Local voluntary organisations bring value to healthcare – but now they need to demonstrate how, says Lisa Weaks.
The voluntary sector plays a significant role in our health system, with the NHS currently spending around £3.4bn a year commissioning services it provides.
The sector makes a vital contribution to improving health by providing innovative services, often to people whom mainstream services struggle to reach, reducing health inequalities and increasing choice for patients.
In theory, by devolving commissioning to a more local level and opening up the provision of services to any qualified provider, the health reforms should provide opportunities for the sector to play a bigger role in the NHS.
In practice, the transition to the new health system is a time of great risk for voluntary organisations, many of whom have built up strong relationships with primary care trusts, on whom they rely heavily for funding.
This is especially true of smaller charities which may not have the same profile or capacity to forge new relationships with clinical commissioning groups as their larger counterparts.
One of the challenges facing voluntary organisations is how to demonstrate value. This value is sometimes difficult to identify – it may come from their detailed knowledge and understanding of the health needs of the community, the trust built up with marginalised groups or the innovative ways they have developed to engage people in managing their health.
However, many voluntary organisations lack the tools, systems and data to evaluate their impact and articulate the value they provide. Meanwhile, commissioners may not be familiar with their work and lack the time to develop a full understanding of it.
One of the aims of the GSK IMPACT Awards is to provide a platform for highlighting the sector’s impact. Run in partnership with The King’s Fund, the awards showcase the work of small and medium-sized charities in meeting local health needs. For example, Age UK Cheshire East supports people being discharged from hospital into residential care. By using its knowledge of local services it helps people select a care home appropriate to their needs and helps to co-ordinate timely discharge from hospital. In 2011, it worked with 315 people, saving an estimated 653 hospital bed days – a saving of nearly £230,000 to the acute sector.
Age UK Cheshire East has also invested in developing ways to assess its impact. It measured social value when evaluating its Fit as a Fiddle project, which provides a range of activities aimed at promoting healthy lifestyles and improving mental health among older people.
To measure the social value of its interventions, it used a simplified version of the Social Return on Investment model, which is a framework for identifying social value and translating this into a financial equivalent. Age UK Cheshire East developed financial proxies to estimate the value of the outcomes achieved against key performance indicators for the project – such as reporting fewer visits to the GP, and fewer visits to accident and emergency.
Other IMPACT Award winners, such as the Health Action Local Engagement (HALE) Project in Bradford, assess the outcomes of their activity to improve their work and demonstrate their value. HALE tackles health inequalities using its local knowledge, partnerships and volunteers to deliver 175 programmes used by 5,500 people on expenditure of only £400,000.
It quantifies the results of its services through surveying users. This ongoing evaluation has shown that after participating in HALE’s programmes, 80 per cent of people felt healthier and more motivated, 36 per cent had reduced their alcohol intake, 35 per cent had improved blood pressure and 13 per cent reported less need to visit a GP.
Healthy Valleys provides a range of services to promote health and wellbeing in rural South Lanarkshire. One of its projects supports infant and maternal health by enabling volunteers to work with families in deprived communities.
This project has doubled the number of young mothers attending antenatal appointments to 98 per cent, making a healthy pregnancy more likely and preventing possible complications during childbirth.
Healthy Valleys estimates that throughout the organisation its volunteers donate 3,245 hours, equivalent to £53,885 invested in communities.
If the rest of the sector is able to follow these leads by finding ways to demonstrate the value they provide, the government’s reforms could yet provide an opportunity for the sector. But the onus is also on commissioners to be proactive in developing relationships with local voluntary organisations. If this happens, the voluntary sector could have a bigger role to play in the NHS in years to come.