Greater Manchester Centre for Voluntary Organisation

A stronger local voice: A framework for creating a stronger local voice in the development of health and social care services

Joint response from the Greater Manchester Centre for Voluntary Organisation and Manchester Alliance for Community Care to the Department of Health consultation: “A stronger local voice: A framework for creating a stronger local voice in the development of health and social care services”

The Greater Manchester Centre for Voluntary Organisation (GMCVO) is the voluntary sector infrastructure body for the sub-region of Greater Manchester. Our aim is to strengthen the voluntary and community sector, build bridges with other sectors, and influence local and national policy. Our work is representing, promoting and developing voluntary and community organisations, working in partnership with local, regional and national infrastructure. GMCVO is also the sub-regional lead body for ChangeUp.

Manchester Alliance for Community Care (MACC) is a voluntary and community sector development agency which works to reduce inequalities in health and social care and wellbeing across Manchester. We support themed networks of voluntary and community sector groups. MACC’s staff team provides a policy and development unit for local groups, particularly small and medium sized groups whose capacity is limited.

Our response is as follows:

What arrangements can we put in place to make sure there is a smooth transition to the new system?

GMCVO welcomes the DH’s suggestion that the period leading up to LINks being established will be ‘a good opportunity for forum members to forge and strengthen links with relevant community groups and voluntary organisations’.

To ensure proper voluntary sector engagement with the LINks we would suggest that local authorities plan their establishment in partnership with the local voluntary sector infrastructure (as opposed to one or two large voluntary organisations). Local authorities should liaise with infrastructure organisations that have the relevant expertise of health and social care issues, to identify potential members and the appropriate host body for the LINk.

In this way the local authority can ensure that the LINk’s membership is diverse and reflects the local community, and that the host body is accountable, fit for purpose, and informed by the views of local people. Through working with user-led groups and voluntary organisations that work with socially excluded groups, local authorities can also ensure that the LINk will give a voice to those considered ‘hard to reach’.

How can we build on existing activity in the voluntary and community sector?

Local VCS agencies are well placed to understand the needs of the communities they work with and some, through their participation in community engagement initiatives, have begun to develop more robust methodologies for gathering data about need. This includes, for example, recruiting and supporting people from different communities to carry out research into what people need and what approaches best meet identified needs. The LINKs would provide an opportunity to ensure that this work is developed and sustained beyond the life of the pilot projects.

Many organisations that are locally commissioned to provide services may be seen to have a vested interest if they are also seeking to influence commissioning decisions. However this can be mitigated to some extent where they are members of a collective forum that has influence as one of its aims and where they are using robust methodologies for gathering intelligence about needs and about what works.

A steering group would bring together the existing PPI fora and those organisations and fora with an independent campaigning role.

One key constraint for small provider organisations is that they lack the capacity to engage in more strategic work. It will be important therefore to ensure that those that do engage are rewarded in some way. This could take the form of supporting them in developing skills and knowledge around needs assessment and evaluation.

The ChangeUp funding regime from central government has made some inroads in building up the local infrastructure capacity of the voluntary and community sector. This is evidenced by the creation of local infrastructure consortia (a partnership of infrastructure organisations) – it would therefore make sense, in the name of “joined up government”, for local authorities to work with the local consortia to identify organisations with a representative function.

Furthermore, most infrastructure organisations currently run consultations with local voluntary groups and people and are well placed to understand the needs and views of the local community, including socially excluded groups that struggle to access mainstream health and social care services.

To build on existing activity in the voluntary and community sector GMCVO suggests that local authorities begin discussions early on with local infrastructure organisations to arrange the composition and work of the LINks. This will avoid the problem of inappropriate organisations acting as self-proclaimed representatives of local people. Significantly, many infrastructure organisations have an obligation to represent the local voluntary sector in its entirety.

What do you think should be included in a basic model contract to assist local authorities tendering for a host organisation to run a LINk?

At the very least it should be incumbent on the organisation making the bid to host the LINk to demonstrate how it represents the interests of the local community in all its diversity, rather than one particular client group or organisation. This could be done by a requirement to demonstrate a track record of working with in partnership with service user, carer and other VCS organisations – including a requirement to show how the organisation monitors and improves diversity within its current work.

Given that the host organisation is likely to be a voluntary organisation, the model contract should demonstrate that the host organisation is chosen after consultation with local people and community groups, as well as the local voluntary sector infrastructure.

Further the host organisation would need to remain accountable to a steering group, which reflects the full, ranges of diverse perspectives.

How can we best attract members and make people aware of the opportunities to be members of LINks?

GMCVO would support a recruitment process that enabled people from the most socially excluded backgrounds more of a voice in the health and social care services they use. This is because often it is people from such groups that are dependent on services and yet have the least say in how they are planned.

It would make sense to advertise the opportunities to be a member of the LINk in places where services are delivered, both in the statutory and third sector.

To this end it would be helpful if the local authority worked with voluntary groups to raise awareness of the LINk and its function in a simple, direct way. Again, publicizing and raising awareness of the new initiative could be assisted by infrastructure organisations.

However, such opportunities will only be appealing and meaningful if backed up by a commitment to provide training, personal development and ongoing support in fulfilling their role.

What governance arrangements do you think a LINk should have to make sure it is managed effectively?

The governance arrangements must be transparent - so that the host organisation is accountable to the LINk members. The host body must be, and be seen to be, independent from the statutory sector, representative of the local community and open to scrutiny from the LINk itself regarding its allocation of resources and training and recruitment of members.

What is the best way for commissioners to respond to the community on what they have done differently as a result of the views they have heard? For example, should it be part of the proposed PCT prospectus? (As referred to in Health reform in England: commissioning framework (DH, 2006c))

It is vital that the LINk achieves real change in the commissioning of services, and that the changes are fed back to patients, service users and the LINk itself. Again this could be communicated to users of health and social care services at the point of service delivery, with the opportunity for feedback and evaluation.

One of the OSCs’ roles could be to ensure that commissioners are doing enough to respond to the community and explain the changes made. This will avoid the problem of local people losing interest and suffering ‘consultation fatigue’ – participating in endless consultations without ever seeing the results.

An opportunity the LINk model offers is to move away from a culture of consultation to one of ongoing dialogue at a variety of levels. Frequently consultations are standalone exercises around a specific process and designed to elicit a response to complex procedural proposals. They are rarely issue based, despite the fact that it is issues which interest and engage people. In human terms, it’s akin to constantly being asked a series of questions which don’t always seem to relate to each other and to which you are expected simply to react with no further discussion. Consultations tend to ask “What do you think of this?” rather than “What do you think?” failing to harness the potential for communities to utilize their unique insight into local issues to develop their own solutions.

LINKs have the potential to engage people in a process in which ideas and learning continue to evolve and which enable people to make a genuine contribution to the planning, development, delivery and evaluation of local health services – but this will only be effective if the formal requirement is placed on commissioners to recognize this. An indicator of the success of this in years to come should be an increase in participatory budgeting – with LINKs acting as the engagement mechanism.

Response submitted by John Butler, MACC:

Tel: 0161 834 9823

Neil Walbran at GMCVO:

Tel: 0161 277 1036

7th September 2006