Whole Systems Change: co-producing new models of health and care. Moving forward together – a think piece following our recent Whole Systems Change event 16th April 2015.

This article is aimed at our Regional Voices' partners as well the wider voluntary, community and social enterprise sector, locally, regionally and nationally. It will also be shared with our statutory sector colleagues, including NHS England, the vanguards, Commissioning Support Units, CSUs, etc.

It is largely intended as a food for thought & information piece. The "what we can do" section may also help organisations to formulate their own thoughts and build on their work co producing new models of health and care. Read the full report


On 16 April 2015 LVSC held an event through the Community Voices for Health Network (CV4H). The event followed on from the CV4H event in February this year to help stakeholders from the health and VCSE sectors understand the complexities of the current health and care system and the need for change. It explored the role of the VCSE sector, local communities and patient bodies in shaping and co-producing new models of primary and community as set out in the Five Year Forward View and Better Health for London report. The event also discussed the role of the patient and community in integrated pathways to delivering healthier individuals and communities.

The event highlighted how co-production could bring about more effective partnerships between the sectors and potentially more funding opportunities for the VCSE. It raised a number of important matters that can be read in the report, but one issue in particular resonated with me. During the event, Dr Sam Everington gave a very interesting keynote address describing the work of the Bromley by Bow Social Prescribing project. A participant asked about the apparent lack of funding going to the VCSE when GPs prescribe a patient or carer to a social prescribing project, which is usually a VCSE organisation. In his response Dr Sam Everington pointed out that we were still living in an age of austerity and that there were no easy answers to this problem. He did however stress that the new models of care, including social prescribing, will open doors for the VCSE to be commissioned and access funding.

Much has been said already about social prescribing, including the opportunities and barriers it can present for the VCSE sector and how social prescribing activities can vastly improve the outcomes and wellbeing of patients and carers. A number of very useful briefings and papers have been produced by RAISE (LVSC's regional equivalent in the South East) and Community Action Southwark about the benefits and opportunities of social prescribing as well as the support organisations like Compact Voice can provide.

The lack of funding going to the VCSE sector represents a significant issue, and not just for the VCSE sector running social prescribing projects and organisations, as so is transparency and accountability.  As Professor Sir David Fish, Managing Director UCLPartners, said at our event: "the VCS needs to have more power about what is spent and where. The sector needs to stand up and demand where funding is spent and how". Transparency and accountability in how funding is spent in effective partnership with the VCSE is a major factor in ensuring a reduction in the UK's stark health inequalities, which is clearly one of the key aims of the new health and care agenda. It is likely to also help to create more level playing fields in terms of funding for the VCSE.  The government has recognised that clinical approaches are not sufficient in bringing about fewer health inequalities but as the recent VCSE Review stated "it's only through partnership, we can - and must - do much more".

There has been a tendency by the statutory sector and commissioners to seek partnerships with and commission larger and specialist VCSE organisations. They are considered safer options in terms of service provision and demonstrable impacts and can deliver with relatively little resources. It is often the small to medium sized organisations that provide niche services that are still often overlooked. Insufficient resources put at risk the ability of many niche organisations to deliver much needed preventative services, including social prescribing projects. If this isn't tackled, we may be at risk of neglecting the health and care needs of many marginalised communities and increasing health inequalities even further.

For the new models of care to work to deliver most effectively and sustainably, we must put in place an accountable, transparent, equitable and sustainable funding /commissioning strategy. This must be co-designed with the VCSE as well as with statutory services & bodies, charitable Trusts, NHS Foundations, Academic Health Science Networks, Vanguards, etc.

In a positive move, steps are being taken to provide easier and lighter contracts for small to medium sized organisations - see Regional Voices' page on Standard Contract Light and the survey (open till 27th July). Regional Voices has also played a significant role in implementing the NHSE Grant agreement - template and Bite-Sized Guide.

So, what can we do?

I will keep highlighting contracts in our regular health e-bulletins.  We can learn a lot from social prescribing projects in London, including Bromley by Bow, Southwark, Brent, Hackney (Hackney CVS' Health & Social Care Forum is working with the CCG to develop approaches to social prescribing), as well as in other parts of the country. I aim to meet some of the London social prescribers to see what we can learn from them and how we can share these locally, regionally and nationally. I will also be sharing expertise with my Regional Voices colleagues across the UK.

How can small to medium sized organisations be better supported?

Alliance Contracting

One way of doing this could be through alliance contracting. Lambeth have an interesting alliance contract around mental health and it seems to be the way Southwark CCG will be looking to commission new services. There is probably some work to be done to prepare the local VCSE to get involved with alliance contracting, as it's a new way of working that requires true collaboration, and risk and information sharing.

Shape local priorities through active participation

It is also worth reinstating how the VCSE should be actively shaping local health priorities because of their valuable knowledge of local needs. This could be achieved perhaps through a strong role in the completion of local JSNAs, HWB strategies and the formation of CCG commissioning intentions. In order to achieve truly co-produced health services the VCSE needs to be involved in setting the priorities.

I feel there is often untapped knowledge in the local sector and this could be used to better inform commissioning decisions and ensure better health outcomes for local people. Co-production at an earlier stage (that is real co-design) - getting the VCSE involved in innovating solutions to local health problems - could also allow for more imaginative responses to these problems rather than just bog-standard commissioning.

Investment in preventative services

Health bodies should be encouraged to invest to save - that is, invest in preventative services delivered by the VCS, rather than spending money at the acute end. An asset based community development approach to health problems can pay great dividends in the future, and this is being noted by some CCGs. Community Action Southwark (CAS) informed me that it was a big part of an " Our Healthier South East London event" recently (which includes Southwark, Bromley, Lewisham, Lambeth and Greenwich CCGs). Rachel Clarkson from CAS has been working on the Southwark and Lambeth Early Action Commission as part of the research team. The final report should be ready by end-July, and once received from CAS, I will share this through our regular health e-bulletin. (Not receiving the Health Bulletin - sign up here.)

There is great potential for Councils for Voluntary Services (CVS) to be considered as prime contractors for a range of preventative services (but note advantages and disadvantages of sub-contracting by NCVO). CVSs are uniquely placed as conduits to front line organisations and some CCGs are seeing the benefits of this. Small-medium sized organisations could be funded through CVSs to deliver preventative and community services. This model of commissioning is currently being looked at in NW London, which is one of the 14 integration pioneer sites. However, as NCVO has pointed out, the process of prime contracting models must be managed well by the prime, sub, or commissioner to work well.

We already know that CCGs have invested in the VCSE to provide services for social prescribing pilots (e.g. Rotherham). VONNE, our equivalent in the North East, led on the development of a service called 'Ways to Wellness' which was "financed by a Social Impact Bond:

"to improve the quality of life of people with long term conditions in Newcastle West by giving them access to social prescribing. It will reduce the cost to the Newcastle West Clinical Commissioning Group (CCG) of supporting these patients".

They will now" put in place a framework to scale up existing work, through a social impact investment solution, and allow up to 5,000 patients per year to access social prescribing. The project has support from the CCG and attracted funding from ACEVO who are interested in the potential to replicate this approach in other parts of the country." They also received funding through the Big Lottery and are expecting interest from other charitable trusts. We must learn from these and other examples.

In London, we could start by raising these issues with London Funders to gauge their relationships with commissioners as well as other social investors. Together, we could explore mechanisms for more sustainable funding to the VCSE that would enable them to provide services to local people, improve their health & wellbeing and reduce their reliance on NHS and social care.

Create more opportunities to raise the issues

There are also other opportunities to address and highlight these issues in London. I have already met with NHS England (London region). They are looking at possible ESF funding (SEIF) with the view to increase employment opportunities that could include VCSE social prescribers.

Make use of London's new vanguards

We must make good use of the new vanguards too - in London they are Sutton CCG and Tower Hamlets Integrated Provider Partnership. I will liaise with the two engagement leads as they will be very keen to hear about VCSE good practice, what has worked well and lessons learned. I will be meeting also with Commissioning Support Units in London as well as with the London Clinical Senates. I will discuss with my LVSC/London for All colleagues to see what support we could offer to the VCSE so that the sector is better placed to demonstrate and strengthen their evidence base and impact.

We are also negotiating with NHS England (London region) membership of the officer group of the London Health & Care Collaborative. This could forge stronger partnerships and relationships between our sector and the Collaborative members including NHSE, London Office of CCGs, CCG sector reps, LAs and NHS provider organisations.  Lastly, we could also share knowledge and support effective engagement & co-production with MyHealthLondon.

Showcase and Share Impact

We need to continue to learn, showcase and share the impact we have already made as a sector in London.

If you have or know of examples of how you have developed strong partnerships /relationships with your CCGs, primary care commissioners, local authorities, health & wellbeing boards around integration, prevention, personalisation, etc do get in touch with me.

We will be sharing widely good VCSE practice examples, locally, regionally and nationally.

Let us move forward together, build partnerships and make us all proud to be part of the new health and care system.

Sandra van der Feen, Health Policy Officer, LVSC Mon-Wed only

Other useful links:



I would like to express my sincerest thanks and gratitude to Rachel Clarkson from Community Action Southwark and Helen Rowlands, RAISE (our Regional Voices' equivalent in the South East) for their advice, support and additional content.


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