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Commissioner perspectives on working with the voluntary, community and social enterprise sector

About this report

The King’s Fund was commissioned by the Department of Health to conduct research that would explore how and why clinical commissioning groups (CCGs) and local authorities chose to engage with the voluntary, community and social enterprise (VCSE) sector.

This report first sets out the methodology we used and then presents our findings on the factors that underpin the adoption of different approaches. We discuss how commissioners’ perceptions of their own strategic role, as well as their views on what role the VCSE sector plays in the local area, appear to exert a strong influence on commissioning decisions.

This is a small-scale piece of research that we hope will make a helpful contribution to the debate initiated by the Joint VCSE Review (Department of Health et al 2016) and other initiatives such as the work of the Health and Wellbeing Alliance, the Office for Civil Society’s Public Service Programme and the report of the House of Lords Select Committee on Charities.

Key messages

  • There is wide variation in the way commissioners engage with the voluntary, community and social enterprise (VCSE) sector. Some commissioners saw their role solely as stimulating a market of providers, with no particular interest in creating a strong VCSE sector. Others had made a clear choice about the value of the VCSE sector as a critical player in developing asset-based approaches to care, engaging VCSE organisations as key partners in co-production of health and care outcomes.

  • The primary drivers for choosing a commissioning approach are local, not national. Strong local leadership, often political, and relationships with the sector are important to creating a partnership-based approach in the face of sometimes seemingly conflicting national priorities.

  • Most, if not all, of the commissioners we spoke to had heard of the Social Value Act and the Care Act, but their knowledge and use of these national legislative powers varied widely, from those that actively used them to support their commissioning intentions to those who were only minimally aware of them.

  • Co-production – sitting down with VCSE organisations as partners and equals – requires strong and mature relationships both within the sector and between the sector and commissioners. These relationships require time and attention to develop and maintain, and leaders of commissioning organisations need to be clearer about the need to invest in relationship-building.

  • While the NHS five year forward view outlines a commitment to developing stronger partnerships with VCSE organisations as part of a ‘new relationship with patients and communities’, in many areas commissioners are not prioritising these relationships.

  • Changes to commissioning may raise more challenges for successful co-production. As integrated care organisations develop, it is unclear who bears responsibility for supporting and developing community assets. There is a risk that more transactional approaches could develop in the absence of clear incentives to involve VCSE organisations in co-producing commissioning intentions.

  • Commissioners reported that they face intense pressure to deliver improved value for money and better outcomes. They were not convinced that grants were inherently better than contracts, rather they emphasised the importance of appropriate and proportionate use of whichever mechanism was chosen.

  • Information governance emerged as one of the most challenging issues around commissioning health and care services from VCSE organisations. For some, this was a serious barrier that prevented VCSE organisations from entering the marketplace.

  • The VCSE sector has a role in coming together to provide a strong and unified voice as it engages with commissioners. This requires leadership from within the sector to manage competition between different organisations. Strong leadership is essential to build collaboration and partnerships within the sector and with commissioners.