By Brendan Hill, Chief Executive, Concern Group
The interim report published in March ably illustrated the sector’s abilities and provides examples of some great work, as well as highlighting some good local approaches where proactive organisations (VCSEs, foundation trusts, local authorities and CCGs) are developing local solutions. It also highlights the barriers preventing greater utilisation of the VCSE sector’s expertise. Below I’d like to explore the key challenges both for commissioners and VCSEs.
Permission from the centre to devise local solutions should be greatly encouraged. In addition the review of the Strategic Partner Programme is most welcome as the current model needs a much broader mandate and representation for the sector for it to work more effectively.
I think the report also raises some very good points on how the sector’s role is not being utilised anywhere near its potential.
Some of the issues raised have been around for some time. For me the big core issue that needs to be taken on is the theme of the ongoing political and NHS narrative, simply put as…. “’We’ like the VCSE sector and you folks should be involved/doing more”. However, the paper demonstrates much of the sector are not being particularly well supported practically to do so, and in some cases because of funding and/or system changes are struggling to stay involved or even exist!
Therefore the issues and challenges I highlight below are focussed on what could be potentially helpful practical steps that should be taken to support the sector on a wider and more consistent basis. Hopefully these challenges will help develop the ongoing conversation, and also test the resolve of all parties.
Challenges for commissioners
The NHS should provide a more overt mandate, permission, or instruction for CCGs to adopt more flexible commissioning routes and payment models, i.e. grants and/or contracts, ‘blended PbR’. These should all be available based on the ‘best fit’. Could NHS England support the following practical recommendations?
- CCGs must give contract length/terms parity with statutory sector for any service delivery i.e. minimum 3 years.
- Guidance to be provided for CCGs to develop contract tenders that are significantly more outcomes based, thus reducing over specified tender documents that over prescribe the ‘how’ to the detriment of the ‘what’. This would allow VCSEs to provide their own rationale and evidence on how they will meet the required outcomes. One could argue this would benefit all sectors. Often the expertise on the ’how’ does not reside in commissioning support units.
- CCGs could be given permission and encouragement to look for an alliance contracting opportunity prior to rushing to procurement, which would support more cross-sector partnership working.
- All CCGs and health and wellbeing boards must have VCS representation.
Challenges for VCSEs
Professionalism on our terms
Better articulation is required on the varied and valuable strands of the sector. We know that many still in ‘statutory world’ do not always understand the breadth of the sector, i.e. multi-million pound service providers, campaigning organisations, community engagement projects, volunteering support and coordination, infrastructure etc. We as a sector should do this better ourselves and think about how we approach working with statutory organisations around the needs of the individual and communities we serve and engage in less ‘shouting from outside the tent’. If VCSE organisations better define and articulate our individual organisations role and purpose it will reduce the opportunities for misinterpretation by our statutory colleagues and government.
Evidencing what we do
Whilst we should certainly be less apologetic about qualitative data and the importance of narrative testimony, if we want to play an integral role in health and wellbeing we need to continue to develop our evidence base for what we do (as referenced in the interim report – Inspiring Impact Hub). However, joint work on this may help our cause. For example, we at Mental Health Concern have worked in collaboration with two foundation trusts on a wellbeing tool (WEMWBS) and how its use can be developed further. This has helped build better cross-sector relationships and understanding
I have yet to see enough emphasis on this important subject. I believe a revolution is required to develop and deliver new models of care and provide services around a social model of health. If the prevention, primary and personalised healthcare challenges are to be met we are going to need a lot more link workers, ‘navigators’, peer support and personal assistants to help people to improve and maintain their health and wellbeing, and manage their personal budgets and social prescriptions.
The VCSE sector is well placed to develop and provide these roles and deliver on these areas of work. In a financially constrained system this will potentially mean (and one could argue should anyway) have an impact on the roles and numbers of the current preeminent professional health roles in the NHS, which may then challenge the structure, size and function of some statutory organisations, foundation trusts in particular. Disinvesting to reinvest is of course especially difficult, but the sector needs to be heard on this and perhaps we can help our statutory colleagues develop this theme further.
Big supporting small
To enable as broad a range of VCSE organisations as possible to develop meaningful roles and new ways of looking at services, I think some of the larger VCSE organisations and statutory players need to start taking a more proactive role on behalf the VCSE sector as a whole to increase opportunities for shared priorities to be developed across as full a range of viewpoints as possible. It is they that often have the capacity to engage at the required level locally and regionally whereas smaller organisations struggle.