Sean Hourigan is Development and Training Manager at The Peer Partnership and Brigstowe. We were delighted when Sean accepted our invitation to take part in a panel discussion at our conference last November, exploring how the NHS can partner more effectively with the VCSE sector to address health inequalities.
You can watch the recording on YouTube here.
In this blog, Sean expands on some of his thoughts at the conference on how health and care services can develop more ‘grown up’ partnerships with the VCSE sector by stepping back and listening more.
In recent years, the concept of co-production has gained much-needed traction in the health and Voluntary, Community, and Social Enterprise (VCSE) sectors. This approach emphasises collaboration between service providers and the communities they serve, ensuring that services are designed and delivered in a way that truly meets people’s needs. However, the journey towards effective co-production is loaded with challenges and power dynamics that require a fundamental shift in mindset and practice.
One of the first steps in this journey is rethinking the language we use when talking about communities and inequalities in health and social support.
The term “hard-to-reach communities” is often used to describe groups that are perceived as difficult to engage with. However, this term is inherently victim-blaming, suggesting that these communities are deliberately avoiding engagement. Instead, the VCSE sector has moved towards the term “underserved communities”. This shift in terminology acknowledges that the failure lies with the service providers who have not effectively reached out to these communities, rather than with the communities themselves.
To truly engage underserved communities, it is essential to change the way we think about service delivery. These communities are often ready and willing to work with service providers, but they need to see themselves and their concerns represented in the services being offered. This means moving away from short-term pilot projects that are frequently cancelled or don’t progress onto anything else, and instead focusing on sustainable, long-term initiatives in which communities see themselves as significant stakeholders rather than as passive recipients of care.
When these “here today, gone tomorrow” projects end abruptly, it not only disrupts the lives of those who value or have come to rely on them but also further erodes trust in the system as a whole. Rebooting these services later can often be met with cynicism and resistance, as the community members have moved on and are reluctant to re-engage with “yet another” initiative that they are assured wants to “take their issues seriously”.
The VCSE bridge
The VCSE sector has come to play a crucial role in bridging the gap between health services and underserved communities.
However, there are significant challenges that need to be addressed if we are to learn from this experience and if the NHS and social care are to successfully work in partnership with VCSE colleagues as part of a truly effective integrated care system.
Often when approaching VCSE organisations to deliver work with them, health services have already pre-written programmes and specific solutions in mind. This approach forces the VCSE sector to fit and tender for pre-defined programmes, rather than leveraging its unique strengths and expertise to co-design alternative and potentially more appropriate approaches and solutions to achieve the same outcomes.
The VCSE sector is inherently skilled at working with communities because its work is always reflective of the communities it serves.
Creating round pegs for round holes
Instead of dictating how the VCSE sector should fit in with plans designed by health services, I’d suggest we turn this on its head: health services should communicate their intended goals and allow the VCSE sector and the community to co-design and co-produce the programmes to achieve these. This approach not only ensures that the services are more effective but also fosters a sense of ownership and buy-in from the community.
Our Common Ambition Bristol programme, an approach that was co-produced by and for African and Caribbean heritage communities in Bristol to support HIV and sexual health awareness, has been an award-winning example of how to create services for a community previously considered “hard to reach” on sexual health matters.
It turns out that they are not hard to reach. It’s just that nobody was talking with or listening to them.
The challenges
Integrated care systems are supposed to be a partnership between healthcare, local authorities, and the VCSE sector. However, in practice, this partnership is often unequal. Healthcare and local authorities have been working together for years, while voluntary sector alliances are a relatively new addition. This disparity can lead to feelings of frustration and bitterness within the VCSE sector, as it is often treated as a junior partner rather than an equal.
Despite these challenges, VCSE colleagues remain hopeful and we continue to engage with the integrated care process. However, our counterparts in health and care services need to recognise the pressures we face. Just like health and care, the VCSE sector is experiencing increased demand for its services. Often, people turn to us after exhausting all other options, seeking support at their lowest point.
Therefore the VCSE sector, especially those providing longer-term support to the communities they serve, plays a critical role in re-engaging these individuals with health services.
The importance of co-production
Co-production is not just a buzzword; it is a vital approach to service delivery that can lead to more effective and inclusive care.
In the VCSE sector we are often better positioned to lead co-production efforts because we are already trusted by the community. Trust is a crucial factor, as many community members may have had actual or perceived negative experiences with health and care services in the past.
The VCSE sector can act as a bridge, helping to rebuild trust and facilitate engagement.
At The Peer Partnership, efforts are being made to build capacity for co-production through training and support. Workshops on best practices, group dynamics, facilitation, and responding to challenging behaviour are offered to help both VCSE and health sector staff. Additionally, we have developed action learning sets to support NHS staff who want to engage in co-production but may lack the time, capacity, knowledge or confidence to instigate such programmes.
Final thoughts
Co-production between health and charity services is a powerful approach that can lead to more effective and inclusive care.
By rethinking our language, changing our thought processes, and leveraging the strengths of the VCSE sector, we can create services that truly meet the needs of underserved communities.
While there are challenges to overcome, the potential benefits make it a journey worth undertaking. Through collaboration, trust-building, and capacity-building, we can move towards a future where co-production is the norm, not the exception.
Get in touch
If you’d like to contact Sean, you can email him at info@peerpartnership.org or via LinkedIn.
Watch the recording on YouTube of the panel session featuring Sean Hourigan.
Posted on January 17, 2025 by Sean Hourigan, Development and Training Manager, The Peer Partnership and Brigstowe.
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