It is well known that some population groups in England have significantly poorer health outcomes and worse experiences of using health and care services than others. Now, it is equally clear that the Covid-19 pandemic has compounded these inequalities, with some groups experiencing both much higher transmission and much higher mortality rates than others.
This picture reflects wider inequalities in the social determinants of health, for example, in housing, income and employment. As the leaders of small and medium-sized voluntary and community sector (VCS) organisations supporting some of these communities, through the pandemic we have seen the lived reality of these inequalities close up. It’s as personal to us as it is to our staff and volunteers; many of us are members of these same communities.
When the first national ‘lockdown’ arrived in March 2020, for us it was never an option to stand our teams and services down: we kept our organisations focused on their missions and committed to finding new ways of remaining available and responsive to those that need us. For some of us that meant rapidly pivoting entire delivery models away from venue-based delivery to outreach, or creating different services to meet both the existing and new needs of communities. For all of us it meant finding novel ways of working and embracing improvisation and learning. It has been, and continues to be, a hugely challenging and exhausting period. Managing the extreme uncertainty caused by the pandemic and the anxiety and distress among our staff, volunteers and service users has been at the heart of our response as much as anything operational or strategic.
Digital technology has played an important part in keeping us connected with staff and volunteers in our organisations, but many of the people and communities we support don’t have the means or ability to access information digitally, and much of our agility and support was therefore, by necessity, physical rather than virtual. This meant going out on to the streets to directly support those in need; for example, by providing counselling support in parks and through car windows, supplying doorstep drops of food, and working alongside mutual-aid groups to provide a safety net for those whose needs were made more acute by the lockdown closure of services and support in the established ‘system’.
'Voice, power and influence lie not only in corporate bodies and institutional might, but in mobilising people and networks'
We all experienced and continue to see dramatic increases in the uptake of our services and support, and we have all ended up overturning established service models and significantly expanding our capacity. Our smaller size has allowed us to be flexible and agile in response to the pandemic, and our scale is also central to our connection to place and the credibility we have among the communities we support.
However, larger organisations often exert more influence both within the VCS and in the wider health and care system. We think this risks obscuring the important role smaller VCS organisations play in the overall health of the system, and in tackling inequalities not just symptomatically, but also, in a more fundamental way, through their social determinants. Taking a systemic perspective, our flexibility and adaptability (facilitated by our smaller size and commitment to purpose) are central to the overall resilience and responsiveness of the health and care system in times of crisis.
For our part as leaders, we need to remember something that social movements have demonstrated very clearly in recent years; that voice, power and influence lie not only in corporate bodies and institutional might, but in mobilising people and networks. We can scale our shared voice without scaling our organisations and losing our close connection to communities and place. And our challenge now is to begin this work. Our ask of system leaders is that the role and strengths of small and medium-sized voluntary and community sector organisations are better understood and recognised, and that we have more opportunity for visibility, voice and influence in the system.
'The virus hasn’t been a "great leveller", from our view it has compounded injustices that societally and politically we were already failing to remedy'
Public-sector understanding of the health and care system frequently locates the voluntary and community sector outside its formal service boundaries. One lesson from the pandemic we must collectively learn is that this cannot continue. We are all connected and ‘the system’ goes far beyond statutory services. Covid-19 isn’t only a crisis of acute care, it’s a crisis of social care and of community; of economy, work and inequality. The virus hasn’t been a ‘great leveller’, from our view it has compounded injustices that societally and politically we were already failing to remedy.
But whatever the challenges of 2020 and now on in to 2021, the pandemic has taught us another lesson we must never forget. It has shown us that system change can happen, and as such we must not miss the opportunity at the heart of the crisis. Will we – that is, all of us in the health and care system – have the courage and foresight to seize and transform the ‘business-as-usual’ attitudes, ways of working and biases that made up our pre-Covid ‘normal’? Can we all re-commit to breaking from our sectoral silos? Can system leaders find new ways to listen to marginalised communities and those who work closely with them, and to distribute leadership, resource and opportunity? And can we each go beyond our services and institutional walls to an expanded understanding of the health and care system that better values difference and reflects our interconnectedness? Simply put, we believe this once-in-a-generation moment demands that we must.
This blog was written by a group of leaders who came together in three facilitated sessions at The King’s Fund in July 2020 to explore the learning from their experiences of the Covid-19 pandemic.