Is it time to look at the third sector afresh?

Guest blog

How do we best define and articulate the role of the voluntary sector in health and social care? I’ve been asking myself that question increasingly regularly.

I run Lancashire Women’s Centres – a medium-sized regional charity working across a number of areas, including health, social care and criminal justice. As well as being a charity, we are also a company, a provider delivering NHS contracts and part of a private-sector-led criminal justice supply chain. The boundaries between the sectors are so blurred they’re becoming hard to see. However, we retain at our heart a set of core values to offer the best services to the most vulnerable in our communities and to have the basic aim of putting ourselves out of business by not being needed any more.

In 2013, Lancashire Women’s Centres was the overall winner of the GSK IMPACT Awards, funded by GSK and run in partnership with The King’s Fund and awarded annually to recognise and reward charities doing excellent work to improve people’s health. One of the key benefits of winning this award is the opportunity to join a growing and formidable network of past winners. As a group, we regularly get together to build our leadership skills, to share challenges and solutions and to shape our relationship with The King’s Fund, the NHS and the wider health and social care system. The knowledge and expertise we bring from running a range of successful health charities is there for commissioners and policy-makers to use and draw from. But how far is this expertise recognised?

The external environment since we won has changed fairly dramatically, with integration of health and social care becoming one of the key challenges to be addressed by the NHS five year forward view. However, despite the recognition in the Forward View that ‘voluntary organisations often have an impact well beyond what statutory services alone can achieve’, from the discussions we’ve had locally and nationally, it appears that the third sector is still poorly represented in successful integrated partnerships. Why is that? How do we better articulate our ‘offer’ and how it fits into an integrated model?

There are some considerable barriers to integration. Looking from the sidelines I see the practical issues – pay scales, organisational culture, information-sharing and measurement to name a few – which mean local authorities and clinical commissioning groups (CCGs) have difficult conversations ahead. Bringing volunteers into the picture as recognised assets who will support outcomes in health and social care and add to workforce capacity is only just starting to happen.

When thinking about writing this blog, I hosted a roundtable for local health leaders from CCGs and public health – to gauge their view of the sector and understand how they saw us fitting into the developing plans. It was apparent that there is a definite appetite and willingness to engage with the third sector, although lots of energy has been spent trying to find a single point of contact, which seems to be causing some paralysis. Working through consortia and partnerships goes some way to addressing this, but I wonder if the same would be asked of the private sector?

Much of the third sector is well able to operate with maturity in a competitive market place. The skills and delivery models within the sector go far beyond delivering volunteer-led services to older people, vital though this work is. Third sector organisations provide flexible and diverse services within health and social care, reaching and benefiting communities often most distanced from statutory services.

I would like third sector organisations to be treated as providers that are already modelling integrated commissioning. Lancashire Women’s Centres work holistically across silos to reduce individuals’ vulnerability and help them to reach their potential. If you help someone to free themselves from debt, improve their literacy, live safely without fear of abuse, then as a consequence their health improves, their management of their long-term conditions improves, their attendance at A&E reduces, and their risk of suicide decreases. Commissioners are starting to understand that.

There is a view that what the third sector offers can be replicated and driven from inside the NHS, that community programmes can be bolted onto clinical services. I would argue this is the wrong way round and is the most expensive option; I advocate getting clinicians out and into communities. My vision for Lancashire Women’s Centres over the next couple of years is for us to have access to GPs that 'belong' to the service users – who will be able to prescribe medication or send for X-ray in a responsive way that fits those with complex needs who might not turn up for an appointment because they are scared to go out in case the bailiffs come, or are so wracked with anxiety they can't get out of the door.

So let the third sector be round the table when plans for communities are being shaped – we understand this is no guarantee of future funding, but we have links to communities and patients that can help shape services in new ways.

Applications for the 2016 GSK IMPACT Awards are now open. Could you, or an organisation you know, benefit from applying?

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Comments

#544283 angela allen
CEO
FHWB Consortium

great blog which articulates perfectly the role and position of the VCF sector - don't send out a late invitation to join the statutory planning party, rather, join the already vibrant VCF party that is already in full-swing

#544286 Malcolm Rigler
NHS GP
Stafford Medical Group.

The idea that GPs might work within and alongside Womens Centres does not fit with the current "partnership model" of NHS Primary Care. If the GP is involved in such activities that would be very time consuming the "partners" back at the ranch will say "this is not cost effective" or "a locum will be needed - who will pay for the locum?" However, in the South West some GP Vocational Training Schemes offer half time GP training and Half Time Public Health Training. At present there are no "progressions routes" into Public Health Sessional work once GP VOcational Training is completed. I think the VOluntary Sector should work with CCGs to ensure that at least some GP sessions are funded for Public Health work such as used to be on offer within the School MEdical Service so that WOmens Centres and other 3rd sector organisations can have access to a GP for the reasons so well described by Sarah in her blog.

#544287 Annabel Hodgson
CEO
No Limits

Really interesting points made by Sarah - and so true. We deliver a range of health related (and other) services to young people through an integrated Youth Information, Advice, Counselling and Support model, bringing great added value through the use of volunteers and mentors and lots of funding additional to health funding. There is no doubt that for every homeless young person we help to house or troubled young person supported through counselling, we are making significant impact on their health.

#544311 Chris Martin
director
VolunteerKinetic

I think the article outlines some of the real difficulties around the 3rd sector and health and how the two can work harmoniously together, Malcolms comments are very interesting around how the process is not effective. We build on-line services for the 3rd sector to better work in complex environments like Health and I would love the opportunity to discuss how better technology could be used to reduce the over all administrative burden of these type of partnerships.

#547725 Grenville Page
Non-executive/Trustee and consultant
Various across health, social care, housing & charities

If we are going to successfully respond to the health and social care challenges we face, deliver against the aspirations of the NHS 5 year Forward View, and achieve our ambitions towards more community and asset based support and early interventions, improve overall well-being, and avoid unnecessary and expensive downstream costs in our health, social care and justice systems, we need amongst other things to leverage, through more innovative commissioning and engagement, the full potential of our community based organisations. I am not just thinking about our charities and voluntary groups, but also our housing associations, social enterprises, academies and schools to name just a few, who are often dealing with some of the most vulnerable in society. This is about creating new ways of working and pathways not just expecting these bodies to do more with no additional resource, but thinking about the outcomes required and what more could they do with maybe new skills, investment and technology, that would provide appropriate support and solutions in the community thereby reducing unnecessary and costly demands to the already stretched health and social care services. Right care/support, Right time, Right Place. This needs to be done through effective engagement and really exploring together what could be done if we just focussed on the individuals in the community, and broke out of our organisational silos. However, the sector also needs to make sure it is able to respond. Too many are not operating at optimum scale, many competing for the same pots of money, and incurring costs in servicing the legal entity itself and keeping the back office running. Charities need to challenge their own business models and whether they could deliver and operate differently where it makes sense to - co-production; partnerships; merger; alliance contracting; and sharing skills, capacity and assets to ensure more of every £ received is spent on front line delivery, and make it easier for public sector commissioners to engage with. The opportunities are significant, and I hope we can together realise the full potential. Just a few general thoughts.

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