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Community-made content which you can improve Case study from our community

We delivered savings to the local health economy and increased voluntary sector contracting through a joint venture

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Sally Chandler of Hillingdon Carers explains how some local organisations formed a joint venture. This successfully increased local government contracting with the local voluntary sector, as well as other benefits to the healthcare system and to residents.

Background

NCVO member H4All is a joint venture of five charities in Hillingdon, West London: Harlington Hospice, Hillingdon Carers, Age UK Hillingdon, Harrow and Brent, Hillingdon Mind and Disablement Association Hillingdon (DASH).

Our mission is to work together and with others to combine the voluntary sector’s specialist skills and knowledge to improve the health and well-being of Hillingdon residents. We have a shared vision of creating environments where residents have access to responsive, fully integrated quality support and advice that helps them to stay independent and to take control of their lives. 

We do this through:

  • developing services that tackle the wider determinants of health and keep residents socially connected and independent for as long as possible
  • innovating and reflecting - we ensure continuous improvement and maintain flexibility in our responses to population health challenges
  • working collaboratively among ourselves and with statutory partners to reduce demand on public services
  • developing models of care that are scalable to other patient groups.

The issues we faced

Our biggest challenges were:

  1. getting a ‘foot in the door’ and establishing our collective credibility with health commissioners, clinicians and strategic service leads
  2. securing our standing with our CCG and Hillingdon Health and Care Partners (HHCP)
  3. promoting the pilot wellbeing service to GPs as a credible alternative to clinical referral for isolated, lonely or frail over-65s living with one or more long-term health conditions
  4. scaling up our activity, extending the service to different cohorts of the population and embedding social prescribing and voluntary sector delivery across multiple clinical pathways

The actions we took

  1. We quickly learnt ‘the language’ of health. At every meeting, from working groups to the HHCP board, we had to be able to demonstrate our ability to function as equals using the language of health professionals.
  2. We had to absorb and process new information quickly and know more than our statutory-sector peers, in order to maintain credibility with everyone from senior finance directors through chief operational staff to clinical directors, as well as having to operate across multiple disciplines.
  3. We used our creativity and agility to present HHCP with solutions to challenges, thereby consolidating our position as a critical partner in the re-design of health services.
  4. We positioned H4All as a leading voice in Hillingdon’s voluntary sector: this facilitated a more coordinated and integrated approach to population health.  We are starting to harness the sector’s combined knowledge about community health needing to inform local commissioning.
  5. To ‘win the hearts and minds’ of GPs, we started with an ‘alliance of the willing’ approach, working closely with those practices that embraced prevention and the need to tackle the wider social, economic and environmental determinants of health.
  6. We evidenced our impact using a recognised tool.  

Positive outcomes

  1. The voluntary sector’s role in community health is now embedded in the ‘collective consciousness’ in Hillingdon. We enjoy significant support from the council, CCG and other HHCP partners. By persisting over three years, we achieved equal voting rights in HHCP.
  2. By adopting a tool recognised by GPs we ensured that we were receiving referrals from all 46 Hillingdon GP practices within six months.
  3. At the end of the pilot, the CCG reviewed our data and cross-referenced it with GP-held data six months pre and post  interventions. This gave us robust evidence of the impact we had on reduced and more appropriate use of GP time, unplanned admissions and A&E attendances.
  4. Our commitment to partnership working and the removal of local competition for funding has enabled us to focus creatively on delivery without the distraction of survival.
  5. Due to our growing reputation for innovation in social prescribing, we have been awarded contracts to co-deliver the link worker function in three London boroughs and to provide the learning coordinator role across London (in partnership with the Bromley-by-Bow Centre).
  6. We secured contracts to work with other population cohorts, and over the past three years have seen the transfer of close to £1 million from the public sector to voluntary sector service delivery.

Negative outcomes

  • The considerable time and energy that we have put into HHCP has barely been compensated financially. H4All is expected to engage in frequent extra-contractual activities, but these are not funded. We have walked a fine line between wanting to be seen as innovative and ‘can-do’ in order to raise our profile and meeting the full costs of our input.
  • All income is directly related to service delivery so finding the resource to appoint central management or business development staff is challenging.
  • The organisation has grown very quickly and is experiencing ‘growing pains’: the back-office infrastructure has not developed at the same rate as the services we provide.

Lessons learnt

  • Voluntary organisations significantly benefit by removing local competition for funding and resources.
  • By creating a constituted consortium, the five founding charities were able to focus on what matters, rather than on survival.
  • The sector has to work twice as hard to gain credibility as equal partners in health service design and delivery with the statutory sector.  However, we recommend perseverance – it’s worth it!

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Page last edited Sep 05, 2019

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