Meeting as equals

My new report, Meeting as equals: Creating asset-based charities which have real impact, will be published by the RSA and NCVO and launched online at an RSA seminar on Thurs 28th January 2021: here

2020 was a year of extremes for voluntary organisations and volunteering. Hundreds of thousands of people have stepped forward to offer to help during the pandemic, including three quarters of a million wishing to help the NHS, people volunteering to help with the vaccination programme, and uncounted thousands setting up mutual aid groups for their street or neighbourhood. Meanwhile hundreds of much-loved charities are providing more support than ever while teetering on the edge of financial collapse as fundraising and earned income has plummeted.

Many charities, like many households and communities, are in survival mode. But for those charities which are able to survive, what then? The future that we might have predicted a year ago has disappeared. Even as many of us live day-to-day, a new future is beginning to emerge. Charities can wait for it to become clear before reacting to it, or we can do what we have always done at times of societal upheaval and be part of shaping it.  

To do that, we don’t just need to overcome our immediate financial challenges, but to recognise and engage with the reputational, public trust and financial crises we were facing as a sector before the pandemic hit. Those issues haven’t gone anywhere. Some were rooted in the difficulties of running organisations which can be complex, large and under financial pressure, while demonstrating the close relationships with community and the very human ethos which all of us expect from charities. Many rose to that challenge and won large public service contracts through responding to the pressure on charities to professionalise and become more commercial and competitive. But after ten years of government funding shrinking far below the level needed for consistently exceptional quality, and some private sector organisations co-opting the language of community to talk about their customers, the challenge now is for charities to demonstrate that we are different. That we can draw on community action just as much as service expertise and that we work in ways which drive the social changes we call for.

During the pandemic, the charity I work for, Shared Lives Plus, has been changing rapidly like many others. We support a national network of Shared Lives carers and Homesharers who share their homes and family lives with people seeking supportive householders. The 170+ local organisations who are part of our network coordinate supportive shared living for over 15,000 people. We’ve seen how more human, personal and deeply community-embedded forms of support can not only be safer and more effective but can be part of creating more inclusive and active communities at a time of burgeoning isolation and loneliness.

The services in our network are based around people who seek support and those who offer it ‘meeting as equals’ and our members are not alone in taking an approach which seeks to find and build on the strengths and potential of people and communities. In writing Meeting as equals: Creating asset-based charities which have real impact, published by the RSA and NCVO on January the 28th, I have talked with charities which have done just that, often in the most challenging circumstances.

Slung Low Arts is a theatre company which was already sharing its space with a working man’s club, and which has now become a food bank for 7,500 households, because, in the words of co-founder Alan Lane, “My desire to make a big piece of outdoor theatre is irrelevant if people are too hungry to come to a play.” This change came about because when COVID hit, and the team thought ‘what do we do now?’, rather than decide that amongst themselves, they posted a letter through the nearest 200 doors to say “we are here, we have transport, what do you need?” and were willing to be led by the responses.

Recovery Connections believes the key to providing a more personalised substance misuse recovery service is that people with lived experience make up the majority of the team at every level. Dot Smith describes working with the ‘messiness’ in her words, which can come with high levels of trauma. But it’s embracing and valuing that humanity which has enabled Recovery Connections to be one of the few services of its kind to be rated as outstanding by CQC.

These organisations are not just willing to talk about new approaches, but also to talk with a new group of co-decision makers. Sharing decision making through ‘co-production’ is the first step in allowing everyone involved with an organisation to start looking for people’s strengths, assets and potential, not just their needs and problems.

The report sets out what it takes for a charity to embed asset-based thinking throughout every aspect of an organisation. It recognises that how we work is as important as what we do. And that how we work is fundamentally about who ‘we’ are. Who is allowed in the room when we make decisions? Who do we employ? Who shares in the resources, but also in the responsibilities and the risks?  We like to say that we ‘speak truth to power’, but we must also recognise the power we have amassed ourselves, even at a time when our resources, capacity and influence can feel diminished. The ‘asset-based’ charity will share its platforms, access, research expertise and resources with communities in support of the issues which feel most important to them, demanding less control in return.

Can a charity deliver government-contracted services and run genuinely independent campaigns? Can a financially-struggling organisation become more commercial as well as more community-rooted? I believe that they can. A concept underpinning asset-based thinking is the idea that some things we see as scarce are in fact abundant when we change our approach. Power and resources are not zero-sum: when we set out to combine the resources and expertise of charities with the resourcefulness and care of communities, we can create organisations which build community capacity and which make a compelling cost-benefit case to those commissioners willing and able to listen. When we look for ways of sharing our own power with those we purport to represent, our combined voices can be louder and the message more urgent.

The future of health and social care – conclusions from the Joint VCSE Review

I have come to the end of my role as independent chair of The Joint VCSE Review which took hundreds of views from voluntary, community and social enterprise (VCSE) organisations and developed actions, co-owned by government and sector, for how statutory and voluntary organisations should work together with citizens to redesign a more community-based health and care system, and then deliver that model. At national level, we helped design the Health and Wellbeing Alliance and the Health and Wellbeing Fund. NCVO provided the secretariat and a huge amount of support and expertise to the review, along with too many colleagues from the VCSE sector and from the Dept for Health and Social Care, NHS England and Public Health England to list here – I’m very grateful to them all.

My conclusions and recommendations for future joint policy work between government and the VCSE sector are here, and I am looking forward to discussing them with Simon Stevens of NHS England, Duncan Selbie of PHE, and Caroline Dinenage, the Minister of State for Care, shortly. NCVO have kindly published my blog on it here, which begins:

What does the health and social care system want from charities and social enterprises? The answers to this vary, and sometimes contradict each other. Voluntary, community and social enterprise (VCSE) organisations are asked to be more efficient and to merge into bigger organisations which can be contracted with, but they are also challenged to remain rooted in their communities and to tailor their work with specific communities. They should be collaborating not competing, while grant funding continues to be replaced with competitive contracting. The public expect charities to be independent, strong voices challenging the NHS and councils when they let people down. Those bodies generally welcome constructive criticism – up to a point.

When the world’s expectations of us become impossibly complex, the question we should ask becomes simple: what are we for?

Read the rest here.

Charities, community groups and social enterprises at the heart of health and care

Today we launch the final report and recommendations from the Joint Review of the Voluntary Community and Social Enterprise (VCSE) sector’s role in the health and care system. This follows a year and a half of hard work by an advisory group (which I have chaired) made up of people from the VCSE sector working together with people from national and local government. It’s been hard work and the co-produced process has at times challenged the usual systems for producing reports, with lots of pragmatism required on both sides. But I feel (and hope you’ll agree!) it’s been worthwhile, in order to build a consensus around a clear view of what the VCSE can and could do, the challenges it faces and the ways in which many of those challenges could be overcome. I’m incredibly grateful to everyone on the group, NCVO who provided the secretariat, communications support and much more, and to lots of colleagues working behind the scenes and in numerous agencies we liaised with, who have all worked so hard to get to publication (see www.gov.uk for full report). Here is the blog which I wrote for the launch:

The goal shared by everyone who delivers and organises health and care services is wellbeing: its creation and its resilience. Whilst we do not want to spend increasing proportions of our lives in medical nor social care, we will all draw upon primary, acute or specialist services at various points in our lives and we want to find them available, caring and well run when we do. However, whether for people with lifelong disabilities, the ever growing older population or those with long term health conditions and support needs, our dreams remain rooted in living well at home as part of welcoming, inclusive communities. To achieve that goal, we need health and care systems which are organised around and support our lives: which can reach us in our homes, support our families to care, and release the full potential of communities.

When people talk about the difference that charities, social enterprises and community groups can make to delivering health and care services, they often focus on the ways that those organisations can reach people whom mainstream health and care services find ‘hard to reach’ or ‘challenging’, get to know them more deeply, and draw upon volunteers to achieve more than paid staff alone can achieve. All true, and extremely valuable, but, our review of the voluntary, community and social enterprise or VCSE sector found, only half the story.

There was indeed wide agreement that good VCSE organisations are better placed than other kinds of organisation to achieve some of the health and care goals which are now seen as crucial to the sustainability of our NHS and social care systems. It is VCSE organisations which often support groups and communities which are otherwise neglected, not only responding to health needs but also starting to address the social determinants (poverty, housing, exclusion) of health and deep-rooted health inequalities. Through drawing on people power as well as money, VCSE organisations are often uniquely able to offer support which looks at the whole person and whole family, thinking preventatively and whole-lifetime. Many of our recommendations are designed to identify, measure and invest in those added kinds of ‘social value’ which VCSE organisations bring into a system desperately searching for more bang for its buck.

The current funding trajectory in some areas is towards large, narrowly focused contracts, which can be appropriate to holding big providers to account, but can be poor ways to create the diverse local marketplace of big, small and niche providers called for by the Care Act and needed to reach whole populations and to offer people genuine choice. The most creative planners and commissioners are drawing on the full range of investment approaches, using contracts creatively alongside grants for community development work, personal budget and Personal Health Budgets for personally tailored support packages, social prescribing to link up vulnerable people with effective charities (with funding following the prescription to ensure that’s sustainable), and social investment to take risks and innovate.

So developing the VCSE sector as a distinct form of health and care provision is crucial and brings value into the system that money alone cannot buy. But for many of the VCSE organisations and local commissioners who responded to our consultation, just as important as how much funding VCSE organisations could win through competing to provide services, was the extent to which VCSE organisations were involved in planning those services: co-designing the local health and care goals and playing a full part in developing responses to local needs and building on local assets and community resources.

Traditionally, the health and care system has been designed largely by the state Continue reading

It’s ‘voluntary’ but not optional

I’m re-blogging the post below from http://www.voluntarysectorhealthcare.org.uk/vcse-review/ which is the website for a review of investment in the voluntary, community and social enterprise (VCSE) sector which I’m chairing on behalf of a group of VCSE organisations and the Department of Health, NHS England and Public Health England. The review is based on the view set out in all of those bodies’ strategies and visions for the kind of enabling, collaborative and community-based approach to achieving health and wellbeing which could only be achieved with a thriving and valued VCSE sector. In other words, a sector which might be known as ‘voluntary’, but which cannot be seen as optional:

Having been asked to Chair this review of the voluntary, community and social enterprise sector, I’ve been more thinking than normal about what kind of VCSE sector we want and what kinds of relationships national and local health and care bodies should have with it. For me personally (and in this blog you’re going to find the personal views of advisory group members, not any ‘official’ lines), the real question here is what kind of health and care system do we want in this country?

If we want the same kind of health and care system we’ve always had, then we need a VCSE sector which gets better at delivering on public service contracts, and provides a steady supply of volunteers to help out alongside professionals. Nothing wrong with those goals, but actually I think we need a very different kind of health and care system, and the national health and care strategies all read as visions for something very different, not just a more efficient version of what we’ve always aimed at. This means a different view of what charities, community groups and social enterprises are there for, and how their contribution should be supported and valued.

If the challenges of 1948 were our major challenges now, the health system would be well able to meet them. But our key challenge now is that health and care is not used by only a relatively small number of people for a relatively short time. A quarter of the population now lives with a long term condition and many of those with several long term conditions. Living well with a long term condition, avoiding health and other crises, is not something even a great service and the most expert professionals can do for us, it is something which is only achievable when people with long term conditions, family carers, communities and professionals work together, each making their own kind of contribution, sharing information and expertise, and backing each other up when things get tough. Living well requires joined-up health, care and housing interventions, but also services which can join up with informal action and arrange themselves around our real, messy, lives.

Charities, community groups and social enterprises can do many things well, from delivering huge public service contracts to running campaigns which change the national conversation, but Continue reading

Why we need the government to act on the Choice Review

With some of our partner organisations, we wrote an open letter last week to Care Minister Norman Lamb MP, urging him to act on the recent Cabinet Office review of choice in public services, which recommended that people should be free to spend personal budgets as they see fit so long as they meet broad outcomes, with the removal of ‘preferred provider lists’ and other traditional commissioning approaches which hamper start-ups, micro-enterprises and other innovators from competing with bigger, more established providers. There’s no point in having control of the money if there’s nothing new or different to buy with it. As reported in Community Care, we warned that without these ‘supply side’ reforms, the risk of personalisation failing in its own terms is high.

A great illustration of the problem is in this Guardian article about how council procurement processes left one social entrepreneur literally starving (at least around lunchtime!) due to their inabiility to renew a contract in a timely fashion. When the basics are so wrong, having an impressive virtual online marketplace for providers and a marketing programme to encourage people to take personal budgets will fall flat.

Our report on Ten ways to stop bashing -and start boosting – micro-enterprise shows how councils can learn from the best work of their peers and get this right, so that we can ‘Make Personalisation Real’, not just another box-ticking exercise.

Making the right connections

My blog on taking an assets-based approach to healthcare reform, particularly where public health and other behaviour changes are required, is on PublicService.co.uk here: http://bit.ly/LJRVab

Simply improving the way we commission existing health services will not achieve what society really requires, says Alex Fox, chief executive of Shared Lives Plus. He argues for a more meaningful reform of social care to challenge the primacy of hospital-based treatment….. http://bit.ly/LJRVab

Micro solutions to huge NHS problems

I spoke at the NHS Confederation conference yesterday about micro-scale and community-based approaches to health care, which was the subject of a paper I wrote for NHS Confed recently (“Working locally: micro-enterprises and building community assets“). The session was chaired by NHS Confed CEO Mike Farrar and packed with NHS professionals who, from their questions, were deeply engaged with community development and ‘assets’ approaches to healthcare. It felt like this agenda is finally getting some momentum in the NHS, which is very good news indeed. Here’s my bit from the session:

When faced with huge challenges like providing healthcare to an ageing population, it’s reasonable to assume that only huge solutions will do.

The problem with that way of thinking is that, whilst some healthcare activities need to take place on a large scale, achieving health itself happens, or fails to happen, on an individual level. Big buildings are sometimes the best place to treat illness, but achieving health generally happens in our own homes, workplaces and communities.

The only way to make sense of that conundrum (big challenges with as many different solutions as there are people) is to push as much of the power to design, control and deliver solutions into the hands of individuals, families and communities as possible.

Social care has gone a little way down this road, at least in its aspirations, if not always in its implementation. Healthcare has, in my view, barely started on this journey and the difference between the health and social care visions is striking in this respect:

The vision for healthcare is that patients will become informed consumers of the choices designed and commissioned for them by GPs and other professionals.

The emerging vision for social care is that citizens will not only be able to choose from the offers of providers and professionals, but also to take charge of commissioning and to pool their resources to design and own new services and enterprises when there is not an existing solution available to them.

Mix in healthcare circles and you will hear “clinical leadership” rather than “citizen leadership” and “patients” rather than “people”.

The comparisons I’m making are not entirely fair on the healthcare sector. If I ever need emergency brain surgery Continue reading

Setting the pace in Derby

Promote Ability Community Enterprise, known as p.a.c.e, is a community interest company set up by Debbie Jones and Craig Fletcher.  Through their 23 years of experience of front line work for the City Council and nine years working with voluntary and community organisations they felt there was a gap in services for disabled people to improve their health and quality of life choices.

From the seed of the idea, developed whilst sitting in the pub, along with donations, a helpful benefactor, support from friends, family and the community and a lot of hard work they now have a centre, with a gym, workshop and café.  They have over 20 clients per week, both self-funders or personal budget holders who buy assistance with support planning, life coaching, woodwork tuition and gym instruction from the three full time workers. Also their café is open to the public.

In the future they are eager to move towards rehabilitation services and are looking to work with local health services to develop preventative and re-enablement support. Find out more about them at: www.pacederby.co.uk

Taking gambles that pay off

This is the third blog I’m writing off the back of a seminar with social care leaders which looked at the question of citizen and community-led change. One of the debates we had on the day was the age old debate of whether change is all about changing systems, legislation and funding routes, or all about changing attitudes and culture. It’s one of a number of questions to which I think the answer is both.

We need to tell stories about, for instance, the lady in Wiltshire who was helped to maintain independence by the provision of a £100 grit bin for her hill, plus some encouragement from her neighbours to share the task of gritting, rather than the provision of a special transport service, or meals on wheels. The latter solution would have helped speed her isolation and reduced her mobility. The former could result in any number of knock-on positive impacts as the people involved got to know each better and thought about other ways they might be able to help.

Stories like that inspire. They illustrate the power of focusing on outcomes rather than mandating processes. A councillor who meets older people in their ward may well be more motivated by that story than by any number of cost benefit analyses and statistics.

But Department of Health Ministers can’t go to the Treasury to make the case for social care armed with anecdotes. They need a robust cost benefit case based on evidence gathered from thousands of people. They need to be able to show cashable savings to real services, not notional Social Returns on Investment.

But how do you quantify the economics of making changes like the grit bin example, without codifying and measuring it out of existence? One solution, I think, is for government to do what it does well Continue reading