The role of the 3rd Sector in the delivery of Health and Social care may be the only long term way to ensure some services survive. This fantastic article from Sarah Swindley, Chief Executive, Lancashire Women’s Centres outlines some of the major problems but also shed some light on the potential benefits.
I run Lancashire Women’s Centres – a medium-sized regional charity working across a number of areas, including health, social care and criminal justice. As well as being a charity, we are also a company, a provider delivering NHS contracts and part of a private-sector-led criminal justice supply chain. The boundaries between the sectors are so blurred they’re becoming hard to see. However, we retain at our heart a set of core values to offer the best services to the most vulnerable in our communities and to have the basic aim of putting ourselves out of business by not being needed any more.
In 2013, Lancashire Women’s Centres was the overall winner of the GSK IMPACT Awards, funded by GSK and run in partnership with The King’s Fund and awarded annually to recognise and reward charities doing excellent work to improve people’s health. One of the key benefits of winning this award is the opportunity to join a growing and formidable network of past winners. As a group, we regularly get together to build our leadership skills, to share challenges and solutions and to shape our relationship with The King’s Fund, the NHS and the wider health and social care system. The knowledge and expertise we bring from running a range of successful health charities is there for commissioners and policy-makers to use and draw from. But how far is this expertise recognised?
The external environment since we won has changed fairly dramatically, with integration of health and social care becoming one of the key challenges to be addressed by the NHS five year forward view. However, despite the recognition in the Forward View that ‘voluntary organisations often have an impact well beyond what statutory services alone can achieve’, from the discussions we’ve had locally and nationally, it appears that the third sector is still poorly represented in successful integrated partnerships. Why is that? How do we better articulate our ‘offer’ and how it fits into an integrated model?
There are some considerable barriers to integration. Looking from the sidelines I see the practical issues – pay scales, organisational culture, information-sharing and measurement to name a few – which mean local authorities and clinical commissioning groups (CCGs) have difficult conversations ahead. Bringing volunteers into the picture as recognised assets who will support outcomes in health and social care and add to workforce capacity is only just starting to happen.
When thinking about writing this blog, I hosted a roundtable for local health leaders from CCGs and public health – to gauge their view of the sector and understand how they saw us fitting into the developing plans. It was apparent that there is a definite appetite and willingness to engage with the third sector, although lots of energy has been spent trying to find a single point of contact, which seems to be causing some paralysis. Working through consortia and partnerships goes some way to addressing this, but I wonder if the same would be asked of the private sector?
Much of the third sector is well able to operate with maturity in a competitive market place. The skills and delivery models within the sector go far beyond delivering volunteer-led services to older people, vital though this work is. Third sector organisations provide flexible and diverse services within health and social care, reaching and benefiting communities often most distanced from statutory services.
I would like third sector organisations to be treated as providers that are already modelling integrated commissioning. Lancashire Women’s Centres work holistically across silos to reduce individuals’ vulnerability and help them to reach their potential. If you help someone to free themselves from debt, improve their literacy, live safely without fear of abuse, then as a consequence their health improves, their management of their long-term conditions improves, their attendance at A&E reduces, and their risk of suicide decreases. Commissioners are starting to understand that.
There is a view that what the third sector offers can be replicated and driven from inside the NHS, that community programmes can be bolted onto clinical services. I would argue this is the wrong way round and is the most expensive option; I advocate getting clinicians out and into communities. My vision for Lancashire Women’s Centres over the next couple of years is for us to have access to GPs that ‘belong’ to the service users – who will be able to prescribe medication or send for X-ray in a responsive way that fits those with complex needs who might not turn up for an appointment because they are scared to go out in case the bailiffs come, or are so wracked with anxiety they can’t get out of the door.
So let the third sector be round the table when plans for communities are being shaped – we understand this is no guarantee of future funding, but we have links to communities and patients that can help shape services in new ways.