Thursday 19 May 2022
The VCSE sector should play a key role in connecting integrated care systems to their local population, giving. Yet, we’ve found that many systems don’t have practices in place to make this a reality, say's Barbara Lozito.
The Richmond Group of Charities, the Somerset Sustainability and Transformation Partnership (STP), the South West Academic Health Science Network (SW AHSN) and the Somerset Voluntary, Community and Social Enterprise (VCSE) Strategic Forum have been working together to identify areas where collaboration between statutory health and care services and the VCSE sector could improve outcomes for people with health problems.
The resultant Somerset Stronger Communities Social Prescribing Project aims to help people with health or care needs find information, advice and support in communities and the voluntary sector so they can better manage their long-term conditions and live as well and independently as they possibly can.
Following a successful Expression of Interest to the Life Chances Fund (LCF), Traverse was commissioned by the Richmond Group of Charities (on behalf of project partners including Somerset STP, the SW AHSN, the Somerset VCSE Strategic Forum, Somerset Clinical Commissioning Group (CCG), adult social care, public health and communities department of Somerset County Council) to further develop the approach, explore its financial feasibility, and assess whether an outcomes-based contract, potentially backed by social investment, is the best option for enabling county-wide roll out of this promising initiative.
The over-arching approach that we used in this project has the following three steps:
First, we considered the cohort question to better understand how many people a social prescribing programme might (or should) address, and the types of need that they have. Second, we examined the impact on outcomes that a programme would be likely to achieve for them, in the short and long-term, and for their wellbeing as well as for NHS activity. Third, we reviewed the financial savings that are likely to follow from the costs and impact of the programme.
Over and above our technical input, we also provided overall coordination support to the wider Somerset Stronger Communities project by advising across three other complementary workstreams delivered by others. These included: (1) Places workstream – enabling the involvement of citizens, organisations and health and care professionals into the design process, at a local level; (2) People workstream – analysis of the potential target populations and development of appropriate outcome metrics; (3) Delivery workstream – gathering information and examples of different approaches to enable the development of Somerset guidelines for effective implementation of relevant delivery models.
Our coordination and steer ensured that all processes and outputs across the various workstreams dovetailed neatly, maximising the utility of evidence and insights while reducing data and research burden on stakeholders.
As a result of our work, we established for the first time across Somerset that an outcomes based contracting (OBC) approach is technically feasible. Our analysis and modelling confirmed that the specificity test, the attribution test, the delivery test, the legal test, and financial test were all met.
In addition, our engagement with the range of project partners also helped establish that while OBC is technically feasible in the case of social prescribing across Somerset, it is probably not desirable to implement the conventional direct OBC as providers are asked to shoulder significant risks. Recognition of the contributions by smaller and local providers, especially in existing practice, further suggests that direct OBC is likely to have an adverse impact on the ability of these providers to participate.
Further analysis indicated that a Social Impact Bond (SIB) is technically feasible in this case and may be appropriate as a number of benefits are evident for commissioners and providers, while reducing significantly the risks of conventional direct OBC for providers and the risks of conventional fee-for-service for commissioners.
As a result of our work, partners across Somerset now have clarity that social prescribing can work at scale. They are also clear that it is amenable to an OBC approach, and that there are ways of constructing this to minimise risks to commissioners and providers. Project partners are currently focusing on filling gaps in three particular areas – Bridgwater/Sedgemoor, Chard, and West Somerset, with the various commissioners committed to resourcing this. Beneficiaries are likely to number between 36,000 and 100,000, depending on the final selection criteria.
The Richmond Group of Charities pulled together their learning and delivered a webinar on 22 January 2019, highlighting Traverse’s work. The national and local partners are currently exploring mechanisms for enabling more strategic longer term collaboration within the voluntary sector locally.