The third sector, patient communities and the changing NHS in England

'Third sector' organisations are being drawn into the heart of healthcare provision under new financing and delivery arrangements for the English NHS. Yet we know little about the effect of the new market upon the relationship of such organisations with their clients and with local community bases. This paper addresses this issue through a case study of the reconfiguration of provider arrangements under the Health and Social Care bill in one English city, drawing on research conducted in 2011 (focus groups and interviews).

We explore third sector stakeholders' concerns and strategies for their organisation in the run up to the expected NHS reforms. Specifically we consider whether existing forms of connections between organisations and their local client bases are likely to change and, if so, whether they will be lost, diminished or enhanced and the implications of that this may have for the kind of care provided.

Our analysis shows that respondents have a highly developed sense of their difference to the NHS (typified as money-obsessed, target driven, controlling, failing to provide choice) and the voluntary sector (typified as empowering, working in partnership with clients, engaged with local communities, appreciating the person holistically). This distinction is fundamental to establishing a unique provider identity. However it is not easily sustained and indeed may need to be broken away from in a climate of fiscal constraint which calls for strategic engagement under new contracting arrangements. In this paper we explore the struggle by third sector organisations to maintain their unique identity as they seek to either i) 'survive on the outside', ii) become part of or to inhabit the NHS, or ii) try to change NHS working practices by working in partnership as 'equal but different'. Each of these carries implications for their relationship with existing communities and the kind of care provided.