Somerset STP has been collaborating with the voluntary sector on a programme and Michael Bainbridge shares his experience of working with the third sector and the challenges faced

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Somerset Sustainability and Transformation Partnership has been working with the Richmond Group of Charities and representatives of the wider voluntary sector on a programme called Doing the Right Thing.

They are exploring what can be achieved if statutory bodies and voluntary sector organisations collaborate to do something practical to improve outcomes for people, but have no pre-conceived ideas about products or providers. Their learning report, Tapping the Potential, is published this week.

Most readers will be familiar with the principles on which the NHS was founded in 1948: to meet the needs of everyone; free at the point of delivery; based on clinical need not ability to pay. Should we feel the need to use the latest terminology, we might say the function of the NHS is to add value to people’s lives.

The function of the NHS is to add value to people’s lives

Many of us pursue fairly specialist careers in the NHS. It is easy to become more and more tightly focused on our specialist field with all its attendant details, processes, relationships and acronyms, and to lose sight of the wider public value that the NHS brings.

For me, one of the best things about the collaborative working in Somerset has been the opportunity to break out of those narrow constraints and form relationships with a much wider range of exciting, dedicated and passionate people.

Chief among these are colleagues from the voluntary sector, many of whom are delivering a level of transformational change in peoples’ lives which is frankly breathtaking. That it is often done on a shoestring compared with the funds available to the NHS, renders it all the more impressive.

So, much for the excitement and enthusiasm. If service transformation relied solely on these factors, then we would be winding down our STP and celebrating a job well done. So, let’s be candid about the challenges we’ve faced working with the voluntary sector.

Challenges

First, there is a mismatch in governance and consequently in pace. Most voluntary sector organisations are fairly fleet of foot when it comes to making decisions.

The NHS, by contrast, operates in a complicated authorising environment that can appear characterised by political imperatives, shifting timescales, obscure processes and multiple and often conflicting objectives. This has been difficult for our voluntary sector partners who see value opportunities and want to pursue them straight away.

Second, are the financial constraints for both the NHS and the voluntary sector. For the NHS, the ever growing demand on budgets makes it all the more challenging to branch out beyond our traditional approach.

There is quite a painful paradox here – we know that doing more of the same won’t work, but we have little or no financial space to explore something different. We can and we will break out of this impasse, but it will take time and energy and commitment.

Many of our voluntary sector partners have seen reductions in their income as austerity bites and are struggling with a rising level of demand as state provided services shrink or focus on their core business.

Many of our voluntary sector partners have seen reductions in their income as austerity bites and are struggling with a rising level of demand as state provided services shrink or focus on their core business

Third, there are also differences in scale within the sector - we’ve been working with the Richmond Group of Charities, a coalition of 14 of the leading health and social care organisations in the voluntary sector. The Richmond Group wanted to achieve something at a greater scale through their Doing the Right Thing programme. Their perspective, drive and range of experience is fantastic.

But we also have to recognise that the majority of voluntary sector organisations are very small, and some are not organisations at all. We mustn’t mistake scale with impact, but this is an easy trap for us in the NHS to fall into.

When you’re dealing with hundred million pound contracts it might not be immediately apparent that a Wednesday night football kickaround in a small market town is delivering huge public value in keeping middle aged men fit and staving off mood disorders. But if we’re clearly conceptualising the NHS as being a mechanism for adding value to lives, then we should be able to spot these kinds of opportunities more clearly.

The NHS can’t, and shouldn’t do it all – we need to respect and work with the wider system and the communities and individuals within them to add value.

That’s why the prospect of working ever more closely and coherently with colleagues in the voluntary sector is so thrilling.