Health and Care Voluntary Sector Strategic Partner Programme 2014 - 15

Application form

Guidance on completing and submitting your application

Please read the Information Pack for Applicants before you complete this form. It is available to download from: https://www.gov.uk/government/publications/invitation-to-apply-to-join-the-health-and-care-voluntary-sector-strategic-partner-programme

If you are using MS-WORD to complete the form, please save as the backwards compatible version. Please do not email scanned or pdf versions of the form.

Email your completed form to strategic.partners@dh.gsi.gov.uk by

12:00pm on 10 January 2014

Applications received after this time will not be accepted

If you have any queries please contact the Voluntary Sector Partnerships Team:

•	By email strategic.partners@dh.gsi.gov.uk

•	By telephone on:

o	0113 2545212
o	0113 2546649
o	0113 2545604

Text limits

We are not asking you to present a proposal or project summary. Instead, we want you to demonstrate how your organisation can deliver on a Strategic Partner role working across the health and care system. You will need to demonstrate how your organisation can meet our requirement for an organisation able to contribute to the priorities of the DH, NHS England and PHE around work, worklessness and health.

There is no text limit, but please try to be as concise as possible.

A - Your contact details

Organisation name
		
Main Contact first name
		
Main Contact Surname
		
Main Contact position
		
Main Contact email address
		
Contact telephone number

B - Joint / consortium / partnership details

If this is a joint / consortium / partnership bid please list the names of all organisations included here. If a single bid please enter ‘Not applicable’.

	
Please confirm that you have an agreed partnership agreement, memorandum of understanding or similar that governs your partnership or consortia. Please attach it to this application.

C - Organisation profile – this is the applicant organisation’s details

Legal name (if different)		
Operating name (if different)		
Abbreviation (if applicable)		
Telephone number		
Chief Executive		
Address		

Charitable status
(Please select one)		Charity	
		Exempt charity	
		Not a charity	
Charity number		
	
Legal structure
(Please select one)		Limited Company	
		Community Interest Company	
		Industrial and Provident Society	
		Unincorporated association	
		Other	
Registration number		
	
Regulatory body (where applicable)		Charity Commission	
		Companies House	
		CIC Regulator	
		Financial Services Authority	
		Care Quality Commission	
	
Area of operation or benefit		
	
Does your organisation provide a service similar to that provided by the NHS or by local authority social services?		Yes	
		No	

D – Equality Impact Assessments

To enable Equality Impact Assessments to be carried out, please provide the following information about your organisation:

Please select which best describes your organisation type		Organisation supporting / representing people 	
		Organisation supporting / representing other organisations	
	
Please select which best describes the scope of your organisation		National	
		Regional	
		Local	
	
Is the organisation named above focused on meeting the needs of a specific group of people?		Yes
	
		No	
	
If Yes, please indicate below which of the following groups best describes the people your organisation focuses on:		Black and minority ethnic groups / communities	
		Disabled people and those with long term conditions	
		Men	
		Women	
		Children or young people	
		Older people	
		Faith groups or those with no religious belief	
		Lesbian, gay or bisexual people	
		Transgender people	
		Carers	
		Families / parents	
		Socially excluded	
		Other (please state)	
	
Is the organisation User Led?		Yes	
		No	

A User-Led organisation is defined as one where the people the organisation represents (or provides a service to) have a majority on the Management Committee or Board, and where there is clear accountability to members and / or service users

If you tick Yes to User Led, this means the majority of your Management Committee or Board are from the groups of people indicated above.

E – Your contribution to the Strategic Partner Programme

In the boxes below describe how your organisation, as a Strategic Partner, can contribute to the Strategic Partner Programme and the health and care priorities of DH, NHS CB and PHE – summarised in the application pack.

1.	Describe the breadth and depth of your organisation’s memberships and networks in the voluntary and community sectors. Include a list of other organisations that you work with and describe how you work with them.

	

2.	Describe and provide evidence of your organisation’s specific expertise and strength in the areas of work, worklessness and health

	

3.	Provide evidence of your organisation’s experience of working in partnership and co-producing approaches at a national level.

	

4.	Provide evidence of your organisation’s expertise in building voluntary sector capability and capacity in health and care.

	

5.	Describe your experience and practice in supporting and enabling effective and accountable representation of citizen and community voice.

	

6.	What is your unique offer as a strategic partner that no other national umbrella or membership organisation can deliver?

If there are other organisations that work and support the same 
organisations in the voluntary sector, please describe how you would propose
to work with them for the benefit of this programme.

	

7.	Explain how you ensure open, transparent and accountable representation of people and community voice that is accessible and supported to be heard and acted upon

	

F – Equality and diversity

How will you ensure that equality and diversity issues are embedded throughout your activities and work as a strategic partner?

	

G – Board of Trustees approval

Is a member of the Board of trustees/Directors aware and content for this application to be made?

Provide his/her contact details below.

	

H – Additional Information requirements

You must also provide:

For established organisations: 
	Your most recent Annual Report and final audited accounts	
	Equal Opportunities Policy Statement	
	Health & Safety Policy Statement	
	Staffing structure for the organisation highlighting which roles would contribute to the programme 	
	Your organisations Business Plan	
	Copy of Memorandum and Articles of Association or constitution / governing document

In addition, for partnership or consortia applications you would need to provide:
	Details of the partnership or consortia arrangements including governance
	
	Confirmation from each organisation involved of their commitment to and role in the partnership / consortia – this could include a letter of support
	
	Confirmation of which organisation would be acting as the lead or accountable body

If you do not have electronic copies of your annual report and final accounts and they are not available through the Charity Commission website you should send hard copies to:

Health and Care Voluntary Sector Strategic Partner Programme 2014-15
Voluntary Sector Partnership Team
Department of Health
2E56 Quarry House 
Quarry Hill
Leeds
LS2 7UE