COVID-19 and the role of Voluntary, Community, and Social Enterprises in northern England in responding to the needs of marginalised communities: a qualitative focus group study

Social prescribing addresses non-medical factors affecting health and well-being. Link workers are key to its delivery by connecting people to relevant support, often in the voluntary, community and social enterprise sector. Funding from the National Health Service means that link workers are becoming a common part of primary care in England. To explore and understand the implementation of link workers in primary care in England. A realist evaluation addressed the question - When implementing link workers in primary care to sustain outcomes - what works, for whom, why and in what circumstances? Link workers and staff associated with seven primary care sites across England. Researchers spent 3 weeks with each link worker, going to meetings with them, watching them interact with patients, with healthcare staff and with voluntary, community and social enterprise organisations. In addition, interviews were conducted with 61 patients and 93 professionals (voluntary, community and social enterprise representatives and healthcare staff, including link workers). Follow-up interviews were conducted with 41 patients and with link workers 9-12 months later. Data were coded and developed into statements to identify how context around the link worker triggers mechanisms that lead to intended and unintended outcomes. We found that link workers exercise micro-discretions in their role - actions and advice-giving based on personal judgement of a situation, which may not always reflect explicit guidance or protocols. Our analysis highlighted that micro-discretions engender positive connections (with patients, healthcare staff, the voluntary, community and social enterprise sector) and promote buy-in to the link worker role in primary care. Micro-discretions supported delivery of person-centred care and enhanced job satisfaction. Data also highlighted that lack of boundaries could place link workers at risk of overstepping their remit. Our research focused on link workers attached to primary care; findings may not be applicable to those working in other settings. Data were collected around seven link worker cases, who were selected purposively for variation in terms of geographical spread and how/by whom link workers were employed. However, these link workers were predominately white females. Enabling link workers to exercise micro-discretions allows for responsiveness to individual patient needs but can result in uncertainty and to link workers feeling overstretched. Poor link worker retention may, in part, be associated with a lack of clarity around their role. Research to explore how this shapes intention to leave their job is being conducted by authors of this paper. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.

BackgroundThe Covid-19 pandemic has exacerbated pre-existing inequalities and increased adversity and challenges for vulnerable and marginalised communities worldwide. In the UK, the Voluntary Community and Social Enterprise (VCSE) sector play a vital role in supporting the health and wellbeing of people who are marginalised or experiencing multiple complex needs. However, only a small number of studies have focused on the impact that Covid-19 had on the VCSE sector.MethodsAs part of a Health Inequalities Impact Assessment (HIIA), we conducted qualitative focus groups with staff and volunteers from five organisations to examine short, medium and longer-term impacts of Covid-19 upon the VCSE sector in Northern England. Nine online focus groups were conducted between March and July 2021.FindingsFocus group transcripts were analysed using Framework Analysis and yielded three central themes: (1) exacerbation of pre-existing inequalities, adversity and challenges for vulnerable and marginalised populations; (2) the ‘price’ of being flexible, innovative and agile for VCSE staff and volunteers; and (3) the voluntary sector as a ‘lifeline’ - organisational pride and resilience.ConclusionsWhile the voluntary sector ‘adapted at pace’ to provide support during Covid-19 and in its continued aftermath, this resilience has potentially come at the cost of workforce and volunteer wellbeing, compounded by political obstacles and chronic shortage in funding and support. The VCSE sector has a vital role to play in the post-lockdown ‘levelling up’ agenda. The expertise, capacity and resilience of VCSE organisations, and their ability to respond to Covid-19, should be celebrated, recognised and supported adequately to maintain its resilience. To not do so threatens the sector’s sustainability and risks jeopardising attempts to involve the sector in addressing the social determinants of health.

Purpose The purpose of this paper is to understand the tensions that marketing practitioners in social enterprises experience, and to explore how these tensions impact the development and implementation of marketing activities. Design/methodology/approach Using an approach informed by grounded theory, this paper reports on an investigation of the tensions facing 15 social enterprises. The primary data comprises semi-structured interviews with senior marketing decision-makers, supplemented with archival sources. Findings The analysis shows tensions and dualities inform the social and commercial strategic marketing activities of the social enterprises. These tensions and dualities are linked to how the organization obtains financial resources, the nature of the organization’s growth, working with myriad stakeholders and competitive versus cooperative pressures. A model outlining the dualities and their links to marketing activities is developed. Research limitations/implications The study provides an in-depth analysis of a small, regional sample of Canadian social enterprises. The study serves as a foundation for future research aimed at elaborating the model we propose. Practical implications The findings point to tensions and dualities that play an important role in enabling and restricting the development and implementation of strategic marketing activities in social enterprises. Understanding the nature of these dualities is crucial for social enterprise managers and social marketers as they develop strategic activities. Social implications Social enterprises engage in activities that offer substantial social benefits, yet the development of marketing activities in these organizations requires confronting tensions that must be carefully managed. Originality/value This paper highlights how dualities facing marketing practitioners in social enterprises influence the development of both social and for-profit marketing activities. The paper offers a model of these dualities. The findings help to extend our understanding of the complex environmental influences impacting marketing practices within social enterprise organizations. Understanding the nature of these environmental influences helps to attune marketers to the potential opportunities and challenges of using social enterprise as an organizational form for launching social marketing programs, as well as providing a theoretical basis for future investigations of marketing practice in social enterprise and social marketing organizations.

The independent review of children's social care (2022) has proposed a radical reset of England's children's services, shifting a remote, assessment heavy system towards one that works alongside communities to help prevent statutory interventions. However, notions around the harnessing of community resources to deliver Early Help are often underpinned by assumptions regarding the voluntary, community and social enterprise (VCSE) sector and the ease with which such organizations can be integrated into preventative strategies. This paper reports findings from embedded research within a unitary authority in Southwest England during remodelling of its Early Help service to work more collaboratively with local VCSE organizations. The study generated data from ethnographic observations, semi‐structured interviews and focus groups with 95 participants, including local parents, service providers, VCSE organizations and Council leaders. The findings illustrate that families value the compassionate, responsive and flexible support available within many VCSE settings. However, differences in practice cultures, regulatory pressures on statutory providers, the need to (re)build trust in communities and sensitivities around power‐sharing and resourcing meant negotiating VCSE sector integration was fraught with complexities. Few studies have gained such privileged access to a Local Authority's remodelling of Early Help services, and this paper has significant insights for the debates surrounding the independent review of children's social care (2022) and its recommendation to bring services ‘closer to communities’.

Voluntary Community and Social Enterprise organisations (VCSEs) bring valuable knowledge of local health and care needs and have skills in engaging underserved communities. This makes them ideal partners for integrated health and care researchers. Yet, they are often excluded from research. This paper reflects on the benefits and challenges of VCSE-researcher collaborations and shares examples from Australia and the UK of how these have been overcome in practice. We explore how integrated care researchers can work with VCSEs to empower the voice of lived experience, bring greater inclusivity in research methodologies and deliver meaningful findings within local and diverse contexts.

PurposeTo study the ways in which the people involve in social enterprises make sense out of what they are trying to do.Design/methodology/approachThe study focused on the issues and concerns of participants in a social enterprise network in Bradford, UK, where the network includes both social enterprises and agencies offering them support. Explains that the study aimed to examine the relationship between the development of social enterprise and organizational identity, processes and problems to determine what shared meanings and sense of shared identity are used by participants to make sense of social enterprise, how these are related to actions and projects within the social enterprise sector, and whether there is network integrity in responding and adapting to changes. Reports on a case study involving exploratory semi‐structured interviews, between November 2005 and February 2006, with 11 key actors involved in social enterprise networks in Bradford, all of which were involved in either delivering services to the community or from agencies tasked with supporting these groups.FindingsFive key themes emerged from the interviews: identifying as a social entrepreneur; organizational identity; common language; growth; and networking. Concludes that the factors involved in the way that actors in social enterprises make sense of their activities include: identity, where most organizations did not identify a heroic leader nor would they choose to become social entrepreneurs; lack of a common metaphor; staying small; and fragmentation.Originality/valueProvides a useful starting point from which to explore the problems faced by social enterprise organizations.

This dissertation delineates the state-induced emergence and mainstreaming of South Korea’s (hereinafter, ‘Korea’) social enterprise sector following the enactment of a social enterprise promotion act in 2007. In particular, this dissertation contextualizes the public sector-led popularization and mobilization of social enterprises and studies the outcomes of this intervention. This dissertation includes analyses of networks, discourse, and geographic agglomerations, and it highlights the pressures, mechanisms, institutions, and organizations that have been integral to this process of state-induced innovation. It contributes to the literature on interactions between the state and social economy organizations, such as social enterprises. The relationship between the state and social economy organizations has been subject to much academic scrutiny, and the Korean case contributes to this literature by illustrating how the state has induced the emergence and scaling of social enterprises as a private organizational form and also by showing where social enterprises have flourished. The Korean case contrasts with the North American and European cases in that in Korea the state purposively popularized social enterprise, as opposed to the North American and European traditions where the origins of social enterprise are more closely linked to civil society. This has implications for how states can induce the founding of private organizational forms that serve their interests. Korea is an especially intriguing case study given that ‘social enterprise’ as an organizational form was almost entirely absent from Korean society prior to 2007, yet has now become embedded into society in the sense that social enterprises are found in nearly every industry and municipal district. There are now thousands of social enterprises in Korea a little more than a decade after the enactment of social enterprise promotion legislation. Civil society has, evidently, accepted social enterprises as a valid organizational form. This dissertation seeks to establish an empirical platform and a theoretical framework which can be utilized for a more theoretical analysis of social enterprise and other social economy organizations in Korea in future studies. Nevertheless, this dissertation does reveal how actors can manipulate the path dependencies imposed by history, and the capabilities bequeathed by it, to forge new possibilities in novel and strategic ways. The Korean state’s ability to induce social innovation is a tangible illustration of such.

INTRODUCTION: In the eco and responsible tourism sector, social enterprises (organisations which fund their social mission through market activities) can meaningfully engage with local communities in their pursuit of social impact. OBJECTIVES: This paper explores the trade-offs social enterprises make to balance market viability and social mission within the eco and responsible tourism context, focusing on how these trade-offs intersect and impact organisational strategies. METHODS: The research adopts a thematic analysis of data collected from nine social enterprise organisations who partook in semi-structured interviews. RESULTS: Two intersecting axes of trade-offs are presented: how beneficiaries are included in the development of market outputs, and the second on how its social value is dispersed. CONCLUSION: A framework is developed to enable self-reflection and evaluation of the trade-offs and risks involved to social mission and market viability.

A social enterprise organisation seeks business solutions to social problems. It identifies social needs and uses the market to address them. Existing literature presents a variety of concepts and frameworks to connect market sector organisations with social amelioration agendas, including corporate social responsibility and stakeholder management. Yet, the demand for such organisations to contribute to resolving social problems remains, and international business and management scholarship in this area needs to be supplemented by literature on governance and regulation. The central objective of this thesis is to examine the potential of the social enterprise as a market sector organisation, to address social problems principally by examining a case study of a market sector organisation dealing directly with the climate crisis. The primary argument of the thesis is that the social enterprise has a unique internal context, which it harnesses to formulate strategies and to manage its external context consistent with a social mission. The unique features of its internal context enable the social enterprise organisation to enact the concept of social enterprise. These features include an explicit and solely social mission, social capital, social entrepreneurship, a stakeholder-ownership structure, and organisational hybridity and heterogeneity. In discussion of the principal case study findings, the thesis highlights that through a social mission, a stakeholder-ownership structure, hybridity and heterogeneity, the social enterprise can operate beyond stereotypes of market sector organisations. It does not have to focus purely on mechanisms for increasing individual, private wealth and can pursue social agendas as its purpose. Using its social capital and social entrepreneurship, the social enterprise can cooperate with other actors in constructing, through regulation and governance, a ‘choice architecture’ persuading actors to make socially ameliorative decisions. This lowers the complexity and uncertainty that characterise the social arena and can lead to opportunities for further cooperation for problem resolution. The central implications of the case study and the literature review are discussed in this thesis by examining the thesis findings in the context of the climate crisis. Through its unique features the social enterprise organisation is able to enact concepts proposed as opportunities for pursuing organisational resolutions to the climate crisis, perceived to be the realignment of incentives to which cooperation, politics and regulation can contribute. These concepts include ‘transformative leadership’ to pursue social equity and justice as a path towards resolution of the climate crisis, and ‘natural capitalism’, the realignment of capitalism with the value of ecosystems and natural resources. The social enterprise organisation possesses the motivation and capability to enact these concepts.

Evaluation of the National Institute for Health and Care Research’s (NIHR) Global Health Research (GHR) Portfolio - Inception Report

BackgroundPrevalence of self-harm In England is rising, however contact with statutory services remains relatively low. There is growing recognition of the potential role voluntary, community and social enterprise sector (VCSE) organisations have in the provision of self-harm support. We aimed to explore individuals’ experiences of using these services and the barriers and facilitators to accessing support.MethodsQualitative, online interviews with 23 adults (18+) who have accessed support from VCSE organisations for self-harm in the Yorkshire and the Humber region were undertaken. Interviews were audio recorded and transcribed verbatim. Thematic analysis was undertaken using NVivo software.ResultsParticipants described how a lack of service flexibility and the perception that their individual needs were not being heard often made them less likely to engage with both statutory and VCSE organisations. The complexity of care pathways made it difficult for them to access appropriate support when required, as did a lack of awareness of the types of support available. Participants described how engagement was improved by services that fostered a sense of community. The delivery of peer support played a key role in creating this sense of belonging. Education and workplace settings were also viewed as key sources of support for individuals, with a lack of mental health literacy acting as a barrier to access in these environments.ConclusionsVCSE organisations can play a crucial role in the provision of support for self-harm, however, pathways into these services remain complex and links between statutory and non-statutory services need to be strengthened. The provision of peer support is viewed as a crucial component of effective support in VCSE organisations. Further supervision and training should be offered to those providing peer support to ensure that their own mental health is protected.

Social prescribing link workers have become part of primary health care in recent years. They help patients to recognise non-medical factors affecting their health and identify sources of support, often in the voluntary, community and social enterprise sector. They form part of wider work to strengthen person-centred care, which actively seeks to engage individuals in decision-making about their health, taking into account their medical, social, psychological, financial and spiritual circumstances. To understand how buy-in to social prescribing and the link worker role is established for a patient, and how this relates to person-centred care. A realist evaluation. Patients engaging with link workers in seven different parts of England were involved. As part of data collection, we observed link workers interacting with 35 patients. We also interviewed 61 patients and re-interviewed 41 of them 9-12 months later. Data were coded and developed into context-mechanism-outcome configurations, which were used to produce a programme theory. Data highlighted how patients might be uncertain about the link worker role but agree to a referral as they sought assistance with their non-medical issues. Patients talked about experiencing a sense of hope through the trust they developed in a link worker. This trust was established through the communication skills and knowledge demonstrated by a link worker, and by their ability to act as an anchor point when required - a reliable, consistent source of support to whom patients could offload. The link worker role also involved connecting patients to external support, which called for sensitivity around how ready someone was to move forward; this was shaped by a patient's motivation but also their capacity to make changes given other demands in their life. Connecting patients to external support could be affected by structural factors outside the link workers' control (e.g. housing options or employment opportunities). We did not interview patients who had rejected the offer of social prescribing, and most had a positive view of meeting with a link worker. Person-centred care is engendered by link workers through their skills, knowledge and ability to respond to the individual readiness of patients to engage with external support. It can be curtailed by structural factors outside link workers' sphere of control, such as access to housing or caring responsibilities of patients. This can hinder patients' ability to 'connect to', leaving link workers to continue 'connecting with' patients as they act as an anchor point. Exploration is required of factors affecting patients who interact with a link worker but do not access external support. Longitudinal work with a cohort of patients, speaking to them on a regular basis, may provide further understanding in this respect. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.

The Voluntary, Community and Social Enterprise (VCSE) sector offers services and leadership within the health and care system in England and has a specialist role in working with underserved, deprived communities. This evaluation aims to identify best practices in self-management support for those living with type 2 diabetes mellitus (T2DM) and to develop a theory of change (TofC) through understanding the impact of VCSE organisations on diabetes management. An appreciative inquiry (AI) was carried out and co-delivered using qualitative interviews and an embedded analysis with VCSE partners. A voluntary service coordinated seven VCSE organisations who assisted with recruiting their service users and undertook interviews to identify the impact of existing activities and programmes. People living with T2DM were interviewed about services. Themes were as follows: (a) individual and group activities; (b) trusted services and relationships across the community; (c) long-term engagement; (d) sociocultural context of diet and nutritional choices; (e) experience of adaptation; and (f) culturally appropriate advice and independent VCSE organisations. The structured educational approach (DESMOND) for T2DM was accessed variably, despite these services being recommended by NICE guidelines as a standard intervention. The VCSE offered continuity and culturally appropriate services to more marginalised groups. This evaluation highlights the importance of targeted engagement with underserved communities, particularly where primary care services are more limited. The TofC is a unique insight into the impact of VCSE services, offering bespoke support to manage T2DM, suggesting areas for improvements in capacity and offering the capability to sustain the VCSE sector as an essential element of the T2DM care pathway in England.

Social prescribing interventions connect mental health service users to community resources, to support physical and mental wellbeing and promote recovery. COVID-19 restrictions impacted the delivery of socially prescribed activities, preventing face to face contact for long periods. The aim of this study was to understand how Voluntary Community and Social Enterprise (VCSE) organisations working with a local NHS mental health Trust responded to the challenges of social distancing during the COVID-19 pandemic. This understanding will be used to make recommendations for future practice, post-lockdown. Using a convergent mixed methods design, we surveyed VCSE providers of socially prescribed activities intended to be accessible and appropriate for people with severe mental health needs. Follow-up interviews explored further how they adapted during the first year of the pandemic, the challenges they faced, and how they sought to overcome them. The survey and interview data were analysed separately and then compared to identify convergent and divergent findings. Twenty VCSE representatives completed the survey which provided a snapshot of changes in levels of connection and numbers reached during lockdown. Of 20 survey respondents, 11 participated in follow-up interviews. Interviews revealed that lockdown necessitated rapid change and responsive adaptation; activities were limited by resource, funding, safeguarding and government restrictions; no single format suited all group members; connection was key; and impact was difficult to gauge. VCSE organisations commissioned to deliver creative socially prescribed activities during the pandemic rapidly adapted their offer to comply with government restrictions. Responsive changes were made, and new knowledge and skills were gained. Drawing on experiences during lockdown, VCSE organisations should develop bespoke knowledge, skills and practices to engage service users in future hybrid delivery of arts, sports, cultural and creative community activities, and to ensure that digital activities offer an equivalent degree of connection to face-to-face ones. Additionally, more effective methods of gaining feedback about patient experience of hybrid delivery is needed.

BackgroundSocial prescribing interventions connect mental health service users to community resources, to support physical and mental wellbeing and promote recovery. COVID-19 restrictions impacted the delivery of socially prescribed activities, preventing face to face contact for long periods.AimsThe aim of this study was to understand how Voluntary Community and Social Enterprise (VCSE) organisations working with a local NHS mental health Trust responded to the challenges of social distancing during the COVID-19 pandemic. This understanding will be used to make recommendations for future practice, post-lockdown.MethodsUsing a convergent mixed methods design, we surveyed VCSE providers of socially prescribed activities intended to be accessible and appropriate for people with severe mental health needs. Follow-up interviews explored further how they adapted during the first year of the pandemic, the challenges they faced, and how they sought to overcome them. The survey and interview data were analysed separately and then compared to identify convergent and divergent findings.ResultsTwenty VCSE representatives completed the survey which provided a snapshot of changes in levels of connection and numbers reached during lockdown. Of 20 survey respondents, 11 participated in follow-up interviews. Interviews revealed that lockdown necessitated rapid change and responsive adaptation; activities were limited by resource, funding, safeguarding and government restrictions; no single format suited all group members; connection was key; and impact was difficult to gauge.ConclusionsVCSE organisations commissioned to deliver creative socially prescribed activities during the pandemic rapidly adapted their offer to comply with government restrictions. Responsive changes were made, and new knowledge and skills were gained. Drawing on experiences during lockdown, VCSE organisations should develop bespoke knowledge, skills and practices to engage service users in future hybrid delivery of arts, sports, cultural and creative community activities, and to ensure that digital activities offer an equivalent degree of connection to face-to-face ones. Additionally, more effective methods of gaining feedback about patient experience of hybrid delivery is needed.