The Wellbeing Alliance

This is reblogged from my Dept Health blog.

The Joint VCSE Review this year recommended 28 changes to the way national and local government invests in – and works with – the VCSE sector.  We identified a shared goal for government, the NHS and the VCSE sector: to help people, families and communities achieve and maintain their own wellbeing.

There was wide agreement that this is best achieved when people and communities are actively involved in co-designing systems and services.

The VCSE sector, therefore, has two vital roles: 1) To make sure people from all groups and communities get involved in the co-design process and 2) To help deliver more person-centred and community-based services.

Today sees the launch of applications for the VCSE Health and Wellbeing Alliance, which we recommended as the national flagship programme to embed the role of VCSE organisations within the health and care system.

VCSE organisations recruited to the alliance will need to demonstrate their reach into local, small scale or specialist charities, social enterprises and community groups. Likewise, they must be committed to helping the Department of Health, NHS England, Public Health England and other national bodies hear the voices of people and communities who use health and care services, so that policies are truly ‘co-produced’.

The alliance, along with a fund expected to be launched early in the new financial year, form the Health and Wellbeing Programme, which will be the place where central government, NHS England and Public Health England come together with VCSE organisations to drive transformation of health and care systems. This single, integrated programme builds on the successes of its predecessor, the Voluntary Sector Investment Programme.

The final report of the Joint Review was published in May and since then work has been progressing to implement the 28 recommendations made.

An oversight group, which includes representatives of a broad cross section of the VCSE sector and government, has been established to oversee the implementation of the recommendations. Some are long term changes, but I’m heartened by the enthusiasm with which a number of agencies have embraced shorter term recommendations about how the state and the VCSE sector can work more effectively together. For example, CQC are thinking about how to include the value of personalisation, social action and the use of volunteers as they review their Key Lines of Enquiry.

Meanwhile, NHS England and partners are developing a social prescribing programme. Some areas are creating living maps of their VCSE assets, which is a vital first step to treating them as partners.

The Joint Review also set out challenges to the VCSE sector itself: to help drive the shift towards ‘asset-based’ approaches (which build people’s capabilities and resilience), to keep and build its roots in local communities and to demonstrate its impact.

The VCSE Health and Wellbeing Alliance is an opportunity to rise to those challenges, which I hope many organisations in our sector will embrace.

It’s still time to Transform Care

We are involved in lots of very promising work at the moment around Transforming Care: the work on which NHS England is leading to get people with learning disabilities and mental health problems or other ‘complex’ or ‘challenging’ needs out of medical institutions and into ordinary homes in the community. The programme is also aiming to reduce significantly the number of people who go into such institutions when they have mental health and other crises.

So far the various post-Winterbourne View scandal workstreams have been a great (ie bottomlessly depressing) example of what can happen when the full might of government and the wider system suddenly throws some of its best leaders, hundreds of millions of pounds and countless staff hours at a problem, backed up by all the pressure of targets and ambitious timescales: a target setting industry springs up, there are huge amounts of activity, much of it happening under almost intolerable stress, but the best spin you could possibly put on the results of several years of this is a gentle decline in the numbers of people in ATU. Some people have left, whilst others have taken their places. Where there is a bed, it will be filled. Collectively, we did lots of perfectly sensible things, but missed several essential things, without which real change could not happen.

Most importantly, ‘we’ – people working in leadership roles in the sector – turned out not be the right people to be making change: we didn’t have the courage or imagination to cede our leadership roles and power to people with learning disabilities and their families because there was neither the time nor resources to do so in our important and urgent work. Except that it turns out there was all the time in the world, because here we are five years later pretty much still on the starting line, and all the money we needed, because we have spent millions. People with learning disabilities and their families would, I believe, have led us slowly and haltingly in the right direction, with results no worse and potentially a whole lot better.

I’m optimistic that the work we are now doing with NHS England will get real results. We have had really strong interest from CCGs who are expressing an interest in the NHSE funding to demonstrate and scale up Shared Lives as a health intervention, not just for people with learning disabilities but lots of other groups as well such as people with mental health problems and older people leaving hospital. We are also developing an alliance contracting model in which we hope Shared Lives provider organisations and other like-minded providers with different models will work together, with the involvement of advocacy and self-advocacy organisations, to put a different offer in place. And we are a strategic partner in the IPC programme, with funding to support the IPC areas to think differently about providing personalised health care in general and Shared Lives specifically.

We’re doing this work because one of the intractable problems at the moment is that pared-down commissioning teams can see that new models might be better, but don’t have the capacity, expertise or relationships to develop them. Providers with good models can’t develop new models without a commissioner helping to define what is needed and in a position to purchase it. Commissioners are reluctant to block purchase care in any case: they are aware they are supposed to be helping individuals to make very individual choices. But without new models of care to choose, individual choice remains theoretical, so we have the worst of both worlds: neither old-style commissioning using its buying power to demand and invest in a better model, nor a functioning marketplace in which personal budget holders can find providers with something they want.

Our work will bring Shared Lives as a new model of care to many more people, but Shared Lives of course cannot be the only solution, and making it available doesn’t on its own shift the current power imbalances. Without changes at a deeper level, I worry that care will remain untransformed for too many people. Here are four changes it is not too late to make:

  1. We need a contracting model which pays for outcomes not time, which any commissioner and provider can use. Where care is paid for by the hour, the incentive for providers is to maintain, not reduce, extremely high levels of support, even where people no longer need it and the ‘care’ is now getting the way. Our alliance contract model will attempt to build this kind of contracting model and our outcome measuring tool will be one way in which those outcomes can be measured, but models of that kind need to pushed out right across the system.
  2. We need to build marketplaces in which people who are receiving care and their advocates can share limited information with suitably vetted providers, so that providers can start making offers to people who have a personal budget or Personal Health Budget, with the support of brokers. This will require investment but save more money than it costs.
  3. We need to build proper scrutiny into the system, led by people and families. Rather than the patchy system of Learning Disability Partnership Boards which work only when commissioners choose to engage with them, but are essentially an optional extra, commissioners and clinicians who are currently unaccountable must be obliged to report regularly on progress to a group led by self-advocacy and families’ organisations. This will focus their minds and make failure and stasis less of an option.
  4. We need ways to move resources from the state system into support for people who live in the community or with their families, to avoid the current cliff edge where a family in crisis can be told “there’s’ no money” one day, only for thousands of pounds a week to be found the day after the family collapses, to pay for institutional care. One way to do this would be for commissioners to be obliged, whenever funding is identified for emergency or medical care, to offer that money first to the existing provider, or to family carers, for them to draw up an alternative spending propose to sustain family or community care. Another would be for individuals to be able to share in savings made when a medical care package is replaced by community care, to build up a contingency fund to spend when in crisis.

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It’s ‘voluntary’ but not optional

I’m re-blogging the post below from http://www.voluntarysectorhealthcare.org.uk/vcse-review/ which is the website for a review of investment in the voluntary, community and social enterprise (VCSE) sector which I’m chairing on behalf of a group of VCSE organisations and the Department of Health, NHS England and Public Health England. The review is based on the view set out in all of those bodies’ strategies and visions for the kind of enabling, collaborative and community-based approach to achieving health and wellbeing which could only be achieved with a thriving and valued VCSE sector. In other words, a sector which might be known as ‘voluntary’, but which cannot be seen as optional:

Having been asked to Chair this review of the voluntary, community and social enterprise sector, I’ve been more thinking than normal about what kind of VCSE sector we want and what kinds of relationships national and local health and care bodies should have with it. For me personally (and in this blog you’re going to find the personal views of advisory group members, not any ‘official’ lines), the real question here is what kind of health and care system do we want in this country?

If we want the same kind of health and care system we’ve always had, then we need a VCSE sector which gets better at delivering on public service contracts, and provides a steady supply of volunteers to help out alongside professionals. Nothing wrong with those goals, but actually I think we need a very different kind of health and care system, and the national health and care strategies all read as visions for something very different, not just a more efficient version of what we’ve always aimed at. This means a different view of what charities, community groups and social enterprises are there for, and how their contribution should be supported and valued.

If the challenges of 1948 were our major challenges now, the health system would be well able to meet them. But our key challenge now is that health and care is not used by only a relatively small number of people for a relatively short time. A quarter of the population now lives with a long term condition and many of those with several long term conditions. Living well with a long term condition, avoiding health and other crises, is not something even a great service and the most expert professionals can do for us, it is something which is only achievable when people with long term conditions, family carers, communities and professionals work together, each making their own kind of contribution, sharing information and expertise, and backing each other up when things get tough. Living well requires joined-up health, care and housing interventions, but also services which can join up with informal action and arrange themselves around our real, messy, lives.

Charities, community groups and social enterprises can do many things well, from delivering huge public service contracts to running campaigns which change the national conversation, but Continue reading