If resources and demand are ever going to be brought into harmony, healthcare systems need to move away from the ‘factory model of care and repair’. This is the welcome dialogue that has prevailed in the context of creaking budgets, rising demand and increasingly complex needs.
So far this has resulted in some much-needed reflection and inspection of the role voluntary, community and social enterprise (VCSE) organisations should play in these systems—not least in the context of this review. But despite great leaps in progress, there is still more to do if we want to make the most of the opportunities that these conversations present.
A steady crescendo
Simon Stevens set the mood music late last year—calling for ‘stronger partnerships with the voluntary sector’ as part of a ‘radical upgrade in prevention and public health’ and a system that empowers patients and coordinates diverse services around them.
There was nothing to dislike there, but it left important questions unanswered. Namely: how will these partnerships look in practice, and why are they important? Increasing integration between VCSE organisations and the statutory system requires some behaviour change on both sides, and behaviour change requires a clear communication of the how and the why, as well as the what.
So, when NHS England produced its Bite-size guide to grants for the voluntary sector earlier this year, I was pleased to see a pretty comprehensive list of the reasons why VCSE organisations should have a prominent role in the system. Charities are generally ‘trusted, accessible and skilled at outreach and engagement’. They have ‘knowledge of the needs and strengths of their beneficiaries’ and ‘routes into and established relationships with particular communities’ which allow them to ‘coproduce tailored solutions to specific local problems’.
It also paid attention to the how—recognising that many VCSE organisations do not have the ‘scale and capacity to compete or to deliver large scale public sector contracts’, and that commissioners should therefore consider grant funding a vital part of their local health economy.
Turning it up to eleven
If these principles and guidelines—alongside other overarching frameworks like the Social Value Act—are going to translate into practice, the real change now needs to happen at a local level.
The localised nature of new commissioning arrangements means that performance and experience is patchy. There is still a need to seek out and provide targeted support to local health economies that are not putting these principles into practice. Getting there relies on three key steps:
- Clarifying the context: It is not totally clear how much the picture varies locally, or why the variation exists. Which CCGs are working most closely with VCSE providers, for example? And why are they doing so? Is it a difference in the outlook and attitude of commissioners, in the quality of local VCSE providers, or simply a particular abundance of VCSE organisations? NPC is currently developing a project to bring clarity to these questions, with a view to elucidating best practice, and uncovering the areas in most need of targeted support.
- Finding the right levers: Beyond national guidelines, thought needs to be given to the best mechanisms by which to effect local behaviour change—through Health and Wellbeing Boards or local authority leaders, for example.
- Making a compelling case: Charities themselves also need to make a strong case for the value that their services bring. This will come through support and capacity building for individual organisations, but also through efforts at the sector level—collaborating to produce a coherent and comparable evidence base that is synthesised and accessible.
So, whilst the general principle that VCSE organisations should be a prominent feature of our future health and care system gathers heartening momentum, our next challenge must be to drive these principles through to practice.
Have your say on the future of partnerships with the VCSE sector here.