At ACEVO’s recent Health and Social Care conference, Simon Stevens, Chief Executive of NHS England, arrived without a speech. Instead, he asked those of us in the audience to offer our thoughts on the best ways to strengthen partnerships between the NHS and the charity sector. There’s nothing like being put on the spot to focus the mind, but there was one question I found particularly troublesome. He asked: ‘What points of engagement are missing?’
Important as it is, I think this question is difficult to answer because it jumps the gun. First there’s a bigger problem to confront.
Better engagement between charities, commissioners and clinicians is a crucial goal, but talking without a foundation of mutual respect is unlikely to yield results. At present, creating more opportunities for charities to engage with the NHS might simply mean a longer list of people who don’t value what they have to say. While at the same time, charities must recognise that the NHS is a highly complex system full of dedicated experts, to which they bring a different and valuable—but not necessarily superior—perspective.
Some clinicians and commissioners see charities as ‘amateur’ providers, associated with well-meaning but inexperienced volunteers, whilst many simply do not acknowledge the benefits of approaches that sit outside the clinical frame. The NHS is a system that rightly values clinical specialism and medical intervention, but this can create a hierarchy of activity that places social support on the bottom rung. Meanwhile, rigid evidence standards, associated with large clinical trials, give preference to certain uniform, replicable interventions (such as medications) at the expense of social and community-based interventions that hold the potential to move the NHS away from its ‘factory model of care and repair’
If we want to see meaningful engagement between commissioners, clinicians and the charity sector, there are a few steps that need to be taken from both sides. From the Department of Health (DH), Public Health England (PHE) and NHS England (NHSE) we need to see:
- Better guidance and stronger leadership for commissioners and procurement teams. Commissioners, as much as providers, are still adjusting to the new architecture of the health service. Better guidance around acceptable levels of risk, evidence standards, alternative funding mechanisms, and the proper use of service specifications will all help to create an open market and produce the best services possible.
- Targeted engagement in areas with poorer performance. The localised nature of new commissioning arrangements means that performance and experience is patchy. While overarching frameworks, such as the Social Value Act, are in place to influence commissioning behaviour, there is still a need to seek out, and provide support to, commissioning bodies that are not performing their role effectively.
Charities, too, need to make sure engagement is meaningful by providing a clear and well-evidenced case for their involvement:
- Speaking with one voice. Expertise and advocacy for particular causes is one of the voluntary sector’s key offerings, but when it comes to the bigger problems, charities risk undermining their common goals by talking over one another. To create a coherent plan for the future, we need to see more upfront investment in activities to clarify and articulate the voluntary sector’s strengths, and more support and guidance for charities wanting to engage with the statutory system.
- Making a compelling case. While commissioners need to be reasonable in their expectations, charities must also make the effort to produce evidence that can support commissioning decisions. This will come through the efforts of individual organisations, but also through efforts at the sector level—collaborating to produce a coherent and comparable evidence base that is synthesised and accessible.
In order to create a system that supports the meaningful engagement we strive for, we need to see more investment in building the evaluative capacity of the charity sector and in convening its disparate voices, but we also need a greater focus on the capacity and attitudes of commissioners and clinicians.
Charities must do their part, but if they are to play a more significant part in supporting good health, they need to feel convinced that what they say will not just be heard, but valued.
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