Sandra van der Feen, Health Policy Officer, London Voluntary Service Council (LVSC)
In June this year, I produced an article following on from our Whole Systems Change: co producing new models of health and care event in April. The event highlighted how co-production could bring about more effective partnerships between the sectors and potentially more funding opportunities for the VCSE sector. One of the issues raised was about the lack of funding going to the VCSE sector when GPs prescribe a patient or carer to a VSCE social prescribing project.
Co-production and design
Much has been said already about social prescribing, including the opportunities and barriers it can present for the VCSE sector and how social prescribing activities can vastly improve the outcomes and wellbeing of patients and carers. Nine of out 10 GPs said in a survey that they believe their patients would benefit from it but commissioners are not always making the best use of this service. This may be because models that have been set up are still rather fragmented and isolated. Some commissioners may not yet fully grasp that setting up models requires establishing robust partnerships between communities, the VCSE, patient bodies, commissioners, local authorities, etc. There are also different interpretations of co-production making the term often meaningless or confusing. Co-production can be perceived as tokenistic rather than real co-design giving communities and the VCSE driving and leadership roles in designing and delivering more community based models of health and social care.
Tapping in to VCSE assets
The VCSE sector should be actively shaping local health and social care priorities because of their valuable knowledge of local needs. This could be achieved through the sector having a strong voice in the completion of local JSNAs, HWB strategies and the formation of CCG commissioning intentions. In order to achieve truly co-produced health services the sector needs to be involved in setting the priorities. I feel there is often untapped knowledge and assets in the local VCSE sector and this could be used to better inform commissioning decisions and ensure better health outcomes for local people. Real co-design – getting the VCSE organisations involved in innovating solutions to local health problems – could also allow for more imaginative responses to these problems rather than just bog-standard commissioning.
The role of VCSE infrastructure – Alliance Contracting
Within this context the role and potential of VCSE infrastructure organisations is often misunderstood or underestimated. Yet, they are often well placed to get involved with and lead on the delivery of social prescribing and other preventative health and social care initiatives and programmes. They are also uniquely placed to support small to medium sized organisations in their areas to become more commissioning ready. CCGs could also greatly benefit by supporting VCSE infrastructure by exploring the role of infrastructure in terms of their role in building capability in the local VCSE market.
One way of doing this could be through alliance contracting. Lambeth have an interesting alliance contract around mental health and it seems to be the way Southwark CCG will be looking to commission new services. There is work to be done to prepare local infrastructure and the wider VCSE sector to get involved with alliance contracting, as it is a new way of working that requires true collaboration as well as risk and information sharing. However as alliance contracting allows for a wide range of organisations to contribute to the delivery of a service, the risk is shared between providers and CCGs and the skills of small and specialist organisations are better utilised.
Investing in the VCSE
Finally, it is often the small to medium sized organisations providing niche services that are still frequently overlooked. Insufficient resources put at risk the ability of many niche organisations to deliver much needed preventative services, including social prescribing projects. If this is not tackled, we risk neglecting the health and care needs of many marginalised communities and increasing health inequalities even further. For the new models of care to work to deliver most effectively and sustainably, we must put in place an accountable, transparent, equitable and sustainable funding/commissioning strategy. This must be co-designed with the VCSE sector as well as with commissioners, including the CCGs, charitable Trusts, NHS Foundations, Academic Health Science Networks, Vanguards, etc. CCGs should also not shy away from grants as they can often provide a better option for smaller groups that do not have the capacity to tender. A Bite Size Guide to Grants to the Voluntary Sector suggests some practical steps commissioners can take to use grants in the most effective way to support local priorities.
Working together, in true collaborative partnership, we will go further to address the health inequalities all our communities face.
If you have an example of co-produced services or want to submit other evidence to VCSE Review you can do so here.