Public health working with the voluntary, community and social enterprise sector: new opportunities and sustainable change
The case studies in this report show great mutual regard and understanding between public health and the VCSE sector – a relationships of equals. To achieve this across the country, more work is needed for public health to understand the positive contribution that VCSE organisations bring to health and wellbeing. The VCSE sector may also benefit from a better understanding of public health, and how local government operates at a time of significant challenge.
There is much that public health can do to work with the VCSE sector to support their role in promoting health and wellbeing, including making sure that they are well engaged in joint strategic needs assessments (JSNAs) and health and wellbeing boards (HWBs), updating the local Compact if needed, and encouraging the implementation of the Social Value Act.
As well as public health, other council departments and clinical commissioning groups (CCGs) also engage with, and commission, the VCSE sector. Joining up this work will bring economies of scale and will also avoid risks, such as destabilising VCSE organisations through untimely decommissioning.
VCSE infrastructure organisations, which provide overall coordination, championing training and commissioning support, make a huge contribution to positive working relationships and ultimately to health and wellbeing outcomes, provided they are focused on the needs of their members, have a ‘can-do’ approach and look outwards to create partnerships. In some areas, these are being squeezed through financial cuts.
Competitive tendering can bring important benefits of quality and value for money if it is applied effectively. However, procurement should be focused on outcomes, not process. It is also important to establish a culture of collaboration and cooperation so VCSE organisations and public health can work together to make improvements and find solutions. The case studies demonstrate what a collaborative approach can achieve.
The transfer of public health brought a time of expansion to the VCSE sector, with new contracts and new delivery models, often aimed at providing integrated services. Many new models are based on a lead provider responsible for service delivery across multiple providers, often from different sectors. Any new and untried arrangements require careful monitoring and support from public health.
The current climate of reduced resources is causing concern that some VCSE organisations, particularly small ones, may become unsustainable. Grass-roots community organisations are often very important from a public health perspective because of their links with people facing health inequalities. Some public health teams are working with council colleagues, CCGs and the local VCSE sector to improve sustainability, through measures such as market development and improving service evaluation.
As well as an overall shift to integrating public health services, such as sexual health, several of the case studies were implementing ambitious integrated health and wellbeing services. A range of models are being used, often putting different emphasis on the extent to which services focus on behaviour change or on the social determinants of health. Good practice emerging from front-runners, such as the importance of appointing a coordinator, is described in this report. Nationally, information to support integrating health and wellbeing services is at an early stage of development.
Several of the case studies were developing community-centred approaches, using different community development models,
which are described in this report. Nationally, there is a significant body of information about community-centred approaches, and PHE is active in supporting developments in this area.