Our journey towards social franchising

Alex Bax is Chief Executive of Pathway and Medina Johnson is Chief Executive of IRISi. Pathway and IRISi are participating in our Exploring Social Franchising programme

We lead Pathway and IRISi (Identification & Referral to Improve Safety interventions), which are organisations focused on tackling challenging social issues through NHS based interventions. Both our organisations face similar challenges in embedding and scaling our approaches in the NHS given its complexity and size. Social franchising is an approach which enables other teams to deliver a proven intervention to agreed standards under a franchise agreement, with the primary aim of maximising social benefit. Franchisees would receive a structured package of ongoing support in return for a fee. We are exploring whether social franchising is an approach that can help with some of those challenges. 

Pathway is a charity running a ‘homeless-team-in-a-hospital’ programme and IRISi, a social enterprise, runs a domestic violence and abuse training and advocacy programme for primary care (the programme is called IRIS, Identification & Referral to Improve Safety). 

Both organisations are values driven, founded on a passionate commitment to making things better for vulnerable people when they turn to the NHS for help. Alongside delivering interventions that improve care for people affected by homelessness and domestic violence, we campaign to raise awareness of the impact these issues have on people’s health.  

Together, as we have both learned more about social franchising, we’ve begun to realise that many of the organisational and business challenges we face are similar despite the different population groups and areas of the NHS that we work with. 

Shared roots and shared challenges

As part of the Health Foundation’s Exploring Social Franchising programme both Pathway and IRISi are working with Spring Impact, a non-profit organisation that works with charities and social enterprises around the world to scale the impact of their social innovations, to systematically break down the challenges of scaling their interventions before building bespoke replication and business models.

Pathway has shared its evidence-backed, innovative service model with ten NHS trusts. One of the challenges has been as simple as identifying who in commissioning organisations to speak to, and therefore what approach should be taken in building relationships with key stakeholders. It has also been complicated to demonstrate financial returns to funders as often the benefits delivered by the project are felt elsewhere in the system. 

The IRIS programme is currently commissioned in 32 areas of England and Wales.  Despite achieving significant spread, the IRISi team feel that they haven’t had the capacity, or a framework, to help define the really important ingredients of the intervention which help to deliver successful outcomes. Because of this the intervention has been implemented in different ways in different areas without fidelity to the original model – resulting in outcomes in some adopter sites that don’t match the success of the original intervention. 

The Exploring Social Franchising programme is helping both organisations to engage effectively with commissioners and find new ways to demonstrate the value of their services to the NHS. So far, the programme has helped to explore a number of challenging areas:

•    The core principles of the interventions which local delivery partners should follow to achieve the same outcomes
•    Who the ‘customers’ are (from the patient receiving the support, to the commissioner agreeing it) and the need to understand their different perspectives
•    How to create a more sustainable and realistic financial model
•    The importance of branding and language when recruiting new sites to communicate clearly the added value from the services
•    Determining the readiness of potential local delivery partners and their support needs

Is social franchising the right approach?

As we’ve understood more about how social franchising might help us, significant questions remain about whether this way of working will deliver the benefits we hope for.  We don’t yet know whether NHS organisations are comfortable with social franchising as an approach; whether our newly defined and described interventions will ensure sufficient fidelity to the model; or the best way to develop and maintain relationships with franchisees. 

Pathway’s purpose is to improve health services for homeless people. For some staff, discussions about branding, marketing and sales feel uncomfortable.  For IRISi, there have been similar discussions around intellectual property, copyright and contracts.  The culture within academia and the third sector – IRISi’s roots – is to share without asking for reimbursement. Sharing evidence for improvement and supporting others is important to both organisations and neither want to lose that way of working. 

However, spreading innovation is hard work and requires teams with knowledge and experience to do it – financial sustainability is therefore vital and this is a crucial issue. Through the programme we have been able to develop what we believe to be a valuable offer for franchisees and test this with potential partners who have responded positively. This gives us hope that social franchising could be the answer to challenging financial sustainability questions.

Systematically thinking about what is core to our interventions versus what can be adapted to the local context of delivery partners has massively helped challenge us on what we believe to be the magic ingredient for achieving better outcomes. Following the systematic process of uncovering what really makes our interventions work, we now have more clarity and hope this will serve us well in building stronger relationships with our local delivery partners. We’ll supplement that with a more structured package of ongoing support and training which will help adopter sites to realise the same benefits as the original project areas.

The next stage of Pathway’s project will see the charity work with new NHS partners to test the acceptability of social franchising and understand whether they will be willing to engage in a reciprocal social franchising relationship. For IRISi the challenge will be to adapt and formalise existing successful processes and systemise them. This will ensure that the IRIS programme offer is consistent across each site with quality assurances processes that are practical, robust and timely.

For both organisations, the exciting promise is a future where our organisations are financially secure and can focus on what we do best, supporting vulnerable people and the NHS services that work with them.