It's great that charities are winning contracts for NHS work, says Cecilie Hestbaek of NPC, but are we getting the best out of them?
The NHS is now the top issue of public concern as we head towards the general election. The government offered one response to this when it announced last week that it will fund big-name charities to act as a sort of buttress, stepping in with their volunteers to take pressure off the health service.
But for anyone considering longer-term solutions, this feels like a mere sticking plaster.
A&E departments are certainly feeling the burden, with last month revealing some of the worst performance statistics on record. Health think tank the King's Fund folds this into wider concerns about the 'disastrous' nature of the NHS reorganisation.
And as the challenge of managing a growing, older population begins to be felt across the NHS, there are urgent questions about how to meet evolving needs. By 2013 17.4 per cent of the population was over 65, a number that rose by almost a fifth in only the last decade; 70 per cent of the current health and social care budget is spent on people with long-term health conditions.
We at NPC published research last year on how health charities might bring their expertise to support the NHS. Our latest analysis, based on data provided by the BMJ and looking at whether or not this is happening in practice, shows a rather mixed picture.
In the latest round of NHS contracts, awarded between April 2013 and August 2014, there were some big winners from the charity sector. Marie Stopes, St Mungos and Mind each took home contracts worth more than ’3 million (in the case of Mind, money spread across regional offices and its central operation). The Alzheimer's Society, Marie Curie and BPas each won contracts worth more than ’1 million. UK hospices, which provide care to people with complex needs outside of hospital, collectively won contracts worth over ’15 million.
But smaller charities — precisely the voluntary organisations who may lay claim to the greatest local knowledge and expertise — didn't fare so well. By most accounts, they struggle to compete.
Some charities we work with say they struggle to match the resources that private companies and bigger charities can put into bidding for contracts. Some argue that the bigger the balance sheet, whether for a private company or colleagues in the voluntary sector, the easier it is for bidders to subsidise their work and make a lower cost bid. Some worry that companies can sidestep tougher goals, whereas charities are mission-bound to help the people who need it, even if the outcomes are much more uncertain.
This poses an intriguing question for philanthropists; one raised at an event on health recently held by NPC. How can the 2 per cent of health funding that comes from philanthropists start to influence the way the other 98 per cent is used? If all the skills and innovations hosted at health charities aren't being fully realised at the moment, can future funding from philanthropists shift the government's decisions in a new direction?
It's an ambitious goal, for sure, but it comes at a time when the NHS needs ambitious ideas more than ever.
Cecilie Hestbaek is a consultant at NPC