In this second blog in our monthly series exploring how power sharing across organisations, people and communities through ICSs can deliver better health and care outcomes for local people, Barbara Lozito considers how we can encourage more effective collaboration between VCSE and traditional health and care services.
Voluntary, community and social enterprise (VCSE) organisations are often embedded in neighbourhoods and have a unique advantage when it comes to engaging the most at-risk and rarely heard communities.
Looking ahead, the VCSE sector should play a key role in connecting integrated care systems (ICSs) to their local population, giving communities a powerful voice, and supporting the co-production of services. Yet, we’ve found that many systems don’t currently have practices in place to make this a reality.
There’s an increasing drive from within the health and care system to work in partnership with the VCSE sector, both to understand the needs of and involve local people, but also as service providers, especially in new models of integrated care. However, the sector may not necessarily be resourced to do the former – and the latter can make organisations reliant on the vagaries of health and care funding and commissioning and bring them into competition with other VCSE organisations.
For the VCSE sector to achieve its full potential in the delivery of integrated care, it needs to be recognised fully as a part of the system and the system needs to make room for it. Building trusted relationships, so that health and care organisations truly understand the VCSE sector, is going to be key to providing quality services which meet local people’s needs.
Traverse has been exploring ways to encourage more effective collaboration and build relationships between the VCSE sector and traditional health and care services. As part of our evaluation of the VCSE Leadership Programme commissioned by NHSEI, we’ve co-developed recommendations with system leaders from the health, social care and VCSE sectors to help ICSs make best use of VCSE organisations in reducing health inequalities.
In this blog, we’ll look at four recommendations for ICSs to fully integrate VCSE organisations as part of the system and put forward our future vision for the role of the VCSE sector.
1. Embedding VCSE networks into health and care pathways through close collaboration with Primary Care Networks (PCNs)
The VCSE sector is crucial to the delivery of health and care services and makes up a large chunk of the workforce. It’s also central to advocating for communities, addressing health inequalities, and promoting engagement, particularly for those who are seldom heard.
Covid-19 has highlighted many ways that health and care systems and the VCSE sector can work effectively together, providing examples nationwide of the VCSE sector mobilising its workforce to deliver vital support. For example, the ‘North Tyneside Good Neighbours Scheme’, where the local council, charities and the CCG worked together to support people shielding during lockdown and the Gloucestershire Help Hub.
There is now an opportunity to take the learnings from this challenging time to help improve preventative and holistic care. In some cases, this is already happening. For instance, the Dorset Population Health Management Programme has successfully integrated the VCSE sector into the ICS, allowing close collaboration between primary care networks (PCNs), multi-disciplinary teams (MDTs)and VCSE organisations. This has helped identify and tackle health and wellbeing issues for specific groups of patients and co-produce solutions.
Successful integration of the VCSE sector in health and care pathways would mean organisations working as part of MDTs within PCNs, understanding one another and collaborating to address local health challenges. VCSE organisations would be able to target high-risk and marginalised patients through holistic and preventative interventions – but this is, of course, reliant on good social prescribing practices being in place.
2. Actively involving the VCSE sector in service design and commissioning
The ability of the VCSE sector to reach into communities, means they can support effective co-production, service design and commissioning with a greater emphasis on giving a voice to the people who use the services.
The Norfolk and Waveney Health and Care Partnership is working with several local VCSE organisations to improve health and care, as part of a Voluntary Sector Health and Social Care Assembly. The assembly is helping to address the challenge of building relationships with grassroots organisations and will represent the needs and views of the communities and the voluntary sector it serves.
Similar work is taking place in Lincolnshire, where the NHS Trust has made a formal link with the VCSE sector through a voluntary sector engagement team. This has allowed them to develop close working relationships, and for local VCSE organisations to be actively involved in governance, social prescribing, hospital discharge and the Covid-19 response.
VCSE organisations embedded in local communities are perfectly placed to help make sure both local and system-wide commissioning priorities are co-produced with local people. For this to succeed, ICSs should work with the VCSE sector and other local partners such as Healthwatch to jointly agree a formal structure for listening to, recording, and responding to feedback.
In addition, commissioning decisions should be made intentionally and strategically, with the system understanding how the VCSE sector contributes to the objectives of the ICS and the NHS Long Term Plan.
3. Establishing VCSE representation within governance structures so that the sector can influence strategy and decision-making
ICSs are typically organised into three main tiers – neighbourhood, place, and system. Partnerships can be built at all these levels, but strong governance is needed to support working relationships between local health and care services and VCSE organisations. Taking care to put governance structures in place and clearly define remits and responsibilities between statutory and VCSE bodies is key. This should be informed through a deep understanding and recognition of the crucial role the VCSE sector plays.
Formal representation can take many forms, but an Alliance/VCSE Leadership Group at system level and of place-based groups can be a good first step. This allows for VCSE representation on the ICS Executive Board and relevant workstreams/programme boards and helps to develop mutual understanding and strengthen relationships further.
The position of the VCSE sector in the ICS could be strengthened through robust governance structures at neighbourhood, place and system levels. This would help to make sure that the VCSE sector is formally represented in the system and that stronger, more collaborative relationships could develop with public sector leaders. Regular communication between the VCSE sector and public sector leads would result in a set of common values and improve knowledge sharing between organisations.
4. Investing in the VCSE sector to make its provision more sustainable
The VCSE sector is a rich source of skills and resources that can bring added value to ICSs. Investment in VCSE organisations provides more than just access to specific services – it allows ICSs to benefit from vibrant and innovative community assets, working in response to local need in ways that ICSs would be hard pressed to do themselves.
VCSE organisations are adaptable and entrepreneurial, having become experts at developing diverse funding streams. Some organisations also deliver services funded by social impact bonds (SIBs). These allow social investors to pay for the early testing and delivery of services, with the organisation receiving further funding based on the delivery of outcomes. St Basils’ ‘Rewriting Futures Programme’, which was funded by a SIB and supported more than 350 young people who were at risk of homelessness or social exclusion, demonstrates the social value that funding can provide.
Embedding the VCSE sector into health and care delivery, commissioning, and governance can only be successful through suitable, sustainable financial investment. This should not just target service delivery, but also strategic development of the sector informed by close working relationships and mutual understanding. The principles that govern investment would be the same for all system partners: memorandums of understanding (MOUs) and commissioning policies should reflect an equitable funding relationship and recognise the value the VCSE sector brings to the ICS.
There should be a funding model in place giving equal opportunities to smaller grassroots organisations as well as the big players. This should be driven by a clear strategy, recognising and understanding how individual organisations could contribute to the overall aims of the ICS. There are different funding models ICSs could consider, including direct funding for groups, dedicated funding for workstreams, or investment in a Programme Lead or Senior Responsible Officer to strengthen collaboration between public sector and VCSE leaders.