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How do you design a structure for partnering across the NHS, local authorities and community groups?

blog | 12 May 2022

Alex Baylis of The King’s Fund, Savannah Fishel of Innovation Unit and Sonakshi Anand of Institute for Voluntary Action Research have some insights from cross-sector place-based partnerships tackling health inequalities.

Innovation Unit, The King’s Fund and the Institute for Voluntary Action Research are all supporting place-based partnerships across the voluntary and statutory sectors. These programmes – called Health Equality, Healthy Communities Together and Connecting Health Communities – are putting the often-espoused theory of working as equal partners to improve health, well-being, and health inequality into practice.

The programmes all involve grant funding from The National Lottery Community Fund – recognising that ‘unlearning’ years of embedded cultures and practices and inviting communities to participate in new ways of working will require some additional resource, at least initially. There is no single secret to genuine collaboration, but the learning from these programmes is relevant for health colleagues up and down the country as new Integrated Care Systems (ICSs) are embedded in legislation and look to develop partnerships.

In March our organisations came together to host an online webinar and networking session on why and how ICSs should partner with the voluntary sector, drawing out learning from across 30 place-based partnerships and signposting to the practical resources we’ve already published (from Innovation Unit, IVAR and The King’s Fund). Speakers from three localities shared successes and lessons learned through their work. Lead organisations across all these partnerships are playing a brokerage role between stakeholders and have shared approaches for doing this effectively. Two key interrelated themes emerged: the importance of building strong relationships with aligned goals – and the role of robust partnership structures to enable these.

We have seen a variety of structures emerging in the partnerships we have been supporting, such as ICS committees, statutory / voluntary sector subject-specific working groups and place-based VCSE (voluntary, community and social enterprise) assemblies. Although cross-sector partnerships are complex, speakers at the event warned against letting the complexity of working out exactly how to partner put you off, as there is an appetite for increased voluntary sector engagement across the statutory system, and an effective structure can optimise this process. As Neil Goulbourne (One Croydon, Healthy Communities Together grantee) said at the webinar, “structures are important to invest time into and need to be actively evolved over time. However, their success is reliant on relationships and ways of working.”

Croydon’s structural approach involved setting up a Local Voluntary Partnerships Board with three main workstreams: shifting power and authority to local people and localities; building a stronger voice for local voluntary organisations; shifting financial resources to the voluntary sector over time and commissioning for outcomes. Milton Keynes’ approach (Connecting Health Communities programme) was to create a VCSE Alliance, described as a “network of networks”, to enable VCSE involvement in strategic decision-making, avoid duplication, and connect back to communities. Both approaches have been effective at remaining close to communities – so that their voices are really heard – whilst driving decision-making at a strategic level, where action can be taken on structural determinants of health inequalities.

At the webinar, Lisa Cowley (Beacon Vision, Health Equality grantee) also spoke about individual relationships as well as structure. She emphasised the importance of investing time into “strengthening connections and trying to understand each other’s challenges”, describing the Dudley and Wolverhampton partnership as “a real meeting of minds with all parties working to understand how we can achieve more for our communities together”. She compares the brokerage role her organisation plays to “a dating agency, working with various groups at the same time and connecting teams to the NHS”. Alongside this relational focus, their partnership has a “solid structure in place with a VCSE Alliance and additional investment to support the culture shift needed across all organisations.” Central to their approach has been expanding their structure across Dudley into Wolverhampton to reflect their ICS’ reach.

Although structure is a key enabler of partnership working, it is not the be all and end all. A key learning from the work in Milton Keynes is the need for a shared purpose amongst stakeholders. Sonal Mehta (Bedfordshire, Luton & Milton Keynes ICS, Connecting Health Communities programme) said that “partnership working takes time, energy and investment. If you start with structures and processes and miss out the “why” then it becomes a challenge to keep going when, inevitably, conflicting demands arise for those who are partnering.” Attempting to align values across organisations in different sectors (and representing diversity within those sectors) is certainly a challenge, especially with limited capacity, but Sonal identified that Milton Keynes’ explicit shared purpose in the area of health inequalities kept them moving in the right direction.

If you’re in one of the many areas thinking through how to organise yourselves for partnering as the new ICSs are embedded, the event is available to view on demand. It includes rich discussion about both the challenges of developing partnerships and potential solutions, with one crucial insight emerging: you are not alone – there is a mandate for increased partnership working, especially as COVID-19 has increased the visibility of the voluntary sector’s unique role. As further restructuring of the sector has deemed cross-sector partnering even more crucial, important steps to take include networking with other places, taking a long-term relational approach to influencing, and putting structures in place to support this work.

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