Care Initiative talk explores innovation in home care

The final Care Initiative Event of 2019 was held on 21 November, when Green Templeton College welcomed Dr Cate Goodlad, Research Associate, Dr Kate Hamblin, Senior Research Fellow, and Dr Karla Zimpel-Leal, UKRI Innovation Fellow from the Centre for International Research on Care, Labour & Equalities (CIRCLE) at the University of Sheffield to present their work on Innovation in Home Care.

Green Templeton alumna Dr Gemma Hughes, who graduated with a DPhil in Evidence Based Health Care this year, reports from the evening:

The frozen landscape of care policy
Professor Mary Daly introduced the event by re-stating Green Templeton College’s ongoing commitment to the subject of care in the face of what she characterised as a frozen landscape of care policy. Dr Cate Goodlad later referred to this lack of policy action to address the care crisis when she reminded the audience of the repeated reviews and commissions which have failed to produce policy changes across successive governments. The significance of caring responsibilities in the UK is made clear in Will I Care?¹, a report from Circle and Carers UK. The consequences for older people of the lack of policy action mean that 1.5 million people have unmet care needs according to Age UK’s General Election Manifesto². Whilst there are some signs that social care is starting to appear in political parties’ general election campaign material, there remains a clear and pressing need to keep up the conversation about care.

Is innovation the answer to social care problems?
In this context, innovation is considered as a potential solution to social care problems. Innovation in Home Care is one area of research being undertaken by the Sustainable Care: connecting people and systems programme led by CIRCLE and funded by the ESRC. Drs Goodlad, Zimpel-Leal and Hamblin presented their findings from reviews of academic and grey literature, and expert interviews about current trends of innovation in home care.

Home care, in this instance, was defined as domiciliary care, or other support provided to people in their own homes, and not residential or nursing care. Innovation is a term that proved to be more difficult to define, though it is commonly used in government documents. Innovation is used to refer to efforts to improve outcomes and contain costs, often through technological solutions, but also through replicable, scale-able, sustainable models of care. Dr Goodlad explained that innovation is a term that has become embedded in policy; considered to be a normative good. Innovation has been linked to the growth of managerialism in the public sector, and is considered to be a driver of economic and social development. However, there are also critical studies of innovation which examine ‘pro-innovation bias’3. Innovation has not always found to be good; some innovation can also be destructive. In short, innovation means different things to different people.

Dr Goodlad provided a working definition used in the Innovation in Home Care research drawn from Osborne’s work; with the criteria for innovation being regarded as: 1) newness, 2) something in use (not just an idea) 3) a process or an outcome 4) representing discontinuity with the past.

What is innovative in home care?
When Dr Zimpel-Leal set out the models of innovation in home care identified from her research with experts in the field, the definition of innovation became even more troubling for the audience. Examples of so-called ‘innovations’ included ideas that were not new to the audience, such as social enterprises, co-operatives, co-produced services, integrated health and social care, housing support, telecare and outcomes-based commissioning, to name but a few. How, then, can these ideas be termed innovative? Is the word ‘innovation’ being over-used? One interpretation of these findings is that ‘innovation’ was being used to indicate non-mainstream or non-traditional services, rather than to describe novel or new ideas. Another interpretation could be that pilots are badged as innovative in order to gain support and funding, whereas in fact incremental change can be equally important.

The limitations of innovation
Findings from the team’s work indicate that the barriers to innovation appear to be structural, linked to issues of resourcing, rather than a lack of demand for innovation from users and providers of home care. The audience brought other perspectives to the discussion which helped to expound the limitations of innovation, querying if we are trying to innovate in what one audience member described as a ‘broken system’? The audience were concerned that the user and provider-led innovation described by this research is just about cost-containment and does not start to address structural problems such as allocation of social care funding, demographic change, divisions between health and social care, or to address the disturbing features of our current social care landscape such as the high levels of unmet need noted above.

The audience also sought to broaden the discussion to thinking about care in different ways, for example by drawing on comparative knowledge from other systems and cultures, by challenging the focus on technology and digital innovations and highlighting the importance of caring relations between people (with a reference to Professor Jonathan Herring’s previous Care Initiative lecture on care ethics.). It seems like we have to change our whole perspective on the way we think about and organise care, moving beyond conversations about technical and other innovations.

Before innovating, both the speakers and the audience proposed, perhaps we need to stop and clarify what problem we are trying to address, and to be clear about what kind of care we want. A national conversation is needed.

Blog author Dr Gemma Hughes is a Health Services Researcher in the Interdisciplinary Research into Health Sciences group at the Nuffield Department of Primary Care Health Sciences at Oxford University. Her research interests include critical analysis of the relationships between health and social care policy, practice and lived experience.

Read more about the Conversations on Care series and the Health & Care Initiative here.

References

  1. Carers UK, University of Birmingham, University of Sheffield (2019) Will I Care? The likelihood of being a carer in adult life https://www.carersuk.org/news-and-campaigns/press-releases/average-uk-person-just-as-likely-to-be-unpaid-carer-as-homeowner 
  2. Age UK (2019) General Election Manifesto 2019 https://www.ageuk.org.uk/globalassets/age-uk/documents/campaigns/ge-2019/age-uk-general-election-manifesto-2019.pdf
  3. Benoît Godin and Dominique Vinck (eds) (2017) Critical Studies of Innovation: Alternative Approaches to the Pro-Innovation Bias. Cheltenham, UK: Edward Elgar Publishing.
Created: 25 November 2019