In November 2014, the Department of Health, Public Health England, and NHS England initiated a review of the role of the VCSE sector in improving health, wellbeing and care outcomes.
Wellbeing is a goal often seen as elusive, particularly by large swathes of the NHS which are still exclusively illness-focused. But achieving wellbeing is increasingly accepted as the goal which all health and care services will need to share if they are going to prevent and manage the impacts of long term conditions. Social care has enshrined wellbeing as its primary purpose in the Care Act and if we are serious about integration around the person, there is an argument for the NHS doing the same.
The final report of the Joint Review of the VCSE sector takes wellbeing as the goal upon which everyone involved in health and care can agree. From that starting point, the report sets out the unarguable case made by charities, social enterprises and community groups that it is their work which is the key to creating and maintaining wellbeing, particularly for people which statutory services continue to overlook or consider ‘hard to reach’. Wellbeing requires health and care systems which are organised around and support our lives not just our needs or problems: which can reach us in our homes, support our families to care, and release the full potential of communities.
There are at least two distinct kinds of role that charities, social enterprises and community groups play in delivering a new kind of health and care service. Firstly, those organisations can reach every section of the community with support that is more tailored, more holistic and which draws upon volunteers to achieve more than paid staff alone can achieve. VCSE organisations can respond effectively to complex health needs but they can also think long term and address the social determinants (poverty, housing, exclusion) of health and deep-rooted health inequalities. VCSE support providers add ‘social value’ into a system desperately searching for more bang for its buck and our report recommended that the existing Social Value Act be much more widely used to embed approaches like social prescribing, personal budgets and peer support.
Secondly, for many of the VCSE organisations and local commissioners who responded to our consultation, just as important as how much funding VCSE organisations could win through competing to provide services, was the extent to which VCSE organisations were involved in planning those services: co-designing the local health and care goals and playing a full part in developing responses to local needs and building on local assets and community resources.
Traditionally, the health and care system has been designed largely by the state, with civil society invited in from time to time for consultation and all but a few citizens struggling to have their voices heard. The statutory system by itself struggles to think beyond the medical model. A system designed with the voices of a wide range of people, facilitated by local community groups and VCSE infrastructure organisations, will naturally tend more towards the goal of good lives in good places.
A wellbeing-focused health and care system would draw fully upon people’s capacity to self-care and the hugely under-valued role of family carers. It would be one in which people are supported to remain included and active members of their communities. A few areas are showing that even during austerity, VCSE organisations can be supported – and challenged – to do this. The VCSE sector needs to use its share of the health and care system’s limited resources, but they also bring resources of their own and they are willing and able to share in the risks and responsibilities of creating a health and care system which supports us all to live well, with the people we live, in places we are happy to call home.
Alex Fox FRSA is CEO of Shared Lives Plus, the UK network for Shared Lives and Homeshare. He Chairs the NHS England, Dept. Health and Public Health England review of the Voluntary, Community and Social Enterprise Sector and sits on the boards of NHSE’s Integrated Personal Commissioning programme and the Think Local, Act Personal partnership, with a community development lead for both partnerships. He is an Honorary Assistant Professor at Nottingham University, and a trustee of the Social Care Institute for Excellence and the Local Area Coordination Network. Alex was named one of Britain’s New Radicals in 2012. He blogs at http://alexfoxblog.wordpress.com/ and @AlexSharedLives