Commissioning the 3rd Sector for the NHS

imgresAmidst the current ‘efficiency savings’, or cuts by any other name, in the NHS, the voluntary or 3rd sector, including the faith communities are an absolutely vital partner in health and social care. Here in Morecambe Bay, we are seeing incredible work done by this sector. Genuinely, the safety net created across this Bay for people with significant mental health issues, chronic physical health complaints, those at the end of life, the isolated and lonely etc is amazing. However, as the financial squeeze increases on the NHS, the 3rd sector, although phenomenally resilient and full of social entrepreneurs with good heart, is really beginning to struggle to secure funding. If the 3rd sector, (which gives far more for far less) begins to crumble, then we will see health and social care completely collapse.


I wish truth and solutions were all black and white, but there is complex grey for us to wade through, if we are to see a more resilient 3rd sector emerge for the sake of our communities. The relationship between the NHS and 3rd sector is complex but vital. I want to briefly highlight some of the main issues and then look at two possible solutions.


  1. Evidence: in order for commissioners to fund projects/organisations, we need evidence that the money invested a) makes a difference and b) makes a saving. Unfortunately data is often not robust enough to make recurrent funding possible.
  2. Fairness: there is currently great injustice built into the the NHS/3rd sector relationship. For example, I know that some of our more struggling publicly funded services, are now referring huge numbers of people into the voluntary sector, as they can’t cope with the capacity, but the funding does not then follow these people. In essence the NHS is dumping people onto the 3rd sector and the 3rd sector is buckling under the weight of it. But the blame is not on the NHS nor the 3rd sector. I’m afraid under resourcing from central government is a key issue here…..but this isn’t going to change any time soon, unless we have a revolution (!), so we need to be creative.
  3. Numbers: commissioning services is really complex. When there are loads of small charities, often doing quite similar things it can be really hard to know who to fund and how to monitor outcomes and effectiveness (like it or not, we do have to give an account for the money we spend!).

So, where might some solutions lie? I would like to suggest two broad possible solutions. I admit they are not perfect and they certainly won’t be the only solutions.


imgresFirstly, here in Morecambe Bay, we are developing ICCs (Integrated Care Communities). These are built around General Practice (be that one or many practices in a geographical area) but incorporate GPs, District Nurses, Community Matrons, Long Term Condition Teams, Community Therapists, Mental Health Teams, Social Care, the City Council, the Poimgreslice, the Fire Service and the Third Sector all partnering together for more effective working and therefore better care for all. One option would be for each ICC to have a capitated budget which would allow each team to decide which voluntary sector organisations would meet the need of their particular areas most effectively and fund them accordingly and fairly.


imagesA second solutionĀ could be for the 3rd Sector to form one or several larger co-operatives. The huge advantage here is that it would then allow a more straight forward commissioning relationship and would allow the many to be become stronger and more resilient together. In a co-operative model, it would be easier to build research partnerships and accountability between members. It would also give the sector more clout as a partner round the table with the various public sector organisations.


My work has taught me how vital the Voluntary and Faith sector is to the ongoing health and social care of our communities. It needs adequate funding and support, without which it will crumble. We need to help partner together to make it more resilient, but in order for this to happen, the 3rd sector must deal with some of it’s default towards self-protectionism and find creative solutions towards a more sustainable future……

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