Change, language and local voice: insights from March’s Reps & Reference meeting 

This Reps and Reference meeting held a mirror up to how it feels to work in and around the health and care system right now.

Organisations were not just sharing updates. They were naming risks. They were also naming something harder to pin down: a sense that progress we have fought for, in how the system values communities and the VCSE sector could slip backwards if we do not stay alert.

Here are three things that stood out.

The system is changing and it feels unstable

A lot of the conversation came back to the ICB changes.

Organisations talked about scale of reduction, early redundancies, and the knock-on impact of losing people and relationships that have held the system together. One concern was that Leeds may not have a dedicated health commissioner in the same way it has had for the past 25 years, with more functions sitting at West Yorkshire level.

That kind of shift changes how decisions get made and where influence sits. It also risks decision making becoming even more distant from people. Not because anyone wants that, but because it is what happens when capacity reduces and responsibility moves up a level.

The other impact of instability is what it does to partnership working. When organisations are under pressure, meetings become more siloed. People focus on their own organisational position. Joined up thinking becomes harder to sustain. That creates a real risk that VCSE delivery and insight gets picked up later than it should, after plans are already set. As a sector always riding the wave of insecurity and change we have learned to face changes by being more joined up, not less. We’re experts by experience of neighbourhood health and community power, there is a massive opportunity to embed the way we were so why does it feel like we’re losing ground not gaining it?

There is a fear of slipping back into clinical models, jargon and closed conversations

Several organisations described a drift in meetings towards clinical language and clinical outcomes, with less space for prevention, community assets, and wider social factors.

This came through strongly in the discussion about neighbourhood health. The point was simple. Neighbourhood health cannot become just a clinical model in a hub. It has to be about how people live, what support exists locally, and what helps prevent crisis in the first place. Let’s thread through the Leeds Ambitions,  Marmot principles and the Better Lives Strategy, remembering that the majority of health determinants are the wider determinants, where we live, work, our environment, connections and diet.

Alongside that was a clear frustration about language. Acronyms and technical terms are creeping in more. That creates a barrier, especially for smaller organisations, new reps, and organisations who are not in these system meetings every week. It also makes it easier for conversations to lose their human focus.

A related point came through too. If the system wants evidence, the VCSE sector can bring it, but it often comes at a cost. Care and Repair shared an example where they funded their own pilot to show how environmental factors contribute to falls. Once the data showed cost savings and reduced hospital use, the system listened more and involved them more.

That story is positive, but it also lands a bigger question. Why do VCSE organisations have to go further than others to be believed. We also know of too many cases where the evidence did show a cost benefit but there wasn’t the budget to fund. 

Power feels like it is moving away from Leeds and the local voice matters

The third theme was about where power sits.

If more commissioning and influence moves up to West Yorkshire level, there is a real risk that Leeds becomes harder to advocate for. One organisation compared it to transport, where decision-making at the West Yorkshire Combined Authority level can feel distant and harder to engage with.

This is not an argument against working at West Yorkshire level. It is a reminder that place matters. Leeds has distinct communities and a VCSE sector that has taken years to build relationships, trust and delivery models that work locally.

There was also a strong message about the Leeds Provider Partnership. If more influence sits there, we need to make sure partnership does not weaken. Organisations were clear that some parts of the system fully understand the value of the third sector. Others still treat it as a nice add on, not understanding the breadth of service delivery. That gap becomes more risky during financial pressure and structural change.

The State of the Sector report is a useful place to start discovering the role of the VCSE and Third Sector in Leeds. The report shows much to celebrate and how it is a sizable Third Sector working across important areas of work with diverse beneficiary groups. It is a snapshot picture of our sector.

Using the principles to hold the line

One practical point from the meeting was about using what is already agreed.

The NHS West Yorkshire ICB Strategic Commissioning Principles for VCSE Collaboration give the sector something clear to reference in meetings. They set expectations around parity in governance, fair resourcing, data and digital integration, and protecting the diversity and sustainability of the VCSE sector.

They help shift the conversation from making the case again, to asking for consistency between the principles and what is happening in practice.

Closing thought

There was a lot of realism in this conversation, but also a shared sense that this is a moment to stay focused.

If the system is changing, we need to keep language human, keep decisions connected to place, and keep partnership real. The VCSE sector is not peripheral. It delivers services, it prevents crisis, and it holds community trust and insight the system cannot get from clinical data alone.