Blog: VCFSE Commissioning in Crisis: Advocating For Our Struggling Sector

We had another lively GM VCFSE Commissioning and Investment Meeting last week, so there’s lots to share with you. Our co-chairs and members were on form, so there was plenty of information sharing and – of course – lively debate.

We spent most of our meeting focussed on how we influence our partners to improve their commissioning practices. A hot topic was the current Leadership Group’s campaign about sector stability – where it had gained traction locally, and what the impact has been so far.

Without doubt, the message has spread far and wide, and has resulted in more conversations locally about the challenges both VCFSE and commissioning partners are experiencing. However, in many cases, it hasn’t led to many practical actions – e.g., a number of localities have confirmed that they are not going to offer uplifts for 25/6.  

The group shared a number of examples of problematic commissioning practices that are happening right now, including:

• Higher uplift rates are being offered to statutory health providers than VCFSE sector providers, despite cost increases being the same, if not higher, in the VCFSE sector.

• Additional uplift amounts are available but publicised to the VCFSE sector contract holders.

• There is no mechanism for commissioners to pay for additional work, so organisations are, in effect, working for free from a certain point in the year – continuing to deliver way past the volumes agreed in the contract so as not to leave people unsupported.

• Disparity in who gets a conversation with commissioners regarding uplifts and contract extensions.

• Significant ongoing delays with health contracts as any commission over £10K goes through the Star process.

• Immediate termination of funding for a project demonstrably reducing health inequalities in the most vulnerable groups, due to inefficiencies in the statutory sector impacting on diagnoses data.

Yet again, the group highlighted the impact of the decommissioning decisions, lack of uplifts, and ongoing uncertainty:

• Several hundred staff are in consultation for job losses across the APC organisations alone

• Staff retention is an ongoing issue

• Organisations are having recruitment freezes on much-needed vacant posts

• Organisations run the risk of Auditors qualifying accounts because they aren’t able to provide written confirmation of contracts

• Organisations needing to becoming trading operations – being more than the social value organisations they intended to be

• Organisations are having difficulty accessing external funding opportunities because they aren’t able to demonstrate secure future income.

So, whilst we welcomed the warm words, the examples shared of actual commissioning practice demonstrate that rhetoric and action are still quite far apart.

The group were very clear that these practices were system-created issues and were NOT being driven by their immediate commissioning contacts – the term “supportive but hamstrung” gained lots of nods around the room.

However, they also identified a very specific knowledge gap for commissioners, around their understanding of exactly how VCFSE finance and compliance works,  with the gap meaning that they don’t see the impact or unintended consequences of delays and decisions being made.

The group suggested some actions that VCFSE organisations might want to consider:  

• Contacting all of your commissioners about the impact of the NI, Agenda for Change, and NJC increases, asking for either an uplift to reflect those and general inflation, or a conversation about realistic expectations of the contract for next year.

• Asking if there are specific workforce–related uplifts that can be applied or passed on.

• Seek advice from your local infrastructure organisation if you’re not sure what you can or should ask for.

It wasn’t all doom and gloom:  

• One provider has had confirmation from GMCA that most of their contracts will be subject to an uplift for 25/6.

• One of our local infrastructure organisations described being successful in supporting local organisations to know what uplift is available and what to ask for.

• Some organisations are starting to receive letters of comfort for next year (although these are passing the risk back to the sector).

Alongside our usual VCFSE members, we were joined by a couple of our key allies within NHS GM – Warren Heppolette and Sara Roscoe – who shared their organisation’s response to the campaign. We talked about how we needed:

• For NHS GM to reflect on the unintended consequences of the Star Process

• To re-escalate the issue of sector stability to the ICB Board, and to chase NHS GM for a meeting with their non-executive directors.

• NHS GM to create new rules and processes that prevent poor practice.

• To create more VCFSE advocates in the system to support us in the meetings that we can’t be in, and to get VCFSE people (infrastructure and providers) in the right locality groups (those that are making decisions). We’ve started mapping this, so the next step is to describe what good looks like, and try to get that adopted in every locality.

• More information on what’s happening in the sector (both VCFSE intelligence and NHS GM contract register) and agreed routes to escalate this formally. We did recognise that we needed to find resources to collect this, though.

• Greater transparency about where growth money is going into the system, and greater opportunities for the sector to access this.

• Greater checks and balances on decommissioning decisions (the scrutiny seems to be overly weighted toward spend).

• The need for an NHS GM market development strategy for the VCFSE sector.

We talked about examples of services being decommissioned in one year, resulting in loss of skills, resources, relationships, workforce, and intelligence, only to be recommissioned a year or two later. We recognised the significant system cost and reputational implications of this, alongside the disruption for potential users of the service.

We were running out of time by this point (as usual), so we quickly mentioned the Procurement Act that came into force in February this year. I told the group that our GMCA colleagues have reassured us that they don’t foresee this bringing in lots of additional red tape. Sam Pickles and his team (GMCA) are planning an event for the sector in the near future, so get in touch with me if you’d like to work with them on this. In the mean time, please remember to look at the information that we have already shared about the Act, and make sure you have signed up to the new portal, if this is appropriate.

Then Edna Robinson gave us the quickest of updates on what the Alternative Provider Collaborative has been up to recently. Because they only had FOUR minutes for this (!!), I’ve persuaded Franky to do a quick blog about this, which will be out very soon. Keep your eyes peeled for that, as they’ve been busy as ever. Some of the work includes their involvement in Urgent and Emergency Care design; developing a Neurodiversity Collaborative; exploring strategic alliances with other not-for-profit providers (education and social care); and influencing the design of a new Manchester City Centre primary care treatment centre.

So, you might ask, what were the big things we agreed to get on with? I think that these are our main actions, so do get in touch with me if you would like to get involved in any of them:

Immediate tasks:

• NHS GM will respond formally to the sector stability concerns.

• Leigh Vallance and Warren Heppolette will co-present an item at the next GM Integrated Care Board, to further escalate the sector stability issues.

• Put a call out to contract, operations, and finance managers across the sector to join an intelligence sharing group.

Medium to longer-term tasks:

• Improve how we gather and escalate VCFSE contracting issues – an early warning system, feeding into commissioning decision-makers.

• Create a contract register of VCFSE-held NHS GM and locality contracts so that we can better track decisions and issues.

• Improve escalation to NHS GM:make a formal link between the VCFSE Commissioning and Investment Group and the NHS GM Commissioning Oversight and Steering Groups, and see if we can more frequent dates to meet informally

• Create clear rules and processes for NHS GM commissioners to adopt, so that current poor practice is weeded out.

• Make sure we have VCFSE people in crucial local commissioning decision-making groups and boards.

• Develop an NHS GM market development strategy for the VCFSE Sector.

• Have twice-yearly VCFSE-specific substantive items at the Integrated Care Board, which Leigh Vallance and Warren Heppolette will jointly present.

We ran out of time at that point, so we didn’t even get to cover some of the great work happening in local areas.

• ‍Manchester is about to launch its new social value policy that it co-designed with local VCFSE and business partners. Watch out for the official launch in April

• Bolton is developing a VCFSE commissioning risk assessment, to better understand the impact of commissioning decisions.
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• There is a new pilot in Stockport, Tameside, Trafford, and Rochdale, helping small and medium, local businesses to access local council contracts, using Nomia, a digital platform. The aim is to simplify the process for SMEs, and hopefully increase the proportion of council budget spent locally, creating local growth and jobs.

• Bury is developing a VCSE/Public Sector MoU, aligned to principles of Accord, which is supporting their commitment to partnership working, with plans underway for a single strategic investment programme for the VCSE sector.

If you’ve made it this far, well done! A ridiculously long blog, as ever, but I hope it’s been a useful read. Do get in touch with me if you want to get involved in any of this work, or share your recent commissioning experiences. Susie.wright@10gm.org.uk