There are so many fantastic examples in Wales of volunteering that makes a real difference in health and social care – so why isn’t this good practice adopted everywhere? Fiona Liddell considers the challenges of scaling up.
Andrew Goodall (Director General for Health and Social Services and Chief Executive of the NHS Wales) in the introduction to A Healthier Wales sets out the vision for transforming our health and social care services:
‘Through local innovation which feeds through to new models of seamless health and social care, we will scale up new ideas and better ways of working to regional and then to national level. A national Transformation Programme will bring pace and purpose to how we support change across our whole system… our real test will be in the delivery of services and improved outcomes across Wales’.
The process described concisely and optimistically in this quotation is no simple matter, however. For example, the introduction of citrus fruit into the diet of sailors in 1601 was undoubtedly a ‘good idea’ but it took until 1795 for the practice to be adopted by the British navy. One hundred and ninety four years!
The question of how you ‘scale up’ good local practice is one that we explored in a workshop at the recent conference on the role of the third sector in delivering Wales’ long-term plan for health and social care.
Participants were quick to recognise (often from experience!) the limitations posed by the short term nature of funding. Often this means that there is no capacity, within the timeframe of the funded project, to explore, document or share the lessons learned with wider networks.
Staff posts often end with the project and so valuable local experience is lost. What’s more, short term funding leads to short term thinking
Quite apart from questions of funding, if a volunteering project is effective in one locality, what is the likelihood that it will work in a different area, where the context and personalities are different? If it works well on a small scale, what’s the likelihood that it will work as well when ‘scaled up’?
Transplant a core model or volunteer activity from one sheltered, ‘incubator’ environment to a more exposed one and it may not necessarily thrive.
We might be better in any case to talk about ‘spreading’ rather than ‘scaling up’ in the case of volunteering interventions, with more emphasis on frequent replication of an idea rather than its mass production
‘Success’ can be judged through different lenses: of economics, clinical outcomes, individual wellbeing or the efficiency of service delivery, depending upon who you are – or who you aim to convince.
There is a certain challenge to us in how we ‘package’ and communicate volunteering interventions which have proven to be effective in one locality, in ways that allow others to make them equally successful elsewhere.
Spreading good practice
The Health Foundation carried out research amongst its own grant holders and partners during 2017-18. It concluded in its report The Spread Challenge that more attention should be paid to the role of adopters rather than exclusively on the innovators of new models and practices of health care.
‘Successfully spreading complex health care interventions will require packaging them up in more sophisticated ways and designing programmes to spread them in more sophisticated ways’. Arguably, most volunteering programmes are ‘complex interventions’ due to the significance of the human component.
Adopters may also need to be adapters as they translate, refine and sometimes significantly reinvent a pilot intervention. This stage is crucial and develops our understanding of what are the essential elements of a project that are necessary for its success and what needs to be tailored to suit local circumstances
Helpforce in Wales
Helpforce, with WCVA as its lead partner in Wales, is working with partners across the UK to foster and spread innovation in volunteering within health and social care services.
It will be focusing increasingly on how successful volunteering can be ‘packaged’ and ‘spread’ for wider benefit. A new staff post has been created in order to develop this work.
In Wales we can learn from experiences across the UK and from the evidence and the methodology which emerges. We shall be reviewing the published literature with research partners in the near future, as well as putting a spotlight on examples of effective volunteering which have strategic potential. If you know of such a project, please get in touch!
The Bevan Commission is embarking shortly on a programme to support the appointment of adopters of health care innovation in each Welsh Health Board. These will be welcome allies in the cause.
Let me return to the horticultural analogy once again, to make a final point: for volunteering innovation to take root, we also need to prepare the soil, that is, to create the capacity and readiness for volunteer involvement.
This means developing the culture of an organisation, the attitudes of staff and the policy infrastructure to enable volunteering to flourish. Working collaboratively with WCVA at national level, Volunteer Centres in every county support organisations with the development of appropriate volunteering programmes and policies.
WCVA will also be preparing the ground through national conversations with a range of stakeholders and through the development of more consistent standards of practice.