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

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.

Prevention

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.

Action

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?