Physical health

Physical health

Testing new approaches to support better health

committed to charities and social enterprises


number of people have taken part in physical activity

of investments ahead or on track to deliver social impact


Demand on the health and social care system is rising due to an ageing population and increased life expectancy for people living with long-term health conditions. Budget pressures mean that it is increasingly challenging to meet the growing demand for services.

Social investment is supporting charities and social enterprises that are developing preventative and community-based services to provide higher quality care for older people both at home and in residential settings and help people stay active and well. Revenue is generated from care fees from individuals or contracting services to commissioners. The development costs for social impact bonds is a barrier for commissioners to engage in testing new solutions.

As in the mental health area, high-quality impact evidence is essential in this to understand changes for patients and clients and sell services to commissioners.

Further information is available on our social issue page for health and social care

Ways to Wellness

Social impact

Increasing high quality home care

Care and Share Associates (CASA), an employee-owned social enterprise, delivers 20,000 home visits per week to 1,000 clients in the North of England which range from short calls to 24/7 care. Since taking on investment from the Bridges Social Entrepreneurs Fund in 2011, CASA won new local authority social care contracts and as a result, has increased its turnover by four-fold and doubled its staff. Big Issue Invest invested in 2015 in the second round of capital raising.

Improving health and well-being of older people

In Belfast, Creative Local Action Response and Engagement (CLARE) received £150,000 of investment from DERiC and are helping to reduce isolation, improve health and well-being and promote independence. Revenue to repay investment is generated from savings in care costs to the local authority as formal care is replaced by volunteers. So far CLARE has supported 126 people and 89% of clients reported that they now feel more connected. This approach has widespread support from a range of statutory bodies who are seeking for the CLARE approach to be use across Belfast.

Connecting patients and providers

SXT Health received a £50,000 investment from Big Issue Invest and offers time, place and service specific information online about sexual health. SXT’s goal is to help reduce the burden of sexually transmitted diseases and unwanted pregnancies by matching health service provider capacity with patient demand. Revenue is generated from payments for service from commissioners.


Charities and social enterprises play a key role in developing innovative models to address health and social care in communities, often in a complex and fragmented funding environment. Social investment can provide the risk capital to expand those models once there is evidence of impact – for example, Shared Lives, where vulnerable adults live in carer’s homes, as well as CASA and DERiC.

The profit margins from delivering social care services are often low, particularly where charity providers face strong competition from lower cost private providers as well the impact of paying staff the Living Wage and for ‘sleep-ins’. Continued reductions in fees paid for care will make it challenging for charities and social enterprises to use repayable finance to grow their business. Most importantly this pressure will make it difficult to continue to provide good care and support to vulnerable people by employing well-trained and responsible paid carers. 

Programmes like Ways to Wellness show there is increasing openness to using outcomes-based contracts to test innovative preventative services by aligning multiple stakeholders, in this case the NHS, Big Lottery Fund and the Cabinet Office. But there are still significant cultural and structural barriers in commissioning practices which include commissioning capabilities, lack of data on current costs and outcomes as well as difficulties in combining multiple budgets and decommissioning acute services.

Social fund managers can play an important role in unlocking commissioner-led investments. For example, the Care and Wellbeing Fund has established the End of Life Care Incubator as a single entity that allows commissioners, charities and social enterprises, clinicians, academics, philanthropic funders and social investors to develop investable propositions around a single issue. 

This type of approach, such as DERiC, can significantly improve quality of life for vulnerable people and also reduce longer term public health expenditure. However it can often take a lot of time to establish partnerships and become embedded in local areas, and it requires strong local leadership.