What is health? Is it only the “absence of illness or injury”? Or is it – as the World Health Organisation recommends – “‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.”
However, you choose to define it, what we do know is that there is a wide range of social factors that determine whether you will experience good health. These factors include where you are born and where you live, what you do for work, and the structures around you that create “inequities of power, money and resources”. Essentially, your health – and therefore your life expectancy – has very little to do with the services you receive in a hospital or GP surgery, and everything to do with the opportunities you have access to within your life and personal circumstances.
Bristol is a city full of contradictions, and one that is most stark is the differing experiences between those who are born and live in certain, more affluent areas compared to other areas where people face poverty and disadvantage.
The term ‘Voluntary, Community and Social Enterprise sector (or VCSE sector) is used to describe a hugely diverse range of groups and organisations, some of which are crewed entirely by volunteers and some of which turn over millions of pounds a year – and every shape and size of organisation in-between. What they have in common is that they all aim to make life better in some way for people or communities.
Much of the VCSE sector focuses on working with people who experience disadvantage, barriers or inequality in some form. The VCSE sector encompasses the people who are there, day in day out, year in year out, in the community centres or social spaces, bringing people together, listening to them, providing advice or support, referring people into other services to get the help they need, and following up with them. It also includes the people running activities that keep people active or give them social contact that they wouldn’t otherwise have, or the chance to learn skills or work towards employment or volunteering. These VCSE organisations offer people on the ground long-term social relationships – the funding for one project may have ended, but you can still interact with the people in that organisation, and they will still care if you are facing difficulties, and find ways to support, empower and enable you. In short, the VCSE sector is the place where real health – not health and social care services, but the conditions for a fulfilled, happy life within a neighbourhood or community where interactions happen – is made to happen.
However, it has historically been really hard for the VCSE sector to demonstrate the role it plays in improving our lives. A huge amount of organisations and groups deliver activities or services that are, essentially, preventative: the group that brings young people together regularly and in doing so prevents mental health issues being exacerbated for those young people; the English language skills programme for refugees and migrants that prevents long-term unemployment; the befriending service for older people that prevents them feeling isolated and experiencing a quicker decline in their physical health. Yet the VCSE sector has always struggled to demonstrate the long-term preventative nature of its work within an analytical framework that calls for metric-driven quick wins. The impact is over a long time period – one that requires a much longer presence and commitment than election cycles at either local or national level, and this creates a disconnect between the VCSE sector and its potential partners in the public sector.
Imagine a scenario where the public sector was not under pressure – again at both national and local levels – to be seen to be investing in the ‘crisis’ services such as hospitals or social care. Imagine what would happen if some of the resources at the disposal of the public sector were invested in the community-based organisations that are leading on a range of innovative services or activities that allow for both innovation and a real commitment to the people within that community to be entwined together.
There are so many solutions to problems already being delivered by the VCSE sector for communities of both interest and place across Bristol: redistributing resources away from the “burning platforms that suck in oxygen” of ‘crisis’ services into the activity that will prevent people’s lives descending into those crises, could make an incredible, life-defining difference for many. To do this would take a lot of courage; public sector organisations would need to be prepared to explain to the public why the latest drug or gadget hasn’t been invested in over – for example – a community-led service that doesn’t look glamourous or in any way connected to our traditional concept of “health and social care services.” It would also take courage to invest in achieving those longer-term outcomes, many of which will not be realised in the lifecycle of that current administration or management, and many of which cannot be easily measured.
However, Bristol is a place of innovation, and we have an excellent set of foundations to take forward this type of partnership working. The abject set of challenges that the public sector – most notably Local Authorities – is facing in terms of extreme budget cuts mean that we simply have to start trying something different. The VCSE sector cannot pull rabbits out of hats; it will need investment: but it can make money go so much further by focusing on the services that have a long-term, deep – and yes, sometimes unquantifiable – preventative effect. We invite the people and communities who are already there on the ground to tell us what the radical reimagining we propose here would look like for them, and we invite our partner organisations in Bristol and nearby to work with us to make this happen.
 Health Equity in England: The Marmot Repot Ten Years On
 Greg Fell, Keynote speaker, NAVCA conference November 2022