Kindling fires in the Bodleian?

It’s like being a student again! I turned up at the Bodleian Library in Oxford on Monday brandishing a somewhat moth eaten Library card, “well, we've not seen one of those for some time", was the amused response. “I’m afraid we have gone digital now". Well, my card was dated 1972 and not used since well back. Still, they issued me with a new plastic thing and I didn't need to take my oath again (which I did in 1972) promising not to “bring into the Library or kindle therein any fire or flame".

The Bodleian was founded in 1602 and is housed in the most magnificent buildings. I'm sitting in the Old Bodleian looking out over to the Radcliffe Camera, built by Wren and one of the Library reading rooms. I wanted to get a seat in there but it was jam packed with proper students hastily trying to cram 3 years work into a few weeks before they submit to their examiners.

Still, I had a splendid view of same from my seat- as you can see

I'm having a reading week in Oxford as part of my Great Project; the history of charity. I went through the Bod's catalogue- over 900 entries come up under “history of charity" but most are histories of individual charities or esoteric sermons and discourses. There isn't really anything that purports to provide a broad sweep of our history since the first still extant charity was established in 598 AD (Kings School, Canterbury). It’s clearly an under researched subject; crying out for a Chair of Charity Studies methinks. That's a broad hint btw. Some philanthropist (or Apple/ Starbucks now they don't bother paying much tax) ought to fund it. I could be available; I have my own gown.

The Old Bodleian

The Radcliffe Camera

What is particularly fascinating is the change that occurred over the Tudor period, following the Reformation, from essentially a religious base for charity actions to a secular form of charity and charity trusts. And as the centuries developed, the rise of the campaigning voluntary organisation emerges; particularly in opposition to slavery at the end of the 18th century and then the great charity movements of the early 19th century against child and animal abuse and prison reform for example.

So we see the move from purely service provision as effectively the arm of the State's welfare provisions to new forms of campaigning and advocacy charity and to third sector bodies that both deliver services and campaign for change. One thing is clear; there is precious little material on this aspect of the work of charities so I need more help.

But I don't want you to think I'm totally immured inside the ancient Oxford walls. I emerge to opine on the Work Programme, health and the like. 

Stephen Bubb

Charity and health provision

Well, we know when dealing with Government that rhetoric can outrun reality. Whether it's Blair or Cameron they are eloquent on the need for an expansion of the third sector in health . And, let's face it, given the challenges of long term conditions and the preponderance of the elderly in hospital beds we know a major expansion of charity and social enterprise provision is the bedrock of reform.

So it was interesting to read recent evidence from the Foundation Trust Network on the strains on casualty show a looming crisis in secondary care provision unless we act to move resources into primary and community care.

 The Nuffield Foundation has produced a report this week on the independent's sector involvement in secondary care. See here for link to the study.

It has the following startling conclusion:

"despite policy interest in social enterprises and the voluntary sector, spending on secondary care services provided by the voluntary sector between 2006/07 and 2011/12 has hardly changed. PCTs spent £410 million with the voluntary sector in 2006/07 (in 2011/12 prices) rising to £600 million in 2011/12 less that 1% of their total secondary care budget. Over this period PCTs spent less of their secondary care budget on services provided by local authorities and others."

Now, a word of caution about this. Clearly the strength of charities does not lie in the provision of hip and knee replacements!  And often the data confuses charity from private, lumping all together as “independent provision". Of course in social care, in mental health and other community provision the third sector share is much higher. In mental health over a third of all provision is third sector and many disability services are provided through charities.

However, I would argue that our charity and social enterprise sector has much to offer secondary care; particularly in growing partnerships between charities and hospitals, around better use of hospital facilities for the elderly or those reaching their end of their lives. ACEVO is working on a study of just such links with the FTN. The new CCGs could be encouraging hospitals to look at radical reconfigurations like hotel-style intermediate wards for the elderly, hospice wards run by charities, social enterprises established to run parts of the hospitals at the weekend so expensive kit is fully utilised, or community-style hospitals carved out of the current hospital estates. Indeed, why not contracts between charities like RNID or RNIB to take over the running of eye and hearing departments?

The crisis in funding requires more lateral thinking. It was less than a century ago charities ran hospitals; some of the finest in the world. Closer partnership working between charities and hospitals has the potential to produce more efficient use of resources and better health outcomes for service users. Charities and social enterprises have an outstanding track record of developing innovative services that can address the underlying causes of ill-health and alleviate pressure on acute services, and the NHS must make the most of this capacity.

But perhaps the most important lesson from the Nuffield study is that the Any Qualified provider system is not guaranteed to lead to an expansion of third sector provision. The reform provisions of the recent HSC Act will have failed if we fail to see a big expansion of third sector provision. Let's be warned.

The Work Programme

A critical report from the Work and Pensions Committee says the Work Programme is not working well for people furthest from the labour market. The report finds that, while the programme is more effective for mainstream job seekers, members of vulnerable groups are being “parked”- i.e. the providers commissioned to run the payment-by-results schemes are choosing to focus on those most likely to get a job anyway, rather than devoting resources to the harder-to-help client groups. Work Programme providers are only paid once they get people into sustainable jobs lasting six months or more, and higher payments are made for more difficult clients. However, the report suggests that these differential payments are not sufficient to incentivise providers to focus their resources on those with complex needs.

According to the report, during the first 14 months of the scheme, 3.6 per cent of claimants moved off benefits into a job lasting over six months. But people in the most vulnerable groups, including the mentally ill, the disabled and the homeless, fared worse. Of the 9,500 former incapacity benefit claimants in the programme, only 20 people were placed in a job that lasted three months. Anne Begg, chair of the Committee, said that the Programme has proved much less successful to date in addressing the problems faced by jobseekers who face more serious obstacles to finding a job — people with disabilities, homeless people, and those with a history of drug or alcohol abuse. She said, “It is clear that the differential pricing structure is not a panacea for tackling creaming and parking.” This message is repeated in a letter in today’s Times, in which the chief executives of Crisis, Mind and Drugscope argue that Work Programme is not delivering as it should for the most vulnerable client groups.

If the Work Programme is to fulfill its potential, it must cater to those furthest from the labour market as well as those with less severe barriers to employment. It is essential that additional payments for hard-to-help clients are sufficient to ensure that they receive full support into employment.  The select committee report shows the Government spent £248 million less on the Work Programme than anticipated in 2012/2013 because of under-performance. ACEVO strongly supports the proposal that the sum saved should now be targeted to help prepare more vulnerable people, such as those dealing with drug or alcohol problems, for the workplace. This could ensure that providers have an appropriate financial incentive to work with hard-to-help clients, and fund the specialist expertise and support that those with complex needs may require.

The Work Programme has potential to help tackle unemployment but it must not allow hard-to-help cases to fall by the wayside. It is now time for the Government to act to ensure the Work Programme delivers for everyone, including those most in need of help.