“It’s a natural friendship, you can’t buy that”

I’ve heard more than one charity describe an internal battle between their mission and their survival. A charity or social enterprise’s mission is often first set by a community. Years later, the terms of their survival can feel as if they are being set in an office by people who at a distance from that community. That was a battle that I heard described by numerous public service-facing charities during the consultation with the VCSE sector which we carried out for the Joint VCSE Review. Hospices are at the forefront of that battle: the hospice movement was founded on the view that a good death is a social, not a medical event. The NHS now leans heavily on hospices, which have, like many charities delivering public services, ‘professionalised’: offering highly sophisticated medical care alongside a wealth of social and practical support, in the community as well as in often much-loved buildings and grounds. Hospices bring more funding into the NHS than they receive from it, as well as countless hours of skilled volunteering, but that doesn’t mean that NHS managers in every area approaches them as equal partners.

I’ve been talking with colleagues from the hospice movement who have been working with Nesta and others on a new model of social action: Compassionate Neighbours. Hospices are great at recruiting volunteers who are a vital part of the service and form bridges between the hospice and the community. St Joseph’s hospice noticed that there was a gap in the support which families were looking for that was not easily filled by traditional volunteering. When someone approaches the end of life, particularly if they have a health condition which requires complex care, it can be an isolating experience for a family. Some friends and neighbours withdraw, or worry about ‘intruding’. Agnes said, “I have friends but no-one turns up to see me, why? I needed to go back to the hospital because … if I was in hospital then people would come to visit me.” Where families do not have a strong extended family or friend network, the hospice felt there could be a new role, and partnered with St Christopher’s hospice to develop the model and roll it out to seven other London hospices, and now further afield.

Compassionate Neighbours was inspired by the Compassionate Communities movement, and the Palliative Care Network in Kerala, India. Compassionate Neighbours do what they say on the tin: they form bonds with families who might otherwise be isolated, visiting regularly, listening, providing practical help so that families who might be caring for someone for an extended time can carry on with some of the activities which are important to them. Some will also use their experiences to start conversations with community groups and local people about what people need at end of life, breaking down taboos: “I used to go past [the hospice] on the bus and now I know that it is a place that’s alive and not about death”.

Volunteer roles can often be tightly defined by the charity recruiting them. This can be necessary for some roles, but

Join us for the launch of the new VCSE action plan

When we launched the recommendations from the Joint Review of the Voluntary Community and Social Enterprise (VCSE) sector’s role in the health and care system, after a wide consultation with the sector,  we made recommendations for national and local government, NHS and VCSE organisations on how our sector and statutory health and social care agencies can work effectively together. Much has changed since then, including the progress we have achieved on some of our recommendations such as the establishment of the Health and Wellbeing Alliance which is a group of charities which help government to design better health and care policy, and which form a link between government and thousands of local groups. But there is still much to do, particularly to persuade statutory organisations to work with VCSE organisations as partners in co-designing better systems and services with the often excluded citizens and communities which good VCSE organisations reach.

So we are relaunching around a slimmed down set of what feel like the most impactful actions. I will be joined by ADASS President Glen Garrod and NHS England director Neil Churchill for a free public webinar on 16^th May, between 3:30 – 4:30pm. We will set out the three key actions we think we need to take going forward, with a chance to ask questions and have your say.

The webinar is aimed at statutory organisations, the VCSE sector, commissioners and other health and care organisations. To join us, click here and follow on screen instructions.

 

To join this webinar, click here and follow on screen instructions.

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.

Charities, community groups and social enterprises at the heart of health and care

Today we launch the final report and recommendations from the Joint Review of the Voluntary Community and Social Enterprise (VCSE) sector’s role in the health and care system. This follows a year and a half of hard work by an advisory group (which I have chaired) made up of people from the VCSE sector working together with people from national and local government. It’s been hard work and the co-produced process has at times challenged the usual systems for producing reports, with lots of pragmatism required on both sides. But I feel (and hope you’ll agree!) it’s been worthwhile, in order to build a consensus around a clear view of what the VCSE can and could do, the challenges it faces and the ways in which many of those challenges could be overcome. I’m incredibly grateful to everyone on the group, NCVO who provided the secretariat, communications support and much more, and to lots of colleagues working behind the scenes and in numerous agencies we liaised with, who have all worked so hard to get to publication (see www.gov.uk for full report). Here is the blog which I wrote for the launch:

The goal shared by everyone who delivers and organises health and care services is wellbeing: its creation and its resilience. Whilst we do not want to spend increasing proportions of our lives in medical nor social care, we will all draw upon primary, acute or specialist services at various points in our lives and we want to find them available, caring and well run when we do. However, whether for people with lifelong disabilities, the ever growing older population or those with long term health conditions and support needs, our dreams remain rooted in living well at home as part of welcoming, inclusive communities. To achieve that goal, we need health and care systems which are organised around and support our lives: which can reach us in our homes, support our families to care, and release the full potential of communities.

When people talk about the difference that charities, social enterprises and community groups can make to delivering health and care services, they often focus on the ways that those organisations can reach people whom mainstream health and care services find ‘hard to reach’ or ‘challenging’, get to know them more deeply, and draw upon volunteers to achieve more than paid staff alone can achieve. All true, and extremely valuable, but, our review of the voluntary, community and social enterprise or VCSE sector found, only half the story.

There was indeed wide agreement that good VCSE organisations are better placed than other kinds of organisation to achieve some of the health and care goals which are now seen as crucial to the sustainability of our NHS and social care systems. It is VCSE organisations which often support groups and communities which are otherwise neglected, not only responding to health needs but also starting to address the social determinants (poverty, housing, exclusion) of health and deep-rooted health inequalities. Through drawing on people power as well as money, VCSE organisations are often uniquely able to offer support which looks at the whole person and whole family, thinking preventatively and whole-lifetime. Many of our recommendations are designed to identify, measure and invest in those added kinds of ‘social value’ which VCSE organisations bring into a system desperately searching for more bang for its buck.

The current funding trajectory in some areas is towards large, narrowly focused contracts, which can be appropriate to holding big providers to account, but can be poor ways to create the diverse local marketplace of big, small and niche providers called for by the Care Act and needed to reach whole populations and to offer people genuine choice. The most creative planners and commissioners are drawing on the full range of investment approaches, using contracts creatively alongside grants for community development work, personal budget and Personal Health Budgets for personally tailored support packages, social prescribing to link up vulnerable people with effective charities (with funding following the prescription to ensure that’s sustainable), and social investment to take risks and innovate.

So developing the VCSE sector as a distinct form of health and care provision is crucial and brings value into the system that money alone cannot buy. But for many of the VCSE organisations and local commissioners who responded to our consultation, just as important as how much funding VCSE organisations could win through competing to provide services, was the extent to which VCSE organisations were involved in planning those services: co-designing the local health and care goals and playing a full part in developing responses to local needs and building on local assets and community resources.

Traditionally, the health and care system has been designed largely by the state

They want us to become like them so that they can understand us

‘The majority of procurement practice is stifled by process and bureaucracy, what appears to be text book practice in reality translates into overly complex, process focused exercises.  Such exercises demand a huge input from providers and commissioners and often miss the point of the intended outcome. Tenders now typically require 30,000 word submissions, and the majority of tendering organisations now support sizable bid teams.’

‘When I’m applying for £500 it’s like I’m applying for £500 million.’

‘Providers if presented with a problem will often identify system wide solutions for commissioners; however this approach is limited, and commissioners often commission small silo services in isolation without asking the provider sector to develop and deliver a whole system change.’

‘They say the VCSE sector is good at reaching ‘hard to reach’ groups, but then they want us to do it in exactly the way they think it should be done.’

Two of those comments came from the four largest not for profit housing and care organisations in the country, and two came from very small, grassroots organisations in the North of England, all of which were contributing to the Joint Review of the VCSE sector (http://www.voluntarysectorhealthcare.org.uk/vcse-review/) which I’m currently chairing. It’s been striking that organisations very different kinds and sizes have all been telling us some of the same things about the challenges they face.

The story of the birth, growth – and sometimes death – of a not for profit organisation is too often one which starts with a need identified by a community, and then becomes increasingly a struggle to stay true to that community and purpose, whilst having to chase funding targets set by people remote from that community. As one grassroots organisation put it, ‘They want us to become like them so that they can understand us.’ The more I’ve listened to people in the not for profit sector during this review, the more I’ve felt that the case we need to make is not for the statutory sector funding the voluntary sector, it’s for the two sectors to work together with their communities to define what is needed and what the total resource of that community – state money alongside people’s time, creativity, passion – can do to meet those needs. One participant cited the example of Bradford council doing just that with their Adult and Community Learning Budget, where the outcomes were set with the VCSE sector, who are now bidding for money in an open and fair process which feels more like an opportunity to demonstrate they are good at what they claim to be good at, rather than jumping through hoops.

There is no simple, risk-free way of spending public money on achieving complex health and care outcomes. Risk is a little like the air in a balloon: squeeze it in one place and it threatens to pop in another. Managing risk is too often confused with making a particular part of the system feel better about risk, with the least imaginative commissioners acting like the anxious manager who reduces the efficiency of their team by micro-managing them. To achieve the optimum balance of risk and efficiency will require a much closer and more respectful relationship between sectors, in which state money like the rest of the community’s resources, is seen as owned by us all, not owned by one part of the system to be given – or not – to another. As one BME charity put it:

‘Each time I meet the commissioners it’s like they’re meeting me for the first time. They haven’t taken the time to understand and respect us.’

The alternative to developing a trusting relationship in which risks can be taken and shared, is often presented as efficiency, rigour, transparency, but can actually result in waste:

• ‘The commissioners hand us over to procurement who don’t know anything about the work.’
• ‘As a small organisation we spend the majority of our time fundraising.’
• ‘Hand to mouth funding wastes so much money: our staff are constantly leaving as their contracts near their end.’

Partnership working has become one of the mantras of the VCSE sector, so it’s interesting to hear organisations – especially small ones who lack the back office to develop complex contractual relationships – challenging even that idea:

• ‘The funders changed their mind about whether the work we were doing with the lead partner (who had received their grant) was a grant or a contract. As a contract it would attract VAT which would have bankrupted us. Luckily we persuaded them to change their minds.’
• ‘The state sector always wants us to work in partnership, regardless of whether that approach is the best one.’
• ‘We work well with private sector organisations without the formal contracting required by state agencies.’
• ‘We are talking less about forming partnerships now and more about solidarity between organisations and causes.’

We are still digesting the views, reports and experiences which many colleagues from the sector are generously sharing with us, and we will do so until the end of the first phase of engagement on March 2^nd, but I think we are all agreed that there are some fundamental changes needed in the relationship between the statutory and not for profit sectors. Those changes are hard and they are not being made anything like consistently, but I am yet to hear anyone suggest any change which wouldn’t be achievable, if both sectors agreed it was important enough.

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