Catherine Needham - Micro-Enterprise and Personalisation: What Size Is Good Care?

MICRO-ENTERPRISE AND
PERSONALISATION

What size is good care?

Catherine Needham, Kerry Allen and Kelly Hall

First published in Great Britain in 2017 by

Policy Press University of Bristol 1-9 Old Park Hill Bristol BS2 8BB UK Tel +44 (0)117 954 5940 e-mail pp-info@bristol.ac.uk www.policypress.co.uk

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Policy Press 2017

British Library Cataloguing in Publication Data

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ISBN 978-1-4473-1922-1 hardcover

ISBN 978-1-4473-1923-8 paperback

ISBN 978-1-4473-1926-9 ePub

ISBN 978-1-4473-1927-6 Mobi

ISBN 978-1-4473-1924-5 ePDF

The right of Catherine Needham, Kerry Allen and Kelly Hall to be identified as authors of this work has been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.

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Front cover: image kindly supplied by Getty

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This book has been a long time in the making and has drawn on the insight, experience and expertise of a wide range of people. The journey from a 2011 research grant application to the Economic and Social Research Council (ESRC) to a 2016 book has involved a lot of talking, thinking and reflecting about organisational size and about what makes for good-quality care and support.

We would like to thank the ESRC, whose funding of the research as a project entitled Does Smaller mean Better? Evaluating Micro-enterprises in Adult Social Care (ESRC Standard Grant ES/K002317/1) made everything else possible.

We would also like to thank our colleagues at the University of Birmingham, and beyond. Stephen McKay (University of Lincoln) undertook quantitative and financial data analysis. Jon Glasby (University of Birmingham) advised on project design, data analysis and evaluation. Sarah Carr (Middlesex University) contributed to the literature review. Rosemary Littlechild and Denise Tanner (University of Birmingham) evaluated the co-researcher involvement. At regular project team meetings, all of these people challenged our thinking and helped steer the path of the research. Many other colleagues looked at draft chapters and provided very helpful comments on our work.

People who use services and carers were involved as co-researchers on the project, contributing to the design of interview materials, leading interviews, assisting in data analysis and helping to disseminate the findings. Their involvement enriched the research process in so many ways, generating insights that would not have been possible without them, as well as keeping us focused on making research meaningful beyond an academic audience. The co-researchers were Tracey Bealey, Isabelle Brant, Hayley Broxup, Roy Dor, Peggy Dunne, Sandra Harris, John Kerry, Simon MacGregor, Adrian Murray, Joan Rees, Anna Stevenson, Brian Timmins, David Walker, Joanne Ward, Gareth Welford and Sheila Wharton. We hope to find ways to work together again.

Many organisations helped us gain access to research sites or to communicate the findings in a range of ways. Community Catalysts and their local coordinators helped connect us to micro-enterprises. Local authorities in the three localities in which we did the research helped to facilitate links to local social care providers. The Social Care Institute for Excellence (SCIE) gave support on communications. Laura Brodrick from Think Big Picture provided graphic illustration of events and created rich pictures which further stimulated our thinking.

We would like to extend particular thanks to the case study organisations themselves and to the individuals and families using their services, who generously gave up their time to be interviewed. Research would be impossible without the willingness of people to allow researchers into their homes and offices, and we are perpetually surprised and grateful that people agree so readily to being interviewed.

Finally, we would like to thank our families for allowing us to commit time to a book project, which never quite fitted into the working day.

As public service providers strive to improve, a common concern is to ensure that they are operating at an optimal size. Hospitals merge with others to achieve economies of scale. Schools that are perceived to be underperforming federate with more successful neighbours to share management teams. Within the social care sector, care homes link up with others in national chains to reduce costs and increase clout in tendering processes. While these examples demonstrate the perceived advantages of expansion, there are also examples of public services reducing their scale to become better fit for purpose. Social work teams spin out of local authorities to form small mutuals that aim to focus better on the core role. Charities split part of their work into a social enterprise that can operate with more flexible financing. Patterns of preferred sizing may depend on the function of the organisation, but they may also be cyclical over time, shifting from big is efficient to small is responsive and back again (Pollitt, 2008). Governments often send ambivalent signals about what size of service provider is preferred: small community social enterprises are encouraged at the same time as larger tendering processes reward consortia of providers (McCabe and Phillimore, 2012).