Neighbourhood health will only work when the VCFSE sector is treated as an equal partner

The central theme at our recent roundtable was simple but significant. If our ambition is to build neighbourhood health around people's lives, we must fundamentally rethink the relationship between health and care systems and the VCFSE sector.

Leaders and voices from across the UK joined the discussion with a willingness to challenge long-held assumptions. Together, they explored an important question: what conditions are needed to create genuine partnership between the VCFSE sector and the wider health and care system?

One reflection surfaced almost immediately.

We often talk about the VCFSE sector as though it is a single entity. One partner. One voice.

But it is not.

It is an ecosystem.

Across every neighbourhood there is a diverse mix of charities, community groups, faith organisations, voluntary organisations and many others.

Some are large national organisations with established relationships across health systems. Others are small, volunteer-led groups that may never attend a neighbourhood health meeting but are often the organisations local people turn to first when they need support.

From a systems perspective, that diversity can appear messy. But perhaps the challenge is not to simplify it. As one contributor reflected, the task is to become better at "navigating that complexity".

Participants shared examples of organisations providing community intelligence that statutory services cannot easily access, building trusted relationships over many years, and using lived experience to shape services from design through to delivery.

We also heard examples of neighbourhood teams where non-clinical roles, many rooted within the VCFSE sector, help people navigate both clinical and non-clinical needs in ways traditional healthcare models often struggle to achieve.

Many colleagues reflected that the VCFSE sector is still too often viewed primarily as a delivery partner.

Organisations are frequently asked to engage communities, deliver programmes or support implementation after priorities have already been agreed.

If neighbourhood health is truly about organising care around people's lives, then the organisations most closely connected to those lives should be involved from the very beginning.

“I think they need to see the voluntary sector as an equal partner from the very start and not just an add-on.”

That is a different kind of partnership.

It asks us to rethink trust as much as governance. It asks us to examine where power sits within our systems, who gets to define success and whose knowledge we value when decisions are made.

Several people described the VCFSE sector as a "bridge" between communities and the health and care system.

The sector often connects with people who may never engage with statutory services, brings together voices that might otherwise go unheard and helps organisations understand the realities of people's everyday lives.

But one contributor offered a powerful observation.

Bridges get walked over and perhaps that is the risk.

If we only ever see the VCFSE sector as a bridge, are we unconsciously reinforcing the idea that its purpose is to help the NHS connect with communities.

The bigger opportunity is to allow the VCFSE sector to help shape what the system itself becomes.

“Health is about far more than the absence of illness.”

Colleagues shared their experiences of how neighbourhood health can mean very different things to different people.

Colleagues shared their experiences of how differently neighbourhood health gets defined and interpreted. For some, too often the conversation begins with reducing pressure on acute services. While that is undoubtedly important, it can feel like a narrow ambition if our broader goal is to help people live healthier, happier and more connected lives.

“How do we de-centre healthcare and organisations and actually re-centre communities?”

The more I reflected on that statement, the more it made me realise that that health is about purpose, belonging, relationships, and the opportunities people have to thrive within their communities. Those wider determinants aren't an additional consideration for the VCFSE sector and that is why the sector brings something distinctive to neighbourhood health.

Colleagues talked about the importance of leadership that understands the breadth of the VCFSE ecosystem and knows who is missing from the conversation as much as who is present. Leadership that can act as a boundary-spanner, translating institutional language and creating space for organisations that don't usually find themselves around decision-making tables.

They also talked about recognising non-clinical roles, not as nice additions to neighbourhood teams, but as essential professions that create the relationships and trust on which integrated care depends.

And they also talked about funding. That it is difficult to build trust, embed within communities and create lasting partnerships when organisations are constantly cycling through short-term contracts that end just as relationships begin to flourish.

“You know, we get the short-term funding, as soon as you've got a project up and running, the funding's come to an end.”

Equally, contracting processes need to recognise the diversity of the sector. If they are designed only for organisations with significant capacity and infrastructure, then we risk excluding exactly those smaller community organisations that make neighbourhoods stronger.

Recognition is not enough

I left the roundtable feeling both optimistic and challenged.

Optimistic because there is growing recognition that the VCFSE sector has a critical role to play in the future of neighbourhood health.

Challenged because recognition alone is not enough.

If neighbourhood health is to succeed, then we must move beyond seeing the VCFSE sector as a delivery partner and start trusting it as an equal partner in shaping strategy, designing services and defining success.