Those of us who are part of the Lancashire & South Cumbria (LSC) VCFSE Alliance have spent just over four years trying to formalise relationships with our statutory health and care partners through the Integrated Care System (ICS) development.

This involved us helping to develop NHSE national guidance which shaped the policy context ICSs develop within. This saw various forms of VCFSE Alliance being established and recognised in all ICSs across England. Locally we try to increase understanding and awareness on all sides and developed a partnership agreement against which we can judge progress.

The pandemic, the legal establishment of our ICS in July 2022, the change in ‘Place’ geography, and more importantly the precarious financial situation it is in (link to ICB board papers CEO report), has led to a prolonged and tumultuous period which has introduced understandable, if thoroughly unwelcome, uncertainty and delay.

We in the VCFSE were asked to organise ourselves, to provide a means of two-way communication and improve partnership working. While it has been far from plain sailing, we have got more things right than wrong, particularly as it has largely relied on people volunteering their time. Since October ’22 the ICB has financially supported the VCFSE Alliance to advance some of this work, most of it vested in the roles performed by Community Futures.

We created and formalised the Alliance, with assistance from the ICB, VSNW and NAVCA, and subsequently the Assembly, we have a high-profile web presence alongside all major parts of the ICS, and have developed key processes to democratise our representation in our system. In May ’23 we signed a Partnership Agreement between the ICB and the VCFSE Alliance.

The next six months will see us develop our ICS assessment of it’s relationship with the VCFSE shaped by a Quality Development Tool co-developed by NHSE, NAVCA and the VCFSE Alliances from each of the 42 ICS across England. Your help will be crucial to this task.

So our initial job is done. We’re ready and waiting for others now to take the concrete steps we expect towards the promised “left shift” of our Health and Care system to a more preventative one, an integrated system which concentrates on addressing the ultimate drivers of poor health.

How does it feel to you?

Here are some of the commonalities I’ve identified over the course of more than 300 structured conversations with VCFSE leaders over the past four years:

• There are destructive elements to intra-sector competition which hollows out the capacity and capability of the sector as a whole.
• This has partly been driven by the nature of procurement practise with the sector by our statutory partners.
• It has equally been partly driven by VCFSE organisations undercutting themselves in the chase for such funds.
• Yes, there has been austerity and cutbacks, but despite years of offering there is still no genuine partnership which considers the VCFSE as a transformational partner.  
• This has a compounding and chilling effect on the sector, a ‘downward vortex’, as it perpetuates the narrative that we are a cheap option and can be played off against one another.
• When we can robustly demonstrate an investment in a VCFSE-led service would save money, often supported by a health economist analysis or other research, the appetite to ‘invest to save’ seems absent. Block contracts with NHS provider trusts are posited as an impediment to this.
• Pockets of good practice don’t seem to spread.
• Meetings, boards and committees are proliferating with no sense of how they all tie together.

So what are we to do?

Despite our suspicion that as the VCFSE is (probably) the largest sector in LSC in terms of economic activity and employment, never mind our social value, doesn’t it always seem that we’re waiting for someone else to sort things out for us – are we powerless?

We have no real idea of the scale of the VCFSE sectors in LSC, we make educated guessed and infer, but we have no central or trusted source of information about the sector; our services, the trends and challenges we share – yet other ICSs have done the work which demonstrates this through “State of the Sector” reports and other initiatives.

Is this a good effort to expend?

We undoubtedly duplicate “back office” functions and hold assets which could be shared more effectively – what can we do to improve our effectiveness together?

At the Assembly on October 19th, we have an unstructured workshop available to discuss some of these issues. One idea is that we form a provider’s arm of the VCFSE Alliance, like those in Greater Manchester have – not a cartel but a collaborative concerned with improving the sustainability of the sector – making collective business cases, improves our own partnership working for non-statutory funds with big impact in our communities, and developing a support offer with smaller organisations.

What do you think?

The ICS has provided funding which has enabled this understanding and the space and ability to think about and ask these questions on a blog and on a newsletter to over 250 organisations aligned through the Assembly. They have even delegated a Director to be an interface with the sector. Another idea we have is to bring together all those VCFSE leads on system boards and meetings on a regular basis to communicate what’s happening, agree some shared aims and objectives to bring into those spaces and coordinate a few key pieces of work; all informed by your involvement in the Assembly and facilitated by the Alliance. 

What do you think?