Wednesday, 22 May 2013

Charity and health provision

Well, we know when dealing with Government that rhetoric can outrun reality. Whether it's Blair or Cameron they are eloquent on the need for an expansion of the third sector in health . And, let's face it, given the challenges of long term conditions and the preponderance of the elderly in hospital beds we know a major expansion of charity and social enterprise provision is the bedrock of reform.

So it was interesting to read recent evidence from the Foundation Trust Network on the strains on casualty show a looming crisis in secondary care provision unless we act to move resources into primary and community care.

 The Nuffield Foundation has produced a report this week on the independent's sector involvement in secondary care. See here for link to the study.

It has the following startling conclusion:

"despite policy interest in social enterprises and the voluntary sector, spending on secondary care services provided by the voluntary sector between 2006/07 and 2011/12 has hardly changed. PCTs spent £410 million with the voluntary sector in 2006/07 (in 2011/12 prices) rising to £600 million in 2011/12 less that 1% of their total secondary care budget. Over this period PCTs spent less of their secondary care budget on services provided by local authorities and others."

Now, a word of caution about this. Clearly the strength of charities does not lie in the provision of hip and knee replacements!  And often the data confuses charity from private, lumping all together as “independent provision". Of course in social care, in mental health and other community provision the third sector share is much higher. In mental health over a third of all provision is third sector and many disability services are provided through charities.

However, I would argue that our charity and social enterprise sector has much to offer secondary care; particularly in growing partnerships between charities and hospitals, around better use of hospital facilities for the elderly or those reaching their end of their lives. ACEVO is working on a study of just such links with the FTN. The new CCGs could be encouraging hospitals to look at radical reconfigurations like hotel-style intermediate wards for the elderly, hospice wards run by charities, social enterprises established to run parts of the hospitals at the weekend so expensive kit is fully utilised, or community-style hospitals carved out of the current hospital estates. Indeed, why not contracts between charities like RNID or RNIB to take over the running of eye and hearing departments?

The crisis in funding requires more lateral thinking. It was less than a century ago charities ran hospitals; some of the finest in the world. Closer partnership working between charities and hospitals has the potential to produce more efficient use of resources and better health outcomes for service users. Charities and social enterprises have an outstanding track record of developing innovative services that can address the underlying causes of ill-health and alleviate pressure on acute services, and the NHS must make the most of this capacity.

But perhaps the most important lesson from the Nuffield study is that the Any Qualified provider system is not guaranteed to lead to an expansion of third sector provision. The reform provisions of the recent HSC Act will have failed if we fail to see a big expansion of third sector provision. Let's be warned.

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