Ensuring involvement in planning
Voluntary and community sector organisations need to be involved in the planning and development of services at the earliest point. However, this can be challenging for a number of reasons. Not only do community-based groups often lack the resources to respond to the requirements of commissioners, but the structure of meetings and the bureaucratic requirements of the process can be intimidating.
Here we provide a checklist to help improve inclusivity in the planning process, developed from discussions in the workshops:
Recommendations arising from our workshops:
- The chair of these meetings needs to actively ensure that all participants feel able to contribute
This may involve addressing the power imbalances that exist to ensure that participants, especially those from community groups, do not feel isolated or intimidated.
- Workshop participants suggested different ways to achieve this.
One suggestion was to use more creative processes to facilitate open dialogue – for instance, by including a section for facilitated conversation from public contributors (if invited) to reflect on how they are experiencing the meeting; others in the meeting will be expected to listen but not to respond. Other suggestions were for a preliminary meeting between the chair and VCSO contributors; a glossary of terms to reduce the impact of jargon; and choosing local community-based venues that are not intimidating, such as an appropriate place of worship.
Workshop participants felt strongly that it was important both for services to have a more ethnically diverse workforce and for health and social care professionals from South Asian communities to be more visible. This was seen as central to increasing trust and increasing the likelihood that people will access these services. Ensuring that there is diversity at all levels requires services to identify appropriate recruitment strategies and to actively manage career progression.
Developing working relationships.
As people from South Asian communities rely on voluntary and community groups to have their care needs met, workers within those groups often act as intermediaries to facilitate their clients receiving care. This may take the form of initiating referrals, accompanying them to appointments, or acting as unpaid interpreters and advocates. In essence, VCSO staff and volunteers often enable health and social care professionals to do their job, making up for the deficiencies within the service.
When partnership working occurs, South Asian community groups tend to be seen as providing the contacts and local expertise to enable effective recruitment and communication. However, the importance of this contribution isn’t always openly acknowledged or met by an adequate distribution of resources. Consequently, many participants from voluntary sector organisations told us that they felt their skills and knowledge were neither fully understood nor appreciated by healthcare providers.
We were told that VCSO staff instead often feel that when they bring the needs of their clients to statutory services, they feel as if they are asking for a favour from them. For instance, when services are asked to provide information in a language that clients can understand, or food that is consistent with a person’s religious beliefs, it can sometimes feel as if they are being asked to provide something extra, rather than meeting a person’s basic needs.
For our VCSO participants, their relationship with statutory services was all too often an unequal one that was characterised by an imbalance of power and in which they depended on the goodwill of health and social care providers to enable their clients to receive help.
Recommendations arising from our workshops:
- Actively seek out opportunities for partnership working.
Routinely involve voluntary and community sector staff in multi-disciplinary clinical and business meetings, with issues around information sharing addressed at the service level.
There is a need for mainstream organisations … to become a partner with voluntary sector. Voluntary sector often cannot go to the mainstream organisation, they don’t know who to contact, plus if they are in partnership, they have to have a proper relationship. For instance, the way the person with dementia going in the voluntary sector talking about his symptoms, this may not be in a way that a memory service person can understand, so they have to work on their cultural competence training. They should have a shared agenda.
- Joint work between small and large organisations should be properly funded.
One of the strongest messages to emerge from the workshops was that all too often representatives of community organisations felt that their work was undervalued and that, consequently, they were providing vital services either for free or at a loss. It is vital for statutory services to fully reimburse community groups for the work they do and to recognise this contribution and commitment. Building respect and partnership working between workers from very different organisations takes time and requires commitment from both sides – work that needs to be funded.
I wouldn’t say that during my career I’ve been guilt free of that [not paying properly for expertise], you want the B at the end of the A, and you go in and think this is the quickest and most efficient way of taking that. But the world has opened up, and we’re rethinking how we work with people with lived experience, of whatever nature. It’s a learning curve
One of the things that comes out for me is the reimbursement of people’s time, it doesn’t have to be financial, it can be in some other way. Asking people what they want in return for being involved. That’s really important, it addresses the balance of power and the involvement in the work
- Openly acknowledge need for improvement and lack of knowledge.
Health and social care teams should actively identify barriers to their services being accessed by local communities, with service managers being open about these limitations and their dependency on community groups. Service managers should:
- recognise where their service lacks specific expertise – for instance, around meeting the language needs of clients or cultural sensitivity.
- discuss the audit outcomes at a senior managers’ meeting, enter on a risk register and formulate an action plan to address the identified unmet needs.