There is a strong and resilient voluntary (VCSE) sector across Buckinghamshire, Oxfordshire and Berkshire West of which one third report a significant impact on population health. As a result of the Autumn Budget statement, VCSE employers are set to face additional costs of at least £21m per year from April 2025, which will lead to reduced service capacity in mental health, homelessness and palliative care among others. This will have repercussions across the BOB health and social care system, including presentations in general practice and urgent & emergency care – or people not seeking support who should.
In view of these risks to NHS services and indeed to people with support needs, the BOB VCSE Health Alliance is calling on our system partners to seek additional funding for commissioned and wider VCSE organisations as soon as possible. Providing this support now will protect the capacity of VCSE organisations working on health and wellbeing to support the Government’s shifts from treatment to prevention and from hospitals to communities.
“Uplifts have been minimal for the last 7-10 years meaning all services are far behind the value at which they were originally commissioned. The NI increase only inflates a gap that is already looming large.” (Alliance member)
The estimated total cost of the Employer National Insurance changes to VCSE employers across BOB ICS is over £21 million. These changes comprise the 1.2%-point Employer NIC increase, the reduction in the secondary threshold – which increase costs for all – and the doubling of the employer allowance – which offsets the former for all small employers including in the VCSE sector. Those are figures for all organisations, whatever their mission and impact. Around 30% of VCSE organisations report a significant impact on health, so the cost to health-oriented charities and social enterprises is around £7m. Around 2500 of the registered 7500 VCSE organisations in BOB ICS are employers and the entire workforce is in the region of 44,500. A very substantial proportion of VCSE financial income (£1.8bn) is on staffing costs. Paid staff hours in the sector outweigh volunteer hours by 4:1.
“We have two contracts, one had the price set 5 years ago pre pandemic, and we have had no increase in revenue but a strong increase in demand.” (Alliance member)
There were 26 responses to the Alliance member survey of which 3 said the changes would save them money, 1 said they were neutral, 22 said they would cost more money. Those who said the changes would save money or be neutral are the small VCSE employers and this is good news for them in light of other cost pressures and demands. 11 respondents expect to be providing an NHS-commissioned service in 2025/26 – these tend to be the larger organisations. Oxfordshire charities may pay the Oxford Living Wage, which is above the National Living Wage, so raises the costs and hasn’t been factored into the £21m figure. The likely management response from those facing rising costs will be a reduction in service capacity (13/22), higher fundraising targets (2/22) or drawing on reserves (6/22). A reduction in service capacity will mean people losing their jobs and less support for service users, members and patients supported by charities, whether running commissioned or independently funded services.
“There is no slack within the operation or room for savings without reducing the service offered.” (Alliance member)
Our 2023 mapping study by Prof Tony Chapman showed that BOB ICS has a strong and resilient voluntary sector compared to other parts of the country – and one that is comparatively less dependent on public sector funding. However, the Autumn Budget follows on from many years where contract values have been frozen or squeezed, leading to an estimate of the VCSE sector subsiding public sector contracts by £2.4 billion per annum nationally, according to New Philanthropy Capital (npc). Inflationary pressures from 2022 have made operations more costly and driven demand for emergency social support from food banks and similar community-based organisations.
“Reducing services within the contract will place pressure on other statutory services and other partners. For example, reduction in supported housing will mean more people are pushed into homelessness, more temporary accommodation having to be funded by councils, mental health likely to decline, more workload on GPs and secondary care so overall ends up with poor outcomes for the person, more overall expense on the system as a whole.” (Alliance member)
It is worth noting that GP practices, councils and all social care providers (not just registered VCSE organisations) will have to pay this additional cost. Oxfordshire Association of Care Providers, has their own campaign around the NIC changes.
We are grateful to Prof Tony Chapman, author of our 2023 BOB-wide mapping study, who provided the modelling for this estimate. The summary data were taken from analysis built from the same model as for the published data for ICS North-East and Cumbria, which was developed with their VCSE local infrastructure organisation (VONNE). Here is a link to the new story and the VONNE report – you’ll find a summary of the methodology in there: Charity employers will face increased financial pressures in 2025 – St Chad’s College Durham
The third sector is engaging nationally with ministers and locally with MPs, for example in West Berkshire. There has been an exchange of letters between NCVO & ACEVO chief executives with the Chancellor of the Exchequer.
The state of integration at place – Exploring how and why place is the ‘engine room’ of integration
Integration at the place level holds immense potential to address the complex challenges faced by health and care services today.
By breaking down silos, fostering collaboration, and empowering local communities, we can create a healthcare ecosystem that is more efficient, responsive, and patient-centred.
The NHS Confederation report emphasises the importance of giving prominence to place in national health policies, enabling better data sharing, and encouraging community-driven efforts. By implementing these recommendations, we can accelerate the integration process and unlock the full benefits of place-based integration, ultimately transforming the way we deliver healthcare.
For more in-depth insights and case studies showcasing the success of integration at the place level, please refer to the full report here.
