Third-sector organizations (TSOs) are recognized for having a unique and essential role in designing and delivering community-centred, sustainable health and well-being services. A World Café workshop at the 2023 International Conference on Integrated Care to explore perspectives on the questions explored the question: How do we characterize the role of the Third Sector in Integrated Care Systems? Are they Partners, Service Providers, Both or Neither? Attendees from Canada, England, Scotland, Wales, Ireland, Belgium, Denmark, and the Netherlands shared perspectives regarding facilitators and barriers to engaging TSOs in integrated care systems, drawing on experiences and practices from their communities and health systems. Building from participant perspectives, we posit that while cross-sectoral alliances between government and voluntary organizations are possible, and this engagement can contribute substantial health-promoting value to society, much work remains to be done. Meaningful collaboration requires attitudinal shifts, new working methods, rebalancing power within the relationships, and sufficient resources to support the collaboration. Creative approaches to facilitating positive engagement of TSOs within integrated care systems can address long-standing barriers and misunderstandings. Sharing and learning through research, evaluations, and networks is essential to achieve integrated care systems based on trust and committed collaboration.

CONCLUSIONS: This article suggests why a different approach may be required for commissioning services from third sector providers than from, say, corporate or public providers. English systems for commissioning third sector providers contain both commodified elements (for example formal procurement, provider competition, commissioner-provider separation) and collaborative, relational elements (for example long-term collaboration, reliance on inter-organizational networks). When the two elements conflicted, commissioners and third sector organizations tended to try to work around the commodified elements in order to preserve and develop the collaborative aspects, which suggests that, in practice, they find de-commodified, collaborative methods better adapted to the commissioning of third sector organizations.
UNASSIGNED: When publicly-funded services are outsourced, governments still use multiple governance structures to retain some control over the services provided. Using realist methods the authors systematically compared this aspect of community health activities provided by third sector organizations in six English localities during 2020-2022. Two modes of commissioning coexisted. Commodified commissioning largely embodied Washington consensus models of formal, competitive procurement. A contrasting, collaborative mode of commissioning relied more upon relational, long-term co-operation and networking among organizations. When the two modes conflicted, commissioners often favoured the collaborative mode and sought to adjust their commissioning to make it less commodified.

BACKGROUND: Within many advanced healthcare systems, patient advocacy associations are gaining a more relevant role in healthcare policy decisions. These associations provide help, representation, and voice to patients and citizens. However, although their role is important, a paucity of research exists analyzing their foundation dynamics, including their organizational decision, from a managerial perspective. To fill this knowledge gap, we formulated two research questions to investigate the motivations underlying the foundation of patient advocacy associations and the institutional pressures influencing the changes that have occurred in these associations throughout their evolution.
METHODS: Using a semi-structured questionnaire developed as part of a larger research project, we collected data about 31 patient advocacy associations operating within the Italian National Health Service. We employed qualitative analysis to examine the associations\' birth and evolution as well as the motivations and influences driving change within the sampled organizations.
RESULTS: Questionnaire responses provided information about the patient advocacy associations\' histories and highlighted their close links with the Italian National Health Service. Our results indicated the motivations for the associations\' establishment could be grouped into five categories: support at the system level, patient protection and support, actions to increase awareness, actions for improving patients\' health and quality of life, and dissemination of knowledge. We also identified the frequency and nature of the changes within the associations and explored the institutional pressures that influenced these organizational changes.
CONCLUSIONS: The results can be interpreted considering the organizational theories that focus on organizations\' establishment decisions and how external pressures impact organizations\' dynamics and evolution.

BACKGROUND: Prevalence 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.
METHODS: Qualitative, 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.
RESULTS: Participants 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.
CONCLUSIONS: VCSE 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.

UNASSIGNED: With increasing attention to models of transitional support delivered through multisectoral approaches, third-sector organizations (TSOs) have supported community reintegration and independent living post-hospitalization. This study aimed to identify the core elements of these types of programs, the facilitators, and barriers to service implementation and to understand the perspectives of providers and recipients of their experiences with the programs.
UNASSIGNED: A collective case study collected data from two UK-based \'Home from Hospital\' programs. An inductive thematic analysis generated rich descriptions of each program, and analytical activities generated insights across the cases.
UNASSIGNED: Programs provided a range of personalized support for older adults and addressed many post-discharge needs, including well-being assessments, support for instrumental activities of daily living, psychosocial support, and other individualized services directed by the needs and preferences of the service user. Results suggest that these programs can act as a \'safety net\' and promote independent living. Skilled volunteers can positively impact older adults\' experience returning home.
UNASSIGNED: When the programs under study are considered in tandem with existing evidence, it facilitates a discussion of how TSO services could be made available more widely to support older adults in their transition experiences.

BACKGROUND: The increase in demand for young people\'s mental health services has been met by a growth of co-located mental health service provision in the NHS and third sector. This research explores the benefits and challenges of the NHS collaborating with a charity to provide a step-down crisis mental health service for young people in Greater Manchester, and suggests how the collaboration between the NHS and third sector may be improved for future projects.
METHODS: Working from a critical realist paradigm, this qualitative case study utilised thematic analysis of 9 in-depth interviews with operational stakeholders from 3 operational layers, to explore insiders\' perspectives of the benefits and challenges of collaboration between the NHS and third sector in the context of the \'Safe Zones\' initiative.
RESULTS: Themes relating to perceived benefits of collaboration were: doing things differently, flexibility, a hybrid approach, shared expertise, and shared learning. These were counterbalanced by perceived challenges: getting the pieces to fit, obtaining a shared vision, geography, lack of referrals, and timing. The importance of effective communication (e.g. of shared vision, standard operating procedures, key performance indicators) was noted as central to addressing challenges and reaping benefits.
CONCLUSIONS: NHS and third sector collaboration can yield a range of benefits, some of which can mitigate against the perceived inflexibility and restrictive nature of usual mental health service provision, thereby providing a vehicle for innovation in step-down crisis care for young people.

The COVID-19 pandemic exerted an extraordinary pressure on the Italian healthcare system (Sistema Sanitario Nazionale, SSN), determining an unprecedented health crisis. In this context, a multidisciplinary non-governmental initiative called Italian Response to COVID-19 (IRC-19) was implemented from June 2020 to August 2021 to support the Italian health system through multiple activities aimed to mitigate the effects of the pandemic. The objective of this study was to shed light on the role of NGOs in supporting the SSN during the first pandemic wave by specifically exploring: (1) the main challenges experienced by Italian hospitals and out-of-hospital care facilities and (2) the nature and extent of the IRC-19 interventions specifically implemented to support healthcare facilities, to find out if and how such interventions met healthcare facilities\' perceived needs at the beginning of the pandemic. We conducted a cross-sectional study using an interviewer administered 32-item questionnaire among 14 Italian healthcare facilities involved in the IRC-19 initiative. Health facilities\' main challenges concerned three main areas: healthcare workers, patients, and facilities\' structural changes. The IRC-19 initiative contributed to support both hospital and out-of-hospital healthcare facilities by implementing interventions for staff and patients\' safety and flow management and interventions focused on the humanization of care. The support from the third sector emerged as an added value that strengthened the Italian response to the COVID-19 pandemic. This is in line with the Health-Emergency and Disaster Risk Management (H-EDRM) precepts, that call for a multisectoral and multidisciplinary collaboration for an effective disaster management.

Successive crisis in Europe have contributed to rethink welfare state and the entrepreneurial role of Third Sector organizations in the provision of community services that progressively have created social enterprises. Its creation is the result of a decision-making process that is collective, not individual, and of a strategic nature, in which the organization\'s culture plays a relevant role. This work aims to describe and analyze the entrepreneurial process, and the key elements that determines the decision of creating a work insertion social enterprise by its promotor entity. As a result, this article proposes an explicative model of social enterprises creation and makes an empirical validation, using Delphi Method in Spanish work insertion social enterprises case.
Las sucesivas crisis en Europa han contribuido a una puesta en cuestión del estado de bienestar y, con ello, al rol emprendedor o productivo de las organizaciones del Tercer Sector en la provisión de servicios a la comunidad, en la medida en que éstas han creado empresas sociales progresivamente. Su creación es el resultado de un proceso de toma de decisión que es colectivo, no individual, y de naturaleza estratégica, en el que la cultura de la organización juega un rol relevante. Este trabajo trata de describir y analizar el proceso emprendedor y los elementos clave que determinan la decisión de crear una empresa de inserción social, por parte de su entidad promotora. Como resultado, este artículo propone un modelo explicativo de la creación de empresas sociales y realiza una validación empírica con las empresas de inserción españolas, utilizando el método Delphi.

Social prescribing schemes refer people toward personalized health/wellbeing interventions in local communities. Since schemes hold different representations of social prescribing, responses to the pandemic crisis will vary. Intersectionality states that social divisions build on one another, sustaining unequal health outcomes. We conducted and inductively analysed interviews with twenty-three professional and volunteer stakeholders across three social prescribing schemes in urban and rural Scotland at the start and end of year one of the pandemic. Concerns included identifying and digitally supporting disadvantaged and vulnerable individuals and reduced capacity statutory and third-sector services, obliging link workers to assume new practical and psychological responsibilities. Social prescribing services in Scotland, we argue, represent a collage of practices superimposed on a struggling healthcare system. Those in need of such services are unlikely to break through disadvantage whilst situated within a social texture wherein inequalities of education, health and environmental arrangements broadly intersect with one another.

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