How can commissioners and the third sector work together to deliver better health and wellbeing for all?
How can commissioners and the third sector work together to deliver better health and wellbeing for all?
One of NHS England’s objectives for primary care commissioning is to support clinical commissioning groups (CCGs) and local professional networks to work collaboratively with local communities to develop joint commissioning strategies. In his first speech as NHS England chief executive, Simon Stevens recognised the value of local communities when he spoke about the need to catalyse change in the NHS by finding sources to unleash innovation and improvement. One source he identified was “the amazing commitment of carers, volunteers and communities to sustain their health and social care services.”
Voluntary organisations have a key role in helping the NHS to meet its objectives, but research by The King’s Fund shows that this potential is often not realised. Here we explore some of the reasons and possible solutions.
Many voluntary organisations have a detailed understanding of their local communities, knowledge about how to join-up care for patients, and the ability to address some of our most costly and complex health challenges. The sector is an increasingly important part of the health and social care jigsaw: approximately 40,000 voluntary organisations work in health and social care with the statutory sector spending around £3.4 billion annually on their services.
However The King’s Fund research on the impact of the health reforms on the voluntary sector pointed out that there are tensions in the way voluntary organisations and commissioners work together. Voluntary organisations can have difficulty presenting outcomes and value from their work in a way that commissioners need; commissioners often lack knowledge of voluntary organisations operating in their area what they can offer to help meet commissioning objectives, and how to build effective relationships with them. We concluded that change would require action from both sides.
More recent feedback from voluntary organisations and commissioners we work with indicated this is still an issue, so earlier this year, we facilitated a discussion between 12 health and social care commissioners and 31 leaders from voluntary organisations to explore the question: ‘How do the voluntary sector and commissioners work together to deliver better health and wellbeing for all?’ The voluntary sector attendees were all members of the GaxoSmithKline (GSK) IMPACT awards development network which is funded by GSK and hosted by The King’s Fund. Membership is gained by winning a GSK IMPACT award, which requires organisations to demonstrate excellence in improving the health of communities. The network supports its members to develop their leadership skills, share experiences and expertise, and build recognition of their contribution to their communities. The members represent organisations contributing to many national commissioning objectives such as supporting people to better manage their health, promoting healthy lifestyles and providing integrated care.
The relationship between voluntary organisations and commissioners was an important theme throughout the event’s discussions. It was acknowledged this could be hampered by differences in terminology and organisational culture. A particular barrier for commissioners was that the wider system did not always give sufficient value to them building relationships. As one CCG commissioner said: “The engagement bit is seen as a waste of time – the system does not give value to building the relationships. How can that be privileged in the system? What do we understand the job of the commissioner to be?”
This was seen as something that needs to change. As one CCG commissioner said: “You always hear that commissioners have not got time – but we can’t afford to not give it the time. We need to make time to do things differently.”
Many commissioners agreed that establishing a shared vision with voluntary sector partners would help them meet their commissioning objectives. As one commissioner explained it: “We should have a conversation about what we are jointly trying to achieve before we start talking about the money – the conversation is the wrong way round.” Some described this as the difference between a commissioning-led approach and a procurement-based process.
The voluntary organisations agreed, adding that consulting them earlier in the process would enable them to use their local knowledge and expertise to help shape commissioning priorities. As one CEO said: “If you want the doorway to a thousand voices you should speak to us at the start.” This could also allow smaller community organisations to form consortia or collaborations to compete with larger organisations.
Some participants went one step further and felt that there should be a clear expectation that services should be co-designed and produced to encourage genuine partnership and relationship building.
Participants queried why good practice in joint working between commissioners and the voluntary sector is not spreading. As one council commissioner said: “No one is joining up the examples of good practice – we need somewhere to collect the examples. The only way you read about them is in a report – there should be one place to learn about this.” Some thought that it would be helpful to have an easily accessible portfolio or library of best practice.
Throughout the discussion it was acknowledged that it was important for the voluntary sector to have access to commissioners’ knowledge and experience and the conversation should not just be about the finances. It was agreed that the voluntary sector could sometimes provide more clarity on its ‘offer’ and the value it brings, and could be more outward facing. Some commissioners thought that voluntary organisations should ensure they had a better understanding of what was relevant to them. Conversely, some voluntary organisations thought commissioners could do more to listen to them and understand their perspectives.
Our event suggests that there is more that unites commissioners and voluntary organisations than divides them. The barriers it highlighted, real or perceived, need to be addressed. If they can be, then the sector can play a key role in unleashing the innovation and improvement Simon Stevens called for.
For more information about the awards and the network please visit the King's Fund website.
Case Study: Project 6
Project 6 is a free, open access charity that provides services to substance users and their families in Keighley, West Yorkshire. The local area has some of the highest rates of drug poisoning hospital admissions and Project 6 has been working with its local commissioning partners at NHS Airedale Wharfedale and Craven CCG to improve interventions for alcohol users throughout the area. Project 6 is running its pilot programme to reduce alcohol misuse working in both primary care and hospital settings. It has established clinics in all 17 GP practices in the CCG area which has led to a considerable increase in the level of screening for alcohol misuse and follow-up sessions to support individuals. The pilot has resulted in a four-fold increase in the number of patients attending structured alcohol sessions; 87% of individuals that engage in this way have been shown to have a significant reduction in their alcohol use.
Project 6’s work at Airedale General Hospital has led to a significant increase in screening for alcohol misuse; in nine months increasing from tens of people to 2,500 screens. It has also been able to contribute to improved discharge planning to reduce hospital readmissions. Like many community sector providers, it provides a holistic service for individuals, ensuring that they do not become defined by their condition, have access to a wide range of support, and can become an active member of their community. This has been shown to support their recovery and ultimately reduces their reliance on health and social care provision, with the associated costs to the system.
