Wellbeing as a core outcome for health and social care

Alex Fox OBE, independent chair of the Joint VCSE Review, Vice Chair of TLAP and CEO of the charity Shared Lives Plus ,talks about the need for inclusive and collaborative leadership.

The imminent social care Green Paper and NHS Long Term Plan are likely to revisit familiar messages about the need for health and care services to be based around new relationships between services and communities. That would be an opportunity for VCSE leaders to show why real changes in those relationships cannot be achieved without us. A blueprint for how relationships between the not for profit sector and state could be improved was developed by the Joint VCSE Review, which was commissioned by NHS England, Department of Health and Social Care and Public Health England. The Joint Review published an action plan earlier in the year, which revisited the key points from our original full sector consultation and report in 2016.  We asked the sector for your views and have been feeding them into both. You told us that the Green Paper and the Long Term Plan should set out the ambition for long-term investment in communities, not just in council services and the NHS.

This isn’t just a case for more funding for the voluntary sector. As long as the NHS is judged solely on clinical outcomes and treatment of illness, investing in communities and community organisations will always feel nice but optional to hard-pressed commissioners. There is much talk in health and care strategies of a move towards the community, prevention and empowering people to stay well, but those aspirations are not yet hard-wired into our health and care system, which means they remain hoped for rather than expected, measured and paid for. Our Action Plan calls for wellbeing to become a core outcome for health and social care systems, demonstrating its human and financial impact on those systems.

The plan says that this will only happen if we co-design health, care and public health systems with local people, particularly those groups and communities which experience the most inequality and exclusion from services. So there is a key role for the VCSE sector as design partners, not just as delivery or provider organisations. If we as a sector do what we say on the tin, we will be the best and often only route for planners and commissioners to have meaningful conversations with those groups and communities that are currently least well-served by state services. Our plan also reiterated our call for the outcome measuring tools, infrastructure and commissioning approaches which can channel resources towards the kind of support which people identify as the best fit with their lives and communities. We have identified routine use of the Social Value Act, for instance, and have worked with the What Works Centre for Wellbeing and others to promote the development of wellbeing measures, as well as helping to design the Social Prescribing Fund which has awarded funding to a number of local areas.

The best councils and CCGs are already investing strategically in their communities and community organisations, and the VCSE infrastructure organisations needed to get the best out of civil society. I hope the Long Term Plan and Green Paper will embed that approach as a core expectation. Our job as leaders of VCSE organisations is to demonstrate why that new relationship with communities is essential to transforming health and care services, and that public services need our leadership in order to build that relationship.

VCSE organisations have rarely been under more pressure, but their leaders need to role-model what coproduction looks like and the new ideas and insights it can bring into health and care systems that don’t feel human enough. We need to deepen our community roots as the USP which sets us apart from the private and public sectors. We need to be prepared to share our resources and any power we have with the people we were set up to serve, as well as demanding to share resources and the commensurate responsibilities with our statutory partners. This calls for leadership which is collaborative, inclusive and which devolves power and resources down to the most local level wherever possible. In tough times, that will take humility, as well as all of our courage.

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