The future of health and social care – conclusions from the Joint VCSE Review

Alex Fox OBE is the chief executive of Shared Lives Plus and was independent chair of the Joint VCSE Review, for which NCVO provided the secretariat. 

What does the health and social care system want from charities and social enterprises? The answers to this vary, and sometimes contradict each other. Voluntary, community and social enterprise (VCSE) organisations are asked to be more efficient and to merge into bigger organisations which can be contracted with, but they are also challenged to remain rooted in their communities and to tailor their work with specific communities. They should be collaborating not competing, while grant funding continues to be replaced with competitive contracting. The public expect charities to be independent, strong voices challenging the NHS and councils when they let people down. Those bodies generally welcome constructive criticism – up to a point.

When the world’s expectations of us become impossibly complex, the question we should ask becomes simple: what are we for?

About the review

The Joint VCSE Review, which I am stepping down from chairing after three years, took hundreds of views from VCSE organisations and their commissioners, and presented a picture of that complexity. We heard constantly about the battle between mission – set by community – and money: contracts specified in rooms which felt a long way from those communities. We heard about the challenge to VCSE organisations to provide evidence of the impacts they claim, and also the limitations of evidence in changing the spending habits of councils and NHS organisations where funds were tied up in an increasingly narrow range of services hit by cuts.

We made a range of practical recommendations including ‘simplest by default’ (not most bureaucratic by default) funding. This was influenced by a strong case from grant-making trusts for the grant as a low transaction cost, high-impact way of funding many kinds of community-based and community-building work.

We were cheerleaders for properly-resourced social prescribing, universal use of the Social Value Act powers, and approaches to bringing data into health and wellbeing work based on the successful Justice Data Lab.

We helped design the Health and Wellbeing Alliance, which brings consortia of national charities together to work with government, NHS England and Public Health England, to co-produce better policy. That alliance made an impact on the NHS Long Term Plan. It also has more work to do to communicate what it does with the wider sector. We have seen its funding, and funding for the Health and Wellbeing Fund which runs alongside it, under constant pressure, at a time when much-reduced government departments need VCSE expertise and challenge more than ever.

A future based on partnership

We based those practical suggestions on a big shift which remains to be realised: state, NHS and civil society must all agree that our future health and care system must be co-designed with the people who use it most, and those who miss out most often. Statutory organisations have been largely slow or unwilling to share their power with citizens. Not all VCSE organisations do either, but the best recognise that that is what they are for. Those are the design and commissioning partners which councils and the NHS need for any real change.

If we started co-designing health and care systems this way, we would also see a much stronger role for the best community organisations, which see the world from the perspective of individual, family and community. This is the key to addressing the inequalities experienced too often by those communities who have been least listened to, and who rarely see the reality of their lives reflected in big statutory plans. That change cannot be pursued as an afterthought. Every council and local NHS system must invest strategically in its communities and community organisations. I hope to see NHS England, Public Health England, the Department for Health and Social Care and their local partners continuing to pursue that goal.


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