1. Building from the bottom up The growing role for voluntary sector providers in tackling health inequalities

2. We won't just do nothing if 100 flowers don't bloom in 100 places. The 100 flowers will bloom, but we'll have to do some gardening and sow some seeds If I had a plan, it would be the wrong plan. The big society will look a bit chaotic and disorderly.

3. Building from the bottom up The context Addressing inequalities Small, local organisations Changes to commissioning How the VCS adapts GMCVO’s work in this area What kind of gardener is needed

4. The context Investment targeted at most costly care which is emergency care Need to invest in areas that stop problems from occuring Demographic change Need to change investment profile

6. Addressing inequalities Health inequalities increasing Those furthest from employment, education and services affected worse Public sector struggling to engage If healthcare is to be rationed or co- payments required this group will suffer worst

7. Small, local organisations There are organisations that are engaged with groups in most need These organisations are trusted Small, local organisations struggle to engage in commissioning processes When organisations grow they lose their reach

8. Changes to commissioning GP consortiums Local authorities centralising AGMA partners sharing services National government commissioning from the center

9. The problem Solutions are close Funding is distant Large organisations have a mixed track record in subcontracting with small, local groups but there is good practice. A gap needs to be bridged

10. Developing commissioning Directory: voluntarysectorhealth.org.uk Prime Contractor: towpath Consortium: Greater Manchester Health and wellbeing consortium

11. Directory Over 100 providers Maps along care continuum: crisis care to self care & prevention Details impact against health priorities Allows an understanding of service boundaries and market supply Basis for partnerships

13. Prime Contractor LSC contract: approx £650k bringing those distant from job market closer to work Turned into 67 grants of at most £12k 2 failures – cash recovered from 1 Over-delivered and exceeded expectations Reduced transaction costs – monitoring delivered by GMCVO through 1 officer Organisations built capacity

14. Health and Wellbeing Consortium Special purpose vehicle Fiscal shield Hub and spokes model Quality assured membership Subcontracts to members Enables market entry for voluntary sector into large scale contracting

15. Our strength We are the solution Not engaging with us is more expensive than engagement We don’t have to engage in processes that don’t suit us By working together we can deliver and create efficiency – it doesn’t have to be more expensive

16. But Marketplace structures will form – especially if payment by results becomes common Work programme points at “tescoisation” of sector Co-operative structures will be more to our liking but we have to create them

17. Questions Are small organisations the solution as we present it? How best can small organisations be involved? How best can they work with larger providers? What support will the voluntary sector need in working in the changed environment?