The Care and Wellbeing Fund – a pioneering social investment from Social Finance
The Care and Wellbeing Fund, a £12 million pound fund set up and overseen by Social Finance, was designed to test whether social investment could be used to support improved health outcomes and be a tool for sustainable innovation and transformation in the health and social care sector.
Macmillan Cancer Support provided half of the investment funds, with the other half provided by Better Society Capital (formerly Big Society Capital). The Health Foundation provided development funding, and top-up funding for the cost of rewarding the outcomes for some of the project financial investments, came from the National Lottery’s Commissioning Better Outcomes Fund.
Social investment is a form of repayable finance to an organisation or programme used to achieve a social purpose. It differs from traditional investment in that social investors are not purely motivated by a substantial financial return, potentially possible with investments into commercial entities.
They are often prepared to accept the high-risk / low return reality of testing innovation, and in this instance new services and models of care, in the pursuit of creating social value and impact.
How it worked and what projects were funded
The Fund initially targeted social enterprises, then expanded into outcomes-based contracts for end-of-life care, and finally into structured investments in primary care.
This shift in focus was informed by our improved understanding of where strategic opportunities lay to deploy repayable finance, and the expertise we were building in particular sectors.
Four areas of investment focus began to emerge:
1. End-of-life care
2. Dementia
3. Primary care
4. Healthy communities
Of the 14 projects that began as social investments through the Fund:
- Seven were end-of–life care projects funded through the End-of-Life-Care Integrator
- Severn were broader health and social care projects – primary care services and social enterprises – funded directly through the Care and Wellbeing Fund.
As the Fund’s portfolio of end-of-life care projects grew, they were contracted through a single entity, the End-of-Life Care Integrator (EoLCI), set up in 2016. This entity “recycled” funding – any returns were paid back into the integrator and then used to fund other projects, rather than going back to the investors directly.
The Fund dedicated half of its 14 investments specifically to end-of-life care, particularly in innovative models that target preventative and community-based care.
The overarching ambition was to improve patient outcomes and experience, and reduce the strain on the acute system.
Care and Wellbeing Fund projects
Primary care services and social enterprises
A social enterprise providing activities for care home residents, including exercise sessions and excursions.
Development of self-managing community nursing teams in Cambridgeshire.
A large social enterprise providing sustainable, holistic, patient-centred care in primary care across 20 practices in Somerset.
A service to improve co-ordination of dementia care across the NHS, social care and voluntary sector.
Investment into an integrated care model that aims to develop an exemplar model of integrated care for replication with other Primary Care Networks (PCNs).
The purchase and development of Cruddas Park surgery in Newcastle to create a Wellbeing Centre.
End-of-Life Care Integrator projects
A service focused on better advance care planning in care homes, the Facilitator identified residents in two nursing homes in Haringey who were approaching the end of their life, and discussed and document their wishes about their future with them.
Emergency admissions into hospitals were reduced by 14%, and 94% of people who were admitted with an advance care plan were admitted in line with their wishes.
It has led to six follow-on Social Impact Bonds, despite the services being relatively small and less established in their respective health systems.
A telemedicine support service provided for care home staff to ensure high quality, safe and personalised care that promotes dignity and choice for all residents.
Development of a community integrated end-of-life care system in Waltham Forest that brought together local services and organisations working in end of life care.
This was achieved through developing an education strategy, a system-wide dashboard, a steering group and increased use of advance care plans.
This successfully and sustainably unified end-of-life care in Waltham Forest, leading to a reduction in unplanned hospital activity from care homes – in 2020, this was 11.2% lower than in the previous 12 months.
A palliative and end-of-life care hub set up to ensure people in the last months of life, and their carers, are supported outside hospital where possible.
A service in which specially trained volunteers helped patients in Somerset to make an advance care plan (ACP) and signposted them on to GPs or other services when needed.
Partners
