Our work at The King’s Fund makes us acutely aware of the current pressures that providers of health and care services are facing. Whether that’s NHS leaders grappling with increased waiting times and workforce pressures, or voluntary, community and social enterprise (VCSE) sector leaders responding to increased demand and changing needs in the wake of Covid-19 and increasing living costs.
Undoubtedly leaders in each type of organisation are doing their best to respond, yet too often these conversations are being held in separate rooms without knowledge and understanding in one room of what is happening in the other.
In 2021, The King’s Fund was commissioned by NHS England to identify actions to address these barriers and, importantly, what is needed to make change a reality. The work focused on three areas in which barriers to greater partnership working are well recognised. They are: commissioning, service design and delivery; sharing data, intelligence and insight; and funding and sustainable investment. Our report Actions to support partnership: addressing barriers to working with the VCSE sector in integrated care systems aims to guide leaders in ICSs and those in the wider sector VCSE to progress on those aims.
Although these challenges can often feel intractable, across England pockets of practice show how decisive action by leaders can create a meaningful shift in relationships and power. Take, for example, One Devon, where commissioners opted to support a number of VCSE organisations to create an alliance that they could work with to co-design local community mental health services. This represents a significant departure from issuing a service specification that supplier tender for through a competitive process. Or North West London ICS, where work to capture and integrate data from local hospices has supported the development of single digital care plan ensuring all end-of-life care providers are able to record and see each other’s contribution to an individual’s care.
These actions, and more, are captured in A framework for addressing the practical barriers to integration of VCSE organisations. It’s a resource we would encourage leaders and operational colleagues alike to explore, to identify the challenges they face and potential approaches that might help them and they could test in their own systems.
It would be misleading, however, to think that actions alone can address these challenges, which are both relational and structural in nature. A core part of our work and reflected in the resource are a series of case examples based on conversations with local leaders that share their narrative of taking action and the process of change.
This draws us to the crux of the matter – because while the narratives highlight key points of learning, what runs through them is an account of change built on a number of fundamental principles. The first is that more equal partnership working is based on relationships. Far from an abstract concept, interviewees told us was this was often about ‘getting to know each other’ whether at a personal or organisational level. To facilitate this process West Yorkshire ICS developed a resource for leaders in the ICS that explains the VCSE sector, while Devon ICS has a mentoring programme that pairs leaders in statutory organisations with leaders in the VCSE. Part of this is about building understanding, but part is also about building networks and connections that can support further system working.
A second principle is that there is no ideal starting place. Many of the changes we heard about began at an operational or organisational level and were about making current ways of working more inclusive of the VCSE rather than starting from a clean sheet of paper. Making small changes together subsequently helped to identify possibilities for more systemic change and built the trust needed to facilitate that.
The third principle is that re-writing how statutory and VCSE organisations work together takes leadership from all parties. For leaders in the VCSE that means identifying ways to deliver their mission that embraces collaboration across the sector and with statutory bodies. Among statutory organisations and ICSs, leaders need to adopt a position of advocacy, consistently bringing VCSE leaders in as an active part of workstreams and building mechanisms that enable this.
In the context of current pressures – the suggestion that leaders act to re-write how they work may feel like a misguided one. Yet if Covid-19 has anything to tell us, it is that the health and wellbeing of the population relies on the contribution of all organisations to a common purpose. Capitalising on those gains while tackling current pressures needs systems to make use of all their resources, and leaders to identify actions they can take to address established barriers to collaboration.