Place Matters facilitates a Community of Practice for organisations that catalyse and
support community businesses which is funded by Power to Change as a legacy to the
Empowering Places programme that ended in 2022. We explore topics of interest,
opportunity or challenge together four times a year.
The group decided to focus on the relationship between social enterprise and the NHS
for several reasons. First, health and wellbeing are a key concern and priority for the
communities the group work with. Second, many community businesses are rising to
the challenge of improving wellbeing in their communities and it is an area that inspires
many social entrepreneurs. Third, community businesses are sensing an important
opportunity. The recent structural changes introducing Integrated Care Partnerships and
Primary Care Networks are creating a more outwardly facing NHS. We were fortunate
that the community of practice group work in two places where the partnership between
the NHS and community business is flourishing in Bradford and Plymouth and we
brought together some of the people involved both in the NHS and community
businesses in those places to talk about how the partnerships are evolving and how to
take that experience to other places.
Our 3 guests were:
Helen Farmer: Programme Director. Access to Care. Bradford District and Craven Health and Care Partnership
Mark Nicholson: CEO Equality Together, Lead for the Manningham Health and Wellbeing Hub Bradford
Kate Smith: CEO Memory Matters Plymouth
Why it is time for a new partnership?
The community of practice is made up of organisations that work with some of the most deprived communities in the UK. Inequality in the health and wellbeing of communities is increasing along with many other types of inequalities. The Health Foundation report that women in deprived communities are 1.77 times more likely to die in areas of significant deprivation than the UK average (men 1.76) and all genders are 50% more likely to suffer poor health two decades earlier than the UK average. The communities we work with need a different response.
Equally, the pandemic demonstrated the responsiveness and capability of the community and voluntary sector to meet public needs and the depth of their knowledge of and relationships with local communities. As Kate Smith put it, the community and social business sector demonstrated their value as a translator and intermediary, connecting the needs in the community with the system. As we move from crisis to recovery, we are looking for our health service to help improve our overall health as well as respond to poor health.
What enables health and community businesses to be partners?
The consensus was that the most important ingredient was the time taken to develop trusted relationships. In practice this means giving time for people to develop those relationships and to create the means through which organisations across sectors can connect and collaborate. For example, NHS colleagues in Bradford talked about creating specific senior roles in the NHS and voluntary sector that are focused on building the partnership.
To be an integral and equal part of the health economy, it is critical that community businesses can be equally accountable as the NHS is to the community. Whilst the community sector was generally felt to hold good data, they do not always understand what data is relevant and useful for the partnership with the NHS.
Kate Smith talked about how Memory Matters collect data about respite hours because there is a long waiting list for dementia care in Plymouth and access to respite is a valuable way of helping manage the condition before people can access NHS care. It is important to understand the pressures on the system and what data helps the partnership make better decisions.
The community sector plays a critical role in challenging the dominant NHS viewpoint on the health needs of communities. Kate Smith talked about writing a “Case for Action” paper detailing 15 cases of people that illustrate the challenges in the health system in Plymouth and the financial consequences for the NHS, along with proposed solutions that work in the context of the local system. It is that constructive challenge, centred in a deep understanding of both the community and the NHS system alike that makes the community and social enterprise sector an important partner.
“Being able to communicate….What anticipatory actions are being taken within that VCSE organisation. How are they (the community sector) reducing hospital admissions… what case studies are actually going to enable the statutory services to really listen and understand, being able to translate the “so what” - what are you doing and why you are doing that. That is the dialogue that has been missing”. Kate Smith. Memory Matters.
It was felt that the NHS is becoming more open to different types of evidence and that qualitative evidence is becoming more valued. Helen Farmer talked about the value of video blogs being shared by the community that communicates the experience of care and how that insight into the human experience is helping the NHS become more person-centred.
The NHS is still learning how to open itself up to work with others in equal partnership. In Bradford, the Integrated Care Partnership in Bradford District and Craven has dropped NHS from its title to indicate that it isn’t the dominant organisation in the partnership. It is creating a network of Health and Wellbeing Hubs that provide preventative and “anticipatory” care tailored to the specific needs of the neighbourhoods they support. Engagement with the community and voluntary sector in Bradford is facilitated through an infrastructure organisation (VCSE Alliance) that acts as the procurement conduit between the NHS and the community sector. The CEO of the Alliance has a seat on key decision-making Boards in the NHS to make sure the community sector is able to influence the health system and that the capabilities of the sector are front of mind.
Building the partnership
In Bradford, there has been a long history of collaboration between the NHS and community sector that preceded the introduction of integrated care partnerships. The partnership is founded on strong leadership across the sectors where consistent investment and continuity have allowed the community sector to flourish. Recently this legacy has been constituted in a Strategic Partnering Agreement (SPA) where the statutory and voluntary sectors, plus the independent care sector are co-signatories. It establishes the way all parties want the collaboration to work and codifies the commitment to each other.
It was also seen as important that the community sector be given responsibility for material parts of the health system where they can demonstrate their value and impact to build trust. In Bradford, for example, the voluntary sector runs a programme called the High Intensity Users project aimed at supporting people who are high users of emergency services and based within A&E departments. The project is one of the innovations that is helping manage winter pressures in the NHS.
Mark Nicholson talked about how the 6 Health and Wellbeing Hubs in Bradford are creating a “middle ground” in the system, acting as a conduit between local people and statutory services. Empowering local people to navigate the system of support and engaging with local assets that create a truly personalised and place-centred approach to care. They have room to innovate and to find other forms of funding alongside public funding. In the Manningham Hub, they address mental health, overcrowding in housing, and poverty as principal determinants of health in the neighbourhood. In other Hubs, there is a different focus e.g.: managing debt and loneliness. Neighbourhood level Hubs bring new solutions and ideas into the system grounded in a deep understanding of the local community. The fact that each of the Hubs in Bradford has quite distinctive capabilities and focus demonstrates the significant differences between the factors that influence health between different neighbourhoods and the importance of centring the work in neighbourhoods.
Two of the catalysts talked about how the NHS is inclined to procure national organisations rather than recognise and nurture local capability. Bradford devolved funding to the VCSE Alliance which then procured based on their knowledge of local organisations and in the long-term interest of nurturing local capability. Investment in platforms that enable the system to work together is critical. Bradford has created a single reporting and data collection system for all providers working around mental health developed by a local Bradford development team. Community businesses looking to deliver health services need to have robust information governance systems in place and enabling businesses to develop this capability is a key role for those supporting businesses to thrive.
We discussed how the funding environment for the community sector is short-term. Even in Bradford where there is a maturity and scale to the partnerships, they are using non-recurrent sources of funding for the Hubs and only committing to funding whilst those sources are available.
In Plymouth the largest social enterprise is an organisation that was spun out the NHS, immediately creating a capability for partnership with the community, but also becoming the dominant organisation in the sector. The catalysts shared their experiences of national organisations being given preference over local organisations, who in turn looked to them as delivery partners. Commissioning and procurement systems continue to be a barrier to local partnerships, although progress has been made in procuring non-commissioned services in the NHS.
There is a step change in the potential for partnership between the NHS and community sector. However, many of the routes to these partnerships have yet to be developed, particularly in places where there has been little history of partnership before Integrated Care Partnerships were formed. What these examples illustrate is that the time is ripe for the community sector and community businesses to demonstrate their unique value and to shape the form that these partnerships will take.
Providing investment and development support whilst the opportunity is taking shape is important to develop the capabilities of community businesses to work with the NHS, specifically, businesses need to contribute evidence and data aligned to the health system accountabilities and both sides need to create the conduits through which the NHS can procure the services from the community sector. This seems an important role for those who catalyse and support community businesses to help develop the infrastructure and connections needed to nurture the partnerships across the UK and grow the community business sector in health.