Ways to wellbeing

Here’s my latest thoughts on the role of the VCSE sector in health and care, reblogged from http://vcsereview.org.uk/2015/10/13/ways-to-wellbeing/ where you can have your say. (I’m also at the NCAS conference this week in Bournemouth so if you’re there and want to meet up please get in touch.)

It says a lot about people who work in the voluntary, community and social enterprise (VCSE) sector that, when asked to decide which of the VCSE review topics they wanted to focus on at the Voluntary Sector North West session this week, delegates quickly decided they wanted to talk about ‘what our sector needs to do to change’, rather than what might need changing about other sectors.

Changing the terms of debate

What needs to change in the sector, and what needs to be defended at all costs, is one of the most nuanced aspects of the debates I’ve heard during this review. There was agreement that the VCSE sector cannot simply say ‘we do good work, it’s your duty to fund us’. We need to be able to present our arguments in an evidenced, professional and compelling way, and in language that statutory sector colleagues can recognise and understand. On the other hand, the sector’s USP is not that it can become identical to the private or statutory sectors. It brings kinds of value and impact that are not readily available to those sectors and which they have not always valued enough to be willing to pay for. Part of the sector’s role is to change the terms of debate, in particular to steer the health and care system away from short term, medical goals and the view that they are there to fix their patients, and towards long term goals, which are based on seeing the whole person and having the humility to listen to that person, collaborate with them and learn from them.

Routes to resilience

The discussion about impact started with how it can be measured but as one delegate put it, “It’s not enough to be able to measure our impacts, we need to be able to demonstrate that we and the impacts we achieve are an essential part of the care pathway.” Then, as another colleague pointed out, the idea of the care pathway is in itself based on a medicalised view of the world. Care pathways sound clear, but are actually paths which twist, turn and peter out or end at brick walls between one service and the next. If we believe that what we need is a national health and wellbeing service, then the pathways we are looking for are instead ‘ways to wellbeing’ or ‘routes to resilience’. Directions in which people, families and communities can grow, rather than strips of tarmac to follow.

Achieving wellbeing

So many of the discussions I’ve been involved in about the role of the VCSE sector, come back, at a fundamental level, to our ability to translate the rhetoric of wellbeing into the right kinds of goals, behaviours and pressures in the system. People have talked to us about a gulf between local leaders who say all the right things, and the reality of their bureaucracies which remain based on achieving familiar short term targets, with the pressure for quick ‘results’ pushed down the system into stressed and sometimes bullied front lines and delivery partners. Models like Year of Care and House of Care attempt to address this, but we need to base our health and care system on a simpler and more compelling picture of how people move towards wellbeing, so that we can demonstrate the role that every part of the system plays in that. Achieving wellbeing always involves:

• being informed (not mired in jargon)
• being valued as a partner (not seen as ‘my patient’)
• having access to resources (not treated as a customer)
• having access to expertise and back-up when its needed (rather than having to jump through hoops)
• being connected to others (not isolated or stigmatised)

Call for action

It should be self-evident that the statutory sector and the VCSE sector play different but equally vital roles in those ways to wellbeing. The statutory sector often holds the expertise, the resources and the capacity to respond in emergencies, for instance, whereas the VCSE sector knows how to get information to overlooked groups and communities; understands how to connect people and tackle isolation; and is based (at its best) upon equal partnerships, not paternalism.

How do we make that picture so clear and compelling that the whole system aims for it, takes risks to achieve it and invests scarce resources in it? Please tell us: www.vcsereview.org.uk

Alex Fox, CEO Shared Lives Plus and Chair of the VCSE Review