Winterbourne View - Time for Change

Today, the report of the steering group I chaired looking at how to implement radical change to care and support for people with learning disabilities is published. You can download a copy from the ACEVO website or from NHS England.

The Winterbourne view scandal, exposed by the BBC’s Panorama programme, shocked the nation. It led to the Government pledge to move all people with learning disabilities and/or autism inappropriately placed in such institutions into community care by June this year. Not only has there been a failure to achieve that movement there are still more people being admitted to such institutions than are being discharged. This has caused anger and frustration.

In the light of the need to achieve progress Simon Stevens, the CEO of NHS England, asked me to consider how we might implement a new national framework, locally delivered, to achieve the growth of community provision needed to move people out of inappropriate institutional care.

Only by a big expansion of community provision can we achieve a move from institution to community. So we need a mandatory national commissioning framework that delivers that expansion as well as pooled budgets, and that focus on the individual’s needs not the system boundaries. The role of the many voluntary and community organisations that both advocate for and provide services with people with learning disabilities and/or autism is crucial to that aim, as are the clinicians, managers  and professionals across this service in health and in local councils, who need to work together to achieve a dramatic turn around.

In tackling this challenge it  became clear to me that we need both a major expansion of community delivery; driven by co-commissioning  but also, crucially, the empowerment of people with learning disabilities. That means a clear and robust Charter of Rights and an effective “Right to Challenge”, backed by strong advocacy and support, that enables citizens to demand change. We also propose that community based providers have the right to propose alternatives to inpatient care from commissioners. We also support a major expansion of the right to request a personal budget; again we believe this underpins an empowerment of the individual citizen to have care and support appropriate to them.

In other words we need to drive change from the top through better commissioning and from the bottom up through  empowering people and families to challenge the system.

Underpinning a shift to community provision and away from inappropriate institutional care are exciting proposals for workforce development and a new social finance fund. In developing community provision we need social finance to support capital development so we propose a “life in the community social investment fund” which will support the provision of working capital, a payment for outcomes fund and an investment readiness partnership fund. This is a new proposal but we recognised that developing community provision needs the funding that social finance can provide and I urge Government and NHS England to push ahead with funding to make this happen promptly.

The steering group I chaired was made up of people with learning disabilities, families, clinicians, charity leaders and professionals. They were clear about the crucial importance of workforce and skills development. This must happen alongside developing community facilities. We were particularly impressed with the momentum around the idea of the Academy set out on this Report. We must ensure that momentum for change is built on by all those involved.

And finally, as well as a mandatory national framework for commissioning that is locally delivered we must have active decommissioning of inappropriate institutional care and closures of such institutions. The timetable and process requires further discussion but a 21^st-century approach to the care and support of people with learning disabilities cannot be based on long term care in an institution.

In putting together this report I relied on all my colleagues on the steering group, and  all those I have met or spoken to, and to those who submitted many comments and documents. Even when  critical we recognised this came about through the anger of those who have seen a system fail them.

In 1851,  the American physician and philanthropist Samuel Gridley Howe wrote  about the “evils” of institutional care. He wrote, “all such institutions are unnatural, undesirable and very liable to abuse. We should have as few of them as possible, and those few should be kept as small as possible .The human family is the unit of society.”

That essential truth underpins our proposals for change and we know they have widespread support . We recognised that as a nation when we closed the old mental health asylums and we must recognise it again here.

I have recommended to the CEO of NHS England that my steering group be brought together again in 6 months to review progress on our recommendations and that we have a formal stock take of actions taken in 12 months time. We can act as a driver for change but clearly it is the institutions themselves that must deliver these recommendations. And deliver them they must.

Over the past few years people with learning disabilities and/or autism and their families have heard much talk but seen too little action. This forms the backdrop to our recommendations and our desire to see urgent action taken now to make a reality of the Winterbourne pledge. They deserve better and this Report provides recommendations on that essential road map for change.

Now it is over to the Government and to NHS England to crack on and implement these recommendations. I believe we may be at a tipping point where action will now ensure we can close institutions and ramp up community provision. My report is no magic wand. Unless these recommendations are implemented we will still be looking at a system that fails some of our most vulnerable citizens. From my discussions with the Care Minister and with Simon Stevens I feel confident we will see progress. But one thing is for sure; if we don’t see change, I shall be there to hold them to account.

At the Daily Mail and ACEVO's Annual Conference

It isn't often that I'm seen in the offices of the Daily Mail! But I was there this morning, talking to "London Live" - the new TV channel for Londoners. I was there to talk about the new ACEVO Manifesto for the 2015 Election, which is launched today at our Annual Conference. A taster appeared in today's Times, from Whitehall Editor Jill Sherman.

Last night we held our Annual Dinner at the Millennium Hotel in Gloucester Road. We had the pleasure of Rob Wilson as our guest speaker, the relatively new Civil Society Minister. Rob praised our new Manifesto (or at least the bits he liked, which seemed to be a lot). 

"Free Society" sets out a costed and implementable 36 point plan for change. As the subtitle says, its policies are designed to "realise the nation's potential through the third sector". We argue the case for entrenching the right of civil society to campaign in legislation. In a new bill of rights for example. We make the case for reforming public services through a Citizens Charter of Community Rights and the need for a preferred provider policy across public services - that provider being the third sector, not the State. And we argue for fines made through the fraudulent actions of bankers to go into the charity sector in a new £470m Community Sustainability Fund, as the Independent on Sunday reported last weekend.

Today we've been at the QE2 centre in Westminster for our Annual Conference of charity and social enterprise Leaders - the country's biggest such gathering

Speakers have ranged from Will Hutton (Chair of our "Remaking the State" Commission), Tim Smit of the Eden Project and  Stella Manzie CBE, one of the UK's most senior and experienced local government officials . Next up is Paula Sussex, Chief Executive of the Charity Commission. 

So now, back to the Conference floor. I'll have more on all of this tomorrow.

Charity Commission: openness, not 'zero tolerance' machismo

This morning’s Times carried my letter responding to Monday’s story about the Charity Commission and Muslim charities. A frankly terrifying piece that seemed to frame an independent report criticising the Commission’s effectiveness into a news story impugning the integrity of Muslim Charities themselves.

Whilst we can’t rule out the theoretical risk of charity funds ending up in the hands of ‘Islamic extremism’– and indeed some Muslim charities referred themselves to the Charity Commission to help audit some of their on-the-ground spending on aid in Syria – it is dangerous and counterproductive to continue attacking Muslim charities as a whole. My letter explains that on the contrary, the UK must make the most of our excellent Islamic charities as our best vehicles for building a common national identity and fostering leadership and purpose in Muslim communities to help combat the risk of marginalisation and radicalisation. Here it is:

Sir, I recently met a delegation of Islamic charities, large and small, that help vulnerable people in this country and abroad (“Charities suspected of Muslim extremist links”, Nov 17). Their work is a positive example to people everywhere, whatever their faith. If they are tainted by perception and association, their work is compromised. Ironically, such groups are our best opportunity to create a common sense of belonging and purpose that prevents radicalisation and extremism.

We require openness and sensitivity on these issues, not “zero tolerance” machismo. The Charity Commission must be transparent about how it has reached these decisions and the processes it has undertaken. Trust in charities is important, and that must be complemented by trust in the charity’s regulator. Otherwise we must consider other arrangements.

Sir Stephen Bubb

Chief Executive, ACEVO

Aaronovitch, Leeds and Winterbourne

Another great ACEVO leadership lunch yesterday, this time with Dave Aaronovitch – the well known broadcaster, journalist and Chair of Index on Censorship. I say ‘Dave’ – as I knew him when he was one. But as he said when he got to 28 it became David so he always knows if someone calls him Dave it’s a very old acquaintance. As I said to him, the same applies to me. Only very old friends call me ‘Steve’ (‘Tony calls me Steve’ as a famous Guardian profile of me headlined).

But I digress. We had a fascinating discussion on the state of the electorate and likely outcomes in May. As he had said in his Times opinion article that morning, pace Alice in Wonderland, ‘none shall have prizes’ next May. And perhaps the parties don’t even want to win. Very interesting also to hear from Peter Wanless, CEO of the NSPCC and author of the recent inquiry into historic child abuse records at the Home Office. He had been on the BBC the day before having to contradict the PM who had said his report showed there was no cover up. ‘He's wrong’ he said trenchantly. Good for Peter – a fine example of a third sector leader speaking truth to power.

Earlier in the week I was at the Leeds Jewish Welfare Board for an ACEVO regional forum; a chance for our Chief Executives to get together to network and share. As is so often the case, thoughts were much around problems on governance and money. Interesting to speak to Liz Bradbury who runs a superb outfit that supports young and old with practical companionship and a raft of services, as well as running a service for people with learning disabilities. We had a chat about my recent work on the Winterbourne report. Indeed another member there talked to me about how they are setting up a new community facility, with social finance support, to enable people to move out of hospital and back into the community.

The report of my steering group on Winterbourne is now finished. Our last meeting has taken place, and the report is off to the printers. It will be launched later in the month. We will have to wait to see the recommendations published  and how they are then received. And then the real work begins in implementing what we say.

I get a strong sense of consensus around what we are saying but we will see. And after all a report is only as good as what people do with it. After 3 years of failure to deliver on the pledge to move people from inpatient institutions there is cynicism around whether there will be action. But I’m optimistic. From what I have heard from all those who have taken part and been involved there is a strong sense that we can now move forward on an action plan for change. We shall see.

But before we get to that launch its the ACEVO Annual Dinner and Annual Conference next week. We will have a rather splendid document to launch.... but I'm not saying on what. And our guest speaker will be old friend Eric Pickles, the Secretary of State for Communities of Government. And we are overflowing with guests like Francis Maude MP, Simon Stevens, Will Hutton, Lady Smith, Lord Wood, and our Minister Rob Wilson MP. But the stars will of course be the charity and social enterprise CEOs!

NHS and charities!

Two weeks ago Simon Stevens published the NHS Five Year Forward View, a high-level strategy document on the future of the NHS. A couple of days later Andy Burnham reiterated his stance that the NHS should be the ‘preferred provider’ of health services, in an interview with HSJ.

Both positions mention the voluntary sector and profess its value. But there’s little hard policy to say how exactly we’ll establish good partnerships with heath commissioners. Enter ACEVO and our new ‘Working in Partnership’ report, published with the Central Southern Commissioning Support Unit.

Our report sets out seven principles to break down the barriers to partnership working between health and social care commissioners and the voluntary sector:

1. Sustainability - Organisations should seek to build partnerships through jointly committing leadership time and resource to understanding each other’s operating environments and contexts.

2. Transparency - Organisations should be open with each other and clear about the purpose and benefits of the partnership for partners, patients and the public.

3. Joint Vision - Organisations should share their vision and plans as early as possible so that they can identify synergies and opportunities to develop a joint partnership vision.

4. Joint Capability - Organisations should seek to enhance each other’s capability through, for example, knowledge transfer or the joint provision of services.

5. Proportionality - Both partners should be equal in the partnership but should be proportionate in their requirements of each other.

6. Innovation and improvement - Organisations should seek to share, develop and implement innovative solutions.

7. Accountability and governance - Be clear about how decisions are taken within each organisation and within the partnership. Agree how you will hold each other to account.

This is excellent progress. Now we need health commissioning units across the country to take these principles on board. ACEVO’s 2015 Election Manifesto - which we publish very shortly - devotes much attention to this area and will give the political parties food for thought. I’ll have more on this next week...

Helen and Douglas House, Cecily and doomed youth

So Saturday was the annual charity Christmas card sale in Charlbury and the Hound and I popped in to help our favourite local charity; Helen and Douglas House, the very first children's hospice based in Oxford. It has a link with my favourite London church , All Saints, Margaret St and the head of the Sisters of All Saints was the founder. They have since moved from Margaret St and set  the mother house in Oxford and the hospice was developed in the extensive grounds of the nuns place there. I'm a great fan of charity shops in general but my favourite has to be their shop in Chipping Norton. Practically all of my curtains come from there; probably Jeremy Clarkson's cast offs, and its always a treasure trove of interesting gifts. So it was a pleasure to support them.

And while on the subject let me mention another very local charity, Cecily's Fund,set up in Stonesfield, the next village South of Charlbury and now based in Witney. It was established in 1995 in memory of Cecily Eastwood who died tragically in a road accident in Zambia whilst working with children orphaned by AIDS. The charity now supports over 8000 orphaned kids and helps them to attend school and to train as teachers and health educators.  

http://www.cecilysfund.org/ 

The weekend was rounded off by the events of Remembrance Sunday. I went to the Royal Albert Hall for a memorial performance of Britten's War Requiem. The singing was magnificent; as you would expect form the Royal Choral Society with my sister Lucy prominent among them. As I mentioned to Peter Ainsworth, the Chair of the Big Lottery Fund who was also there that it's rather good having a sister with a superb voice, slightly better than mine indeed and useful at Bubb weddings, funerals etc.

Britten's work is set around the Latin Mass and the poems of Wilfred Owen: "Doomed youth" sums up the dreadful slaughter of youth in the Great War, my great Uncle Vivian included.

Caption. Can you spot sister Lucy?  All the proceeds from the concert are going to Veterans Aid, who are ACEVO members! And that it's being broadcast on Classic FM 8pm on Tuesday 11th November!

And finally a visit to see the poppies in the moat at the Tower. A quite extraordinary sight.

Its 62 and going strong

I've always thought that today's big fireworks shows are in honour of my birthday today but Guy Fawkes usually steals the show. I wonder if his example of upsetting the establishment has influenced my career? 

Of course 62 is no age these days. As my team reminded me Disraeli became PM at 70 and Gladstone formed his 4th administration at 84. So you will be seeing much more of Bubb in his 6th decade. Joy!

I usually take the day off for my birthday but this year its not exactly worked out that way. We are finalising the Winterbourne report so it can be launched at end November ( it needs first to be put in easy read) and I have various meetings on social finance and our new leadership programme.

But don't feel too sorry for me. Its lunch at the Ivy and dinner at the Shard. Reaching 62 needs to be celebrated in style.