation day at London City Hall for adult social care professionals and their third and private sector partners to explore new service models.

Participants will be supported to think about radical new approaches to meeting social care needs. The focus will be on delivering better outcomes in more sustainable ways over the long term, using all the tools, approaches and methods that are available in the internet era.

The day will focus on three themes:

Better independent living
Better care homes
Better social support models

The event will be followed by an £200k innovation fund to incentivise, select and pilot the most promising ideas for new service models.

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To achieve real change

we must match the level of innovation we’ve seen in technology with equal innovation in the structures, processes and models to which those technologies are applied.

It’s time to talk about

New Service Models.

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Innovation Day Objectives

To bring together like-minded professionals working in different sectors who have a common interest in improving social care outcomes.

To raise awareness about and explore the potential for new service models to help improve social care outcomes.

To prime participants to develop specific ideas for new service models that can be submitted to a LOTI innovation fund.

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Context:

Challenges in Adult Social Care (ASC) and what they tell us

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Challenges for Adult Social Care

Demand is growing

1.5 million people or 1 in 7 have unmet care needs. The number will rise to 2.1 million by 2030 if governments fail to act. (Age UK)
The population of England aged over 65 will increase by over 40% by 2038, and the numbers of disabled older people will increase by almost 50%. (LSE)

The current system is under huge pressure

300,000 people waiting for a social care needs assessment. 600 new a day adding to the backlog. 37,000 waiting for care packages to start, 210,000 waiting for a review.
82% of social care directors increased referrals of people discharged from hospital (ADASS)

Costs are unsustainable

Social care is currently the second biggest cost to councils after education, and is rising rapidly. Nationally, it reached around 18% of local government expenditure as of 2021/22 - or £21bn. In London, ASC cost £2.7bn in 2021/22, or 18.4% of expenditure. This has risen from £2.4bn since 2010/11.

It’s hard to recruit and retain staff

Up to 80% of social worker time is spent in front of computer. (FutureGov)
There were 105,000 vacancies advertised on a given day in 2021. (Skillsforcare)

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The case for new service models

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The day-to-day operational pressures of running Adult Social Care Services are rightly top of mind for people working in the sector.

But we also need to carve out a safe and supportive space for those who want to think creatively about how we build sustainable models that can work over the longer term.

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Our hypotheses

In light of these challenges, we believe that:

Solving these problems will require more than incremental change or just improving the digital tools used by social care professionals. �
We need to radically rethink the way ASC needs are met: helping prevent needs from arising in the first place and finding more effective ways to support people when they do need help.�
Local government acting alone cannot adapt its services fast and dramatically enough to meet these needs. New models need to be developed in collaboration with NHS, third and private sector.

In short, now is the time to think creatively about new service models.

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Public service reform options are limited by time, money and statutory responsibilities.

Less obviously, the solutions we choose to implement may be constrained by our perception of what level of change is,

in principle, possible.

Now is the time to start changing that perception.

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The limitations of improving existing service models

When councils seek to improve their existing services, there are a certain number of factors they can adjust to improve outcomes. They can:

Dial up or down the level of time, money, staff and assets that are applied to addressing a particular need.
Put in place different structures; subdividing or combining teams or functions.
Refine or adopt new processes.
Change the timing of their interventions – intervening earlier in a issue, when it’s smaller, simpler and cheaper to resolve.
Change the locations they serve or from which they deliver services.
Create incentives to influence demand.
Change (within legal limits) who is eligible for certain services.

Alter the scope of a service – perhaps focusing on a core offer while reducing the provision of non essential elements.
Prioritise resources, time and attention based on cases of highest risk, need or importance.
Raise or consciously reduce awareness about a service.
Train staff in new skills to make them more effective, productive and adaptable.
Adapt the business model of the service and/or altering who pays, for example by charging citizens for certain aspects of a service, or paying suppliers by outcomes.
Use technology and data to enhance their work in a wide variety of ways.

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We’ve been inspired by seeing examples of organisations that do things very differently...

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The Buurtzorg model places community nurses in self-managing teams of no more than 12. In the Netherlands, the result has been the creation of 900 teams, supported by just 50 administrators and 20 trainers.

Patient satisfaction rates are the highest of any healthcare organisation, impressive financial savings have been made and employee satisfaction is high.

https://www.buurtzorg.com/about-us/buurtzorgmodel/�

Radical restructuring

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Many ambulance trusts are now able to send out an alert to GoodSAM.

The GoodSAM app alerts qualified first aiders in the vicinity of someone experiencing cardiac arrest, highlighting their location and that of the nearest defibrillator so they can hurry to the scene and potentially save a life.

https://www.goodsamapp.org/

Augmenting the capacity of a public service with volunteers

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Online platforms can be used to connect two sides of a market in a particular sphere, matching those with certain needs with others who can address them.

Equal Care Coop helps connect those in need of care with local carers, and uses a cooperative business model to ensure carers are paid more.

https://www.equalcare.coop/

Government as matchmaker

Image credit: StockSnap on Pixabay - CC0 Creative Commons

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Beam crowdfunds support for homeless people, giving them bespoke assistance to access careers, homes and true independence.

They don’t just help them manage an immediate crisis, but equip them with everything they need to thrive.

https://beam.org/

Providing bespoke, preventative help

Image credit: monicore on Pixabay - CC0 Creative Commons

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Transport for London publishes real-time, machine readable data, which external developers have used to create more than 600 apps that help Londoners navigate their city.

TfL has thereby stimulated the creation of useful digital products without building or commissioning them themselves.

Open data innovation

Image credit: Free-Photos on Pixabay - CC0 Creative Commons

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What makes these examples interesting?

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What’s different about new service models?

What’s interesting about these new examples is that they change more elements of a service than are typically considered when the public sector acts alone. For example they alter:

Who’s (able to be) involved. Citizens, volunteers, freelancers, charities, third sector organisations and businesses can be involved in shaping or providing for a certain need. E.g Trained volunteers support ambulance crews through GoodSam.

Relationship. Instead of having a top-down or centralised model, we might swap to a more decentralised or distributed model. E.g Buurtzorg’s distributed, self-organising teams.

Ownership / Organisation Types. We can adopt new organisation types that change the incentives for those who work within them. E.g the Equal Care Coop uses a cooperative model.

Funding Method. There may be alternatives sources of funding, such as crowdfunding, matched crowdfunding (where an organisation matches or tops up contributions from the crowd), community shares, and so on. See how Beam crowdfunds for homeless people’s support.

Power. Power might be radically shifted to different people within a service to change who acts or how they act. E.g. The Buurtzorg community nursing model involves a radical shift of power and responsibility to the front line.

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What’s different about new service models?

Public Sector Role. Most importantly, new service models typically entail local authorities playing a very different role, shifting from being service deliverer or commissioner to, for example:

Funder / investor – providing money to support external organisations to develop new solutions to local needs;
Incubator – bringing social enterprises under their wing to support them in developing solutions and providing ready access to funding, expertise and mentorship
Signposter – councils already point citizens towards useful external services, but this could grow to include a far wider pool, such as the digital social innovators listed at digitalsocial.eu;
Convenor – bringing different actors together to collectively address an issue;

Matchmaker – connecting people in a community with certain needs with individuals or organisations who can address them;
Incentiviser – for example see Essex County Council’s use of challenge prizes to incentivise external innovators to help them find novel solutions to local issues;
Placemaker – taking responsibility for the outcomes they want to see in their communities and building their resilience.
Data provider – publishing and providing rich context around the data they collect to enable the creation of a broader range of services created by others

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Traditional Model of Public Services
Time	Money	Staff	Assets	Structures	Processes
Timing	Location	Incentives	Eligibility	Scope	Prioritisation
Awareness	Skills	Business Model	Who Pays	Technology	Data

New Service Models
Who’s involved	Relationship	Organisation Type	Funding Method	Power	Public Sector Role

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Why are these extra factors helpful?

Who’s involved	⇒	Increases capacity available to solve a problem

Relationship	⇒	Avoids excessive bureaucracy Provides more localised solutions

Organisation Type	⇒	More money stays in the system, paying higher wages

Funding Method	⇒	Increases funding & Enables donors to see their impact

Power	⇒	Residents manage own wellbeing. Frontline staff practice their vocation

Public Sector Role	⇒	Takes pressure off public sector having to do everything itself

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Theme	Better Independent living	Better Care Homes	Better Support Models
Key points	• New forms of home-care release additional capacity in a local care system • New forms of home-care offer greater flexibility and control to people • Care workers in this model find it easier to manage competing demands on their time • Care workers in this model are delighted with their ability to be person-centred carers	• Residential settings can still allow for users to take responsibility and live independently • Changing where residential care is delivered can be key to a different experience • Involving inter-generational mixing was a common way to promote wellbeing • Care processes and daily activities were organised in a different way to achieve independence and community in residential settings	• We can prevent health and care needs by addressing people's social needs • Later interventions are best driven from health data • Earlier interventions are best led by citizens • Organisations can come together to achieve a shift in this area in one city • Technology has been a powerful enabler for promoting independence
Egs.	North West Care Co-operative reduces hourly care costs by 10-20% by running with lean overheads. CeraCare have achieved a 45% drop in hospital admissions in one place by enhanced home-care provision.	Shared Lives Plus residents save councils £30,000 per year compared to typical residential care. 83% of Shared Lives Plus residents found it easier to make friends in the scheme.	GENIE facilitated NHS savings of c.£170 - £400 per user. 11.25% reduction in total health costs associated with U-PROFIT's early nursing intervention.

What’s the evidence base for the impact of new service models?

We must be open and honest that new service models are inherently more experimental. However, LOTI’s recent research with PUBLIC found that:

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About the

Innovation Day

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What we want to do now

LOTI’s innovation day on 21 November is a chance to start the conversation about new service models, and seek out a coalition of the willing to explore them further. Participants will be able to:

Meet and network with like-minded people in the public, third and private sectors
Visit a expo of organisations that exemplify the potential of new service models
Learn about LOTI’s framework for thinking about new service models.
Share their ideas for how things could be done differently
Find out about LOTI’s New Service Models Innovation Fund and how to apply.

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Outline Agenda: Morning

Time	Activity
9:30	Arrival and networking breakfast Participants have chance to meet each other
10:00	Welcome and Introductions Housekeeping \| About LOTI \| The opportunity of new service models \| How the day will work \| How the fund will work
10:15	Keynote: Paul Najsarek, Non-Executive Director, South London ICS To set context on the nature of the problem and the need for innovation
10:30	Meet the coalition of the willing! Icebreaker activity on tables to help make new contacts with like minded innovators across different orgs & sectors. My ideal outcomes Activity to discuss what participants wish could be different in ASC.
11:00	New Service Models Expo Participants meet with organisations who have specific, tangible examples of meeting needs in new ways.

Main room set up cabaret style, with participants from different orgs and sectors mixed across tables.

11am Expo takes place in three breakout areas. Participants can move around and meet interesting organisations.

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Outline Agenda: Afternoon

Time	Activity
12:00	How do you design new service models? Participants are invited to reflect on the expo examples and what principles sit behind them. LOTI provides overview of the case for new service models and the potential benefits they offer. Guests invited to quietly reflect on what barriers they see
12:30	Lunch & networking - and objections board
13:30	Design Session - Part 1 There will be four themes to consider in different parts of the venue. Participants will be split into four groups and rotated around the themes - spending 30mins on each. Facilitators will support them to think about: What are the greatest pain points to address? What opportunities are there for new service models?
14:30	Tea and Coffee Break
14:50	Design Session - Part 2 Groups visit the remaining 2 thematic areas. For the same exercise as Part 1
15:50	Feedback from each group
16:15	Reminder of fund details and dates + package of support to help them develop ideas
16:30	Guests depart

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About the

New Service Models Innovation Fund

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New Service Models Innovation Fund

LOTI will launch a New Service Models Innovation fund to fund 2 pilot projects.

We’ll invite proposals for ideas that:

Are relevant to one or more of the themes of:

Better independent living
Better care homes
Better social support models

Involve at least two LOTI boroughs
Are enabled at some level by better use of technology and data
Can test an idea in practice - not just a discovery report.

AND meet at least two of the following four criteria:

Focus on prevention rather than reaction
Involve collaboration between public and third or private sectors
Entail boroughs playing a different role from delivering or commissioning a service
Radically empower residents and/or front-line practitioners.

We can offer:

£100K per pilot�
Access to digital, data and innovation mentors from across the LOTI network�
Project management capacity�
LOTI’s outcomes-driven methodologies

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New Service Models Innovation Fund Timeline

Mon

21 Nov

Innovation Day

Fund opens

for Expressions of Interest

Wed 23 Nov

Webinar & Q&A on Innovation fund

Mon 28 Nov

Webinar & Q&A on Innovation fund

Mon 9 Jan

Closing date for EOI

Wed 11 Jan - EOI Reviewed by Panel

Mon 6 Feb

Closing Date for Full Proposals

Fri 13 Jan - feedback on EOIs

From Mon 16 Jan Mentors available to help work up proposals

Wed 8 Feb

Panel Meets

Fri 10 Feb

Clarification interviews

w/c 13 Feb - successful projects informed

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