This guest blog is by Ruthe Isden, Head of Health Influencing at Age UK—part of the Richmond Group of Charities – and the Group’s Acting Director. The Richmond Group is a collaboration of leading health and social care organisations in the voluntary sector and this blog details how voluntary, community and social enterprise organisations can engage with and help shape Integrated Care Systems (ICS)—the replacement for clinical commissioning groups, as set out in the Health and Care Act 2022.
As the Health and Care Bill passes into law and Integrated Care Boards finally take on their statutory responsibilities, there are genuine opportunities for the voluntary, community and social enterprise (VCSE) sector to share their knowledge and expertise with systems, shape services and really tackle health inequalities—but only if both sectors know how to create these opportunities.
Charities and voluntary organisations of all sizes demonstrated the true value of our sector during the Covid-19 pandemic, making herculean efforts to reach into the heart of communities that we understand well, playing a vital role in getting help to those who needed it, tackling the inequalities exposed and exacerbated by Covid-19 and disseminating messages to keep people safe. In rising to the challenge, we demonstrated the best of the agile and ‘can-do’ approach that characterises the sector. We came together with local authorities, local resilience forums, the NHS and care services to achieve some extraordinary things at an extraordinary time. Existing partnerships were expanded and new ones built at tremendous speed.
Working collaboratively during a crisis (when ‘business as usual’ is suspended on all sides) is one thing; however, building and sustaining long-term, strategic partnerships between Integrated Care Systems (ICS)—ushered in by the Health and Care Act—and the VCSE sector over the long haul is going to need a different kind of lasting investment and effort.
I think it’s fair to say that while this collaboration is happening and working well in some areas – North-West London springs to mind – the commitment in the Health and Care Bill relating to ICSs, to approach population health in partnership with the voluntary sector, still feels some distance away.
Challenges in bringing together the NHS, local government and wider partners were always to be anticipated of course, you cannot simply legislate good relationships into being. A culture of trust, based on mutual recognition of, and respect for, each other’s assets, skills and capabilities takes time to build. The experiences of the last two years stand us in good stead, but it’s critical we capitalise on the opportunities that this unprecedented period has created. In particular, we cannot take for granted our collective progress. Relationships drift, people move on, institutional memory fades and barriers resurrected. We will need a relentless focus on removing the remaining obstacles to true cooperation, to continue to invest time and energy in our networks and alliances, and to be prepared to be pragmatic and creative.
But as we pull closer to the 1 July ICS implementation date, my fear is that this focus will be lost. There is a real risk that local discussions around collaboration are already becoming increasingly bureaucratic and inward looking as the attention shifts onto governance and structures. We also know tensions and challenges are emerging—some new and some more familiar—not least finding local organisations and leaders with the bandwidth, capacity, or (in some cases) the comfort of sustained core funding to enable really strategic thinking.
A platform for change
Nonetheless, the publication later this year of an updated NHS Long Term Plan provides an important and timely opportunity to set the tone and expectations for joint working. And all the planning and activity that will follow—nationally and locally—must work hard to design the right spaces to enable and support collaboration. Good relationships and collaboration can never be ticked off the ‘to do’ list. So we have to build structures and processes to make it as continuous, natural and seamless as possible.
A first step will be to ensure ICSs and place-based leaders are able to hear from and work with a wide range of partners, without creating unwieldy, ineffective structures or endless working groups that, realistically, are not a good use of time for either VCSE or system colleagues.
To do so, ICSs will need to make it as easy as possible to engage. VCSE organisations come in all shapes and sizes. We can be national or local or both. Some of us are place-based, some population based, and some centred around particular issues or conditions. We do a huge variety of things from research and innovation to advocacy to direct services and support. We all have a role to play and a ‘one size fits all’ approach isn’t going to work. Instead focus on making structures, roles and responsibility as transparent as possible—working out who to talk to and how to contact them needs to be easy. Integrated Care Boards should also actively promote their strategies, programmes and priorities, inviting comment and questions from VCSE partners. We need to jointly invest in the infrastructure and platforms that allow the VCSE to come together with statutory partners in practical forums aimed at fostering joint working and delivery. As VCSE partners we need to practice what we preach and role model good collaboration – something that is a founding principle of the Richmond Group. And the statutory sector will need to be realistic in talking about funding.
Transforming engagement into collaboration and action will then also require us to hold on to that spirit of ‘can-do’ creativity and pragmatism. Identifying what we as a VCSE sector, along with ICSs, want to achieve and finding ways to make it work. If systems, processes and structures are getting in the way, we need to commit to working through and around those challenges rather than giving up on the ambition, embedding lessons learned for next time as well. This means concentrating less on governance, and benchmarking success around good relationships and outcomes. We know there is no utopia here – just continuous and sincere efforts to make it work.
We know we face enormous challenges. Over a decade of rising need and declining funds meant that health and care systems were fragile heading into the pandemic. And now with our population and services still reeling from the impact of the last two years, we are facing a once in a generation cost of living crisis. If this isn’t a burning platform for change, what would be?