The voluntary, community and social enterprise (VCSE) sector is notable for its scale and diversity, from small local community groups, to large national charities focusing on specific populations. The VCSE sector delivers key services that support the health and wellbeing of the population. In addition, it contributes vital insight and intelligence on the needs of the people and communities it engages with and is frequently a route to engaging with communities.
The establishment of integrated care systems (ICS), formalises a move away from competition towards collaboration, by asking leaders of health and care organisations to operate as part of a system. In doing so, it asks those leaders to not only plan and deliver health and care services, but to do so with the aim of improving population health.
The role of the VCSE sector in population health
There are a multitude of ways in which the VCSE sector contributes to population health. For instance, in recent work from The King’s Fund we heard about how involvement of the VCSE alliance in discussions about managing pressure on hospital beds in North West London ICS led to a proposal from the alliance to provide active case management support. This recognised the holistic needs of people attending A&E while building on established models of support organisations in the alliance were delivering elsewhere.
In North East London, the ICS has been joining up insights and intelligence with local VCSE organisations to understand the disproportionate attendance of A&E by certain communities, and what patient experience tells them about why this is happening.
One of the biggest opportunities for improving population health is in addressing the wide range of factors which determine people’s health. Each year, The King’s Fund runs the GSK IMPACT awards to recognise small and medium sized charities and their contribution to health and care. A consistent feature of award-winning charities is their focus on issues such as domestic and sexual violence, marginalisation, and the support required by individual and communities to live well. All of these are factors that contribute to the health outcomes of communities.
Tackling barriers to partnership working
However, as The King’s Fund’s latest report demonstrates, there are a number of well-established barriers to better partnership working with the VCSE sector. These include challenges associated with commissioning, service delivery and design; sharing data, intelligence and insight; and funding and sustainable investment.
Many of these barriers reflect wider siloed ways of working – whether its data systems built for the NHS, or approaches to commissioning which can present undue burden for smaller VCSE organisations and in some cases undermine their sustainability. There are a number of actions that can be taken to start to change this balance, but as our research shows, real momentum comes from when these actions form part of developing new ways of working and lead to change at a strategic level.
Strategic changes that can make a difference
Recent research by the National Association for Voluntary and Community Action (NAVCA) into the development of cross-sector working with the VCSE assessed just over a quarter of ICS’s to be trailblazers of progress towards VCSE partnership building. Our own research identified a number of actions which aimed to tackle barriers to partnership working and helped to embed the VCSE sector as part of a system wide approach to population health.
The first was investing in building and developing a VCSE alliance. VCSE alliances are groups of VCSE organisations that have come together around a common set of aims or principles. They provide an ICS with a single point of contact for communication, engagement and reach into many VCSE sector organisations across the ICS footprint at system, place and neighbourhood levels. As a result of funding from NHS England, there are now VCSE alliances in all ICSs. However, how developed they are and the extent to which they contribute to the work of the ICS varies and is a key point at which ICS and VCSE leaders alike can contribute to ensure an appropriate infrastructure for involvement.
A second area for consideration is having a dedicated leader for developing the role of the VCSE within the ICS. For example, Humber Coast and Vale ICS have appointed a dedicated VCSE programme director who is responsible for connecting the health system with the VCSE sector. A key facet of this role is having someone who understand and is able to negotiate the different cultures of the organisations involved.
A third approach is the development of a VCSE commissioning framework. The Greater Manchester Commissioning Framework outlines key ways of working between the ICS and organisations involved and the local VCSE sector. Importantly it was created through intense consultation and interactions between commissioners, commissioned VCSE groups and leaders from across health and social care. The commissioning framework includes a number of recommendations for improved partnership working and VCSE and serves to support ongoing conversations around agreed aims.
Shifting the emphasis and sharing the challenges
The approaches above represent steps towards new ways of working. They are often the result of many conversations as well as a commitment from both VCSE and statutory leaders to learn about each other and try something different. They are also far from an end point. Examples such as West Yorkshire Health and Care Partnership, demonstrate that this is not just about developing an approach to working with the VCSE, but valuing and embedding the contribution of the VCSE across all workstreams.
The requirement for systems to improve population health is an ambitious one. Many organisations currently face unprecedented levels of demand and the capacity to think long-term is challenging. Yet both are dependent on finding ways of meeting and reducing need. The contribution of the VCSE sector to providing support and engaging with communities make it a key player in meeting those needs and provide a unique route for ICS’s to create strong communities that create good health.