Authors' objectives: There is increasing recognition in England that voluntary sector specialist sexual violence services are essential in providing crisis and longer-term support to victim-survivors. However, there is limited empirical evidence about the scope, range and effectiveness of voluntary sector specialist provision and commissioning, or what victim-survivors want from services. Explore victim-survivors’ experiences of accessing and using voluntary sector specialist services. Analyse the range, scope and funding of voluntary sector specialist services and how demand is managed. Explore the usefulness of different approaches to service delivery and different therapy models. Explore how different principles underlying service provision influence service delivery. Investigate referral patterns and pathways, and how voluntary sector specialist services fit with each other and link to the wider network of services for victim-survivors. Explore how arrangements for commissioning and funding services for victim-survivors across health, local authorities and criminal justice have evolved. Develop a taxonomy of the voluntary sector specialist services/service models being commissioned and provided. Make recommendations for the commissioning and provision of voluntary sector specialist services at practice and policy levels. Sexual violence (SV) is defined as any sexual activity or act that takes place without consent. In England and Wales, crime survey data indicate that over half a million people experience SV each year and the number who disclose to the police or seek support is increasing annually. More than 90% of victim-survivors are female. There is strong evidence that SV affects health, relationships, confidence, work and family life over the life course. In most parts of England, grassroots voluntary organisations have developed services in response to local needs. Although services vary from area to area, they often include crisis and longer-term counselling/therapy; telephone helplines; face-to-face advice; advocacy; play therapy for children; practical support in accessing other services; support groups and social and holistic activities. Most victim-survivors self-refer, while others are referred to voluntary sector specialist (VSS) SV services by a general practitioner (GP)/health/social care professional. VSS services sit alongside other local services for victim-survivors. In the last 12 years, there has been increasing national recognition in England that VSS services are essential in providing crisis and longer-term support to victim-survivors, enabling them to recover and thrive in the longer term. However, there is very little empirical evidence about the scope, range and effectiveness of VSS provision, or what victim-survivors value and want from services. There is no systematic review evidence and the few previous studies that exist are small scale and local. In addition, there is no literature on the effectiveness of different approaches to commissioning services for victim-survivors. There is also a paucity of evidence about the needs and experiences of staff working in VSS services, who can do so in a voluntary capacity. The aim of the study was to develop a comprehensive, national profile of VSS specialist services for victim-survivors in England, giving voice to service users’ experiences and using a comparative analysis of the range, scope and funding of services, victim-survivors’ service experiences, service models and approaches, service linkages and commissioning arrangements. The purpose was to make policy and practice recommendations to strengthen the overall service response to victim-survivors of SV. Explore victim-survivors’ experiences of accessing and using VSS services, identifying what needs are being met for which groups of victim-survivors and what encourages victim-survivors to take up services. Analyse the range, scope and funding of VSS services and how demand is managed. Explore the usefulness of different approaches to service delivery (including peer support and delivery by volunteers) and different therapy models. Explore how different principles underlying service provision influence service delivery, including feminist and trauma-informed principles of care. Investigate referral patterns and pathways, and how VSS services fit with each other and link to the wider network of services for victim-survivors. Explore how arrangements for commissioning and funding services for victim-survivors across health, local authorities and criminal justice have evolved over the last 3–5 years, and how they have impacted on VSS service provision. Develop a taxonomy of the VSS services/service models being commissioned and provided. Make recommendations for the commissioning and provision of VSS services at practice and policy levels, in order to strengthen overall service provision for victim-survivors of SV.

Authors' results and conclusions: We captured the combined findings conceptually and diagrammatically into a new model comprising six themes: the complex and precarious funding landscape; the challenge of competition for funding and contracts; the importance and success of partnership working with organisations; the pressured environments within which voluntary sector specialist services work; different roles, scope and eligibility of voluntary and statutory services within an area; and the ways services are organised and delivered, underpinned by services’ values and philosophies. The PROSPER study has provided hitherto missing evidence regarding the funding and commissioning of sexual violence services in England. The findings are likely to be useful in informing future commissioning of such services. The PROSPER study has also presented some unexpected opportunities for learning, particularly regarding co-research in the field of sexual violence. We also claim a contribution to theory development through the expansion of a current theoretical framework that may be of use to others working in the specialist voluntary sector. Macro commissioning context: Overall, we found a complex (and precarious) funding landscape. It is a context in which national government and centralised funding policies are not reflecting local needs and the reality of demand. The study highlighted the challenges of competing for funding and contracts, where formal partnerships are viewed as beneficial from the commissioners’ perspective, and support VSS services to pool knowledge and resource and compete for bigger contracts. In the abscence of which, joint-funded, large contracts favour larger, often generic providers. This macro environment has impacts on victim-survivors, because the commissioning agenda acts to move services away from being truly victim-survivor led. Organisational structures: The study highlights the increasing range of VSS services providing therapeutic and practical support to victim-survivors through the commissioning process. A feature of this has been the ‘upskilling’ of staff to provide services to victim-survivors. In addition, there is clear evidence of services working closely with each other to support victim-survivors. However, from a less positive viewpoint, we identified a complex patchwork of services across statutory and VSS organisations that victim-survivors can struggle to naviagte. Within the VSS context, a concerning feature is the pressurised environment (e.g. high caseloads, rising demand, higher client need) and working with increasing complexity in clients’ lives. There is evidence that practitioners are leaving VSS services, with an attendant loss of specialism and expertise from the sector. In terms of service provision, we heard from practitioners and victim-survivors that there are problems with referral processes. We identified a contradictory pattern as regards the degree to which VSS services meet the needs of victim-survivors: there are unmet needs and under-represented groups, but this is balanced by examples of good links to support for under-represented populations. Relationships and people: We found that good relationships do exist between many statutory and voluntary sector services with examples of innovation and close partnership working. Most services work with a variety of commissioners, but there is varying satisfaction with these arrangements. From the viewpoint of victim-survivors, services can be hard to navigate and access. Moreover, uncertainties about waiting times can undermine victim-survivors’ trust and the perceived quality of support they receive. Values and principles: The study provides clear evidence that VSS services are highly valued by victim-survivors. VSS services offer a dedicated, protected environment for victim-survivors where the shame and stigma of SV are understood and challenged. Needs-led services are important, which focus on survivor empowerment. Feminist and trauma-informed approaches are valued within the VSS sector, a viewpoint that was shared across the participant groups. Gender awareness is also important, within a broad framework that takes account of intersectionality. From the perspective of VSS organisations, detailed understandings of sexual abuse constitute what it means to be a specialist, trauma informed service. We captured the combined findings conceptually and diagrammatically into a new model. It comprises six prominent themes: the complex and precarious funding landscape; the challenge of competition for funding and contracts; the importance and success of partnership working with organisations; the pressured environments within which VSS services work; different roles, scope and eligibility of voluntary and statutory services within an area; the ways services are organised and delivered, underpinned by services’ values and philosophies. The PROSPER study has provided missing evidence regarding the funding and commissioning of VSS SV services in England. Even if the focus of future research is on VSS delivery (as is the case with much research in this field), it is likely that the wider lens of commissioning such services will have relevance. We claim a contribution to theory development through the expansion of a current theoretical framework that may be of use to others working in the VSS sector. The PROSPER study has also presented some unexpected opportunities for learning. At the forefront of these are the insights gained into co-research in the field of SV. We have presented transparent accounts of the strengths and limitations of this process.

Authors' methods: Interviews with key stakeholders, focus groups with victim-survivors; a national survey of key stakeholders. This multimethod study comprised five sequential work packages: work package 1: exploratory interviews with commissioners and providers and focus groups with victim-survivors; work package 2: national survey of service providers and commissioners; work package 3: in-depth case studies in four areas of England; work package 4: co-research with victim-survivors; work package 5: data integration. Co-production was built into the study from its inception through robust patient and public involvement and engagement activities. These included a co-applicant who is a survivor of sexual violence, plus the appointment of five expert-by-experience co-researchers. The COVID-19 pandemic meant that we were unable to use the proposed methods of data collection for the qualitative components. Mitigation was through developing online modes of data collection. Recruitment to the case study phase did not reach intended thresholds, but rich insights were drawn from earlier phases of the study. Co-production was built into the study from its inception through robust patient and public involvement and engagement activities. These included a co-applicant who is a survivor of SV, plus the appointment of five expert-by-experience co-researchers. The study was divided into the following work packages (WPs): WP1: exploratory interviews with commissioners and providers and focus groups with victim-survivors; WP2: national survey of service providers and commissioners; WP3: in-depth case studies in four areas of England; WP4: co-research with victim-survivors; WP5: data integration. We drew on Billis and Glennerster’s theory in relation to voluntary sector services as the underpinning framework. The theory identifies the unique features of voluntary sector services as: flatter organisational structures with less distance and distinction between senior or decision-making staff and those on the front line; closeness to communities; being mission-led and driven by core values and purpose. These three domains were relevant and appropriate in shaping our analysis. However, our findings went beyond values, communities and organisations, to include a broader commissioning context. We chose to adapt the theory and add a broader, macro level that encompassed the commissioning level/context. Data integration was thus achieved with reference to four theoretical domains: (1) macro commissioning context; (2) organisational structures; (3) relationships and people; (4) values and principles.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/18/02/27

Year Published: 2025

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/WWKT3077

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: United Kingdom

DOI: 10.3310/WWKT3077

Organisation Name: NIHR Health and Social Care Delivery Program

Contact Name: Rhiannon Miller

Contact Email: rhiannon.m@prepress-projects.co.uk