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Dan corry presentation
This document summarizes a debate about the role of the voluntary sector in health and social care. It discusses how the voluntary sector can help move towards a new era of partnership between health and social care. While integrating health and social care seems logical, cultural and structural barriers have prevented it from happening. The voluntary sector is well-positioned to play a big role because charities consider the whole person and all their needs, not just medical issues. The document also examines specific areas where more work is needed, such as how the health service can better partner with charities, how charities can save the health service money through prevention and addressing social determinants of health, and how charities can influence and create systems change within health care
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- 1. Tavistock Square Debates Towards anew era of partnership in health and care #TSQDebates
- 2. v CAN THE VOLUNTARYSECTOR HELP US TOWARDS A NEW ERA IN HEALTH AND SOCIAL CARE? AGE UK Tavistock Square Debate February 24 2015
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- 4. TRANSFORMING THE UKCHARITY SECTOR 4 NPC works at the nexus between charities and funders Charity SectorFunder Increasing the impact of charities eg, impact-focused theories of change Strengthening the partnership Eg, collaboration towards shared goals Increasing the impact of funders eg, effective commissioning Consultancy Think tank
- 5. PARTNERSHIP BETWEEN HEALTHAND SOCIAL CARE A NO BRAINER • But does not mean it is easy • Would have happened by now – lots of talk, pilots, experiments etc • Even SIBs not taken off as yet WHY NOT HAPPENING? • Cultures • Incentives • Behaviours (central and local govt; clinicians etc) 5
- 6. VOLUNTARY SECTOR SOMETIMESSEEN AS PLAYING A BIG PART? WHY? 6 Bad Reason Better Reason Best Reason Cheap. Millions of free volunteers Often good at what they do The best charities worry about the whole person, their journey, all their needs
- 7. SUPPORTING GOOD HEALTH 7 Charities’role supporting patients • Patient voice and involvement • Navigating the system • Prevention and early intervention • The social determinants of health Charities’ role influencing the system • Delivering services • Influencing the design of services • Making state resources go further Seven essays discussing the role of the charity sector
- 8. FIVE YEAR FORWARDVIEW “The NHS will become a better partner with voluntary organisations and local communities” 8
- 9. AREAS WORTH DOING MOREWORK Can the health service work better with charities? How can charities save the health service money? How can charities influence the health service?
- 10. CAN THE HEALTH SERVICEWORK BETTER WITH CHARITIES?
- 11. HOW DOES THEHEALTH SERVICE WORK WITH CHARITIES? 11 1037 280 444 164 128 704 26 11 246 Primary care Secondary care Community-based services NHS provider Private company Charity or social enterprise Primary, secondary and community contracts by provider type
- 12. WHAT DO WENEED TO KNOW TO MAKE THIS AN EFFECTIVE SYSTEM? • What types of providers are being commissioned by CCGs? • How are CCGs approaching the pre-procurement phase? • What influence has the Social Value Act had on the approach of CCGs to commissioning? 12
- 13. HOW CAN CHARITIES SAVETHE HEALTH SERVICE MONEY?
- 14. HOW CAN CHARITIESSAVE THE HEALTH SERVICE MONEY? 14 Preventative health Social determinants of health People with identified health needs
- 15. PREVENTION AND THESOCIAL DETERMINANTS OF HEALTH • How do charities best insert themselves into this agenda? • How can we encourage funders to recognise the importance of earlier intervention? • How do we address the challenges of measurement in this field 15
- 16. HOW CAN CHARITIES INFLUENCETHE HEALTH SERVICE?
- 17. HOW CAN CHARITIESINFLUENCE THE HEALTH SERVICE? 17 Charities Statutory system Systems changeServices Research Advocacy Policymakers Commissioners Clinicians Models of systems change
- 18. SYSTEMS CHANGE • Whatkind of influence is realistic for charities to exert? • What kinds of interventions work in what circumstances? • How can we best share this knowledge within the sector? 18
- 19. FUTURE RESEARCH 19 Commissioning How doesthe health service work with charities? Prevention and social determinants How can charities save the health service money? Systems change How can charities influence the health service?
- 20. “CAN THE VOLUNTARY SECTORSAVE THE NHS” IS THE WRONG QUESTION How it can help join it up, change its focus, bring innovation and a holistic approach to health and social care is the real need for focus 20
- 21. v THANK YOU New PhilanthropyCapital – Transforming the charity sector thinkNPC.org
Editor's Notes
- #3 My angle more from vol sector – important not least as this event supported by 3 great orgs AgeUK, RVS, Red Cross
- #4 My background Govt – including CLG/HMT/No 10 (where did lots on health) Ran local govt think tank
- #5 Talk and click thru slide. Work with many charities and funders in health and social care space Also we set up Commission on Voluntary sector and ageing (with ILC-UK) that reports in mid March
- #8 Want to pull back a bit to consider how charities can help in health of our nation. Not just about older people but they are clearly what is causing most anguish now (and anything that helps in other age groups arguably frees up resource for this group) We put together 7 areas in a recent publication (read out fast). Tested out with roundtable with lots of charities and event with various folk (including Paul Famer of Mind and Sarah Pinto Duschinsky of NHS England).
- #9 At same time, NHS chief exec Simon Stephens’ 5 year forward view opens up a lot of space for vol sector. His priorities include Empowering patients to take control of their own health, breaking down divisions in care- including between hospital and community Addressing what he calls a “factory” model of care and repair, It’s something we and many in the sector really welcome – it’s very positive for role of sector and the things it advocates for to be welcomed in this way But it is just a vision – no detail of how it will come about That’s been left for us to work on Our challenge is how we all work together as a sector to make it a reality And we have some ideas In response to crisis in A&E Cabinet Office £1.2m given to charities to mobilise volunteers in some of the most under-pressure A&E units. Comes on top of £2.6m given last year to support volunteer schemes and help OP get well and stay well. At least govt and health service recognise charities are key even if clumsy and only a sticking plaster. Out of all our work so far three areas of where NPC thinks the charity sector has a role—and where we need to talk in more detail about how it delivers that role more effectively.
- #10 And we intend to do more research and investigating on them at NPC
- #11 Will look at one aspect of this – the work coming via CCGs
- #12 BEFORE CLICKING This comes from BMJ data they got via FOI Charities and social enterprises were awarded 387 (11%) of the total contracts awarded during this time. Private companies were almost three times more successful, securing 33% (1,149) of the contracts, with the remainder going to NHS providers (1,915) and ‘other’ providers (43), such as local authorities and universities. While this demonstrates that the market place contains a variety of provider types—as intended by the 2012 reforms—these figures suggest that contracts are not yet evenly distributed between them. Then subdivide a bit [CLICK] This graph shows that charities and social enterprises form a small proportion of providers across primary and secondary care. Perhaps as expected. While charities do slightly better in contracts for community-based services, which include helping patients in their own homes and providing rehabilitation outside of hospital, they are conspicuously under-represented in an area where they might be expected to thrive. Voluntary sector providers were awarded just over 1 in 6 of these contracts, outweighed nearly three times by private providers.
- #14 So that discussion is about what's already happening – looking at the system as it is But to really recognise value of charities they system needs to change The things purchased need to change; the understanding of needs to change The way the health system as a whole thinks about how it allocates resources needs to change – and we think charities have an important role in the way that looks So our second area of focus is on prevention and soc determinants of health
- #15 Want to pause on this Not a new idea but just so difficult to shift spend out of acute services when everything is experiencing higher demand. What happens at the moment happens through public health - With ring fence in public health only assured as far as 2015/16 its unclear what the shape of funding for prevention will be after that. Which means that this conversation is urgent - the time is now to make this case. We think this is key for charities. It’s core business – seeing people as a whole, addressing the underlying causes of health problems. In many ways much easier for charities to take that view than any single part of the health service which is by its nature specialised. The way we’re thinking of the issues is this Everyone focuses in the inner core – smallest number of people, most money. Next ring out is prevention – stopping people at risk from getting health needs: so reducing admissions etc Third is social determinants – the underlying reasons that people are at greater risk of health problems. At each stage, the name of the game is preventing people from moving into an inner ring. Yet the big challenge is that the further out of the central ring you go, you don’t know exactly who’s going to need the help, and the more people you need to reach to ensure you’re making a difference. It gets more diffuse. In economics terms how do you avoid deadweight? Charity sector (and others) – often conflate all these. Do need to be clear what is meant by each concept, the kind of work that happens under each – and the implications of working in that space for various things – esp what you’ll need to measure to prove you’re making a difference and what this really means in practical steps. What does it mean to demonstrate you’re having an influence on the social determinants of health, what can you do to prove it, and are the people holding the purse strings going to be convinced? What we really need here is some realism and nuance to the conversation—what about the reality for small community organisations – what do they need to be able to say to their commissioners – what will it cost them to do – and is this a reasonable proposition?
- #16 How, with limited government spend can commissioners decide how to promote safe, healthy communities We know many people working in this area – inst of health equity, Richmond group. We think there are things we still need to know, This is the bread and butter of many charities’ work – how can that be best recognised – and for what type of organisations is it appropriate and reasonable to do so? How wide are we drawing that outer circle? Recognise it – but to do so realistically. Its not for the charity sector to do all the running – dialogue about how much evidence is enough
- #17 So that’s a discussion about what charities do …and what they could do (or at least recognising what they already do) when it comes to delivering services But in terms of saving the health system – it needs to be about more than that What do charities KNOW What can they offer that hasn’t been recognised before
- #18 {FIRST CLICK} charity sector much smaller so influencing what system does most important. Second CLICK Each of these themselves are complex too so not easy to work out how.