Philip Green has revealed glaring problems in how Government commissions. He concludes that Government needs more central commissioning and a more joined up approach. He is right.
Yet in some areas it appears Government are about to move in the opposite direction i.e. local commissioning and breaking up central approaches. A discussion I had with Nat Wei in the Cabinet Office suggested that most Government commissioning will move local. He repeated this point in the recent Lords debate on the sector.
Yet in many cases to do so will involve the loss of economies of scale and encourage duplication and waste; exactly what Green is warning against.
I had a worrying conversation with the CEO of the NHS on central commissioning. I used the glaring example of diabetic retinal eye tests, currently usually carried out in hospitals, doctor surgeries or vans. The cost is significant - up to £400 per test. Yet the same test can be done by, say Spec Savers, for £15. And guess what, you can get it done at the weekend or evening, which is more than can be said for your local doctor.
So why does the DH not put out a national tender for these tests and get a great deal for patients, and even better team up a deal with Diabetes UK on follow up, I asked Nicholson. He said it will be down to local GP commissioners. Absurd. They won't get the deal from the opticians the DH could. A chance to save wasted on the grounds of ideology.
And there are plenty more examples; community equipment, things like wheelchairs could be sorted better and cheaper in a national tender. And there are a range of my members who fear that what has been commissioned centrally by DH will go local.
Another example, the Family Planning Association; a great organisation that is commissioned by DH to produce family planning advice etc. Quality is high and economies achieved. Is this to go local? If so it will cost more, quality impaired and even possibly some GP commissioners deciding not to bother.
So, my message for Francis Maude MP, as he prepares his Commissioning White Paper, is to bear in mind the principles of subsidiarity (indeed there is a helpful Papal Encyclical on this); make the decisions at the appropriate level. If central gives savings and quality, don't make it local. If quality and empowering citizens, as in personalising services, then go local.
Sometimes central and national is good! And that also applies to "big charities" where in that Lords debate Nat Wei was attacking what he calls the "big charity mindset".
I had a meeting with a range of my members last night to discuss the current situation. My Chair, the CEO of RNIB, was talking about the empowering role that charity has for the blind and visually impaired. They run the worlds largest talking books service, efficiently and economically sending out some 40,000 books a week. They have the size and strength to do that. That will not be delivered locally. They also had the power to pioneer the development of the talking chip application that you can now buy commercially and which enables blind people to navigate the TV channels. Companies said it was not possible or commercial so RNIB sunk their money into it and did it. Now you can buy it. That would not have been possible by a small Charity.
And it is directly empowering citizens.
Likewise with Tomorrow's People pioneering work placing advisors in doctor's surgeries, Turning Point's connected Care service, Addaction's family centred pilots, Catch22 contracts for prisons, or ICan's work on tools to identify learning difficulties in schools at an early stage.
And let's remember some of the recent brilliant campaigns to raise awareness on mental health, or on ageing by Age UK, or child poverty by Barnados and Action for Children. They show why big charity is so vital to the health of our country. Attacking their work is not just unhelpful but raises suspicions about whether Government just wants a local small sector because it is more biddable.
The laws of economics do not stop at the gates of a charity so what Green has identified for commissioning by Government applies to the third sector.
Of course I agree with Nat that all charities must look to their laurels. Big charities need to continue to show flexibility of approach and guard against bureaucracy. They must retain trust of members and clients.
But also, and Nat did not raise this point, small charities need to develop capacity and professionalism so as to provide the best for their beneficiaries. This is not a game of small good, big bad.
The problem of Big Charity is one I don't recognise as he articulated it. I think Nat needs to get to know our great national charities a tad better before preaching about them.
And why is it that big business is ok but big charity is not?
A great letter in The Times yesterday from my old boss, the wonderful Sir Rodney Brooke, who complains that Tesco is to force a major supermarket development on the community in Ilkley. They don't want it and it will close down local shops.
I wonder, will the Big Society Network be supporting local communities that want to protect their locality and its business and shops against the degradation of Big Supermarkets, including ASDA? Will they be jetting into Ilkley to support those good folk fighting off this unwelcome development? I'm sure other parts of our third sector will!
Of course as charities grow they must take care to marry efficiency and professionalism with always promoting the beneficiary. The CEOs I know understand that well. So let's pay tribute to their work, their dedication, innovation and skill as well as celebrating local and small. Trying to divide the sector on size is hardly a helpful contribution to building a Big Society Nat?
I had thought we had moved away from this attack big charities nonsense. In a diverse sector we need the strength of local and community as well as national or large. The work ACEVO has done with BASSAC on this point illustrates how we can work together. Let's do that. And encourage that.
So I shall be looking to Nat spending time with the big charities to get to know their work. I am sure we can allay any concerns he has. And we shall get him on side!
And Nat, do meet Philip Green!
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