A new NPC evidence review highlights the value of the voluntary and community sector to the health and care system. But the evidence alone won’t be enough to ensure that these important services continue to reach everyone who needs them, writes Charlotte Augst (Richmond Group of Charities).
My first proper (?!) job after leaving academia was working as a researcher in the House of Commons. At the time, debates about fox hunting were raging, with well organised campaigns on either side of the argument. I remember that in the end, much of the discussion focused on a couple of pieces of evidence: does the fox feel distress and fear as it is being chased? Or not? Both campaigns provided evidence, both contested the quality of the evidence produced by the opposing camp.
This now seems a very long time ago, but what has stayed with me ever since is a belief that arguments about evidence and the lack of it, are often used to hide much more profound disagreements, about values, about nature, about class and so on.
Having just launched an important report, based on a collaboration of 15 health and care charities who worked with New Philanthropy Capital (NPC) to pool their evidence for charity led interventions ‘that work’ – I am reminded of this insight. Our starting point was that the evidence we have for improving health and wellbeing outcomes, but also for a more effective use of healthcare resources, is often fragmented: condition specific, localised, based on small numbers. So working with NPC, we developed frameworks to collectivise this evidence of impact. Unsurprisingly, it confirmed what we all know:
We can of course have sophisticated arguments about grades of evidence, methods of evaluation and scaleability, but looking at the dozens of very accessible case studies that feed the analysis it seems to me that a few principles of what works run right through the diversity of approaches: care coordination, risk stratification, carers support, volunteering, providing emotional and practical, as well as clinical support.
All the successful interventions in the compendium of good care compiled by the Richmond Group of Charities and our partners combine at least a few of these principles. If we really want to continue arguing about evidence, here are a few points I would make:
- There is no relationship between the quality of evidence for an intervention and its propensity to roll out. Looking at the case studies we have in the mix, some have rolled out very successfully with not particularly strong evidence behind them, others have very strong evidence, but haven’t been picked up by commissioners or providers.
- Often a charity (and even the very large ones are dwarfed by the budgets of an average commissioner or provider in the NHS) can provide evidence that something works well for the few people they managed to support in this way. Then system partners ask for evidence that something can be rolled out at pace and scale. But pace and scale need to be generated in collaboration between committed charity colleagues and the resources of the statutory system.
- There is often no evidence for the ‘mainstream care’ provided by the NHS. Has anyone ever evaluated whether a yearly outpatient appointment with a consultant increases patient activation, or improves wellbeing? Do we have any evidence that having a ‘named GP’ makes a difference? What was the evidence for setting up foundation trusts?
So in short, I am really proud of the evidence we have collectively brought together, synthesised and made accessible. It is now crystal clear that there is much people and the system lose out on, if they don’t routinely work with patient and volunteering charities.
Let’s together unpack what the real barriers are to better partnership working: the immense pressures the health and care system are under; a lack of capacity in the system to think beyond these immediate pressures; a lack of belief that preventative approaches really work; and tendency amongst charities to gun for maximum asks for multiple causes, rather than for pragmatic solutions.
Let’s not discuss whether the fox enjoys the hunt. It doesn’t.
Views expressed are the author’s own and do not necessarily represent those of the Alliance for Useful Evidence. Join us (it’s free and open to all) and find out more about the how we champion the use of evidence in social policy and practice.