New action plan for VCSE Review published

“We welcome the new action plan from the Joint VCSE Review, which has set out an important vision in which voluntary, community and social enterprise organisations work with the NHS to co-design and co-deliver health and care services with local people. The action plan has a strong focus on greater use of Social Value Act powers by health and care commissioners which enables commissioners to seek added social value from local providers and more value for public money in partnership with charities and community groups. Use of the Act should be more routine in health commissioning.”

Simon Stevens, CEO, NHS England.

What do voluntary, community and social enterprise (VCSE) organisations want from government and the NHS? Ask our statutory partners and many will say, “money” and then add “but we don’t have any!” The first part of that is true, of course. The VCSE sector can often manage with less money than other kinds of organisation, because it is often better at drawing on different kinds of resources as well: people’s freely given time, support from local community and businesses, use of community resources. But all organisations working in health and social care, whether statutory, private or not for profit, need money to run. The difference between statutory and voluntary organisations is not their need for money, it is that typically statutory organisations control that money, and VCSE organisations do not.

Two years ago the Joint VCSE Review held a full consultation with the VCSE sector and its partners, and produced a report and 28 recommendations based on what we found. We heard that VCSE did not want to be in the position of asking for money: they wanted to share responsibility for the resources available, and to help people who use public services to share that responsibility. When statutory organisations and commissioners say ‘there’s no money!’ they have often started with the assumption that they must keep spending the money they have on what they already do. Local people, particularly from groups and communities who are not well-served by current services, can take a different view, if they have the opportunity to take part in genuine decision-making (as opposed to being ‘engaged’ and ‘consulted’ by decision-makers reluctant to give up any real power). So our key message was that, if we are serious about community-based, community-owned health and care services, which both expect and ask more of citizens, we need to get serious about co-designing those services with the people who make most use of them. VCSE organisations are the only ones with any track record of doing that. The fact that co-design and coproduction are still seen as slow, difficult and optional, rather than essential to improvement and tackling inequalities, is a good indicator of how much current commissioning teams need their voluntary counterparts and the communities they reach.

King’s Fund research commissioned in response to the Joint Review found a clear distinction between commissioners who co-commission and those who see their VCSE partners as there to provide the services designed without their input. So our new action plan’s three actions include co-design becoming a core expectation, with commissioners recognising that some of their scarce resources could usefully be invested in user-led and grassroots groups which are their only viable routes to the people with whom they need to co-design the future. As areas start to co-design in that way, as pioneers like Greater Manchester are already doing, they are hearing a clear demand for health and social care services which help people to live well and to remain independent and resilient in the face of long term health conditions, so our other two actions are to embed wellbeing as a shared goal for health and care services, and to enable local leaders to commission, demand and pay for wellbeing and resilience. We heard from the sector about the need for tools to be freely available to small local organisations, not just to large organisations with research and evaluation budgets. And we were excited by the promising examples of social prescribing and other approaches which, when done well, enable commissioners to work with intermediary local bodies to get their resources effectively to the full range of VCSE organisations. We argued in our original report that fund should always be on a ‘simplest by default’ basis, avoiding expensive, time-consuming and overly bureaucratic processes which are often evidence of a lack of understanding of what the VCSE can bring, rather than reflections of any real regulatory imperative.

Our action plan, which has been adopted by the Health and Wellbeing Alliance, is an attempt to bridge the statutory and voluntary worlds. That bridge will enable people to travel more freely between their lives at home in the community and the world of service support which can too often be inaccessible. One tangible way to bridge between the values of the VCSE sector and what the statutory sector will place a value on, would be to use routinely the existing Social Value Act powers, which allow commissioners to demand social value such as use of volunteers, or employment of people with lived experience, from all of their contracts. Jon Rouse says, “The Greater Manchester Health and Social Care Partnership based our working relationship with the voluntary, community and social enterprise (VCSE) sector on the recommendations from the Joint VCSE Review, which included that statutory and voluntary agencies should work together with local people to co-design better health and care services. We welcome the new VCSE action plan and expect to lead the way in using the Social Value Act powers routinely in our health and care contracting, to get the best value possible from public funds.”

Bridging between those two worlds means building from both sides, so I want to end with a challenge to my own sector. It’s not enough for us to talk about our community roots: we need to demonstrate that they are still strong and healthy. If we are to share in the power that goes with co-owning health and care systems and their resources, we must also be willing to share responsibility. The inequality of our current public services, and their outcomes, was the strongest message we heard during our consultation. As voluntary, community and social enterprise organisations we need to look hard at our practices and the way we make decisions ourselves, to be sure that we are part of the solution to that injustice.

Read the action plan

New Action Plan for VCSE Review launching soon

Given the changing health and care environment, a second phase of the Joint VCSE Review will be launched on 16 May 2018 to refocus local and national action around a revised set of recommendations.

We invite you to join Alex Fox OBE (Chair of the VCSE Review), Glen Garrod (Executive Director of ADASS) and Neil Churchill (Director, NHS England) at the webinar on 16 May from 3.30pm. The webinar is aimed at statutory organisations, the VCSE sector, commissioners and other health and care organisations.

To book your place on the webinar, please e-mail england.voluntarypartnerships@nhs.net with ‘VCSE Review’ in the subject header.

Progress on implementing the recommendations of the VCSE Review

The independent Chair of the VCSE Review, Alex Fox OBE, has published an update on the progress of implementing the recommendations of the joint group’s final report.

The report, based on the largest ever review of the voluntary sector’s involvement in statutory health and social care, urged local hospitals, clinical commissioning groups and councils to do more to involve expert charities in the design and delivery of services of all kinds. It included 28 recommendations which were jointly agreed by the Department of Health, Public Health England and NHS England.

Download the Chair’s update.

Final report published

The final report of the VCSE Review has been published.

The report, based on the largest ever review of the voluntary sector’s involvement in statutory health and social care, urges local hospitals, clinical commissioning groups and councils to do more to involve expert charities in the design and delivery of services of all kinds.

The report includes 28 recommendations which have been jointly agreed by the Department of Health, Public Health England and NHS England.

Alex Fox, who chaired the review has written an article summarising the findings.

Download the full report or download a short version comprising the vision and recommendations.

Collaboration around the needs of people not the needs of bureaucracies

Barbara Gelb OBE, Chief Executive, Together for Short Lives

If ever there was a need to build understanding, partnership and collaboration acrossCapture sectors then it is now. But this collaboration must be centred around people not built round bureaucracies.

As we mark Children’s Hospice Week, the publication of the VCSE Review final report is both timely and welcome but, like many, I hope the positive words and reflections move quickly into clear and beneficial actions. Continue reading

Final report of the VCSE Review launched

Alex Fox is CEO of Shared Lives Plus and independent Chair of the Joint VCSE Review. Read the final report.

The goal shared by everyone who delivers and organises health and care services is wellbeing: its creation and its resilience. Whilst we do not want to spend increasing proportions of our lives in medical nor social care, we will all draw upon primary, acute or specialist services at various points in our lives and we want to find them available, caring and well run when we do. However, whether for people with lifelong disabilities, the ever growing older population or those with long term health conditions and support needs, our dreams remain rooted in living well at home as part of welcoming, inclusive communities. To achieve that goal, we need health and care systems which are organised around and support our lives: which can reach us in our homes, support our families to care, and release the full potential of communities.

When people talk about the difference that charities, social enterprises and community groups can make to delivering health and care services, they often focus on the ways that those organisations can reach people whom mainstream health and care services find ‘hard to reach’ or ‘challenging’, get to know them more deeply, and draw upon volunteers to achieve more than paid staff alone can achieve. All true, and extremely valuable, but, our review of the voluntary, community and social enterprise or VCSE sector found, only half the story.

There was indeed wide agreement that good VCSE organisations are better placed than other kinds of organisation to achieve some of the health and care goals which are now seen as crucial to the sustainability of our NHS and social care systems. It is VCSE organisations which often support groups and communities which are otherwise neglected, not only responding to health needs but also starting to address the social determinants (poverty, housing, exclusion) of health and deep-rooted health inequalities. Through drawing on people power as well as money, VCSE organisations are often uniquely able to offer support which looks at the whole person and whole family, thinking preventatively and whole-lifetime. Many of our recommendations are designed to identify, measure and invest in those added kinds of ‘social value’ which VCSE organisations bring into a system desperately searching for more bang for its buck.

The current funding trajectory in some areas is towards large, narrowly focused contracts, which can be appropriate to holding big providers to account, but can be poor ways to create the diverse local marketplace of big, small and niche providers called for by the Care Act and needed to reach whole populations and to offer people genuine choice. The most creative planners and commissioners are drawing on the full range of investment approaches, using contracts creatively alongside grants for community development work, personal budget and Personal Health Budgets for personally tailored support packages, social prescribing to link up vulnerable people with effective charities (with funding following the prescription to ensure that’s sustainable), and social investment to take risks and innovate.

So developing the VCSE sector as a distinct form of health and care provision is crucial and brings value into the system that money alone cannot buy. But for many of the VCSE organisations and local commissioners who responded to our consultation, just as important as how much funding VCSE organisations could win through competing to provide services, was the extent to which VCSE organisations were involved in planning those services: co-designing the local health and care goals and playing a full part in developing responses meet to local needs and building on local assets and community resources.

Traditionally, the health and care system has been designed largely by the state, with civil society invited in from time to time for consultation and all but a few citizens struggling to have their voices heard. If we are to have a health and care system which is designed around individuals, which draws fully upon their capacity to self-care and the hugely under-valued role of family carers, and in which people are supported to remain included and active members of their communities, then the voices of people who make long term use of health and care services and their families, must be at the heart of planning processes from the start and throughout. It is the VCSE sector which has consistently demonstrated it can reach and engage with local communities: helping even those most often overlooked to speak up, contribute and take the lead. Our recommendations set out how VCSE organisations can be supported – and challenged – to do this.

VCSE organisations want to share in the health and care system’s limited resources, but they also bring resources of their own and they are willing and able to share in the risks and responsibilities of creating a health and care system which supports us all to live well, with the people we live, in places we are happy to call home.

PPG volunteers lead successful social prescribing clinic pilot

Ben Smith, Policy Development Officer, Voluntary Action LeicesterShire (VAL)

In April 2015, West Leicestershire Clinical Commissioning Group (WLCCG) commissioned Voluntary Action LeicesterShire (VAL) to manage and deliver a social prescribing pilot based at the Rosebery Medical Centre in Loughborough.  The aim of the pilot was to introduce a social prescribing service within a single GP practice and to provide some insight into the range of factors that are key to its implementation. West Leicestershire CCG also agreed to provide funding for the Voluntary and Community Sector services available through social prescribing to increase the sustainability of the service. Continue reading