Title: Does Smaller mean Better? Evaluating Micro-Enterprises in Adult Social Care
Funder: Economic and Social Research Council

Abstract: Are care services best delivered through very small, locally-based services that are 'close to the user' or do large organisations offer more efficient and effective care? As care for older and disabled people in England is becoming more personalised and deregulated, it is important to move beyond the anecdotal claims about small, innovative micro-enterprises and establish an evidence base. The government's Big Society and personalisation agendas are encouraging more very small organisations to get involved in supporting older people and people with disabilities. Within social care, personalisation has led to more people being given control over their own care budget, with the freedom to purchase support from lots of different types of service provider. Micro-enterprises are one of the types of organisation that people can purchase support from. Buying support might mean purchasing domiciliary care (someone to come to the house to provide help with dressing and washing) or paying to attend a day centre. However, it might mean purchasing something very different. One micro-enterprise provides dance classes, for example. It might also involve purchasing something which is better suited to your care choices as a person from an ethnic minority, or as someone who is lesbian, gay, bisexual or transgender. There is often an assumption that 'smaller is better', because small organisations may be more flexible and innovative. However it is also possible to argue that larger organisations will perform better because they can use economies of scale and deploy a wider range of resources. Existing studies of size and performance do not usually include very small organisations like micro-enterprises, making it hard to draw conclusions about the link between size and performance. Using interviews and surveys with 108 service users and carers in 27 case study organisations, across three local authorities, this research will compare outcomes and value for money across micro, small, medium and large care providers (defined by the number of staff working in them). It will: - Use interviews to talk to service users and carers about their experience of using the service - Use a survey to get comparable data between service users across the case study organisations, and compare that to findings in the national Adult Social Care Survey conducted each year by the Association of Directors of Adult Social Services (ADASS) on behalf of the Department of Health. - Involve some 'non-traditional' service users - black and ethnic minority people; lesbian, gay, bisexual and transgender people - to assess how far micro-enterprises are better than larger organisations at providing tailored support. - Compare the prices charged for services in the case study organisations with the outcomes reported by users to see how far organisations are delivering value for money. Talking to users is likely to be particularly effective when other service users do the interviews. This is because interviewees may be more comfortable speaking to other service users and the user-interviewers can design interview questions that get to key issues from their own experiences. The project will recruit and train service users and carers as co-researchers, involved in research design, interviewing, data analysis and dissemination of findings. The project aims to produce findings that are of direct relevance to local authorities, service users and other organisations as they commission care services, and to social entrepreneurs as they develop provision. It also aims to deepen social scientific knowledge of the relationship between organisational size and performance in welfare services, of relevance to academics working in fields such as social policy and public management.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE