Coincidentally a month or so later I was asked to become an independent Director of a new Social Impact Bond funded service to tackle loneliness – Reconnections – run by Age UK in Hereford & Worcestershire. As a founder of the Campaign to End Loneliness with an interest in what works in reducing older people’s loneliness it was an opportunity I wasn’t going to miss.
Naively when I started I assumed my role would be to champion the interests of older people ensuring that investment decisions didn’t override their interests and that the service didn’t simply go for the low-hanging fruit, the easiest to reach. But I was entirely wrong about that – I soon learnt that the desire to deliver a valuable and effective service was the number one driver for all the directors and investors sitting round the table – and that they all shared my concern for the most vulnerable people. Indeed, the investors’ depth of expertise in delivering services in health and care has been just as impressive as their business rigour. The moral and ethical dimensions of the service have been the drivers of process – not secondary to them.
On the back of a contract with Worcestershire Country Council (in consortium with three CCGs) social finance was raised to pilot a new service designed to reconnect lonely older people with community activity. After referral into the service, individuals are assessed and their loneliness measured against an established scale (the UCLA scale for aficionados). They then co-design a plan to engage with activities in the community, supported by a volunteer. Their loneliness score is then re-measured at 6 months and 18 months and the County Council pays a fee for every point of reduction in their loneliness. The model is based on health economics which demonstrate that the reduction in loneliness reduces the downstream costs of GP visits, hospital admissions, home care or residential care.
The benefit of the social investment is that it de-risks service commissioning – the Commissioners pay none of the start-up costs – only for the results achieved and long term, if results are delivered, the service could become self-sustaining. The service user taps into their own assets and interests and those of the community – linking them to a huge range of activities already on offer in their area and giving them support to have the confidence to re-connect, find new hobbies and hopefully build new friendships. And fundamentally the service improves those peoples’ lives, makes them more fulfilling and purposeful, allowing them to use their skills and passions and contribute.
That’s the theory. In practice, the social finance approach brings with it a rigorous test and learn approach – which drives continuous service improvement and generates really meaningful learning. Too many charities run services for a period and then evaluate their impact at the end. They miss the chance to make sure every individual getting a service gets what works best for them at the time they receive it. To me, this is one of the greatest benefits of the social investment approach.
The detailed monthly reporting does tell us a lot about the number of referrals, volunteers in the pipeline, support being delivered and results collected. We use the data to continuously review the blockages, the falling off points and where processes could be improved to enhance the experience of the service users. But it still ensures that the individual peoples’ stories shine through and that we feel the fabric of the service not just read the numbers. Crucially it helps illuminate the unintended consequences of process and the deeper moral questions about who the service is designed for, how it builds confidence and resilience and delivers a sustainable and personalised service.
A few years ago I was asked where I thought the skills gaps were in the sector – and I pointed to service design, impact measurement and project management. Indeed, when we set up the Campaign to End Loneliness 6 years ago, once safely behind closed doors all the founders admitted that their services were not as good as they should be at really demonstrating their value and the benefits for service users. So generating real learning about what works – the outcomes for service users and the relative value of different approaches has been a crucial part of the Campaign’s work. The Reconnections Service has been so rigorous it shines a light on how to generate that learning which has wider benefits than just the service users in Hereford & Worcestershire.
For me personally it has been one of the stimulating learning experiences of my career. It has fundamentally re-shaped my understanding of service design and quality.
More specifically it has raised important questions about reducing loneliness. Like;
- what is the impact of assessment and eligibility criteria on the individual?
- why do some people refuse a service or drop out and what are the other real life events that have an impact on people’s lives beyond the control of a service and how should it respond?
- how can support and connections be sustained?
- why it's easier to shift someone’s well-being and their appreciation for a service rather than their deeper feelings of loneliness
- how can we better segment services between low, moderate and chronic needs?
- how do you best manage and incentivise multi-agency services?
I am hugely inspired by the opportunity I’ve had to learn as a Director of this new service. I recognise how challenging it’s been for a small staff team to work in this way, and seen how committed they’ve been to truly making a difference to older peoples’ lives. I’ve seen first hand that social finance isn’t a silver bullet to solve our funding woes or secure the future of preventive services. But more crucially I’ve seen the opportunity it's given to test a new approach and to generate wider learning helpful to all who are trying to deliver better outcomes to service users.