Why Involve the Third Sector in Health and Social Care Delivery?

Why Involve the Third Sector in Health and Social Care Delivery?
Scottish Government & the Scottish Third Sector Research Forum
December 2011

Q&A Need-To-Know for Policy Makers

The challenge

• How can we reduce demand for acute services?
• How can we support people to take control of their own health and social care outcomes?
• How can we ensure that people and communities are involved in the design and delivery of services?
• How do we effectively integrate health with social care?

For policy officials making critical decisions about health and social care spend, these are increasingly pertinent questions.  The Healthcare Quality Strategy aims to make Scotland’s health care services world leading.  How can better partnership with the third sector help to achieve this ambitious objective?

The Scottish Government has acknowledged the positive role of the third sector in delivering better and more equal public services. Now as Ministers attempt to address the perennial challenges facing Scottish society, with even less money available, preventative approaches have been prioritised, and there is an urgent need to identify how the third sector can be engaged more effectively 1.

This briefing paper is a collaborative piece of work by the Scottish Third Sector Research Forum 2.  Drawing on available evidence we’ve demonstrated where and how the third sector is contributing to health and social care services delivery in Scotland.  Tapping into the most robust evaluations we could find we’ve provided examples of the third sector’s contribution towards the healthcare Quality Outcomes ambitions for Scotland 3.  We’ve also looked to this selected evidence for key messages concerning the hurdles to overcome in reaching a better engagement.

The Evidence Base

Our rapid review indicates that evaluative evidence demonstrating the impact of the third sector (especially economic impact) is limited and much of the available documentation consists of case studies. Our ability to build a more in-depth narrative around efficacy is limited by this evidence base and as such, we are not able to provide all of the answers. For example, whilst the nature of the available evidence dictates the focus of this paper on more positive examples, we are also interested in learning lessons from approaches that don’t work so well. This paper represents a starting point, drawing upon those projects that have undergone robust review to make some general conclusions about third sector activity in this area. Routing out more examples from organisations and facilitating more evaluation to support the development of this evidence base is a key objective for the Third Sector Research Forum moving forward.

Key messages and recommendations as identified by our review:

There are often distinct features of third sector service delivery which complement and enhance public sector services. These differences are not just tendencies towards particular characteristics (such as a holistic view of service users wellbeing) but are also shaped by localised features – the involvement of volunteers or the passionate drive to deliver outcomes appropriate to the community within which the organisation is embedded.  Approaches to engagement need to be mindful of differences and both the challenges and opportunities these lend to collaborations. We need to build an evidence base which assists further understanding of the mechanisms which have allowed third sector organisations, acting alone and in partnership, to facilitate improvements in the health of individuals and communities. Continued work is also needed towards developing forums for communicating and developing ideas around services and their delivery which are user-friendly for all stakeholders, built on platforms of mutual understanding of the increasing pressures on resources and its effects on all sectors.

What is being done by the third sector?

* There are a vast number of third sector organisations (TSOs) working in prevention, particularly in the area of food and healthy eating initiatives, active living projects and support for early years and older people. 

* The third sector is collaborating with service users 4 to provide self-directed support, personalised service packages and training in self-management techniques.

* Working closely with communities 4 is a key tenet of the third sector approach. In many cases organisational structure and aims have been generated by members of a particular community in order to fill gaps they have identified in service provision. 

 * Third sector projects are frequently produced with the aim of developing social networks, building social capital and reducing isolation amongst vulnerable people. These positively target health through improvements in general wellbeing and the better dissemination of healthcare messages.

Why does it work?

The available evidence suggests

* Close ties with geographical and service user communities has enabled TSOs to gain an expert knowledge of local needs and preferences, allowing them the potential to develop more effective and relevant initiatives.

* Volunteers drawn from within third sector organisations target communities, contribute to this expertise and provide a flexible and economically efficient organisational structure.

* There is now consensus that health and social care services within Scottish communities need urgent attention 5.  Knowledge of and ability to react to calls for change can be hampered by complicated communication pathways. As organisations frequently embedded within geographical and service user communities, TSOs are often free of this additional information filter. As this paper will attempt to demonstrate TSOs have already moved to meet these demands and are making positive contributions to improving services.

Guide to reading this paper

We’ve selected case studies from our wider review and linked these to a general analysis of third sector activities as they relate to each question.  A table with more of the case evaluations is provided on page 7 and these are referenced in the text by letter (A, B, C etc).  References to general literature throughout the paper are numbered (1, 2, 3 etc) with full detail provided in the Bibliography.

See full docuement here