Social challenges are as tough and engrained as ever. With the increasing strain on health and care services, the mantra ‘more for less’ has become deafening and, on occasion, paralysing. In this intimidating context it remains just as important but altogether harder to ask the important question, how can we help change the way our society works to better service the most disadvantaged?
Even at the best of times, finding effective solutions to social challenges is a question of alchemy. Creative solutions must also be practical ones, and a strategic view need to pick up the detail of local delivery. Needless to say, there is no short cut to achieving this combination. Anyone offering a simple answer may well turn out to be a false prophet and any time spent working with the people who really drive change on the ground confirms just how hard it is to change the system.
One of my particular interests is in devising and re-thinking funding models which could help encourage a more sustainable approach to delivering change. Inflexible government funding programmes sometimes strangle innovation and can be disconnected from the people on the ground. Traditional grant making can likewise end up being led by a set of priorities which aren’t sufficiently responsive and don’t always lead to sustainable services.
One alternative is social investment. Could social investment be a way to allow money to go further than traditional grant making and complement government funding programmes? For instance, could social investment support the development of better community and preventative services - areas of care which are still often relatively neglected? And could those investments generate value through establishing alternative, better and cheaper care and/or reducing acute demand?
My main learnings from supporting the development of social investment partnerships with Social Finance and the End of Life Care Incubator have been the following:
The risk-taking investment structure is useful for forcing early discussions of goals and alignment of stakeholders; and
The impact and value are much greater when we combine risk taking investment with hands-on clinical, operational, analytical and programme management support. For instance, a palliative care clinician with huge experience of establishing similar services and I worked as a pair to support a London CCG and a large community and mental health NHS provider in developing a new community based end of life care service.
In my few years working alongside health and social care services, I have also seen how difficult it is for those involved in the delivery of services to have the time to input into the kind of programmes which are looking to change the structures they work in. We need to discuss the role social investment may have in this capacity issue.