The story so far
Why and who? Background
Between us, we have over a hundred year’s experience of working in health and care and lots of evidence we make a difference for the people we work with. But we all talk about what we do in different ways, which can make us difficult to work with as a sector. So we brought our evidence together in a report called ‘Untapped Potential’. This showed collaboration to be crucial to making the most of the voluntary sector, but also found we all - public services and voluntary sector alike - need to get better at doing it. So we decided to invest time and money into figuring out how to make this happen.
Where? Collaborating in Somerset
Over the summer of 2016, we settled on working in Somerset. Doing the Right Thing is essentially a local ‘collaboration of collaborations’, with representatives of the Richmond Group of Charities, wider voluntary sector and public services looking at where we can add the most value by working together.
The Richmond Group invested in local and national programme management to scope the collaboration, develop an action plan and bring everyone together, including a National Steering Group. We had no pre-conceived recommendations about what DTRT would focus on, but we all want people to be able to live as well as they possibly can. Prevention quickly emerged as a shared ambition.
Toward the end of 2016, we publically signalled our shared commitment to collaborate in the Health Services Journal.
About Somerset
One in four people living in Somerset will be aged 65 and over by 2021, something that won’t happen nationally until 2050. Around 44% of people live with a long-term condition, compared with 28% nationally. There is increasing demand for GP services but a reducing number of GPs, with almost a third intending to retire over the next three years. Somerset will have a health funding gap of £600million by 2020/21 if no action is taken. On the plus side, there are 2,800 registered charities in the county, and many more community groups.
What? Deciding the focus of our collaboration
After a few months of scoping, we reviewed our learning and considered the opportunities for collaboration. Demand for Somerset’s GP services is rising, but the number of GPs is falling. We also know some people go to their GP with problems for which there are no medical solutions, and GPs want to provide support, but don’t always know how to do so.
‘Social prescribing’ approaches (as they are referred to within the NHS and local authorities) aim to build communities and link people with family and friends as well as practical and emotional support from the voluntary and community sector, often via primary care. They are working well, but are only available in a few parts of Somerset. It felt sensible to work as a collaboration to equitably scale social prescribing across the county. With a specific idea emerging, we held a workshop with Somerset residents. They were overwhelming positive about social prescribing approaches.
While the collaboration agreed to prioritise community-based prevention, but we also recognised other pressures within Somerset, especially supporting people in and out of hospital.
How? Developing our plan
We continued developing these themes and proposed three workstreams:
- Local community building: Continuing to build and maintain relationships within and across sectors in Somerset. We used ‘community’ to mean a group of people with a shared interest in people’s health and wellbeing and a commitment to improve it. In practical terms, this was about the local programme manager participating in meetings and events with staff from public bodies and the voluntary sector - bringing people with common interests together.
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Linking local with national: Acting as a link between partners. An offer from the national Richmond Group teams and National Steering Group to bring their expertise and experience into Somerset, once local leaders confirmed their priorities. In practical terms, this was about coordinating the National Steering Group meetings, facilitating workshops and meetings in Somerset with national experts when these could usefully move work on, and representing Somerset and this work to national bodies, including through conferences and events.
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Delivering a collaborative project: Testing the feasibility of an outcomes-based contract – potentially financed through a Social Impact Bond – to scale 'social prescribing' across the county. Overseeing the tender process for suppliers of the expertise that we did not have the capacity for within our collaboration. In practical terms, there were a number of elements to this:
- Greater involvement of local people, professionals and organisations as we moved from scoping to design.
- Analysis of the target population for an outcomes-based contract to understand how many people may benefit from this type of service and how best to identify them.
- Further development of outcome measures that work at both an individual level to understand a person’s story and how best to support them, as well as at a group level to understand what the service is achieving and how to continuously improve it.
- Building on our work to understand the common components of ‘good’ approaches to developing, establishing and running these services. [This did not include software or associated equipment, as we had not identified the problem technology might solve and were not in a position to write a specification for it].
- Developing a business case for an outcomes-based contract that included financial modelling, based on the analysis of the target population, as well as an assessment of viability for investors.
In May 2017, Somerset’s Voluntary, Community and Social Enterprise Strategic Forum and Sustainability and Transformation Plan leadership team formally committed to deepen the collaboration to deliver these workstreams.
In August 2017 we submitted a joint Expression of Interest to the government’s Life Chances Fund, seeking funding to help us take this work forward. We learned our application was successful in October and received £30,000 of development funding in December 2017. The South West Academic Health Science Network generously matched this grant award.
Charles has extensive experience of the NHS in a variety of senior positions in both primary and secondary care, as well as PCTs and Health Authorities. He was Chairman of NAPC from January 2012 to January 2015 and was also Chairman of NHS Clinical Commissioners.
In July 2012, he was appointed Adjunct Research Professor at the Ivey School of Business, University of Western Ontario, Canada for the MBA in Health Innovation and in July 2013 was also appointed Adjunct Research Professor in Clinical Neurosciences at the Schulich school of Medicine and Dentistry at the University of Western Ontario, Canada.
As an Executive member of the NAPC, which represents the out of hospital sector in the NHS Confederation, Charles is very active in the development of policy in healthcare and internationally, and has been active in advising Governments and international organisations. He also has experience of military medicine until recently acting as Director of Medicine and Clinical Governance for the British Armed Forces in Germany.