There are often barriers to the voluntary community and social enterprise (VCSE) sector working in an Integrated Care System (ICS), as highlighted in recent research by The King’s Fund. While working together can be complex and, at times challenging, there is also the potential, through successful collaborations and partnerships, to find new solutions to local health issues and make enormous strides in addressing health inequalities.
We know that partnerships or even collaborations do not just happen, and it can take perseverance from everyone involved to shift the way a health system works to create long-term change and genuine integration across services. Our work with the 120-strong network of past GSK IMPACT Award winners has highlighted some of the barriers to making these partnerships work.
Barriers include charities having the sense of being locked out. They might have solutions to local issues, but there is a lack of opportunity to co-produce ideas. It is often said that the NHS has ‘the same people talking to the same people’, which makes it harder for new voices to be heard, particularly those not already embedded in the system.
The issue of managing risk comes up a lot too, with charities and smaller organisations disproportionately affected. It seems that risk is often put on these smaller organisations, even though they are much less able to bear it. At the same time, they report feeling more scrutinised than public sector providers. They talk of being over-monitored and performance-managed.
Finally, real change takes time. It is not unusual for charitable funders to enter ten-year funding relationships, in the acknowledgement that real change, and being able to evidence this differently, will take more than a couple of years. Short-term contracts, contracts agreed late or sudden decreases in funding can present real issues for charities and small organisations.
Potential in collaboration
Yet community-centred delivery is particularly important in the context of the 2022 Health and Care Act. One of its main purposes was to establish a legislative framework that supports collaboration and partnership working to integrate services for patients.
It also places a duty on newly formed integrated care boards (ICB) to address health inequalities. This can be difficult to prioritise in daily work amidst immediate system pressures. The VCSE, which is rooted in the very heart of communities where health inequalities can be most apparent, is an obvious part of any solution. This is because it has a deep reach into communities, can demonstrate creative and cost-effective solutions to local issues, and, crucially, can reach people who experience the greatest health disadvantage.
The value of partnership and collaboration with the VCSE is highlighted in these examples.
Croydon BME Forum
The charity Croydon BME Forum is seen by its ICB as ‘the voice of the communities around what we do within the NHS and what we commission’. It worked with local commissioners and partners – Mind in Croydon and the South London and Maudsley (SLaM) Mental Health Trust – to address racial inequalities in access, experience and outcomes in mental health care.
South West London ICB had previously commissioned Croydon BME Forum to work with Mind in Croydon and SLaM on a pilot service in general practice and a separate project to tackle racial inequalities in accessing mental health care. In 2022, the ICB then commissioned them to open the first Croydon Health and Wellbeing Space in a local shopping centre. As commissioner, it funds full delivery of the service.
This community-driven mental health hub offers psychological support to prevent deterioration in people’s mental health and alleviate crises. The space was designed not to look like an NHS facility to circumnavigate the stigma that may prevent people from seeking mental health support.
In its first year, it received 475 self-referrals and 300 referrals from healthcare providers. The feedback showed that all patients felt the advice they received was helpful and that they had improved their health. Such is the success that two more hubs are planned.
New Citizen’s Gateway
New Citizen’s Gateway supports asylum seekers and refugees in North London. In the last year, it has seen a surge in demand from 13,000 to 18,000 enquiries. At the same time, the charity has also had to cope with a hostile environment, including appalling hate mail.
The organisation supports the physical and mental wellbeing and welfare of asylum seekers and refugees with the aim of reducing health inequalities and social exclusion. Support is provided on a wide range of issues, including explanations of how to register with a GP and when to call for an emergency. The charity also offers tailored counselling and support services in nine community languages to address depression and trauma.
It works with a number of public services, such as local housing services, GP surgeries (which receive training on the health needs of asylum seekers and refugees) and food banks. The charity also works closely with the local council (London Borough of Barnet), schools, faith groups, and local charities, including Mind in Barnet and Citizens’ Advice. In addition, it works with the former Barnet CCG (which commissioned a number of its core services, including a multilingual counselling service).
Brighton & Hove LGBT Switchboard
Brighton & Hove LGBT Switchboard addresses inequalities of LGBTQ+ people in the Sussex community. National research shows that members of the LGBTQ+ community may avoid accessing health care services for fear of discrimination from staff, be less likely to report domestic abuse and be excluded from discussions in health and care settings, including end-of-life care.
This charity’s work includes a specialist dementia support network and domestic abuse service. It also works with Brighton and Hove City Council, which is a key commissioner, to improve local services. For example, it has provided advice on how to embed LGBTQ+ inclusion into the council’s framework for recommissioning care home contracts. The charity also works with the Brighton and Hove Memory Assessment Service and with a local social prescribing service for trans and non-binary people.
There are many more examples like this. But there are also many examples of VCSE organisations finding it hard to get the first conversations going with ICBs. Many report feeling ‘locked out’.
Opportunities for integration, innovation, and addressing health inequalities are being missed. It may sound simplistic, but starting a new conversation with a lesser-known organisation could be the key to unlocking the outcomes that systems need to achieve.
These projects were winners of the GSK IMPACT Awards delivered by GSK in partnership with The King’s Fund. Now in their 26th year, the awards recognise the outstanding work of small and medium-sized charities working to improve people’s health and wellbeing in the UK.