Choice.

A few years ago, as the country's first ever third sector minister, Ed Miliband published an action plan to increase the role of charities and social enterprises in delivering public services. The report identified health and social care as one of five priority areas where the sector had the greatest potential to contribute, and talked about the then Labour government's aim to ‘embed the highest quality procurement practice and reduce barriers to entry for the third sector’.

The current Government have made similar statements. And Monitor are about to produce a report on steps to ensure a fair playing field in commissioning.

I believe that the case for this kind of action is compelling. The NHS is a cherished national institution, but faces huge challenges; needs to find new ways of doing things, and the third sector could help provide these new ways of doing things. And I believe the case for change remains compelling today, in the wake of the Francis Mid Staffordshire inquiry, not to mention the huge financial challenges to come.

The NHS needs to change. It needs new ways of doing things. The third sector has a lot to contribute, and we should be capitalising on that potential not seeking to keep it at bay. And yet there are currently moves afoot in Parliament to do precisely that, by amending the regulations on NHS procurement. Politicians arguing they don't want competition because they have an ideological objection to the private sector need to understand this. If you halt competition it keeps out the innovation charities could bring to the table just as much as it does the private sector. It puts the interests of the incumbent producers above those of patients. And it denies people choice.

There are currently regulations on NHS procurement before Parliament. Those regulations essentially say that commissioners should get the best provider to deliver a service, not simply renew their contracts with whoever is doing it now. And that when they do so, they should act in a fair, transparent way. They require commissioners to base their decisions on what benefits taxpayers and patients, and they explicitly promote integration of services. I hope Parliament will pass them. It’s important to us.

Cash for Communities; planning for disaster.

Always worth seeing what the Scots are up to! I had a Monday morning session with most of the key Directors in the Scottish Government and their boss Peter Housden. I was there to talk about the journey of public service reform in England; I began in 1165 AD but did speed up. But the value of all such discussions is the mutual learning and the session had been carefully crafted so as to highlight some of the reform and change in Scotland.

What particularly struck me was their “Cash Back for Communities" scheme. The government take the proceeds of crime and put them to community use; specifically for young people. It is targeted on the third sector and £50m has gone into sector support at the front line; they estimate 600,000 have been helped and it has utilised over 11,000 youth volunteers. And in the second phase of this scheme it has been run by a third sector body.

Now when the Government in England were looking at using dormant accounts money to fund a social investment bank I argued we should also use the proceeds of crime. At the moment the money recovered from drug barons, big thefts etc. just goes back to the Exchequer. But you can see the logic that Scotland sees of using this money to pay back the community that has been robbed.

So I intend to ensure this idea is fed into the policy making bodies that are preparing for the coming General Election. Indeed as I was having dinner sat next to Nick O'Donughue (CEO of Big Society Capital) at the RBS Business School I mentioned it to him as a great way of expanding capital for the sector. I can see another cause for me to bang on about.

The Scots also have what they describe as an "assets based" approach to public service reform. In other words people are an asset as opposed to a liability and the idea is to capitalise on those assets in communities and with citizens. We had a great debate and some lively exchange on potential from the Grayling rehabilitation reform and health service reallocations (closing hospitals for example!)To fund prevention and integrated care.

But then it was a taxi off to Gogarburn - to the RBS Business School. ACEVO has been involved with our corporate partner RBS in planning a leadership event for the more well established (say older!) Third Sector CEOs. And to look particularly at the development of the business and strategic and scenario planning. Not as so often happens a 3 or 5 year horizon but longer term; to 2025 to be specific. The emphasis of this event was not personal development, though no doubt that happens, but on the way we lead our organisations to grow or contract and to make the key strategic decisions. Too often our sector leadership courses get stuck in talk about our personal styles, strengths and weaknesses and ignore the business need. They are far too “uncommercial" and usually downgrade learning to concentrate on sharing and caring.

We were lucky to have some top class academics; indeed the same ones that teach the RBS directors. Prof Kevin Kaiser from INSEAD led a session on value creation and scenario planning with Dr Franck Schuurmans.

As you can imagine when you have a lively set of charity CEOs there was fun as well as challenge.

The Business School is a marvellous facility; built in the expansionist days of the Bank so it shouts wealth and power. So there is some understandable reticence about it from current RBS people but the upside is they are now using this in a positive way to support third sector leadership. This was the first leadership event but they look set to continue, and given there is so little access to the academic learning that is available to the business community because of cost , then this is a superb way for the Bank to show its reconnection with its customers and the communities they live in.

Chris Sullivan, the bank's CEO of Corporate Banking was there and I told him just how valuable this could be. Of course there are still issues with the big banks and reform is needed and overdue (a Community Reinvestment Act is essential- another cause I shall be lobbying for!) but we need strong banks that connect and support economies and communities. They have had a kicking and now need to be back on track. I believe people like Chris, and Hugh Biddell our ACEVO link, can chart that course back. As Chris said they lost that original sense of banking as a service to communities and have lost the trust that went with it. A positive reengagement with our sector is one way they feel they can do this.

Huge Biddell and colleagues

Intensive programme. Strong learning. Good teachers. And naturally a bunch of splendid CEOs. I was busy taking notes as a range of my Board members were there also taking notes, not to mention the estimable Ralph Michell sitting next to me smiling wryly at mentions of the foibles and failings of Chief Executives.





ACEVO Director of Policy, Ralph Michell


So a late night journey back to London. My Board meeting today. We are looking at our 3 year strategy!

Edinburgh.

Packed the Hound off to the dog walker and took myself and partner off for a splendid weekend of luxury and relaxation in that gorgeous City (indeed partner born here). Booked a great hotel with a splendid view and 2 rather lovely armchairs in the alcove of the room where we drank champagne out of 2 champagne glasses we purchased from the St Columb Hospice charity shop. Made us feel like an elderly couple!

We were staying in Stockbridge, the Scots equivalent of Notting Hill though I'd be shot for suggesting this. And a very vibrant charity shop scene. We went in 8 of them on Saturday afternoon. I can't understand those people, especially in councils (or indeed Mary Portals) who denigrate charity shops and say it shows how the High St has declined. In fact charity shops have been keeping the High St alive. And they are not all at the bargain basement end of the trade. Why, the Stroke association has a pair of fine brogues for £ 110 and an Italian pair of trousers for £38! I did not purchase!

Part of the joy of not being a spotty youth is that occasionally one can push the boat out in search of great food. So we ate at Wishart in Leith, one of Scotland's finest and at the Rhubarb in Prestonfield House. The later is a fine establishment, built in 1687 for a former Lord Provost. I was amusing myself to eat here as my Scottish fifth Great Grandfather , the Rev Thomas Somerville was born up the road 2 years after that and 5 years after the Somerville’s were summarily evicted from the land and took a boat to Ireland and greater fortune. Does this entitle me to a tartan one wonders? Perhaps not, if only on sartorial grounds. The restaurant is called “Rhubarb" because a former owner, Mr Dick, introduced rhubarb to Scotland!

But I am also to do some work this week! This morning I joined Peter Housden, the Head of the civil service in Scotland (and former Permanent Secretary at DCLG) to talk to his colleagues on public service reform. I then went off to the RBS Business School where we are having a third sector leadership event. I shall Blog more tomorrow on both! In the meantime a photo of me at Prestonfield House will have to make do.

À la recherche du temps perdu

A campaign to improve hospital food featured prominently on the News. Rightly so, t was one of the striking things about the Circle run hospitals; the quality of the food was outstanding. So it should be; the connection between the words hospital and hospitality are not coincidental. As I've blogged before one of my members runs the St John's Hospital in Bath. Established in the 12th century it was a place of refuge and support. It did indeed provide hospitality as part of the healing process. We have forgotten this important lesson.


Mind you I'm not at all sure about the breakfasts in my old College. Rather dire this morning. All self service. Not at all as I remember. But of course it was 40 years since I sat here as an undergraduate, surrounded by the grand portraits of former Housemen (13 Prime Ministers no less). I'm sure the quality of the fried eggs and bacon has declined?

That could not however be said of the Dinner on High Table; suckling pig stuffed with black pudding. It is indeed a high table, set above the serried ranks of the massed student ranks. Somehow I doubt the spotty youths were dining on suckling pig: there are things too good to be wasted on youth. Last night I was in a guest room on the same staircase in Meadows I had in 1973! I remember the view so well.

The Dean and Chapter were having breakfast together before a meeting of the Chapter so I had an amusing conversation with the Dean about my evening session with students on working in the third sector.



40 years ago I doubt anyone here would have made a career choice about working in charities. Yet now there is strong interest, backed by real potential of a strong and fascinating career in a growing sector. For no doubt, despite our funding trials, the sector is growing. It offers the answers to many of the problems faced by our public sector so impossible to think it will not grow, even despite the problems of the reform process; as demonstrated so vividly today by the PAC report on the Work Programme.

Oxfording

Mission and Vision


Well, we have all been on the courses and know all about the supposed importance of above. But it can be overdone. And sometimes it's is even a joke. I remember the session at the Top Managers Programme I did with the civil service some years back when they described an example of the perfect mission and vision statements. They were from Enron!

But they can also be a great way of anchoring your work. We are currently reviewing our own statements in ACEVO as part of our 3 year strategic review, which follows on from a large survey of members, non-members and stakeholders.

It needs to be clear and simple. Something that moves beyond spin and rhetoric. A great example was on my brother's daily retailer column recently.

He quoted the excellent Johnson & Johnson corporate credo. Written by the founder himself in 1943, there is fantastic clarity in the language; "We must provide competent management and their actions must be just and ethical" and “We must be good citizens: support good works and charities and pay our fair share of taxes".

Perhaps Starbucks, Amazon etc. could learn?

I'm just on the train to Oxford. Speaking at my old College (Christ Church) to students about working in the third sector. And who knows, perhaps internship opportunities! It means dining on High Table. You will get the picture if you have ever watched Harry Potter as Christ Church Hall is one of the sets for the films!

Have just been at Monitor to talk about their fair playing field review. They have been tasked by the DH to come up with recommendations on some of the barriers to fair competition between the sectors. It's crucial to the many charities and social enterprises who want to expand their offer of better focused services. It has been a well conducted consultation and the team of staff at Monitor is highly competent and engaged. I am confident of a good report. It will then be down to the DH and Commissioning Board to implement what they suggest.

It is interesting to reflect that since the listening exercise the fuss and hassle around the very idea of competition is dying down. As I said to David Bennett it is hard to imagine a politician now talking about the “magic of the NHS ...not values of markets, money and exchange but values of compassion, care and co-operation ". I quote from a Conference speech of Ed Miliband last year. Time has moved on. We realise many parts of the NHS fall short of the standards of care and compassion we do expect from our NHS and that these can and should be provided by other providers like charities as well as the public sector.

But perhaps my most fun part of the day was meeting the Professor of Fundraising at Bologna University (Italy’s oldest). They are in advance of the UK in having a masters degree in charity fundraising. They hold an annual gathering and convention for fundraisers. It attracts big audiences and is perhaps a touch more fun than other such events as is Italian! They want me to speak next year. What a surprise I said yes!

Entertaining and gagging

Entertaining last night at home, so somewhat jaded this morning. Emma-Jane Cross, the dynamic and go getting CEO of Beatbullying and Wanda Hamilton, the engaging and effective Director of Fundraising for RNIB joined me and my niece Amy and her Christ Church boyfriend, for dinner. A fine meat pie from a Yorkshire farm (no horsemeat for my guests) and a stunning 2009 Shiraz from the Jarra range in Australia which I brought back in my suitcase from Perth. The Hound was just too excited, especially with the left overs!

Congratulations are due to the Royal Colleges of Surgeons and Physicians. Their presidents have spoken out against the disgraceful culture of gagging and hounding of whistleblowers in the NHS. They need to. Doctors are at the front line in seeing how bad management affects patient care. They need to speak out more and not be punished when they do!

But I am not convinced the NHS as it stands is capable of making a major culture shift towards openness. There needs to be more independent scrutiny and the announcement that Camilla Cavendish is to head an enquiry into health care assistants is a great step forward. The NHS needs outsiders to challenge entrenched view and attitudes.

Will culture change? We see today from a report in the Times that the current enquiries into the high death rates in a number of hospitals will ignore whistleblowers. The NHS Commissioning Board statement was astonishing. This is “not about investigation of historical issues" they said. Not to talk to the very people who had raised concerns about patient care and discuss how this happened on the basis its history is an indication of how bad the culture is and how far the NHS needs to go in reforming itself.

And this just adds strength to the need for more diversity of provision of health services and for stronger citizen and patient voices. If you want a new culture, new ways of doing things, it is crazy to try to lock out third sector organisations and the innovation and person-centred approach they bring.

We also need a “right to challenge" for organisations and citizens. There are many good people working in our hospitals and, as we now know, many who have been silenced from telling us about bad care. The fact that this has led to unnecessary suffering and, in cases, to the death of patients is a scandal. Action is needed to reform the culture that goes beyond mere statements from politicians. As they say, actions speak louder than words.

Yesterday I had a fascinating chat with the CEO, Michele Rigby and the new Chair of Social Firms, old friend John Pepin. They are an umbrella body representing social enterprises whose prime focus is on giving employment to the usually excluded- people with learning disabilities or mental health issues for example.

There is a brilliant example around the corner from the ACEVO office in York Way; "Clarity" set up in 1854 to make soap and employing blind people. So to be a member of social Firms you must be third sector, earn at least 50% from trading and employ at least 25% from the hardest to reach communities. A great example of what our sector does best. We campaign but we also take action to provide support to the marginalised and excluded. These are the type of organisations that the Work Programme should be including but often do not. The recent Third Sector Research Centre report on the Work Programme makes dismal reading but also provides us with evidence to make the changes we need to the programme so it does work better for our sector. Our ACEVO task force on the WP is now underway and looking at what practical ways we can suggest making changes now but, importantly, looking at how to conduct the next round of tenders after the current 5 year contracts end. It’s not good enough to whinge about the problems. We need solutions and ACEVO as a CEO body is determined to provide those.

The glories of the countryside

There are just so many advantages to spending weekends in the glorious Cotswolds; one being never having to go to a supermarket for processed beef! I've always been a fan of a proper local butcher having grown up in a village in Kent where we had one such. The Sunday joint became the mince for Monday's cottage pie (using one of those funny old grinding machines you clamped to the table and minced by hand as opposed to pushing a button) and the only contact with horses were those my sister used to groom.
And we are lucky to have the advantage of Farmer's Markets; Saturday I was in Chipping Norton buying a shoulder of lamb from the Callow Farm. And if there is no Farmers market there are 2 splendid butchers, Slaters (which provided the sausages for the No 10 bbq for Obama) and Bealds, which as the Prime Minister remarked to me, provides excellent venison.

I also popped into the splendid Parish Church, a very fine monument to the richness of the local wool trade. It has an unusual hexagonal Porch, as seen here;

My Saturday shop also took to me to the Chipping Norton Theatre as they are doing a production of Tennessee Williams' Glass Menagerie. Chippy has acquired a reputation for the "Chipping Norton set" of Rebekah Brookes and other such scoundrels but in fact it has a strong radical past, returning labour MPs when it had its own constituency and indeed one of the founders of the Colony of Massachusetts was once a Burger of the Borough.

The weather was particularly fine and the Hound enjoyed a romp around the Charlbury churchyard while I did a bit of informal volunteering by cutting the ivy off a number of the old headstones. Shame when you can't read the names I feel. My own burial plot is here (you can tell I was a Scout, “Be Prepared" as they say) so I like to keep things tidy when the council skimp.

So now it’s back to Brixton. Maybe not countryside but its famed market is a rich source of the exotic fruits and veg not available in Chippy!

The Condition of Britain

In Barking at the launch of " the Condition of Britain ". ACEVO is working with ippr on this important project, intended to influence policy makers and political parties.

Jon Cruddas MP, who is leading a policy review for the Leader of the Labour Party is speaking at the launch.

Over the next two years we will have to ensure that as the three political parties frame their policy, they understand the potential of the third sector; both in delivering public services that are citizen focused and as champions and advocates.

Only yesterday the PM was exclaiming that "It is good news that volunteering is up and charitable giving is up- the big society is getting bigger." The problem with this sort of political soundbite is that it ignores much of the reality of the third sector experience and the potential we can bring; especially in transforming public services.

But the Labour Party is often no better. They show signs of slipping back to a view on public services that assumes they are best delivered by state employees. But Jon Cruddas has a more open view. He understands the power of citizens taking control. He spoke about the potential of communities, though he spoke only of communities of place. We have to be wary of the romantic notion seen in the Labour Party - and perhaps not only there - that communities of place are always progressive. So many of my members have to deal with the prejudice of many against disability and mental health.

And the Lib-Dems; some good MPs with sector experience but they are sometimes dominated by a " municipalist" tendency because that is their power base and so often see our sector through that prism.

Jon is impressive.  I challenged him on the "producer interest" of the Labour Party and he accepted this is an issue that this project needs to tackle. The project will be led by Nick Pierce- one of the country's best policy brains - and with Ralph Michell, almost certainly the sector's finest policy brain.

My favourite question was from a former priest who said he was fed up by being called a "customer" when he is a citizen and these are his services! Spot on. Exactly the same point needs to be understood by the NHS when they spend the vast majority of our resources on long term conditions but see us all as "patients" not citizens.

So a good start. Though not one graced with coffee. They only managed Nescafe and hot water and the milk ran out. It made me grumpy.

If you want further info go to the ippr website www.ippr.org. and also contact Ralph Michell at ACEVO ralph.michell@acevo.org.uk

Volunteering; Good news. Bad news

The good news; the proportion of people volunteering regularly has increased for the first time since 2005, new figures from the Cabinet Office indicate.

Given the tough economic climate, these are remarkably positive figures that demonstrate both the generosity of the British public and the resilience of our sector.

The third sector benefits hugely from the support and participation of so many people, and the challenge now is how to grow and protect this great national asset at a time when many charities are feeling the effects of public spending cuts.

Now the bad news; DWP have been caught out by the Appeal courts for abuse of laws on forced labour.

Miss Reilly had to leave her voluntary work at a local museum and work unpaid at the Poundland store in Birmingham, under a scheme known as the "sector-based work academy".

She was told that if she did not carry out the work placement she would lose her Jobseeker's Allowance.

Commenting on the victory she achieved in the Appeal Courts she said that making her give up her voluntary work and sending her to Poundland was wrong.

"Those two weeks were a complete waste of my time, as the experience did not help me get a job," she said.

"I was not given any training and I was left with no time to do my voluntary work or search for other jobs.

"The only beneficiary was Poundland, a multimillion-pound company. Later I found out that I should never have been told the placement was compulsory."

"I don't think I am above working in shops like Poundland. I now work part-time in a supermarket. It is just that I expect to get paid for working."

She said she hoped the Government would "rethink" how it tackled long-term unemployment.

"I agree we need to get people back to work, but the best way of doing that is by helping them, not punishing them."

There are some serious issues here. Clearly Miss Reilly should not have been told she had to work at Poundland for nothing or lose her benefit. And it cannot be right that she had to give up her voluntary work (with all the potential benefits for getting her a job) for unpaid Poundland work (which she says was not useful for getting a job).

And what prey was the response of the DWP. Contrition? An acceptance that they might need to make changes to the scheme? Useful guidance for the organisations who are out there delivering these schemes because they really do want to help the long-term unemployed into work? No, like their response to the scandals of the disability work test, they hit out. Said the Judges were wrong. And even if they weren't they would change the law.

Of course it is important that we have work placement schemes, and there is evidence they do help people into work, but DWP should have the good grace to admit there are ways this could be done better.

And that brings to mind a joke passed on to me by Stuart yesterday;

" overheard in Westminster:
Could the PM confirm that Atos have established that Richard III is fit for work ".

The Pope and car parks.

Many of us remember the visit of the Pope to the UK and I was lucky enough to be invited to a number of the functions. I thought I would share some of the photos of the Benediction in Hyde Park.

 

And moving back to the subject of Kings in car parks, my former Director of Strategy Seb Elsworth (now ensconced in the SIB) sets me straight on the cousinage degree issue. Apparently Richard would be something like my 20th cousin and he adds, cuttingly, that probably means some 1 million other cousins as well. So big funeral eh.

Caring and sharing

Well, at least the principle of a cap is established. But clearly at 75k it is significantly above the 50k Dilnot said was the absolute maximum it should be set to make a real difference. So the campaign goes on. The Social Care Alliance, which draws together many ACEVO members, statement is worth reading:

“Having campaigned strongly for the Dilnot model, the Care & Support Alliance anticipates tomorrow's announcement as an important step forward in starting to protect families facing huge bills for care and support services. Although if reports are correct and the cap has been set at £75,000 and thus far higher than the original recommendation of £35,000 from Andrew Dilnot - it establishes a significant principle that families should have some protection from losing almost everything to care costs.

But the high costs of care, plus the cost of board and lodging will still cause real fear and anxiety for older and disabled people and their families so we urge the Government to urgently set out a timetable for making care more affordable.

Families struggling now with the costs of long-term care should also not have to wait four years for change. Some of these reforms can be delivered now and we urge the Government to take the earliest opportunity to at least introduce the rise in the means-test.

"However, this is only part of the answer for how the care crisis is tackled. A critical part of the Dilnot proposals was delivering sufficient funding to ensure enough care was available to meet growing demand. The funding gap for care is growing – this means that older and disabled people and their families are going without vital support. To end the crisis in care Government must also urgently deliver a sustainable funding solution that makes sure care and support is available to all who need it."

So this will require review and we will be making a forceful case for the political parties to go further when they are drawing up their manifestos for 2015.

It’s a clear anomaly that if you are ill in old age you receive free care on the NHS, as should be, but if you require care and support to remain at home or in residential care this can cost you dearly.

The cousin in the car park

Assiduous readers of the Blog will recall my mother is Anglo- Irish, born in the rather gorgeous fishing village of Union Hall in Co Cork. Her great grandfather x4 was one Thomas Somerville, born in 1689 and Vicar of those parts. He made a rather splendid marriage to a rich lass, Anne Neville. My rather blurred photo shows her portrait hanging at Drishane in Co Cork;

Now Anne was from a fine family and a direct descendant of Joan Neville, one of the daughters of John of Gaunt. Joan's sister Cecily made an advantageous marriage to the Duke of York and in 1452 produced a son they called Richard.

Richard's rather battered corpse has recently been discovered under a car park in Leicester and, as we now know, identified as King Richard III.

So hence I am a something like 16th cousin once removed or a second cousin 16 times removed. Or whatever, as I can't count. Rather tenuous I know but I am expecting an invite to the funeral! And those rival umbrella sector CEOs should take note. Cross me at your peril. Remember what happened to the Princes in the Tower. Let's just hope Stuart is not related to Henry Tudor!

And from car parks to cricket grounds. I was at dinner in the Oval last night! The annual dinner of our sister organisation SOLACE (the Society of Local Authority CEOs.) Amusingly I found myself on a table with Tony Hunter. He is the next President of SOLACE and CEO of NE Lincolnshire Council. He greeted me warmly as he had worked out I was the same Stephen Bubb he had known many years back in Oxford. His best mate from school (Doncaster Grammar) was on my staircase at Christ Church. We were both appalled when we realised this was over 40 years ago. He said my laugh was instantly recognisable!

Tony is also a trustee of SCOPE. Richard Hawkes, their ebullient CEO (and ACEVO member naturally) was at the table: busy planning for the future. He has been a strong voice for disability rights and social change and forthright in his denunciations of the disgraceful operation of the new disability work assessments that have proved so disastrous. Indeed the Commons Select Committee have today condemned them. How pathetic that DWP, instead of looking at s system that has a 40% success rate for claimants at appeal, dismiss the report and attack the MPs. Perhaps those in DWP responsible for this might remember that some people with cancer, wrongly denied benefit, died before their appeal was heard and show contrition.

The dinner was rich pickings for networking and remembrances of times past (my days in local government). I didn't spot the CEO of Leicester City Council however...

In sickness and in health

So a day dominated by health issues. The reverberation of the Francis Report continues to echo. How right he is on the central conclusion that the culture of the NHS has become driven by corporate self interest and cost control instead of patients and their safety.

That's damning: but that is in fact what many ACEVO members report from their own client’s experience. I had lunch with Jeremy Hughes of the Alzheimer’s Society and he said they reported a 48% dissatisfaction rate with services in that they believed their relative or friend came out of hospital worse than when they went in.

So can the culture change? Many of the professional groups understand the desire for change. It was interesting listening to Naill Dickson of the BMA this morning talking about the need for Doctors to challenge and report on bad care. I hope the new CCGs will start to use their commissioning power to decommission bad care and to put quality of care as a key component in making decisions on who provides.

There are many calls for sackings and resignations. It is indeed strange no one seems to be taking the can for what is the most gross abuse. On the same day as Francis, RBS were saying that the people involved in their own Libor scandal were sacked.

But whatever the desire to see culprits pay the key is to see how things can be changed. I'm confident that David Nicholson has seen the need for radical shifts and will drive that. He has the standing to secure such a radical shift in attitudes. He must now ensure the new Commissioning Board put patients first. So the Nicholson challenge is not to find £20bn of savings but to implement a patient first culture. He has had a chastening experience. He can use that for good. And he must.

But culture change must always be backed by legal and process changes. So we must have a legal duty of candour. And this is the time to revisit a key recommendation of my Report on Choice and Competition; to introduce a legal right to challenge bad service delivery. So in future patients and relatives who did see what managers wilfully ignored, can tackle bad care by demanding a new provider.

I think we in the charity sector can claim we run organisations that do put patients above cost and have a Culture that welcomes and encourages patients and citizens.

This was something we were discussing at an ACEVO roundtable with the DH and Cabinet Office this morning. A group of our health members were debating how we get a grip on the new commissioning structures and the need for collaborative approaches and alliances between charities and between other providers in hospitals and the private sector. We have developed great partnerships on campaigning; the dementia alliance, the disability groups etc. But we have been less good at putting together consortia to bid. And we need to. So that will be a challenge for ACEVO to see how we can support that movement.

And to cap of my health day I had a long conversation with the CEO of the Migraine Trust, one of those brilliant small national organisations that do effective work in supporting the many people who have this debilitating condition but for whom their Doctors keep prescribing paracetamol or a brain scan!

Leadership failures; leadership triumphs

We all probably know cases of neglect and abuse in our hospitals from the care our elderly relatives receive. The disgusting details in the Francis report are indeed truly shocking but it is clear this is not an isolated case. And this abuse carries on. What was chilling in the "Today" programme report was that they had to get actors to speak the stories they had been told by nurses and carers of neglect and bad care. So the culture that punishes whistleblowers not the abusers continues; and this is not confined to hospitals. It was also a culture in the regulator, the CQC where even those that spoke out at their Board were victimised.

A culture is deeply engrained but stems from the leadership in any organisation. Those most at fault in this saga are the Leaders in management in the NHS and DH who set the boundaries and failed to act on abuse.

So no amount of new regulation will help if staff still feel they cannot speak out and patients and relatives cannot have complaints sorted.

It is now the task of the leadership of the service to stop making excuses about “cuts" and low staffing levels, or explain how the majority of care is good, and act. Reward whistle blowing. Take all complaints seriously. Sack those managers at the top who fail to change. To paraphrase Voltaire, a few sackings are needed “pour encourager les autres".

So the challenge for the NHS Chief Executive is a root and branch change in management culture which he must lead. And for all those in our new CCGs, use the power of commissioning to effect such change.

Turning from poor leadership to good; Cameron is to be congratulated for his stand on equal marriage. He is right; it is a step forward for the country. He has put belief and values ahead of party politics. This should always be applauded. In time; and I suspect not that long this will have settled down and be seen as correct and proper. In time even the Church establishments will calm down; just as they did when they realised their opposition to slavery was wrong, or in the case of Pope Pious Nine, that giving workers the vote was fine too.

And I agree with the PM's decision to appoint a new Chief Inspector of Hospitals. The other Chief Inspectors are good role models; people who speak out when they see abuse - like our Prisons Inspector Anne Owers. Fearless. To be afraid of. An avenging Angel. Appoint one now!

Cooking in Istanbul

I've always been fascinated by Istanbul ever since a lad when I used to look at my grandfather Harry's postcard collection. He came to Constantinople in the 20s and sailed up the Bosphorus and the collection of fine old postcards is still in my possession. Our hotel overlooks the old walls of the Topkapi Palace, the former home of the Sultan.

View from Hotel Sireki konak

No visit would be complete without a trip to the Grand Bazaar. Why did I buy 4 carpet cushions I wonder? Still, a bargain. At least I thought so but then I am probably crap at bargaining. At least I resisted the carpets, always a trap for the visiting tourist.


A most pleasant meal last night, cooked at my own fair hands. As you can see here. But a Jamie Oliver I ain't.

I prepared Kisir and Kuzo Kavurma, as you ask. Perhaps with a little help! With all that effort though I needed a proper meal and so with my brother and wife in tow we went off to one of Istanbul's top Ottoman restaurants.

And now it's back to London. In time for the annual Guardian Public Services Summit.

Postcard from Constantinople

There is something most gratifying about a proper cut and shave. The full works; wax, cut throat razor, threading for the eyebrows and a soothing massage to finish off. Shame you have to come to Turkey for the full works these days. Health and Safety finished all this off in England. I'm feeling particularly healthy after a visit to a Turkish bath yesterday; nothing like been yanked around and pommeled to restore the joints to working order; my masseur assumed I was a Professor as I was so hunched up!

I spent Saturday visiting some of the architectural triumphs of one of the world's greatest architects, Mimar Sinan. There are 2 mosques I particularly like. The Rustem Pasa has a sumptuous interior decorated with 450 year old Iznik tiles. Amusing to note that at the time this mosque was being built my own cottage in the Cotswolds was also being put up; on a slightly less grand scale perhaps. And it was at the same time that after an exchange of letters between the Emperor Suleiman the Magnificent and Queen Elisabeth 1 that the English chaplaincy in Istanbul was established (in 1568). Just outside this Mosque is one of the few remaining "charity stones". After Friday prayers the rich would leave the Mosque and place gifts on this stone. This had to be done anonymously; none of that ostentatious philanthropy of modern day oligarchs. Then the poor would leave and take what they needed; again secretly. Not exactly a charity shop but you get the idea!

Tiles in the Mosque 

The charity theme is replicated at the other great Istanbul mosque, that of Suleiman himself; the Suleymaniye Camil. This is one of Sinan's masterpieces and he is buried nearby. The mosque was surrounded by philanthropic buildings; a hospital, school, restaurant and rooms for the poor and itinerant. You can still eat here in the shaded courtyard though not for free anymore. It’s a favourite eating spot of mine.

On Sunday it was Christ Church, Istanbul for Matins. This Church is G.E. Street Victorian gothic, erected as a Memorial to the Crimean war dead in 1868. Modestly tucked away in a side street on the Asian side.

Then an evening of Ottoman cuisine in a restaurant overlooking the Blue Mosque. A rather generously stuffed aubergine was followed by what appeared on the menu as a typical Ottoman dish; lamb, oven cooked in yogurt and herbs. What appeared was what we call “shepherds pie" if somewhat more herby. And I finished with another Ottoman classic, rice pudding! And tonight I'm at a Turkish cooking class - my brother Nick and his wife are arriving to join us.

Social Value Act

If only procurement actually took account of the broader social impact when decisions are made!

Well, at least from this week councils and CCGs, as well as other public bodies, now have to implement the Social Value Act- it came live yesterday.

I was at a meeting in the Commons with Chris White MP, father of this Act, to celebrate the new Act but crucially to discuss how we ensure it is implemented.

We talked about how to make the new Act stick. There was a lot of discussion about information and encouragement; which we must do, but I suspect what will drive change is legal challenge. So we will be keeping an eye out for bad procurements that fail to take account of social value. We will be encouraging members to alert us to bad practise.

And Peter Holbrook (SEUK) and I are writing to Monitor and the NHS Commissioning Board to ask how they will ensure the health service will implement the Act in the new CCG structures.

ACEVO has been surveying members as part of our 3 year strategy review. It’s always fascinating to get feedback and our members have not been slow with their opinions. Some challenging (one accused me of being a nasty leftie, which makes a change from been denounced as an arch privatiser) and frankly surprising if not , but the vast majority of responses so far has been to endorse our stance and tone as we promote the sector, work with Government and criticise when needed. But survey not finished. If you are a member feel free to join in the debate. Tell me what you think. We have even asked non-members. We report to our Board at end of February.

And now I'm packing my bags. No, not fleeing the Charity Commission after my trenchant comments, but off for a long weekend in Istanbul. A great city. I intend to have a long soak in a Turkish bath and have a proper full on shave and haircut. I shall return looking pink and refreshed!