Curing chronic ‘pilotitus’: Why we need new funding approaches in health and social care
In recent years there’s been an explosion of innovation and a spike in new services to support older people, often pioneered and funded by non-statutory bodies. But what happens when the funding for these ‘pilots’ runs out? To achieve systemic and sustainable change we also need to consider innovative finance.
We get money in according to assessed need and then spend based on historic allocations — we need to be able to demonstrate we can align spend to outcomes and safely move money around the system.
Warren Heppolette, Chief Officer for Strategy & Innovation, NHS Greater Manchester Integrated Care
With tight budgets, our focus on lack of resource is understandable. But I would argue that it has also stopped many of us thinking creatively when it comes to finance.
As a sector we are wedded to traditional funding approaches. This has resulted in:
- commissioning and funding flows not aligned to the outcomes that matter
- perverse incentives created by measuring the wrong things – ‘whatever is measured is managed’
- a ‘hand to mouth’ economy for provider organisations
- great services not sustained
- charities and other funders’ impact limited
This in turn has led to a ‘pandemic of pilotitus’. A situation in which significant resource is directed into the duplication and replication of services and‘new ideas’, overlooking the myriad of robust, community-based offers that already exist, and that are often fighting to be sustained.
Whilst this is a recurring challenge across the health and social care sector, it is particularly acute in those parts of the system concerned with supporting older people with dementia and other needs. Not only are those living with dementia negatively affected by ‘pilotitus’, but so too are their unpaid carers – the friends and relatives on whom the whole system hangs.
I can’t take a break. He is looking for me and he will forget. Even for injections, he has to come with me. Everything we do, we do together. I can’t see the wood for the trees.
Unpaid carer, Live Well Dementia Hub, Stockton-on-Tees
Recognising these challenges, Social Finance, The Dunhill Medical Trust and Alzheimer’s Society formed a partnership to understand how systemic change can be achieved for older people with dementia and other needs; building on what works and finding solutions to what doesn’t.
Given the prevalence of dementia, an ageing population and the disbanding of a strategy for adult social care reform, this programme and its exploration of alternative forms of investment and funding, comes at a critical time for the sector.
What we did
We embarked on a 15-month ‘test and learn’ programme, where we provided initial funding and support for innovative services, to build a body of evidence for commissioners and funders to change the way support is funded and delivered.
We partnered with 6 service providers working in the community who had identified innovative delivery options and were committed to working in an outcomes-based way — The Rainbow Foundation, Sage House by Dementia Support, Genie, Shared Lives Plus, Leicestershire County Council, and Marie Curie.
The Marie Curie Dementia Care and Respite Service in West Glamorgan supports unpaid carers and those they care for throughout their caring journey, as explained by a carer in the video below.
Our work was guided by the ‘Routes to Scale’ framework – a tool developed by Social Finance, in partnership with national social change makers, and shaped by over 10 years’ experience of driving systems change at scale.
This approach allowed us to build an evidence base for alternative finance, and to answer questions on the types of impact measures that could be used if a sustainable funding model was established.
We launched our report Taking an outcomes focussed approach to improving care for older people with dementia and other needs at a learning community event on 3rd October 2024.
At the event there was broad consensus around one of the reports main conclusions — namely that there is an urgent need to explore alternative funding mechanisms, including but not limited to, social investment.
This echoes NHS Confederation’s call for every Integrated Care Systems (ICS) to have a portfolio of social investment.
We need to explore other avenues. At the NHS Confederation, we are working with partners to explore the scope for models of social investment in which upfront money generates a return through reducing demand. Ultimately, every ICS should aim to have a portfolio of social investment projects.
Matthew Taylor, CEO, NHS Confederation
If we are to achieve this proposed shift towards social investment we need to:
- work with statutory partners to reallocate the funds that are already available within the system
- invest in community-based services that understand local need
- prioritise integrated approaches to care which have deep levels of trust with their communities.
At the event, our learning community agreed that a critical next step is to bring together value-aligned funders who are committed to changing how critical services for older people and their unpaid carers are invested in and supported.
And so that is what we are doing! Our funder roundtable is on the 21st November — please get in touch if you’d like to be invited.
Join our funder roundtable event
We are convening a funder roundtable event on Thursday 21st November to assemble like-minded funders and commissioners who want to change the way services for older people with dementia are financed. This is an invitation only event, but if you’re interested in joining us, please contact Fleur Taylor-Sutton
Contact us
