This report presents findings of an evaluation of micro-enterprises in social care in England over 2013 to 2015. Organisations were classed as ‘micro’ if they employ five or fewer full-time equivalent staff.
The aim of the project was to test the extent to which micro-enterprises deliver services that are personalised, valued, innovative and cost-effective, and how they compare with small, medium and large providers. The research was based at the University of Birmingham. It was funded by the Economic and Social Research Council (ESRC), as part of a project entitled, Does smaller mean better? Evaluating micro-enterprises in adult social care.
The research found that many aspects of micro-enterprise provision did allow them to offer a more personalised service than larger care providers. This was particularly the case for care and support that is delivered within the home. The more personalised care provided by the micro enterprises stemmed from three aspects of their approach:
Differences between micro-enterprises and larger care providers were less evident in relation to day activities. Although there were several examples of micro-enterprises offering highly personalised day activities, we also found examples of larger providers offering a wide range of choices which some people welcomed. Whilst most people liked the chance to build closer relationships, some micro-providers and some people receiving support from micro-enterprises spoke of concerns about the risks of over-attachment and burnout.
The outcomes of care and support are closely interwoven with the ways in which care is delivered. Indeed many people did not talk about their support as having a distinctive outcome outside of a personalised experience of care, discussed above. This was particularly the case for home-based support. For activities outside the home there was more likely to be articulation of an end result (making new friends, building confidence, getting fit, finding a job, etc) which was distinguishable from the support that made it happen.
The research explored three distinct types of innovation displayed by care providers:
Micro-providers were found to be particularly good at how and who innovations when compared to larger providers, but findings relating to what innovations were inconclusive. In relation to how innovations, micro-providers were more flexible than larger providers in the way in which care in the home was delivered (e.g. staying to have a meal with someone rather than simply preparing food and then leaving). Examples of who innovations include micro-providers which offered support in potentially marginalised communities and others which were set up and run by people with disabilities.
The distinctive contribution of micro providers appears to be the ability to offer more personalised and valued care than larger providers without a higher price tag. Price data provided by all of the organisations in the research indicated that the hourly rate for micro-enterprises was slightly below that of larger organisations.
As we showed above, this was not at the expense of quality, as responses on use of time and choice/control (from the ASCOT questions) were at least as positive as for larger providers. With the larger providers it was easier to identify trade-offs between price and quality: the cheapest prices were offered by those that conformed to the 15 minute care visit model, and the people who used these services reported high rates of turnover among care staff. At the more expensive end of the market, larger providers were able to match the micro provider offer more closely, providing longer care visits and better staff continuity.
Factors that help micro-providers to emerge and become sustainable include dedicated support for start-up and development – from organisations which understand the distinctive context of the care sector. Strong personal networks within a locality had also helped micro-providers to get started and market themselves to people who might use the service. Balancing good partnerships (including with local authorities) with maintaining an independent status was also viewed as central to sustainable success.
Some local authorities have a quality mark scheme that micro-providers can apply to join. This helps the micro-providers to build local credibility for their enterprise and gives assurance to local people about the quality and safety of the support.
Inhibiting factors for micro-enterprises include a reliance on self-funders given low levels of direct payment take-up in many local area, and low numbers of local authority referrals; the difficulty of maintaining a staffing base with only a small number of people using the service; and the financial fragility of the organisations, some of which were barely covering their costs. Most of the micro-providers involved in the research, especially domiciliary care providers, felt that they needed to grow slightly to gain more organisational and financial stability.
Micro-businesses in all sectors are known to find it difficult to survive, but personalisation reforms in social care have ostensibly made it a supportive environment for micro-scale provision. The case study micro-providers expressed frustration at the rhetoric of individualised commissioning/market diversity and the reality of managed personal budgets and preferred provider frameworks.
The full report is available below.