ARVAC Bulletin 99

A Healthy Approach to Research

Introduction
Health and quality of life really do go to the heart of the voluntary sector and a recent report, the Heartland Territory (2005), confirmed that instinctive knowledge. The report was commissioned by Yorkshire and the Humber Regional Forum (Regional Forum) in response to requests by regional health agencies to help to improve the involvement of the voluntary and community sector (VCS) in the health agenda. Information about what was happening was sparse and the research was needed to find out what might support improved engagement. A small grant paid for an action research project whose aims were to:
• gain a deeper understanding of how voluntary and community organisations (VCOs) currently and potentially could engage with public health agencies;
• develop models of engagement that best suit both sectors’ requirements and resources.

It is an appropriate time to be looking at these issues because the policy context is increasingly recognising the wider determinants of health, the importance of preventative approaches, the necessity of engagement between sectors and new structures are emerging at regional levels.
These wider determinants of health such as income level and access to services are very much part of the established concerns of the VCS though not necessarily recognised by the sector as contributing to public health.

In terms of engagement, the service delivery role of the VCS in health is relatively well developed but involvement of VCS organisations with health agencies in order to shape and define policy and strategy is not well established.

An early challenge in this work was that of definitions. Whilst public health is defined formally as a distinct activity separate to that of the wider health agenda, voluntary and community organisations see themselves as working on health issues and do not make the distinction. Nor do they always see their work in community development or campaigning, for instance, as being part of “public health”. Yet, when there are issues of engagement there are very different structures in the two areas that may require different approaches.

Methodology
The study used a variety of means to find out what was going on in health engagement and what organisations in the VCS and the health sector wanted.
A range of regional and local VCS organisations were consulted and a self selected sample group with a specific interest in public health was targeted for a more detailed discussion. Regional public health agencies, Strategic Health Authorities and local Primary Care Trusts were also consulted.
There was a Regional Forum members’ advisory group and a consultation about the research draft recommendations. In these ways, the research connected experiences and perceptions on the ground and in different agencies to a potential programme for action and development.

Key findings
Other sectors have been quicker to develop engagement and partnership working but “health” is catching up. At the national level there is a strategic agreement for closer partnership working between the Department of Health, the NHS and the VCS. The Compact provides a framework for relationships and there is a Non-governmental Public Health Organisations’ Forum bringing together different players. At the more local level there are Patient and Public Involvement Forums; Local Strategic Partnerships sometimes have health sub committees and there are local health partnership boards.
In all of these there is good work going on involving the VCS. However, the concept of engagement is one that needs further development within the health sector and the engagement that does happen tends to be primarily about individual patient experience not the broader involvement of the voluntary sector in the policy and planning arenas of health. In addition, engagement is patchy and inconsistent across the region.

Findings in more detail
• Many VCS groups are involved in work which has a health impact - indirectly or directly. Sometimes they do not describe that work in terms that health professionals recognise and sometimes they do not see what they do as having a health pay-off.
• On the one hand, there was much interest and willingness on the part of the sector to engage with health agencies but on the other hand, that engagement was ad hoc, sometimes reliant on individual relationships and had no consistent framework for representation, partnership working and other forms of involvement.
• Staff with a health engagement remit within infrastructure or delivery organisations had few opportunities to meet and share experience.
• Good local work in health engagement stayed local because there was no means to link it together, learn lessons and have an impact on policy and planning.
• The cultures of the NHS and the VCS can be quite different and have very different starting points but there was a real desire to improve engagement on both sides.

It became clear, in the course of the study, that the work the sector does in health links both public health issues and NHS issues - which are dealt with by two different bureaucracies. And whilst the sector does not see a major difference (indeed delivery can and does inform strategic engagement in important ways) the health agencies find it difficult to bring the two areas together.

Next steps
The work of the project drew together ideas about how the current situation could be improved and these are largely agreed by the VCS and by health agencies. Principally, it was agreed that second tier support resources were needed to improve the consistency of engagement and representation; that a framework for partnership working was essential and that local experience of the VCS needed to be aggregated to ensure that it had an impact at policy levels. Practical actions - such as awareness raising events for both sectors to improve mutual understanding; thematic workshops on things like housing and health and work with health authorities on improving commissioning opportunities - were widely approved.

At the moment work is in progress to turn ideas in the report into a project plan and to find resources to fund the continuing work. The re-organisation of health at the regional and local levels creates both a new opportunity for engagement and underlines the necessity for resourced and strategic involvement of the VCS.

Judy Robinson is the Director of Yorkshire and the Humber Regional Forum
Heartland Territory (2005) can be downloaded for free from www.regionalforum.org.uk.
Contact: office@regionalforum.org.uk