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Can the voluntary sector be successfully embedded in integrated care systems?

Integrated care systems (ICS) will become formalised in July, with the statutory incorporation of integrated boards and integrated care partnerships in the 42 system areas across England. This reform aims to create a better system of health and care where the patient or service user receives more timely and efficient care, delivered seamlessly across organisations and sectors. This builds on aspirations in the NHS Long-Term Plan, which has a focus on reducing health inequality, putting citizens, patients and carers at the centre, and moving services ‘upstream’ to focus more on prevention. This policy shift speaks very strongly to the voluntary, community and social enterprise (VCSE) sector.

Furthermore, the ICS Design Framework, published by NHS England in June 2021, includes an enhanced role for the VCSE sector, not just as service providers but in system leadership and governance. The guidance gives local systems flexibility in how they interpret guidance on the role of the sector, but it does also make some key recommendations:

  • It sets out benefits of working with the sector, encouraging ICS leaders to value its knowledge and expertise and invest in grassroots groups.
  • It points to the value of local VCSEs, rather than focusing solely on the work of larger providers and refers to some of the challenges the sector faces, including the substantial resource required to engage strategically with the new structures.
  • It requires integrated care boards (ICBs) to have a formal agreement in place for engaging and embedding the VCSE sector in system-level governance by April 2022.
  • It focuses on VCSE alliances as the mechanism to develop this, and to build on what already exists, including local VCSE infrastructure (explained below).
  • It notes the importance of the role of the VCSE sector at place and neighbourhood, and the need to join these together across an ICS area, and to work with what already exists.
  • It notes the need for a coordinated system approach to social prescribing and engaging the VCSE in multi-disciplinary working via primary care networks.
  • There is brief reference to the expectation that provider collaboratives operating at ICS or supra-ICS level should continue to involve the VCSE sector, noting the innovation the sector brings to the design and delivery of services.

Sceptics among us might feel that this is yet another public service restructure that is being hailed as a ‘gamechanger’ for the VCSE sector. But I am heartened by the level of attention the guidance has given to the VCSE sector, and this has been backed up by funded programmes to build the capacity of the VCSE to engage in the transformation. I have been involved as a consultant delivering some of this work for the last five years, currently with NAVCA, the national body that represents what our sector calls ‘local infrastructure’ – organisations that support and represent charities at a local level.

With this opportunity comes immense challenge. A key challenge in terms of the ‘VCSE as equal partner’ is the very nature of the sector. Unlike the NHS provider sector, which is usually a handful of large NHS foundation trusts, the VCSE is thousands, or tens of thousands, of organisations, ranging from tiny community groups with no staff to multi-million pound ‘household name’ charities. This is what enables the sector to be agile, responsive to the needs of its constituents, and able to reach the most vulnerable in society. Yet from the outside it can appear unwieldy, difficult to navigate and uncoordinated.

The VCSE sector in all 42 ICS areas is currently being supported to develop a VCSE Alliance. This can:

  • provide a unified ‘voice’ for the sector
  • manage competing interests
  • provide a ‘front door’ to the sector for external stakeholders
  • amplify the voices of the most vulnerable and unheard
  • provide a platform for the sector to work towards being a proactive, independent and well organised sector, with its own agenda and strategies
  • enable the sector to have a stronger voice and more coherent relationship with other stakeholders, such as local and devolved regional government, the corporate sector and the bigger and more strategic grant funders.

The main challenge is that, in many of the ICS areas, the VCSE sector has not needed to organise at this geographic level before, and so new relationships and working arrangements are needing to be formed. And we know from much of our previous work in this sphere that the ‘pick a model’ approach to collaboration simply does not work. It is vital that time is spent doing the hard work of building the foundations of collaboration. In a nutshell, these are:

  • Building sustainable relationships
  • Creating a truly shared vision and values
  • Working out principles of joint working, and getting these recorded in policy documentation
  • Investment and resources
  • Strong leadership.

Of course, another big challenge is how the sector it is resourced to create and maintain leadership and representative structures. These roles, to be done properly, require significant time commitment.

My team has been commissioned to do a ‘deep dive’ into the VCSE structures and networks, and their influence, in one system area. The aim of this is to map their existing structures and capability, to inform their new system-wide alliance structure. This highlighted some great examples of leadership and representation, linked into to statutory sector structures, for example, a pilot project to mentor leaders of small BAME-led organisations in new rep roles, which included funding to backfill their time, to enable their participation in strategic networking. Yet it also exposed significant structural weaknesses, such as big disparities of investment in the VCSE sector, and particularly the local infrastructure function, and the lack of voice that many charity leaders experience, particularly those from very small organisations. We hope that our recommendations will help them to resolve some of these challenges as they build their VCSE alliance.

Lev Pedro is a freelance consultant, specialising in the role of charities in public service transformation and delivery, currently working as an associate to NAVCA on the programme ‘Embedding the VCSE in ICS’, funded by NHS England.

Last Updated on 31 January 2022