It is time to form new relationships with voluntary and community sector organisations, involve them earlier in the planning processes, and find new and creative ways to support the sector, says Lisa Weaks
The NHS Five Year Forward View sets out a vision to develop a new relationship with patients and communities. It talks about getting serious about prevention, empowering patients and engaging communities.
It also talks about the NHS as a social movement, shifting power to patients and citizens, strengthening communities and improving health and wellbeing, and as a by-product helping moderate rising demands on the NHS.
The voluntary and community sector is extremely diverse
The new care models programme and the sustainability and transformation plans (STP) could offer opportunities to translate some of this into action. Forty-four areas are developing their plans to help ensure that health and care services are built around the needs of local populations.
Delivering these plans will require the NHS to work across sectors and with its local community.
Achieving this in practice is often challenging, particularly given the tight timelines for developing the plans.
The King’s Fund works closely with health charities through the GSK IMPACT Awards, which celebrate the work charities do to improve health and wellbeing. As part of this, we support a network of previous winners, bringing them together to continue their professional development, learning from external sources and each other on an ongoing basis.
This work highlights how the voluntary and community sector can be an important partner for the health service, with their in-depth understanding of local need and ability to offer person-centred services.
We also know that they are often not involved in discussions, do not feel they are treated as partners, or are only brought in once the key decisions have been made. Conversely, if you are an NHS leader tasked with engaging with communities in a local area, working to a tight timetable, where do you start?
The voluntary and community sector is extremely diverse and there can be thousands of organisations, ranging from large national charities to small volunteer-run groups, covering health issues in one area.
Of course, there is no one answer to this. Unless local relationships (and trust) are already in place, it can be hard to develop these from scratch in time to respond to NHS planning timetables.
But developing knowledge about and relationships with local voluntary sector providers, who really understand the local context and population needs, is worth the investment of time. It can identify those that can take up a strategic leadership role and bring multiple partners together.
Developing relationships with local voluntary sector providers is worth the investment of time
Involving a range of voices from the start can ensure the process benefits from the sector’s local knowledge, its reach into marginalised communities, its ability to provide high quality cost effective services, and the armies of volunteers that support these organisations.
This year’s GSK IMPACT Award winners provide some interesting examples of how the sector can support the aspirations of the forward view.
Age UK South Lakeland works across a wide rural area to support the health and wellbeing of local older people. South Lakeland has a greater than average population of people over 65 with associated health concerns.
The charity has developed the Compass Assessment tool to identify the issues that may put an older person at risk of reaching crisis point (and possibly ending up in hospital). A detailed client assessment is carried out by staff either based in GP surgeries or in the community.
Each client receives an action plan of intensive holistic support, and volunteers help to deliver this service for up to 16 weeks. This reduces pressure on health services by identifying potential patients before they go into crises and managing their needs in the community, reducing likelihood of ending up in care or hospital.
The organisation has also taken up a strategic role in the local health system, bringing together local charitable and statutory providers to share information and simplify referrals.
The charity Groundswell supports people who are homeless. Research shows a strong relationship between poor health and homelessness – almost three-quarters (73 per cent) have a physical health need, with 35 per cent attending accident and emergency in the past six months and 26 per cent being admitted to hospital.
People who are homeless are much less likely to access health services when first needed and less likely to complete necessary treatments. As well as being detrimental to their long term health, this can result in a higher cost to the NHS.
To address this, Groundswell offers one-to-one support for homeless people, who attend health appointments across eight London boroughs. It provides reminders and covers travel expenses, while volunteers accompany people to their appointments to help them build confidence, to enable them to continue to access services independently.
This reduces missed appointments and unplanned admissions, with an independent evaluation showing a reduction in NHS costs for treating patients who are homeless of 42 per cent. Groundswell’s services also support homeless people to escape the cycle of homelessness.
Finally, Shakespeare Hospice in South Warwickshire, which supports adults and young people affected by life-limiting conditions, has worked hard to understand what the local population wants from its hospice.
It sought the views of people with life limiting illness and their families, and also local health and social care professionals. They found that, where possible, people wanted services at home, including at end of life.
Funding is extremely tight, and relationship building can be seen as an extra burden on people’s time
It decided not to invest in inpatient beds, but in a very robust hospice at home service, taking hospice care beyond the walls of the traditional hospice, supporting people in their own homes using qualified nurses rather than healthcare assistants to provide the care.
It has been nationally recognised for leading innovation in hospice care, which includes offering a bespoke transition service to support the move from paediatric to adult services.
Like the NHS, the voluntary and community sector is under immense pressure. Funding is extremely tight, and relationship building can be seen as an extra burden on people’s time.
A joint review of the voluntary sector just published by the Department of Health, NHS England and Public Health England makes some worrying observations.
The review found some voluntary organisations lacking confidence and hope, along with the pressure of meeting the demands of contracts and grants that were defined elsewhere and which were becoming shorter term and more narrowly focused. In many places the sector was shrinking.
To realise the aspirations of the forward view and for a new relationship with patients and communities to emerge, a new relationship is needed with the voluntary and community sector. Financial constraints and pressure on people’s time risk squeezing this out.
But a much greater risk is the cost to the NHS and communities if the sector’s knowledge of and links into communities is not utilised and is allowed to erode.
Despite the pressures facing all parts of the health and care system, it is time to build new relationships with voluntary and community sector organisations, to involve them earlier in their planning processes, and to find new and creative ways to support the sector which builds on its strengths and fosters creativity.
Lisa Weaks is third sector manager at The King’s Fund. The 2017 GSK IMPACT Awards, the 20th anniversary of the awards, was launched earlier this month at www.kingsfund.org.uk/gskimpactawards
- Admissions and discharge
- Community services
- Department of Health and Social Care (DHSC)
- Five year forward view
- Health charities
- King's Fund
- New care models
- Older people’s services
- Public Health England
- Quality and performance
- Sustainability and transformation plans (STPs)
- Voluntary sector/third sector