The drive to open up public services to competition has proved controversial, nowhere more so than in the NHS. Sir Stephen Bubb, chief executive of the Association of Chief Executives of Voluntary Organisations, wrote to David Cameron earlier this year raising concerns that public sector monopolies could be replaced by “private-sector oligopolies”. Large private sector providers are cornering new markets in public services at the expense of charities and other smaller community-focused organisations. Bubb argued that contracts are too often focused on cost savings rather than “engagement, collaboration and social value”.
Big is not necessarily beautiful when it comes to addressing ingrained, complex and costly health challenges. Organisations that are close to their communities can respond to their needs in a more targeted way. Their understanding of their client group enables them to identify pockets of unmet need and find innovative solutions, while engaging and galvanising local communities and helping to co-ordinate services across a range of organisations.
The GSK Impact Awards winners, for charities improving community health, demonstrate the distinctive contribution made by these smaller organisations. For example, Mayfair Community Centre in Shropshire works with a local population with twice the national average of people over 65. Unsurprisingly, this includes a high number of people living with long-term conditions, who are more likely to be unnecessarily admitted to hospital if their needs aren’t managed well. Where GPs identify people at risk of hospital admission, Mayfair co-ordinates a package of support and care based within the community. It also ensures that vulnerable people with long-term illnesses are paired with one of its 270 volunteers who support them to live independently by helping with simple but essential tasks like filling in forms and the shopping. Those supported by volunteers show a 30% reduction in the need for home visits by NHS professionals, 71% reduction in emergency admissions and 55% reduction in the use of the GP out-of-hours services.
Other local charities work with vulnerable groups and those with specific needs. Rise in Brighton, which supports victims of domestic violence, is working with the ambulance service to identify those in need of support. Research suggests that two women a week are killed by a male partner in the UK and it is estimated that domestic violence costs the NHS £1.2bn annually to treat physical injuries. Rise has trained local ambulance service staff to identify new cases of abuse, improve rates of onward referral and break patterns of abuse, providing an innovative intervention which has enormous human and financial costs.
As many as one in 12 young people are caring for a family member. This can take a heavy toll and many of them suffer emotional and behavioural problems and ill health. Gloucestershire Young Carers, another GSK Impact Award winner, works with 70 local GP surgeries to identify young carers. It also works with the local mental health trust to improve hospital discharge arrangements to ensure that children caring for parents with mental ill health (40% of GYC’s current users) are identified and provided with the support they need. It also encourages different service providers to come together to take a whole family approach, working across health, education and adult services to ensure that young carers get the support they need.
Those commissioning public services face many challenges, not least significant financial pressures and the need for efficiency savings. The temptation to think that contracts with big, private-sector providers will deliver better and more cost efficient services will always be there, but at what cost? It is important to not lose sight of the vital contribution made by small community-based organisations such as those supported via the GSK Impact Awards, and really hear what they have to say.
Read the article here.