The NHS reforms set out clear aspirations for the voluntary and community sector as a provider in health services, a source of support for commissioning and a partner in tackling health inequalities. The sector already operates extensively within health and social care, with the NHS spending around £3.4 billion annually on their services.
The sector is known for its diversity, flexibility and ability to respond to the needs of local communities. Many organisations straddle health and social care, providing exemplars of how to deliver integrated care. Others provide disease specific services, promote healthy lifestyles, encourage self management of health conditions or tackle health inequalities by facilitating greater access to services.
This year’s GlaxoSmithKline IMPACT Awards, run in partnership with The King’s Fund, demonstrate the enormous impact that small to medium sized charities can have on health in their communities. The 11 winning organisations competed with 450 others and demonstrated that they had a detailed understanding of the needs of their communities, developed strong partnerships and represented very good value for money.
Many of these organisations are currently heavily reliant on funding from their local PCT and have significant concerns over their long term viability as these bodies are dissolved. It will be a real challenge to the clinical commissioning groups (CCGs) to maintain these important local services, while grappling with their new responsibilities and setting up their processes.
Many organisations from the sector report that they are finding it extremely difficult to even get on the radar of the CCGs, despite their track record of achieving strong outcomes and good value for money The Metro Centre in Greenwich, south east London, is a good example of the positive work being carried out by this sector. It works to tackle high-risk sexual behaviour, and provides information, counselling and community-based HIV testing. It can demonstrate the impact of its work, and in the last six years it has grown from working with 600 to 25,000 people a year. Seventy percent of its income now comes from the NHS. Metro estimates the huge potential cost savings from its interventions aimed at preventing HIV infection: the lifetime cost of treating someone with HIV in Greenwich is greater than the annual cost of conducting personalised, intensive HIV prevention with over 500 high risk clients. Also, as a community provider it can provide a full HIV / STI screen for £75 which compares with £116 through the NHS. The community-based testing clinics also have other benefits - they are open at flexible times and weekends, and are conducted in an informal and relaxed environment, usually assisted by teams of volunteers.
As commissioners strive to make efficiency gains, it is possible that they will pursue even fewer, larger contracts. The risk is that smaller organisations may be dismissed as being less efficient or viewed as less credible than their larger counterparts. However, this ignores the considerable local community intelligence they have. For example, Hale Project in Bradford (Health Action Local Engagement), started by the PCT and now an independent charity, tackles health inequalities using its local knowledge, partnerships and volunteers to deliver 175 programmes last year, reaching 5,500 people on expenditure of only £400,000. It calculates that for every £1 the NHS has invested HALE has brought in an additional £1.17. After participating in Hale’s programmes 80% of people felt healthier and more motivated, 36% had reduced their alcohol intake, 35% had improved BP and 13% reported less need to visit a GP.
A good health system will have a range of provider organisations in terms of size, scale and scope, delivering a variety of services to meet the needs of different populations. The value of the voluntary and community sector should not be underestimated - both as service providers and strategic partners.
It is crucial that commissioners understand what is offered by community organisations. The sector can have an important role in representing the voice and interests of patients and communities. Some of the most entrenched and high cost health problems will not be addressed by medical solutions alone. Working with organisations who understand and are trusted in their local communities can play an important role in improving health outcomes.
- Lisa Weaks is third sector programme manager for The King's Fund.