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Do micro enterprises offer care and support on a scale that's just right?

Posted by: , Posted on: - Categories: Care and support, Guest author

Dr Catherine Needham, Reader in Public Policy and Public Management at the Health Services Management Centre, University of Birmingham, assesses the virtues of micro-enterprises in the delivery of good care and support services...

micro enterprisesBarbara works on her own, providing help in the home to about 14 people in her local area. She is very flexible in what she does, from preparing food to cleaning out cupboards and taking people to the doctors or to concerts. She explains how she left her previous work with a large domiciliary care agency:

I was always getting in trouble for doing too much, like cooking meals and doing somebody’s washing. And when I was made redundant, that was it. I just made me mind up I was going to do it.

This is one of the micro-enterprises included in a recently completed research project based at the University of Birmingham, funded by the Economic and Social Research Council.

Dr Neddham: 'We found that micro-enterprises deliver more personalised, innovative and valued support for a similar or lower cost than larger providers.'
Dr Needham: 'We found that micro-enterprises deliver more personalised, innovative and valued support for a similar or lower cost than larger providers.'

Prompted by an interest in the ‘Goldilocks’ question - what size of social care provider is ‘just right’? - we compared micro-providers of care and support (employing five members of staff or fewer) with small, medium and large care providers in three areas of England.

27 care organisations took part in the study, covering a range of sizes and functions, including day activities and home support. We interviewed 143 people, including owners, managers, employees, carers, and those receiving services, including older and disabled people and used the Adult Social Care Outcomes Toolkit to generate outcomes data.

We found that micro-enterprises deliver more personalised, innovative and valued support for a similar or lower cost than larger providers. These benefits seem to be based on the micro-enterprises having greater continuity of staff, greater staff autonomy and greater accessibility of managers compared to larger organisations.

Micro-enterprises can find it hard to get started and to stay in business. Often lacking the local authority contracts and promotional resources of larger organisations, they market themselves through word-of-mouth and local networks. For micro-enterprises to flourish, local authorities need to help them access dedicated support, e.g. through support organisations like Community Catalysts. Professionals such as social workers and GPs need to know what is available in their patch so they can make referrals.

More individualised commissioning, including higher take-up of direct payments, will also be needed, so people can purchase their own support.

Find out more about micro-enterprises.

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  1. Comment by Pearl Baker posted on

    I think this is a great idea, well done. I would like to here more about the funding issues. I would also like to know what choices the patient has in who supports them, and how the Personal Budget is applied to this? and will the patient pay the Provider, or will the LA pay, as you will appreciate life becomes very difficult if the patients is required to pay, (which I am sure you know about) am I too assume the LA pay for this service..

  2. Comment by Catherine Needham posted on

    Pearl, thanks for the comment. The funding and choice issues vary a lot depending on where you live and whether or not you are eligible for local authority support (which is means-tested). If you are a self-funder or if you are eligible for a direct payment from a local authority, you can potentially commission a micro-enterprise yourself. If you have a personal budget that is managed by the local authority, it is unlikely that this can be used to pay for support from a micro-enterprise.The full report goes into more detail about these issues on pages 16-20:,-final.pdf