VCSEs in the NHS: Breaking down barriers to entry

Advantages of engaging with VCSEs

The voluntary sector has both the capacity and the expertise to deliver quality care which is embedded within communities.

Embracing partnerships between the NHS and VCSE sector provides opportunities to enhance community engagement and deliver specialised, local support that can complement NHS services, improving patient outcomes and, as a result, efficiency.

More specifically: 

• 1. Patient education and engagement: Many voluntary providers may have greater credibility in the eyes of those living with long-term health conditions, as well as the general public. This is in part due to the heightened standards of governance demanded of registered charities and the extra level of regulation to which they are subject, as well as the fact that there is no “profit” motive in the voluntary sector, which can be a source of distrust. In turn, the heightened level of engagement this creates can increase the chances of identifying early signs of deterioration and equip individuals with life skills that help them manage their own health and address wider circumstances which impact on their health.
• 2. Specialisation: VCSEs can often be more innovative and flexible in their methods than more ‘traditional’ providers of care. Charities and voluntary organisations often provide specialised services that the NHS may struggle to deliver due to resource constraints or rigidly defined pathways. These include mental health support, palliative care and community-based rehabilitation. These organisations can fill the gaps between NHS primary and acute care, supporting the shift to community-based care.
• 3. Holistic service offering: The NHS recognises the need to address wider determinants of health. However, resource constraints, the difficulties of showing cause and effect with prevention or early intervention, plus questions about whether it is even within the statutory remit of NHS bodies to seek to address wider determinants of health, make this a space where VCSEs are particularly well-placed to act. Often such organisations providing services to the NHS can draw on a wider range of resources than exchequer funds, and can offer a wider range of preventative and alternative health pathways for individuals in the community, which might not be offered as an affordable option by private sector organisations.
• 4. Equity: Voluntary and charity organisations are often embedded in their communities, meaning they can reach under-served populations and facilitate access to services more effectively than NHS Trusts. They also often have the knowledge of, and engagement with, both patients in the community, and other community groups providing a range of health solutions, to work in partnership with NHS Trusts and enable them to provide more effective care to those patients.

Tips for VCSEs

Understanding relevant elements of the health system, and key legal and operational considerations can help VCSEs fulfil their purposes while at the same time supporting the NHS:

• 1. Procurement: Bidding for a contract in a regulated procurement can be daunting and time-consuming for smaller organisations, with lengthy, complex tender processes and strict requirements. That said, policy is shifting in the direction of a more VCSE/SME-friendly procurement landscape. The Procurement Act 2023 requires contracting authorities to have regard to VSCE/SME participation in designing and running procurements. In addition, PPN 001 – SME and VCSE procurement spend targets, which applies to both the Department of Health and Social Care and NHS England (although not to Integrated Care Boards and NHS trusts and foundation trusts), sets central spending targets. Whilst this is not an immediate solution, it demonstrates a clear willingness from the public sector to open up its supply chain to VCSEs and such organisations should be aware of the overall policy perspective and support on offer when considering entering tender processes.
• 2. Income use: VCSEs (in particular those which are charities) benefit from a unique position in terms of their funding, being able to combine NHS funding for immediate or chronic health needs, local authority funds to help address wider determinants of health and the organisation’s own funding to further its social or charitable purposes. This gives opportunities to develop a more holistic service model which extends beyond any one particular care pathway, positioning such organisations well to deliver outcomes-based services and sustain population health.
• 3. Public trust: A recent Skills for Health poll suggested that 83% of the public would favour suppliers which prioritise social purpose over profit. VCSEs are often embedded within their communities, and are subject to strict regulation from various sources including the Charity Commission, the Charities Acts, SORP, fundraising and campaigning regulations and sector-specific legislation, all of which underpin their operations and drive high standards of conduct. Most of all, their activities are legally confined to a limited set of charitable purposes, which prevents them from misuse or poor management of funds (and any such activity will be subject to immediate intervention). With public trust and confidence in the NHS declining, whilst public trust in charities has been steadily improving over recent years, closer working with voluntary bodies can provide a platform to refresh trust.

Blake Morgan has significant expertise in supporting voluntary providers in the health sector, as well as deep experience in NHS and other healthcare contracting. Find out more about our services and how our team can benefit providers here.

This article has been co-written by Chris Hardy, David Hill and Laura Sherratt.