Time to change?

Author: Lisa Taylor

Lisa Taylor, VONNE's Health and Wellbeing Programme Director, reflects on the themes and learnings from the recent NHS Confed Expo. How do health systems need to change? How is the VCSE sector being supported and involved in that change as an integral part of health service delivery and as a strategic partner?  

I was fortunate enough to attend the NHS Confed Expo recently, and heard several speakers from across the country, including Amanda Pritchard, Chief Executive of NHS England, talk about how our health system needs to change in order to survive.

Sam Allen, our North East and North Cumbria Integrated Care Board (NENC ICB) Chief Executive, delivered a very well-received session entitled “Driving improvement at place: working with communities to transform local services.” Sam introduced her very positive thoughts on working with and within communities, and handed over to the North East Changing Futures leads, Mark Joyce and Francis Donnelly, who shared their experiences and some incredibly detailed data mapping. 

The mapping clearly showed the value of the interventions provided through the Changing Lives programme by gathering historic involvement with services across the health and justice systems, logging all types of interactions and their cost, and bringing the timeline up to the present day. It showed a dramatic drop in health and justice involvement as soon as Changing Lives began their involvement. The data mapping process itself was very time-intensive, but when combined with the moving stories of real-life experience, was a perfect example of the “hearts and minds” approach needed to push this agenda forward. 

Amanda Davey, Health Inequalities Clinical lead from the Bay Medical Group in Morecombe, shared examples of the innovative ways of working happening in the Morecombe Bay area, which rely equally on both health and VCSE input, wrapped around a hyper-local approach to community-led service design and tackling the wider determinants of health. This way of working, and that of Changing Lives, is centred around a whole-person support model which is so common in the VCSE sector, yet relatively rare within the health system. 

Another notable example of a positive community-led service is a family-run GP surgery in Peterborough which gains strategic direction from its patients, and has made recruiting the local community to work within health as one of its priorities.

Attendees from the health service seemed to be in full agreement that all of these approaches are the correct way forward and should happen at speed across the health system. This “immediate need to change” approach was echoed in many of the sessions I attended. There certainly seemed to be no arguing with the point that things can’t go on as they are, and that the VCSE sector is needed to deliver services effectively to communities. 

What I felt was not explored in the sessions I attended was how to enable systems to explore working in this way - including how to manage the cost implications of tasks essential to progress such as cross-sector data collection and analysis. All of the changes highlighted require relationship building, co-production and mutual understanding, which in turn require significant investment in time and resources from all parties, which are sadly lacking in all parts of the system. Input from everyone collectively is needed to ensure that capacity across all sectors is managed during the development stages of system change, but there is still work to do at a national level to enable this within all ICS’s.

This national sea change is positive, but does any of it make any practical difference to our own smaller VCSE organisations, or to our organisations that are at risk of being unable to deliver services due to contracting issues? I would say not. 

However, from my privileged position as VCSE Integrated Care Board (ICB) representative, I have seen a huge amount of progress over the past 2 years, including the formal agreement of our Memorandum of Understanding which we created as a sector to define our relationship with the ICB, and which they have unequivocally signed up to. The ICB has also publicly acknowledged that it needs to do better in relation to VCSE contracting, and there is work in progress at the highest levels of the system to make this a reality, but it is not a quick process to change a system as large and as new as ours. 

With these positive developments, I would say that it is realistic to expect that the contracting system will be better for VCSE delivery organisations at the end of this financial year, and that the relationship between our sectors will develop as we are able to get to know and understand each other better.

Over the past few years, there has been a lot of talk about doing things differently, and a lot of interest in the VCSE sector both as service provider and as point of access to the voices of our most vulnerable communities, but less so as strategic partner. This is all increasing, however at grass roots level there has not been a lot of evidence of large-scale systemic change to tackle the challenges so commonly experienced by smaller VCSE organisations. 

Reflecting on the progress that has been made in our own system, the indication is that we are definitely on our way to a better future, but we need to accelerate if we are to ensure the sustainability of the VCSE sector, which props up so much of our health system.

The process of change is a complex one, and although we can all agree that now is the time for change, we also need to enable all parts of our system to have the time to change, and to make timely change to prevent the system failing, and to prevent the loss of any more VCSE organisations or services. This will be the real test of how integrated our integrated care system really is, and it can’t be carried forward without all parts of our system working together as one.

VONNE, in partnership with Cumbria CVS, leads the North East and North Cumbria VCSE Partnership Programme - a VCSE alliance that works to ensure that the VCSE sector is embedded at all levels of our NHS Integrated Care System (ICS). Read more about the VCSE Partnership Programme