Following recommendations made by the Joint VCSE Review, The Kings Fund has produced an important report on the different ways that NHS and council commissioners view not-for-profits (VCSE organisations) and the impact of those views. To caricature the report a little, there is a spectrum, from commissioners who see VCSE organisations as fairly disposable support providers, to be funded with spare cash when they can, to commissioners who want to co-design health and support services with local people, and recognise that they need to see their local charities and community organisations as the way to engage people in doing that. The consequences of those different approaches are profound. They also have ramifications for the new Integrated Care Systems which are planned as the latest ways to join up health and care and which follow on from recent health planning processes (‘STPs’) that rarely involved local people (and were labelled ‘secret cuts plans’ as a result). The report says,
“Changes to commissioning may raise more challenges for successful co-production. As integrated care organisations develop, it is unclear who bears responsibility for supporting and developing community assets. There is a risk that more transactional approaches could
develop in the absence of clear incentives to involve VCSE organisations in co-producing commissioning intentions.”
If we want a genuinely transformed health and care system that not only fits together itself, but also fits with people’s lives, we need health and care planners to see their local civil society organisations as co-designers, and to challenge those organisations to reach and engage groups and communities that have historically been excluded and poorly served.
Escaping the invisible asylum 