This article focuses on the benefits and challenges – rather than specific outcomes – of a urology outpatient collaboration with a charity offering cancer screening and support
Abstract
NHS services have a rich history of collaboration with charitable community organisations. While some partnerships are well established, engaging with local minority groups and community charities can be both rewarding and challenging to manage. This article explores a short-term collaboration between urology outpatient services in Nottingham and a local charity promoting cancer awareness among Black people and those with minority ethniticies. Emphasising challenges and benefits over specific outcomes, the article highlights how forging new relationships allows nurses to break free from traditional constraints and embrace new ways of working. Such engagement fosters interaction with committed charity workers, who can enrich nurses’ specialist practices with new perspectives.
Citation: McAllister B (2024) Collaborative working between the NHS and charitable organisations. Nursing Times [online]; 120: 4.
Authors: Bría McAllister is urology nurse practitioner, Nottingham University Hospitals NHS Trust, and currently seconded as a Wellcome Trust fellow to undertake a PhD programme in reducing healthcare inequalities; Lindsay Thompson is co-founder, CEO and service development and delivery manager of B’Me Against Cancer (BMAC).
- This article has been double-blind peer reviewed
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Introduction
The NHS has a long history of collaborative work with charitable organisations. From the beginning of its inception in 1948, volunteers and charities were in hospital wards and at reception desks providing support to NHS staff and patients.
The Women’s Royal Voluntary Service – which now flies under the more inclusive flag of the Royal Voluntary Service (RVS) – was founded in 1938. Among its aims were providing support to hospitals by helping with mealtimes and non-medical ward-based roles, as well as driving ambulances (RVS, 2024). When the NHS was formed, volunteers were already in place to help the fledgling service on its way. These days, alongside the ubiquitous RVS tea shop, most hospitals have a dedicated charity working to raise funds for their local trust.
Charities provide support over a wide range of services and situations, from funding vital research, supporting respite care and donating healthcare equipment, to empowering community support groups and providing a listening ear in times of crisis. By harnessing the passion and dedication of their volunteers, charities regularly show how much can be achieved, often on a restricted budget, to improve the lives of others.
The Charities Act defines a charity as an institution that is both established for charitable purposes only and subject to the control of the High Court’s charity law jurisdiction (Charity Commission for England and Wales, 2013). There are strict rules in place defining what constitutes charitable activity and how charities fulfil their obligations to serve the public good. Charities have to:
- Operate openly and transparently;
- Register their objectives with the Charity Commission;
- Produce annual reports of their activities (National Council for Voluntary Organisations (NCVO), nd).
Bowles et al (2023) studied the impact of charitable sources of income on the operational budgets of NHS trusts. While the NHS is predominantly funded through direct taxation, the study found that the contribution of charitable activities added several hundred million pounds per year to available budgets. The study’s authors do caution that, while there can be no doubt of the positive impact of charitable donations, the fact that these funds are directed towards specific causes – for example, cancer or children – the result can be an uneven distribution of funds throughout the health service as a whole.
The intricacies of collaboration between charitable organisations and the NHS is not an area that has been widely researched, and there have been few academic reports relating to the practicalities of collaborative working between the NHS and charitable bodies or community groups. However, the creation of such networks has been shown to have great benefits in communities (Southby and Gamsu, 2018). The involvement of local leaders in helping health promotion can have a positive effect on communities, with evidence that community-based initiatives backed by the NHS show clear improvements in local wellbeing (Fagan et al, 2010).
Community leaders are often described as prominent figures who, although not always holding a formal role, are seen as advocates of the local community and often serve as a point of liaison between that community and official organisations, including charities and authorities. Creating new collaborative services that combine such disparate services as the NHS and local charities will always bring challenges alongside its benefits.
New perspectives that charities can bring to old problems, and the flexibility to work outside of the constraints of the NHS can transform care provision (Hyndman and McKillop, 2018). In contrast, however, finding ways for services to work together and agree on a shared vision can be challenging (Dutton et al, 2023). Adapting the stringent working policies of the NHS – for example, lone-worker policies, protocol-led care packages or geographical restrictions – to the needs of local communities, such as the need for flexibility, continuity and innovative thinking, can be difficult in joint ventures, thereby affecting the provision of services in the community and the ability of disparate groups to develop collaborative and reciprocal relationships with NHS services (Goodman et al, 2005). Despite the challenges, however, collaborative working creates clear benefits for all involved (Dutton et al, 2023).
As NHS budgets are squeezed ever more tightly, it is highly likely that the NHS will become more reliant on charities to be able to fund treatments (Man, 2016). Already, strong evidence has shown that:
- Significant levels of care would not be possible without the support of charities (Johnson et al, 2015);
- Charities often take the lead in researching, raising awareness of, and providing testing for, many illnesses (Griffiths et al 2020).
Many charities and community groups may run on goodwill and are often staffed by unpaid volunteers, so it is vitally important that they feel valued to continue the work that they do (Dutton et al, 2023). With this in mind, further research into the area of joint working may be needed to enable NHS staff and community partners to work together more effectively.
A recent survey by Mahase (2020) on the work carried out by UK charities found that post-Covid changes in fundraising have had a dramatic impact on the services and support that charities can provide to the NHS. A significant drop in donations has left some charities facing a major funding crisis, with many having to reduce or cancel their activities, which has had a devastating knock-on impact on the NHS (Mahase, 2020).
“By harnessing the passion and dedication of their volunteers, charities regularly show how much can be achieved, often on a restricted budget, to improve the lives of others”
The collaborative project
The urology unit at Nottingham City Hospital recently had an exciting experience of direct collaboration with a charity to create a community service. The service was developed to provide community-based prostate cancer assessment for men of Black and minority ethnicities. These men are more likely to develop prostate cancer than men of a Caucasian background, but are less likely to approach their GPs for routine assessment (Jones and Chinegwundoh, 2014).
The service ran for two years, with a lead-in time of six months for preparation. Its findings have been audited and reviewed, providing further information on clinical outcomes (McAllister et al, 2019). This partnership achieved great things, both in terms of creating inclusive patient care in a community setting and of forging strong links with a local charity, enabling us to reach an at-risk population on their own terms.
Objectives
We were approached by a local charity, B’Me Against Cancer, which works with men of Black and minority ethnicity backgrounds to raise awareness of prostate cancer and support those who have been diagnosed with the disease. It was very keen to create a community-based clinic that would help to:
- Reduce the perceived stigma surrounding prostate cancer;
- Improve engagement in their community.
The clinic provided information about, and testing for, prostate cancer. This took the form of a consultation, in which attendees were offered a prostate-specific antigen blood test and rectal examination. Positive test results prompted a two-week referral to hospital for further investigations. These services were provided over and above existing provision with the local NHS and offered the standard of care patients should expect from their GP or hospital clinic, delivered in a safe and familiar space. To achieve this, the charity needed to collaborate closely with the local NHS trust.
Service development and provision
The charity prides itself on its excellent track record of finding innovative ways in which to raise awareness of cancer in men of Black and minority ethnicities. It had identified a specific health need about prostate cancer assessment, which had the potential to leave the men in that community at risk of developing undiagnosed prostate cancer. This led it to approach the local community commissioning group with a proposal to bring prostate cancer assessment to the local community. As can be expected in approaching such a large and often unwieldy service as the NHS, there were some initial frustrations in contacting the most-appropriate people to present their proposal.
Once contact had been established, one of the first actions to be taken was to create a steering group; this was made up of members of the community charity alongside those who would be directly and indirectly involved in delivering the service – namely, nurses, medical staff and representatives from the community commissioning group. Both the urology team and the charity representatives were equal partners in this collaboration and both sides contributed equally to the steering group.
During the planning stages for the service, the group held regular meetings. These continued throughout the life of the service and provided:
- Oversight;
- A forum in which challenges, developments and improvements could be openly discussed.
Once this meeting format was established, our partners from the charity found communication and collaboration easy and effective. In the words of the managing director of the charity: “Once the process got started, it seemed that all the people were there, and everything started to fall into place. We found where the flow was going, and things started to work without having to stress too much.”
Challenges
While the charity found that most of its difficulties and frustrations emerged during the early stages of service development, and reduced as the partnership continued, those NHS staff who were involved in the service, conversely, found that their difficulties lay in adjusting to working with partners whose experience and expectations lay outside of the normal NHS routine.
The level of personal investment on the part of the community partners caused some issues, especially in the areas of inclusivity and when decisions had to be made about the shape and scope of the service. It was felt that more care than usual needed to be taken to make sure all partners were kept involved in conversations, as there was a high risk of accidentally offending individuals.
There was also a strong feeling of frustration among some NHS staff that requests were being made by the charity about the shape and delivery of the service that could be viewed as being unreasonable or unnecessary; one example of this was the proposed provision of evening clinics. Although both sides agreed that evening clinics were something to work towards, it was difficult for the community partners to understand the impact of issues such as staff rotas, laboratory opening hours and lone-working policies, and the inherent difficulties involved in implementing a change that, in their eyes, was simple and uncomplicated.
Funding was provided entirely by the local community commissioning group, and it is our impression that this led to some friction between the local community group and NHS providers, as it led to a perceived imbalance of power. To counteract this, however, the premises used were entirely owned and maintained by the local community group involved, which allowed it to retain ownership of the service.
Clinics were also staffed by a mixture of NHS nurses and charity volunteers, thereby helping to create a good working relationship. As the partnership progressed, we found that we fell into a more comfortable rhythm allowing for easier and smoother relationships between the staff and volunteers from both the NHS and the charity. Box 1 offers advice for setting up a similar project.
Box 1. Advice for similar projects
- Facilitate effective communication – having a steering group that meets regularly to design and oversee roll-out of the service is vital to success. An open forum – such as a group chat (whether in person or over digital services, like Microsoft Teams or WhatsApp), regular meeting space or post-service debrief – gives everybody a voice in the project
- Clear and achievable goals give everybody a structure to work towards
- It may be necessary for both sides to set boundaries, whether that is about what services can be delivered or when it is reasonable to call or email partners
- Be patient – everybody is learning how to work in a new way, in a new environment and with a new group of people
- Expect the unexpected – not everything will go smoothly, and difficulties will arise that nobody foresaw
- Embracing opportunities to work with outside organisations will always challenge your conceptions and practice, but the results will be worth it
The service was created as a short-term initiative and funded for a total of two years by the community commissioning group. Funding was not renewed at the end of this time, leading to the planned closure of the service.
Conclusion
Developing collaborative services between the NHS and charitable bodies can raise a variety of challenges, not all of which will be predictable at the outset. It can, however, create great opportunities to develop services in new directions or help existing services to become more inclusive and accessible, thereby improving the health outcomes of users. Those taking part in such projects have the potential to find new ways of working and new perspectives on their roles as they engage with services to which they may not usually have much exposure. This applies equally to members of charities and the NHS.
Key points
- Collaborative working between the NHS and charities can improve and enrich the patient experience
- Working with charities requires flexibility and understanding, but offers nurses an unparalleled opportunity to enhance their practice
- Establishing a steering group comprising members of the charity and relevant NHS staff is essential for collaborative working
- It is important to try to find ways to ensure all contributors feel welcome and valued
- Collaborative working between NHS services and charities is likely to increase as NHS budgets are squeezed
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