Micro-providers offer good value for money but struggle to get referrals from social workers

Social workers need to be informed about local micro-providers so they can make more referrals to them, because of the benefits they offer when compared with larger services.

That was the message from a two-year Birmingham University study into micro-enterprises in social care – defined as organisations employing five people or fewer.

Researchers compared 17 micro-enterprises with four small, four medium and two small providers, delivering residential, day or home-based services, based on analysis of unit costs and interviews with 143 staff, people using services and carers.

Examples of micro-providers

The micro-enterprises studied in the research included:-

• Full Lives, a domiciliary care service with four staff delivering a mixture of personal care and support to access activities outside the home to three people.
• ‘Our House’, which provides shared accommodation to people with learning disabilities, in which the landlord supports the tenants to access social activities.
• A day service with six part-time staff that helps people with learning disabilities integrate into their local communities.
• A flexible service provided by a woman to 14 people in her area in their own homes, including preparing food, cleaning out cupboards and taking them to appointments.

Key findings

The key findings from the research were that:

1. Micro-providers offered more personalised support than larger providers, particularly for home-based care, because of the autonomy given to frontline staff to vary the service offered, greater continuity of frontline staff and the high accessibility of managers to both frontline staff and people using services. For day-based activities, there was less of a gap between organisation types, with some interviewees arguing that the diversity of provision offered by larger organisations potentially made them more responsive.
2. Users of micro-providers were more likely to report that the service helped them to do the things they valued and enjoyed, compared with users of larger providers. There was no statistically significant difference in relation to the extent to which users reported services offering choice and control.
3. Micro-enterprises were more innovative than larger providers in terms of how services were delivered, supporting marginalised groups and involving service users in the running of the organisation, though not in terms of what support was offered.
4. The benefits set out above were delivered at a slightly lower cost – in terms of hourly rates for care – than larger providers, showing that micro-providers offered relatively good value for money. Researchers stressed that the small sample size meant this finding could not be generalised to say that micro-providers were always cheaper.

Lack of referrals

Despite the benefits identified in the study, researchers found that micro-providers were often reliant on self-funders because of low levels of take-up from direct payment users and low numbers of local authority referrals.

The lack of referrals was due to the fact that many micro-enterprises were unable to get on to local authority framework agreements and preferred provider lists and few were Care Quality Commission-registered, making them much less visible than larger providers.

Researchers were told that councils favoured larger agencies, referred people to their own in-house trading companies for provision or gave people alphabetical lists of services to contact, leading people to just call the first few on the list.

What social workers and commissioners need to do

To boost referrals, the report recommended that:-

• Social workers need to be informed about local micro-enterprises so they can refer people to them.
• Social care teams need to promote flexible payment options, including direct payments, for people wanting to use micro-providers.
• Commissioners need to enable micro-providers to get on to preferred provider lists.

Other recommendations included for the CQC, and regulators more generally, to ensure their processes were proportionate and accessible to small organisations, and for micro-enterprises to be given start-up and ongoing support.