News and Comment

What role should the voluntary and community sector play in urgent care?

Monday 5 August 2013


‘I know we are supposed to commission services from the voluntary sector but what do they actually do and how do we commission them?’ (The words of a CCG commissioner at a recent OPM simulation around urgent care)

CCGs may miss out on a tremendous opportunity to increase the capacity of the urgent care system if they continue to under utilise the voluntary and community sector.

When I was asked the question above, I wish I had had sufficient time to explain that whilst social care provided by local authorities is contracting due to tighter budgets and increased demand, communities often have the assets that enable them to provide individuals with much of the low level support required to maintain independence following short stays in hospital. And that in any case, successful and sustained recovery is as much about self care as it is about formal care from either the NHS of the local authority.

A less than scientific but nonetheless revealing goggle search shows that some CCGs are already working closely with voluntary organisations to:

  • Provide ‘soft landing’ services to ensure a discharge is successful i.e. up to 7 x 1hour visits once patient returns home to ensure compliance with medication, appropriate nutrition and addressing fears and anxieties about being home.
  • Carry out discharge planning with at risk patients and service providers prior to patients having contact with urgent care
  • Provide palliative care via cancer support charities such as Marie Curie and Macmillan on an in-reach basis i.e. facilitating early discharge back to home for terminally ill patients or those which chronic pain

Additional investment may indeed be needed, but it might be that this investment (or some of it) could go towards community infrastructure rather than direct service provision. Because where communities have assets or infrastructure in place, the services mentioned above can also be provided on a self care and/or mutual aid basis, such as that which is becoming prevalent in substance misuse, with the increased visibility of mutual aid organisations like AA.

In actual fact, what I did have time to say was it’s not difficult to commission the sector as they are well used to challenge funding. CCGs could do worse than putting an innovation pot out there and watching the amazing ideas come forward from voluntary and community groups. The difficult bit is then having the courage to invest in often small but committed groups of people.

So then, a plea to commissioners: put aside some of the new funding for frontline workers for the VCS. You could either strategically commission them to provide care at home (things like befriending or resettlement services); or, pose the sector a challenge (and make a fund available) to provide a service that will reduce urgent care costs. If you wanted you could even further incentivise the VCS by stating if impact can be quantified, the best performing service will be made mainstream.

We will be blogging regularly about the issues concerning urgent care services over the summer, so please keep a lookout for future content.