Ways to Wellbeing

Alex Fox, CEO Shared Lives Plus and Chair of the VCSE Review

It says a lot about people who work in the voluntary, community and social enterprise (VCSE) sector that, when asked to decide which of the VCSE review topics they wanted to focus on at the Voluntary Sector North West session this week, delegates quickly decided they wanted to talk about ‘what our sector needs to do to change’, rather than what might need changing about other sectors.

Changing the terms of debate

What needs to change in the sector, and what needs to be defended at all costs, is one of the most nuanced aspects of the debates I’ve heard during this review. There was agreement that the VCSE sector cannot simply say ‘we do good work, it’s your duty to fund us’. We need to be able to present our arguments in an evidenced, professional and compelling way, and in language that statutory sector colleagues can recognise and understand. On the other hand, the sector’s USP is not that it can become identical to the private or statutory sectors. It brings kinds of value and impact that are not readily available to those sectors and which they have not always valued enough to be willing to pay for. Part of the sector’s role is to change the terms of debate, in particular to steer the health and care system away from short term, medical goals and the view that they are there to fix their patients, and towards long term goals, which are based on seeing the whole person and having the humility to listen to that person, collaborate with them and learn from them.

Routes to resilience

The discussion about impact started with how it can be measured but as one delegate put it, “It’s not enough to be able to measure our impacts, we need to be able to demonstrate that we and the impacts we achieve are an essential part of the care pathway.” Then, as another colleague pointed out, the idea of the care pathway is in itself based on a medicalised view of the world. Care pathways sound clear, but are actually paths which twist, turn and peter out or end at brick walls between one service and the next. If we believe that what we need is a national health and wellbeing service, then the pathways we are looking for are instead ‘ways to wellbeing’ or ‘routes to resilience’. Directions in which people, families and communities can grow, rather than strips of tarmac to follow.

Achieving wellbeing

So many of the discussions I’ve been involved in about the role of the VCSE sector, come back, at a fundamental level, to our ability to translate the rhetoric of wellbeing into the right kinds of goals, behaviours and pressures in the system. People have talked to us about a gulf between local leaders who say all the right things, and the reality of their bureaucracies which remain based on achieving familiar short term targets, with the pressure for quick ‘results’ pushed down the system into stressed and sometimes bullied front lines and delivery partners. Models like Year of Care and House of Care attempt to address this, but we need to base our health and care system on a simpler and more compelling picture of how people move towards wellbeing, so that we can demonstrate the role that every part of the system plays in that. Achieving wellbeing always involves:

  • being informed (not mired in jargon)
  • being valued as a partner (not seen as ‘my patient’)
  • having access to resources (not treated as a customer)
  • having access to expertise and back-up when its needed (rather than having to jump through hoops)
  • being connected to others (not isolated or stigmatised)

Call for action

It should be self-evident that the statutory sector and the VCSE sector play different but equally vital roles in those ways to wellbeing. The statutory sector often holds the expertise, the resources and the capacity to respond in emergencies, for instance, whereas the VCSE sector knows how to get information to overlooked groups and communities; understands how to connect people and tackle isolation; and is based (at its best) upon equal partnerships, not paternalism.

How do we make that picture so clear and compelling that the whole system aims for it, takes risks to achieve it and invests scarce resources in it? Please tell us: www.vcsereview.org.uk

4 thoughts on “Ways to Wellbeing

  1. Call for Action.
    INVESTMENT is the operative word here, we need to convince LAs and CCGs that there is a huge cost benefit by investing in the third sector. We are struggling to engage with our local CCG in order to provide services the same 24/7 care we provide via social care budgets at a fraction of the cost of the Preferred provider. There could be a huge cost benefit nationally.
    How do we achieve this ?
    1 Do away with preferred providers.
    2 “Encourage” LAs and CCGs to ask the voluntary sector what services they can offer to help them provide services.
    3 Make the application to provide these services much easier for the voluntary sector. The procurement process is supposed to be easier, but the copy I have in front of me now form our local CSU, has very little difference than before,and virtually rules us out.
    Illustrate how investment in the true sense of the word often delivers a profit, in our case it has delivered a tremendous profit as after our 3 year “set up” funding in 2004, we have generated our own funds by making a small charge for our services. Evidence is that our charges are two thirds lower than the third provider.
    Hope this helps.

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  2. West Lancs Peer Support have found that the procurement process for small organisations like ours are to risk averse.
    Our CCG have informed us we have to register with CQC to manage the funds of a person who holds a Personal Health Budget, we have since found that this is not the case. You have to register if you employ the PA (which we do not) but our CCG are making it a condition that you have to employ the PA, this would deny the patient of the choice and control over their care, which is the object of the exercise.
    We have also to comply with the “Finlay Scott Recommendations (June 2010) on indemnity cover, and Article 4(2)(d) of directive 2011/24/EC”
    There are 26 pages to this application that would try even the large organisations knowledge, let alone the small organisations that are being encouraged by government to apply, or is it just a box ticking exercise ?
    Does this sound like the procurement process is being made easier ?
    The irony is, that a patient we have been supporting for some years, now has a PHB and we are managing the funds as before. But the CCG will not engage with us so they have arranged with social services to pay the PHB budget to us then social services invoice the CCG.
    It may be that our fees that are 50% lower than the existing Preferred Provider charges, may be rocking the boat. As we deliver the same services as the Preferred Provider that would be a huge cost benefit to the CCG, so why not engage with us.
    We are one of the organisations that on the NHS England “Gearing Up” program, so we have had the training regarding PHB.
    We manage for 76 people with range of disabilities, 4 with 24/7 cover and have been doing so since 2004, we work with the DWP managing budgets for people with Dementia as Corporate Appointees, and have had no problems with the services we provide, so why are the CCG making it so hard for us to work with people with a PHB.
    Have any other organisations experienced this ?

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