More than 36,000 voluntary, community and social enterprise (VCSE) organisations work in health and social care. Most are small – and most always will be. Often they are run by passionate, committed and highly individualistic people; what one of my colleagues has called “courageous leaders”.
These organisations are highly “geared”: on average, those we fund through the Lloyds Bank Foundation have a staff-volunteer ratio of 1:30. Many volunteers and staff connect with organisational purpose because they have experience of the issues, personally or through their family.
None of this is easy for commissioners of services. But the starting point is to work with the VCSE sector as it presents, rather than what you might wish it to be. So it should be warmly welcomed that NHS England, Public Health England and the Department of Health are making clear they want to work with the grain to realise the sector’s contribution to health and social care goals that we all share.
This reassurance emerges from the interim report of a review set up by the three government bodies, working with the sector, into how the government should fund VCSE organisations in health and care. The review, chaired by Alex Fox, chief executive of Shared Lives Plus, intends to continue its work after the general election.
But sustaining the VCSE sector is a tough ask. At the foundation, we are concerned at what is happening to the thousands of small and medium-sized charities we fund. The odds are increasingly stacked against them as they tackle rising demand with falling budgets. And yet they are best equipped to deal with some of the most intractable and high-cost health and social care issues: mental health, alcohol and drug misuse, domestic violence, and homelessness. They form relationships with people who often neither trust nor are trusted by, society. And they work holistically with people’s complex issues and lives, rather than on a single issue.
The snag is that VCSE groups don’t conform to a contracting model built for the private or public sectors. We think there is a better way to support them, which is why we brought together eight independent funders and the Association of Charitable Foundations to contribute our thinking to the review.
If 97% of VCSE organisations are small and local, they need a funding system that embraces this as a strength through greater localisation, flexibility and the use of grants over contracts. If they are better able than commissioners to determine how to meet the needs of the people they reach, then commissioners must recognise they also have a good sense of what should count for evidence and “impact”. If better outcomes and innovation are achieved by helping organisations collaborate and share, rather than compete, we need to design a system that encourages this.
These are fundamental challenges to a commissioning system increasingly built for scale, competition, standardised outcomes and unit price. We look forward to the next stage of the review.
