This is the third blog I’m writing off the back of a seminar with social care leaders which looked at the question of citizen and community-led change. One of the debates we had on the day was the age old debate of whether change is all about changing systems, legislation and funding routes, or all about changing attitudes and culture. It’s one of a number of questions to which I think the answer is both.
We need to tell stories about, for instance, the lady in Wiltshire who was helped to maintain independence by the provision of a £100 grit bin for her hill, plus some encouragement from her neighbours to share the task of gritting, rather than the provision of a special transport service, or meals on wheels. The latter solution would have helped speed her isolation and reduced her mobility. The former could result in any number of knock-on positive impacts as the people involved got to know each better and thought about other ways they might be able to help.
Stories like that inspire. They illustrate the power of focusing on outcomes rather than mandating processes. A councillor who meets older people in their ward may well be more motivated by that story than by any number of cost benefit analyses and statistics.
But Department of Health Ministers can’t go to the Treasury to make the case for social care armed with anecdotes. They need a robust cost benefit case based on evidence gathered from thousands of people. They need to be able to show cashable savings to real services, not notional Social Returns on Investment.
But how do you quantify the economics of making changes like the grit bin example, without codifying and measuring it out of existence? One solution, I think, is for government to do what it does well, which is to set out the kinds of outcomes it is interested in and to ensure that there is a single set of tools which anyone can use to measure them. That used to mean endless forms, but more recently, tools like the Nottingham University and the Princess Royal Trust for Carers’ Adult Carer Quality of Life Questionnaire (AC-QoL) and ASCOT have shown that you can boil down questions into 10 point questionnaires which take a few minutes to fill in and which can be useful in their own right as ways of structuring conversations about how things are going. Local information can be entered straight into a website which gives services their local data (useful for making the case to your funders), whilst anonymising it and gathering it nationally for use by academics and policy makers. Belief is not enough, but ‘rigour’ doesn’t have to mean ‘rigid’.
This kind of approach gives an answer to the question of whether to pilot and evaluate before scaling up, or to ‘let a thousand flowers bloom’.
The answer is that you can take a thousand small gambles on initiatives like the grit bin, as long as you are able to tell which ones are working and which ones aren’t. You have to be prepared to stop or change the latter. For initiatives that work, you can ‘scale out’ (create the conditions in which lots more people can get together and come up with their own imaginative solutions) rather than ‘scaling up’ (buy a grit bin for everyone).