The voluntary and community sector (VCS) is an excellent example of why localism in health care can be so effective. Overall, the NHS spends £3.4 billion annually in the voluntary and community sector, which has a strong track record of working with communities and supporting individuals to manage their health better.
Small community-based charities provide excellent examples of how national health issues can be tackled at a local level. It is often these organisations' detailed understanding of local need, the trust they gain from their communities and their ability and willingness to work holistically across multiple services that allows them to be so effective.
The winners of this year's GlaxoSmithKline IMPACT Awards, run in partnership with The King's Fund, showcase these qualities. For example, in Bradford, the Hale Project has worked with local people to improve their blood pressure, tackle obesity and reduce alcohol consumption, with many participants reporting less need to visit their GP. Last year, the organisation delivered 175 different programmes, costing just over £400,000.
Blackburn with Darwen Healthy Living have put local people at the centre of the design and delivery of their services to combat high levels of obesity and alcohol abuse. Healthy Valleys in Lanarkshire, which works in a very deprived area, has used local volunteers to almost double pregnant mothers' attendance at health care appointments – in a group that was not previously engaging with health services. Providing services to more than 11,000 local people annually, Age UK Cheshire East has helped support the health and wellbeing of an ageing population and can demonstrate direct savings to the NHS, as well as the wider social value of its work.
All of these organisations are held in high regard by their local communities and benefit from huge volunteer involvement that helps to keep costs low. However, many smaller community-based charities are concerned that the health reforms may make it difficult for them to continue to provide their services. Complicated procurement services give larger providers the advantage as they can offer services across a wider area. Some smaller organisations are also frustrated by their lack of influence in the commissioning process as they struggle to have the same profile and powers of negotiation as the larger providers.
While the NHS implements the current reforms, it will be important to ensure that community-based work is able to flourish. However, this will present some challenges for the new commissioners. For example, do they understand the scale and scope of their local voluntary and community sector? Do they know how to engage effectively with it to improve local health outcomes, and what will happen if they don’t? Do they understand the direct and wider value of this work and have they thought through the pros and cons of only engaging via a larger lead provider? Conversely, does the VCS understand and know how to deliver what the local commissioners need, and does it know how to articulate its own value, in order for these partnerships to flourish? Many of these areas were explored in a recent report by The King's Fund and the National Council for Voluntary Organisations that examined the potential impact of the health reforms for the voluntary and community sector.
There are, of course, no simple answers to these questions, and most solutions will need to be found at a local level. This will only happen if the NHS and local authorities do not lose sight of the invaluable contribution made by local VCS organisations and if dedicated commitment, time and resource is made available to support the sector.