My latest update from Linkedin (and, yes, congratulations Martin for 10 years working at Newcastle CVS) for some reason reminded me of the exercise I had to do at the interview for my job here at VONNE. I was asked to draw up a voluntary sector health and wellbeing manifesto for the election. I’ve had a quick look to see what’s changed. The NHS has issued their own Guidance on Grant Giving (for which many thanks) but everything else still seems pertinent today. So, here it is, in its entirety. Feel free to disagree and add your own ideas and wishes. You may even wonder how on earth I got the job. But do remember it’s my personal thoughts and not VONNE’s.
“It was apt that Simon Stevens started his first day as the new head of NHS England here in the North East. More perhaps than any other region we typify the problems faced by a creaking health and social care system. We have some of the best 5 star quality services in the country somehow matched, overall, by the worst health and wellbeing. We are faced with more people living longer, but often in ill-health, an epidemic of loneliness and people with long-term conditions sliding into dependency. We will also soon start to see money moving away from the North East health economy because of changes in capitation funding.
Stevens argued that services need transforming, with more integration and mental and physical health unified. He also mentioned ‘the critical role of the Third Sector and the innovation value of new providers’. The Marmot Review ‘Fair Society, Healthy Lives’ has also stressed the importance of a multi-agency approach to tackling health inequalities, placing the VCSE alongside health, social care, education, housing and employment services.
But there is a growing gap between the aspiration and the reality. Funding has been seeping away from the VCSE at a rapid rate. Contracts have grown too big for most VCSE organisations to apply for. Often they are based on very narrow and traditional outcomes. Improving general wellbeing, resilience and good mental health are seldom included by commissioners. Involvement by the VCSE in service design, improvement and commissioning has become fractured. In the case of some NHS services such as hospital closure, it has been denied altogether. The broad value of the VCSE, as an asset that can Inform, Shape, Deliver and Review, is ignored more often than not.
So what would make a difference? What should the next Government be doing to improve health and wellbeing? How can the VCSE play a full role in transforming the future direction of health and wellbeing?
Here are some key messages drawn from the experience of the VCSE in the North East:
- Ensure that commissioners must engage with their local VCSE in all aspects of service design, improvement and change. Annual Reports must show who has been involved in developing commissions and what was done differently as a result of that involvement. We know that things have to change, some services will close and that will be painful but if we are fully engaged we can help, advise on and support that process.
- Give the VCSE a place and an active voice alongside Healthwatch on Health and Wellbeing Boards and on Clinical Commissioning Groups. Fully involve the VCSE in the process of carrying out Joint Strategic Needs Assessments and in drawing up and reviewing Health and Wellbeing strategies. We often work in and with the most disadvantaged communities and can help reflect and identify the issues and work with communities to design the best solutions.
- Enforce the Social Value Act and ensure that all public bodies are required to publicly demonstrate how the services they commission and contract have involved and addressed local concerns and led to an improvement in health and wellbeing.
- Ensure that contracts don’t unthinkingly exclude smaller community-based providers, who may have developed innovative solutions appropriate to their local situation but can’t bid because of the size or complexity of the contract.
- Re-issue Cabinet Office directions advising commissioners that they can, and should, directly grant-aid VCSE providers where contracting may be inappropriate or not particularly cost-effective.
- Support and fund local and regional infrastructure organisations, which can develop stronger partnerships, support and promote a consortia approach to contracting and enable closer and integrated working, both within the VCSE and with other public and private partners.
- Stop disinvestment in proven preventative services, particularly around mental health and emotional well-being. Encourage further investment through initiatives such as social prescribing and the ways to wellness approach. Prevention is always better (and cheaper) than cure.
- Support projects which identify people at risk and can encourage and enable them to take more responsibility and thus control of their lives and their health and wellbeing. The VCSE is well placed to support a move away from a service based on treating illness to one which can predict, personalise and prevent.
- Establish a payment process which measures, values and pays for prevention, healthy wellness and a sense of well-being, both in individuals and in wider communities.
- If a pilot has been shown to work, don’t stop funding it when the pilot programme ends, roll it out more widely.
- Assess the impact that proposed government policies, particularly on welfare reform and income support, may have on the health and wellbeing of individuals, families and disadvantaged communities.”