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Social Impact at Scale

Spring Impact Spring Impact

Lessons on Scaling in Complex Systems

Reflections from a year of scaling health innovation with The Health Foundation

Over the past year, we’ve had the privilege of working alongside The Health Foundation (THF) and Q Exchange to support innovators tackling some of the UK’s most complex health challenges. Across three separate engagements, we’ve helped 26 project teams build their readiness to scale, strengthen their impact models, and navigate the messy middle between innovation and system-wide change.

What We Delivered

  • Getting Scale Ready (GSR) programme for THF grantees
     Seven teams took part in our flagship five-week GSR course, exploring how to scale their solutions sustainably. Participants included projects focused on carbon analysis of clinical pathways, peer support networks, adolescent health inequality, and emergency first aid education for young people.

  • One-day scale training for Q Exchange project teams
    This intensive session brought together 13 Q Exchange teams working at the frontline of NHS innovation-from improving maternity investigations to tackling health inequalities in wound care, neurodiversity and eating disorders, and drug-related harm. The day gave them practical tools to think about scale from the outset.

  • GSR programme for a mixed cohort of alumni and current grantees
     A final GSR cohort brought together six teams from both current THF funding streams and former Q Exchange grantees, continuing our mission to embed scale thinking across the innovation lifecycle.

Across all three engagements, we saw strong participation and received glowing feedback. Project teams valued the chance to take a step back, stress-test their scale strategies, and connect with peers. Several teams told us they’d made immediate, practical changes to their plans based on the tools and coaching provided.

What We Learned: Lessons for Scaling in Complex Systems

Supporting these health-focused teams gave us the opportunity to reflect not just on what it takes to scale within the NHS, but on broader lessons relevant to any organisation pursuing system-level change. Here are some insights we think will resonate with other social entrepreneurs and mission-driven teams navigating the challenges of scale:

  1. Subject matter expertise deepens impact
     Our role is to bring robust scaling tools and strategy support—but those tools have the most traction when paired with deep sector knowledge. In healthcare, for example, understanding the NHS’s decision-making landscape, language, and logic is key to supporting teams to apply scale thinking effectively. For those working in similarly complex systems, partnering with experts can help bridge that gap and ensure your approach lands.

  2. Organisational readiness is a crucial ingredient
     Several teams had promising ideas with strong early traction—but hadn’t yet built the internal conditions to scale. Common challenges included lack of clarity on ownership of the work, limited time to engage beyond delivery, or early-stage thinking around resourcing and partnerships. For any team looking to grow, it’s worth asking: how ready are we—structurally, culturally, and strategically—to take the next step?

  3. The right match between support and stage makes all the difference
     Where participants were aligned with the programme’s aims, we saw greater momentum and strategic breakthroughs. Where they were earlier in their journey or facing immediate operational hurdles, it was harder to create that same traction. It’s a reminder to us—and to funders and support providers—that designing for scale isn’t one-size-fits-all. Matching the offer to where teams are at is essential.

  4. Scaling support should evolve over time
    This work reaffirmed something we’ve seen across sectors: scaling journeys rarely follow a straight line. What teams need at one point—say, a focus on articulating value or clarifying a pathway—shifts over time toward resourcing, partnership, and adaptation. Our own approaches to support need to reflect that evolution, and connect to what’s come before to create a more continuous arc of support.

Whether you’re working in health, youth services, education or climate, these lessons apply. Scaling social impact is complex, and effective support requires a mix of rigour, adaptability, and the humility to meet organisations where they are.

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Getting Scale Ready helps you move from ambition to action. You’ll gain the skills and confidence to lay the foundations for long-term scale and build a strategy that ensures you can do it all sustainably.
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