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Not the way to fund a care pathway – the role of the voluntary sector

April 7, 2015

blog vcs pathway

Recently I was on a panel making decisions on grant applications by voluntary organisations to a one off fund commissioned by Sheffield Clinical Commissioning Group.

Of the total fund just over £400,000 was focused on CCG health priorities – the fund was four times over-subscribed. Applications had to meet one or more of the following criteria:

  • Reducing Urgent Hospital Admissions
  • Support People with long term conditions
  • Move provision of care to a community setting
  • Reducing Life Expectancy inequalities in people with serious mental illness or learning disabilities
  • Help all children have the best possible start in life

The selection process was organised efficiently and professionally by South Yorkshire Community Foundation – who gathered together a diverse panel which contributed to the competence of the overall process.

Details of the fund are here; I was struck at the number of applications from:

  • organisations who support small groups of people who have very substantial needs. For example people who are homeless, substance misusers, women who have experienced domestic violence and people with complex learning and physical disabilities.
  • groups who support people who while their clinical health needs have been addressed by NHS services continue to experience the impact of their health condition once they have returned home – such as people who have had a stroke.
  • neighbourhood organisations who provide a bridge between people in communities and local health services – in particular primary care.

I realise that this is not a scientific survey, but I was left with the following thoughts – and these are general ones – not specific to Sheffield.

Easily Ignored Groups

The perfectly understandable focus on providing services for the whole population too easily leads to insufficient attention being given to small vulnerable groups with complex needs. This is particularly the case for groups of people whose poor social and economic circumstances are have a negative effect on their health. I think this is driven in part by the tyranny of population level targets but also by a default emphasis on clinical services which means that the crucial role of services that help people connect, build confidence and engage with mainstream provision is insufficiently recognised.

Care Pathways.

One of the things that worries me is the way in which mainstream commissioning can still ignore the complete care pathway. I set this out in an earlier blog – when I told the story of Stroke Action in Enfield. Its just not good enough to address peoples physical health problems and then put them back into the community – less physically able and less confident – this is a recipe for social isolation, poorer mental health and early re-admission. There are growing number of positive examples – such as Stroke Action and the Voluntary Action Rotherham Social Prescribing work which we need to be building on systematically across all commissioning pathways.


We need to be much better at taking into account the role of community anchor organisations with regard to helping build local community infrastructure that allows people to access support services in their communities, use public services more effectively on their terms and most importantly contribute through volunteering in their neighbourhoods.


Despite government imposed austerity I do think that commissioning organisations and big public sector providers can do more to address the deficits above.

I think that some of this is recognised in the NHS England 5 year forward view, with models such such as the (rather long winded) Multi-Speciality Community Partnerships being proposed. These could provide a mechanism for designing service models that have the voluntary and community sector in at the beginning.

In order for this to happen local commissioners have to raise their game this could mean:

  • Local Authorities and CCGs developing volunteering and voluntary sector funding strategies through the Health and Wellbeing Board.
  • CCGs pushing NHS providers to develop service pathways that reach out into communities and to do this in partnership with the voluntary sector.

I think that this could not only help build better local services but through stitching these services into the fabric of local civil society  it helps to build an alternative narrative to the one that says that marketisation is the most effective and efficient way of improving health and wellbeing.

What do you think?

5 Comments leave one →
  1. April 10, 2015 11:42

    Very thoughtful and important observations and seeing similar issues arising in social care commissioning and funding. The drive to reduce the number of contracts to easier to manage and administer for commissioners has the potential to miss these smaller local organisations who are not only meeting needs in their communities but also bring a great deal of social capital/added benefits to the way they work and contribute to prevention with their direct services and the informal supports of advocacy, information, advice, signposting, writing reports for professionals etc. I also see the language of outcomes being spoken but still a concentration on counting things and reducing risk as being priorities.

  2. April 14, 2015 11:00

    I would love to see more of these smaller funding initiatives. Small and medium sized charities and voluntary groups can’t compete with multinationals for large contracts – and rarely want to, yet they have the expertise and ability to address issues that frequently get missed in the commissioning process.
    One example of this is people with no recourse to public funds taking up hospital beds. Hospital staff need to free up beds when patients are well enough to be discharged, but are reluctant to discharge people back onto the streets, as they will almost certainly end up back in A&E, probably in a worse condition than before. Charities like ours (the Boaz Trust), who provide accommodation for certain groups with NRPF (in our case refused, destitute asylum seekers), regularly get calls from hospitals in exactly that situation, who have held on to patients beyond their discharge date – yet we cannot help, because our accommodation is full, and we have no funding for discharged patients.
    Hospital beds cost hundreds of pounds per night: our charity can accommodate and support someone for a fraction of that, yet there is no mechanism at all for that to happen. If the NHS was to fund charities to look after hospital discharges, it would save a huge amount of government money, and reduce the strain on hospital beds.

  3. Liz Twelves permalink
    October 11, 2017 19:47

    You’re absolutely right, there needs to be a whole system perspective. Many services seem to see themselves in isolation from a bigger picture and consider the snapshot of time when people are with them. I’d like to think a stronger focus on outcomes along with a robust population/equality perspective would help but I suspect there is neither the capacity or the capability to design solutions that do this. Perhaps one important thing is to end a relentless reduction in recurrent funding to the community and voluntary sector because it’s easier than unpicking the unwieldy medical models that have evolved over time.
    Liz Twelves

    • October 11, 2017 21:11

      Thanks Liz – helpful comments – its interesting seeing the current effort on “transforming’ health and care – with STPs and Accountable Care Systems – regrettably the starting point continues to be getting leaders of statutory health services together first with a commitment to involve the voluntary sector a bit later. Not going to break the paradigm there! All the best Mark


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