Thursday 28 November 2013

Movember ending...fags off

Of course I do have a rather personal interest in "Movember"! It was heartening to see how many MPs at PMQ yesterday were sporting Mos. And in our own sector notables among those growing Mos are Rob Owen of the St Giles Trust and David Fielding our head hunter friend. I've donated to David's giving page. You can see the result here

Having had prostate cancer I think I can be let off actually growing one (it would look awful) but I do think Sir Stuart needs encouragement to join in next year. Perhaps all the umbrella heads ( excluding Caron obviously) should , so come on Joe and year? I’ll sponsor you too.

I shall be seeing the non moustached Sir S shortly- we are going to a meeting of the Commission on Civil Society with the Charity Commission and the Electoral Commission to discuss the future of the Lobbying Bill. The next report of the Commission will be out soon with recommendations for changes to the Bill following the ACEVO inspired " pause". Let's hope the Government, who seem in u-turn mode, will listen. I'm hopeful we can secure meaningful change; the Commission work on this has been tremendous. Good work by Bishop Harries.

And congratulations to Jeremy Hunt and his health team on persisting with the arguments on plain cigarette packaging. Looks like its going to happen. So it should. We can't afford to loose any battles in the fight against cancer.

Monday 25 November 2013

A new Dawn... But journeying hopefully.

So it’s the annual conference day and first off is the keynote speech by Dawn Austwick, 7 weeks into her new job as CEO of the Big Lottery Fund.
 She said she likes,
"Grantees with attitude". It’s important for funders to tell funders what they need or want. Good point and note to all applicants! She also said Social investment; needs to be driven by mission. Not money. Mission driven social investment will trade returns for mission. I think this is a lesson for Big Society Capital who really do need to think more about the value they put on unsecured lending.  That is what the sector needs. Not too many fancy new finance instruments, just straight forward loans. 

But the morning was probably stolen by Sandra Schrembri, St Barnabas house who talked of the trials of her transformation of a hostel in Soho Square into a members club for social leaders who will finance the work they do with the unemployed. ACEVO members can join at discount. And you should. It’s a great place (

Perhaps the most challenging and thought provoking was Matthew Taylor. I reproduce his Blog here. Well worth thinking about.

...However, I find myself booked in tomorrow to do two talks about leadership and change with the expectation that I use the RSA as some kind of case study.

It is gratifying that Action for Children and ACEVO think there is a success to be described (it may just be they’ve heard I am cheap and do jokes), but I will be admitting from the outset that my seven years here provide as many stories about what can go wrong and of how hard change can be as it is does exemplars of best practice. Nevertheless I am going to try out one way of conceptualising change, not so much as a description of what we have been doing here but more as a guide which might have helped me do things better had I used it from the start.
My suggestion is that purposive organisational change can be seen to have four stages: ‘basic inquiry’, ‘conventional alignment’, ‘existential inquiry’ and ‘transformational alignment’.  As this implies, the four stages comprise two pairs at lower and higher orders of ambition.
‘Basic inquiry’ describes the stage – often following the appointment of a new leader – when essential questions are asked about the organisation’s purpose, performance and fitness for purpose. This stage precedes change and so there is in our accelerating world a tendency for leaders to do it too quickly or superficially or to treat it as a process of confirming initial prejudices. Patience and humility are useful attributes if the leader is really to understand why it that certain patterns of thinking, acting and performing have become embedded: things which look functional may reveal themselves to be less so and things which seem otiose might on closer inspection have a deeper purpose which needs to be appreciated even if not preserved. It’s probably best not to emulate my first RSA staff meeting in which I said in nearly so many words ‘you’re all a bit rubbish but don’t worry I’m here to save you!’.
‘Conventional alignment’ describes the process whereby the leader tries to bring some clarity to the organisation’s purpose and aims and then seeks to align the organisation with those objectives. This is partly about desisting from things which don’t align and enhancing those which do, but also about capacities and competencies. An example of this for the RSA was the processes of engagement, conflict, investment and trial and error which followed the insight that the RSA Fellowship wanted to shift from being largely a social and recreational club to an integral part of delivering our charitable mission.
This stage will tend to lead to a substantial turnover of staff, indeed it is often what people think of when they talk about organisational change. It can be slow and difficult and when it has been at least partially accomplished there is an entirely understandable tendency to feel the job is done.
‘Existential inquiry’ describes the point at which an apparently well-functioning organisation comes to see that it is not in fact standing for or achieving the change (relevant to its mission) it most wants to see in the world. This is a deeper moment of reflection and calls for leaders to identify a profound challenge even though the rest of the organisation feels it has only just gone through a painful process of becoming fit for purpose. ‘But’ the leader says ‘for what purpose’?
An example here might be the head teacher of a school which has gone through basic inquiry, found out why it is not ‘good’ or ‘outstanding’ and has done the tough things in the conventional alignment stage necessary to achieve that status. But then, after a summer break in which staff members have celebrated reaching the harbour of OFSTED approval, they return to a head who asks ‘we may have the seal of approval, but can we really say that we are transforming the life chances of pupils and inculcating a deep love of learning?’  At issue here is not just what the organisation does but its culture, ethic and imagination.
The RSA is in this stage right now as it undertakes a strategic review based on the conviction that we must see success in terms not of outputs or organisational health (in which terms we now do well) but substantive real world change.
‘Transformational alignment’ is a stage to which I aspire but which I can’t say I have ever managed to attain. It is the point at which the organisation does not need to be changed, nor much led in the conventional sense, because its culture is profoundly attuned with a powerful sense of purpose, one which not only drives high performance but creates an organisation-wide process of continuous self-improvement (which will, by the way, involve the ‘clumsy’ coming together of hierarchical, solidaristic and individualistic power).  This stage should be what leaders aspire to. If they achieve it they should enjoy it to the full if only because changes in context or fortune or the complacency and overreach promoted by success mean that sooner or later it will end.
The obvious questions posed by this schema are (and having written a thousand words I suspect I am by now talking to myself): why is it necessary to go through two loops, can’t one go straight to ‘existential inquiry’; and, how can I reasonably encourage leaders to pursue a state of ‘transformational alignment’ when I can’t actually say I have created or experienced it myself?

In reply to the first, existential inquiry is too profound and difficult to be accomplished while an organisation is failing to deliver on its narrower output goals. Indeed existential questioning may be a bad idea when the often thankless heavy lifting of ‘conventional alignment’ is under way.
The second question is harder: all I can say is that I have had from time to time had that sense of deep conviction of purpose combined with an openness to continuous inquiry and improvement, but it has been around one off projects or particular moments not at the level of a whole organisation. Anyway, to get through the hard graft of organisational change don’t we need to believe there might be something rather wonderful –albeit only temporary – at the end of it?

And let me leave you with a charming photo of me, William Shawcross and my Chair Lesley-Anne. Caption competition anyone?

Wednesday 20 November 2013

A meeting at DH on our A+E plans.

Disappointing, but some constructive discussion was had, but frankly, we need to do more if we are to avoid a winter crisis in our NHS. I am not convinced that the department of health is currently aware of the potential of the voluntary sector’s offer to help. We will continue to push at all levels of government to encourage them to act on it now. I did get a feeling that there is some movement, particularly in their promise to review the plans of the target 53 hospitals to see if any of them have looked at their role our sector can play.

We will be meeting with Jeremy Hunt in two weeks so that they can update us on any progress and on the discussions they have had about  our offer and we will continue to discuss this matter with Number 10.I'm suggesting a big Summit to see how our sector can be used to tackle the looming A+E crisis.

Now it’s back to dear ACEVO and our annual conference taking place tomorrow. Tonight it’s our annual dinner where we will hear from Lisa Nandy, the shadow civil society minister and Sir Bert Massey introducing our leadership awards.

In the build up to the dinner the Guardian have published a think piece. Read it here. A clarion call to protect and cherish our campaigning role.  

Tuesday 19 November 2013

Doing radio on our Plan for A+E.

I hate early mornings. So reluctantly I was up to do an interview at 7am with BBC Radio 5 Live. But a good slot to talk about our plans to help relieve pressure on A+E departments this winter. I'm seeing Jeremy Hunt this afternoon to talk about it.

And then off to Millbank to do all the local radio stations. Stuck in a small room - with my headphones on - I was busy for a couple of hours chatting away to radio York, Essex. Lincs etc etc. Good to know all the hundreds of regional ACEVO members would be hearing me as they drive about their business!

So what is it we are proposing?  In October I was asked by No. 10 what we could do to help reduce pressures on A+E this winter. We know that much of the increased demand in a cold snap is from more elderly people. And we know that many elderly people end up in hospital beds unnecessarily. This winter’s crisis is likely to be especially bad, as seen by the PM’s decision to get personally involved. It’s clear that charities could be an important way to cope with demand and improve the quality of care in A+E.

So I met with the heads of our 3 largest national charities dealing with these issues; RVS, the Red Cross and Age UK. In a week we had produced and sent off a plan to No. 10 and DH.

It’s worth reproducing that here. This is the short paper I sent and we will discuss later today with Jeremy Hunt. I'm hopeful we will get traction. It’s sensible and affordable, and in fact it will save money longer term.

Here it is.
Proposed crisis programme from charities to support A&E services this winter.

Every winter, tens of thousands of older people die or become seriously ill due to the cold placing huge strain on A&E. Age UK has calculated that the annual cost to the NHS in England of cold homes is approximately £1.36 billion - not including the large associated costs of social care.
ACEVO has identified three of its members that have the scale and experience to be able to implement a crisis support service to work with hospitals and GPs to identify and support targeted frail elderly, reduce A&E attendance, reduce admissions and secure early discharge.  Working with AGE UK, Royal Voluntary Service (RVS) and the British Red Cross, these crisis services could be provided this winter to the target 53 hospitals if decisions are made quickly. 

1. Reducing the amount of time that people spend at A&E 
  • As part of a triage team who try and re-route people away from A&E with treatment being supported at home or via primary care.   
  • Providing an ambulance support model whereby when an older person calls an ambulance, Age UK attends too with the effect of supporting people who don’t need to go to A&E.  Age UK has experience of offering this service. 
  • Provision of A&E assisted discharge services for vulnerable people where there is no clinical need for them to remain in hospital but there is concern that there is no support at home.  The Red Cross currently has support at home schemes in 162 locations in the UK.  Age UK operates a similar service. 
  • ‘Home from Hospital’.  A package of care provided by Age UK for older people recently discharged from hospital which prevents re-attendance and readmission to A&E.  Support involves linking person to support services and acting as GP liaison. 
  • Supporting early discharge of patients from hospital .Patients who are poorly but stable (commonly frail elderly people with LTCs) remain under the formal care of the hospital consultant but cared for at home. At home they receive extra nurse-led support for several days and help such as washing and dressing. (RVS has experience delivering this  support; readmission rates since its introduction at the Royal Free have fallen from about 20% to 3.5%.)

2. Providing support on A&E and elderly wards
  • Managing the volunteers in the hospital as a total group and expanding their role to work on-ward alongside the medical, nursing and staff teams to improve patient outcomes.  Help with people’s hydration and feeding as well as providing company and interactions to improve recovery time.
AGE UK, RVS and BRC all providing services in this area.  

3. Providing support to GPs with most vulnerable patients
  • Working with local doctors and CCGs to catch those older people who are habitual attenders at A&E, consumers of blue-light services – generally because of loneliness and isolation.
  • A home health check – 100 local Age UKs delivering a check to 5,000 of the most vulnerable older people’s homes (identified by GPs). To ensure they are safe and ready for winter (e.g. no trips/falls hazards, energy efficiency measures in place).  
  • 1m leaflets via local Age UK and GP surgeries on “Stay well Choose well” supported by Age UK telephone line.  

Crisis package: Management of  relationships, plan and coordinate the work to be undertaken by each of the charities and to provide a formal evaluation of this crisis intervention for future planning.   ACEVO is in a prime position to coordinate these activities and would be keen to do so.