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Isolation: small may be beautiful when it comes to solutions

Posted by: , Posted on: - Categories: Care and support, Communities, Information sharing, Innovation

“With one million people aged 64 and over in the UK reporting that they are often or always lonely, the newly appointed Minister for Loneliness, Tracey Crouch, has a big task on her hands,” says our returning blogger, Social Care Institute for Excellence Director of Business Development and Delivery, Ewan King.

Ewan King: '[Commissioners] need to use their market-shaping role to find ways for smaller providers to enter the market in greater numbers.'
Indeed, her job could be one of the most challenging facing any minister right now. She will expect local authorities and Clinical Commissioning Groups (CCGs) to do their best to work together to tackle this problem - with limited resources.

She will want to see imaginative solutions for reducing social isolation and loneliness in adults that go beyond simply providing better services.

These solutions could include traditional services such as better information and advice and home visits, but also new approaches which harness the potential of families and communities. How can the field best respond to this challenge?

No magic intervention

There are no simple answers of course. As our latest highlights report Tackling loneliness and social isolation: the role of commissioners identifies, the evidence-base for interventions among adults is emerging but remains inconclusive.

Likewise, there are no ‘magic’ interventions for all lonely older people and what works for one person in one place may not work for someone else in another.

Commissioners must identify and commission a range of interventions to meet the needs of lonely older people and engage with providers from a number of different sectors if they are to address this problem.

Dame Esther Rantzen DBE, Founder of Silver Line, discusses her own feelings of loneliness in this blog for SCIE

That means working with organisations to provide one-to one interactions, not just group and other similar activities.

They will need to work co-productively with local people who will often propose the best solutions. North London Cares is already demonstrating the benefits of this approach.

But at the same time, local authority and CCG commissioners will be driven by the need for services to be cost-effective and efficient.

They will have expectations that contracted organisations can supply routine information and are able to monitor data quickly and comprehensively. But these expectations, laudable as they are in a publicly-funded commissioning body, may be difficult and, in some cases, impossible for smaller organisations to meet.

For example, a shopping service run by a volunteer-led scheme may lack the administrative staff to respond quickly. Meanwhile, smaller organisations may not have the finances to fund staff members to provide the information.

Squashing innovation?

The need for extensive amounts of information to furnish commissioning tenders may limit the potential for smaller organisations to respond. Yet the services offered might be ‘just right’ for a group of people. The needs of the system may squash innovation from the start if we are not careful.

Commissioners have to be brave: to move away from block contracts and be willing to commission small providers - or at least help more people tackle isolation through personal budgets.

They need to use their market-shaping role to find ways for smaller providers to enter the market in greater numbers. They also need to develop new ways of measuring impact, and paying for the delivery of outcomes such as improved resilience, independence, self-care and social connections rather than traditional task and time outputs.

Small is beautiful, they say, but it may also be necessary when we’re thinking about the support that isolated older adults need and deserve.

Tackling loneliness and social isolation: the role of commissioners

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  1. Comment by Christine Margaret Bentham posted on

    Smaller voluntary sector social clubs were killed off slowly after the community care act when funding from LAs was often stripped out. Expecting volunteers to fundraise is a big ask and so many areas now lack these informal clubs that give so much to people. Bringing these back would help not all but a lot of people. Just one visit a week can bring an event to look forward to and a purpose.

  2. Comment by Mr R W Ebley posted on

    Bring back drop ins