Health and care matters

ACEVO has a strong membership in charites and social enterprises in social care, health and disability, so we hold an annual national conference to debate issues of concern and hear from key people in the sector.

We had a bumper crop this year. All the main parties set out their stalls. Paul Burstow MP, Jeremy Hunt MP and Andy Burnham MP spoke, but perhaps the most interesting session was when Simon Stevens (head of NHS England) set out some of the issues he faces leading NHS England, and asked for our views.

Inevitably, since the emergence of the disgraceful new grant conditions to be imposed by DCLG to snuff out advocacy in our sector (that morning's Times) there were questions on this. Paul Burstow from the Lib Dems was quick to denounce what he called "the Pickles gag" and Jeremy Hunt, though he would not comment directly on the Pickles move, was clear about charities' right to campaign.

We launched our Alliance Contracting report at the conference. There's more details here.

Alliance Contracting is a new way to promote more collaboration in health and care settings - a post-competition approach that builds on more collaborative approaches and consortia-building. Current government procurement is so often costly and overly bureaucratic. It has favoured private sector bodies too much because we don't operate on a fair playing field. Andy Burnham was particularly supportive of this approach.

Indeed his policies of entrenched rights for the third sector in delivering services, and 5 to 20 year contracts were music to the ears of our members. In fact, as I observed to David Brindle of the Guardian, I think this is the most radical approach to the sector of any politician in any party. Much to be supported and perhaps a benchmark to encourage others to follow. We shall pursue at out forthcoming third sector hustings on 24 March - everyone very welcome!

And let me leave you with some photos of our speakers yesterday.

Charities and A&E – quiz the ministers!

Well today’s been good for drawing attention to charities’ work in A&E. We’ve announced a new programme with Red Cross, Age UK and RVS, funded by the Cabinet Office. 700 charity volunteers to work in the 29 most under-pressure A&E departments around the country, and help reduce demand on A&E over the next 12 weeks. See today’s Telegraph for an excellent roundup by Chris Hope.

Naturally, this is the precursor to bigger things. I’m making sure that government collect evidence of how charities can reduce the load on A&E. It’ll be a good evidence base for a wider national intervention in future years. Charities need to be integral to A&E strategic planning in future. This programme will help make that happen.

But what of the parties’ thoughts on the third sector’s role across social care + health? At election time this is the important question.

On 3 March ACEVO’s Health and Social Care Conference is the biggest such third sector event. In central London (and in front of the BBC + other cameras!) we’ll have not only Jeremy Hunt but also Labour’s Andy Burnham and the Lib Dems’ Paul Burstow to put their respective pitches to third sector leaders. With lots of time for questions. And in the morning we have a session with Simon Stevens of NHS England – an excellent chance to discuss progress on his five year forward view.

I highly recommend you come along, whether you’re third sector leader or anyone else. Tickets here: https://www.acevo.org.uk/event/spring-health-social-care-conference-2015. See you there!

Noisy Leadership

Are you a quiet or noisy leader? What works best? I was at one of our ACEVO regional meetings in Oxford last week, and we had a fascinating debate on this in the wake of recent controversies.

A key role for any social leader is 'speaking truth to power'. But how do you do this? There are some CEOs who believe you must never speak out in public and do all your lobbying behind closed doors. They fear that if they are publicly critical they will be cut off from access or 'got at' in some way. 

This is wrong. No politician or senior official will pay you much attention if they think you will never speak out. That would mean they can safely ignore you. They will pay attention if they think you might speak out publicly, and if they think that what they are proposing is going to be criticised in the public domain. We social leaders hold a vital weapon in our hands. The media love us and we are trusted. When a politician or government official is interviewed the public are inclined to be skeptical. When we appear, there is trust in what we say and claim. Ipsos MORI’s trust surveys (like this one usually indicate that around 15-20% of the public trust politicians, while more like 60-70% trust charities.

Being quiet, then, will not achieve what you want. Of course, the power to speak out must be used judiciously. You should be careful to modulate your criticisms with praise when it is due. Always slamming everything just doesn't work. But on occasion you must be noisy.

I'm certainly not regarded as a shrinking violet. On the Oxfam issue I have been very outspoken. Indeed my views featured in opposition to some backbench government MPs on Friday's BBC Radio 4 World at One. But I have tempered this with lots of work with government when there are issues we care about as a sector. I doubt I was asked by David Cameron to write the choice and competition report in the listening exercise because I'm a quiet leader, or to speak with him when he launched the Open Public Services White Paper because I was seen as docile.

An independent and robust civil society must not whisper but make itself heard. That is why we must avoid the temptation to keep quiet over the election period. CEOs and their trustees must determine to speak out when that is needed, and tell people if they feel they are being gagged. Lord Finkelstein, for one, as he said in Parliament last Thursday would like to hear if charities and campaigners feel gagged by the provisions of the Lobbying Act.

This may sometimes get uncomfortable. I didn't exactly enjoy the dirt heaped over me after my robust defence of professional salaries for CEOs or the sarcasm of Daily Mail columnists. But leadership is often uncomfortable. If you can't stand the heat, get out of the kitchen - as they say. And good leaders are able to juggle when backdoor diplomacy is best and when it isn't.

There are many leadership styles. As many as there are leaders I suspect. But being noisy has its place!

And on the subject of noisy leadership I guess you could add the recent example of the Prime Minister in Europe. I was interested in the interview with Jeremy Hunt MP on Today this morning. He made the point that "leadership can be lonely" and he is right. Leadership is not always about seeking or getting a consensus. Sometimes a decision needs to be taken that may not be universally popular - as we saw with the row over Junker. That may be a decision you have taken that may not be universally popular with your Board or your staff, and that's a lonely position.

I remember one of the early ACEVO posters which said (over the picture of a mountain) "it’s lonely at the top". That is exactly why an organisation like ACEVO exists; to support and advise CEOs and to provide a peer network that gives that support when difficult decisions have to be taken.

Bad food and MPs...

Well done to Michael Gove MP for the new guidelines on food in schools, cutting out fries and sugary drinks. High time too, as obesity among kids soars and the rise in cases of diabetes and pre-diabetes is increasing significantly. And what may you ask is our health service doing about it? 

Well, in hospitals, sweet nothing as they say. Walk into most hospitals and the tempting offers on chocs and coke from vending machines and cafes are all around. Why, Guys hospital even has a McDonalds on the premises. And at Tommies you walk in past an array of retail outlets piled to the gunwales with unhealthy food options. It's time hospitals got on message. I realise they are turning a fast buck on these outlets but I thought they were about improving our health! Could Jeremy Hunt take a leaf out of Michael Gove's book on this? And let's face it. Most elderly people in hospital for a long period emerge malnourished - Age UK has run their excellent campaign against malnutrition in hospitals for almost 10 years now. Hospitals just don't get good food, let alone healthy food. End of rant. 

We had a Social Investment Business reception at the House of Commons this week (more sticky buns on offer there; I said no!). We were introducing some of our investees to MPs and we had a good cross-section of Members from all parties, as well as Ministers and their Shadows. Nick Hurd MP gave a great speech and emphasised the point I had made about how social finance is one of those subjects where you do find cross-party consensus. The Big Society Capital started off as a Labour idea, but was taken up enthusiastically by the Conservatives, and David Cameron is a great advocate of social investment. And Minister for Civil Society Nick Hurd has been a great champion for our sector. He has a lovely approach to the role which combines an oft laconic style with wit and passion for the sector. He even went so far as to describe me as ‘an institution’. Obviously kind comments by him about me simply reinforce my view he is a perceptive chap.

The event was sponsored by Crispin Blunt MP, a former Prisons Minister and a non-exec on my Social Investment Business Board. His comments on a range of issues make great common sense, as I told him, now that he has been freed from the cares of office! But the fun of this event was in meeting the many charities and social enterprises that have taken loans to promote their ambitions. 

SIB has made over £350m worth of social investment to over 1000 organisations. This makes us the UK's largest social investor. I'm chuffed to be their Chair. And in the spirit of keeping fit I can report I spent an hour in the Brixton gym last night. Needed to after that rather splendid dinner at the Cass Business School on Wednesday.

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.

Issue

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.

Plan

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. 

The challenge of Age!

 Chairing a conference today on the effects of demographic change and austerity on our health and care systems. It rather echoed the speech by Jeremy Hunt on Friday about how we care for our old people.

Jeremy has made the care of the frail elderly a theme for his time as Secretary of State for Health. He is right to do so. We know that one of the major failings of the health service is that too many old people are in hospital beds when they could be better cared for at home or in the community. We know that the impending crisis in A&E over winter will be largely driven by our inability to care effectively for older people at home and when they get to hospital ensuring early discharge. Part of the answer to the winter crisis lies with the many excellent national charities that work in hospitals and the community such as The Red Cross, RVS and Age UK.

The statistics about age are interesting.

Those currently 65 will live to 84. (So I reckon I might make 90; lots more time to give the third sector the benefit of my views!).

And the current population of  65s will grow from 9m in 1995 to 19m by 2050.

In terms of the Public Spending demands, state pension/social care & health for older people will rise from 14% of national  income to almost 25 % in a decade.

But let's not think of this in terms of the apocalypse. Our debates on the elderly are usually couched in terms of problems and burdens. We forget the majority of people who volunteer are over 60. Its a huge cohort of largely active and engaged people. People who vote (unlike youth!). People who contribute to civic life and debate.

However we do need to change the way we provide many of our public services, especially in health and social care.

Many of my regular blog readers will have missed my Blog for the last week. I'm afraid it has been particularly manic and I managed a week of breakfast meetings and evening events as well as the usual round of meetings (not to mention our Board away-day on Friday).

We are also gearing up for the Lobbying Bill debate in the Lords tomorrow. So a week of chatting up Lords and Baronesses; tough job but someone has to do it. A superb article by Polly Toynbee in Friday'sGuardian summed up the importance of the issue for charities and our broader civil society. It's at times like this that ACEVO as an umbrella organisation for third sector CEOs comes into its own.

Reflections on Leadership.

Both main Party Leaders have talked at their Conferences about their leadership role. We tend to discount reflections from politicians about leadership but we shouldn't.

Being Leader of a political party must be a relentless, full on and difficult task. You are rarely thanked and have to put up with some gross nonsense; Cameron with the pics of him on the beach changing, or the disgusting articles in the Daily Mail about Ed's father (which really plumb new depths in so-called journalism).

Politicians are held in low esteem, but imagine how those in our sector would cope with this sort of publicity?

The job of a charity CEO is not in the same league, but there are parallels. One word you don't tend to find on the CEO job spec is resilience. But you need that in spades.

It’s a bit of a cliché, but the CEO's job is a lonely one. It can be hugely stressful. I was interested in the interviews with the CEO of Lloyds Bank when he admitted the job had been so hard he had been told by doctors to take time out. I doubt anything in our world matches the scale of the Lloyds problems, but if you are running a charity and the financial pressure is such you fear the organisation may go under, that is a huge strain on the CEO. In ACEVO we continue to get calls to our CEO in crisis line. Only last week we had to refer 4 CEOs to our legal and advice support services. This is at a level we have never experienced in ACEVO for a decade - so it gives you an idea of the real difficulties being faced by members.

That level of stress and pressure can have consequences if we are not resilient and part of our core function as ACEVO is to provide help to the individual CEO; that's part of our public benefit mission to improve governance and charity well-being in our sector. We are the only body that does this work and I know from members who have been supported how valuable that is.

When matters get personal and things move from a criticism of decisions to personal attack - as can happen to politicians - then it's particularly difficult to know how to respond, let alone the toll it takes on you. I had a taste of this myself over the summer when a routine ACEVO stakeholder event in the Lords, for which I paid half (as some family were there too and a birthday cake was brought out), was portrayed in the Daily Mail as a personal birthday party - as though anyone writing such a story would invite a heap of politicians, journalists and other stakeholders to their birthday party! Difficult to know how to respond to this, in the wake of the stories on CEO pay in certain sections of the media. It was clear this was a particular media attempt to undermine my robust defence of executive pay.  I have to say the firm response of many members who saw through the attacks was enormously comforting, though I worry that the episode may put off others from being so upfront on explaining the need for professional pay.

In a leadership position, ultimately, you have to accept that speaking out brings consequences. So resilience is needed. The bottom line is always what is good for the clients, members or beneficiaries you represent. It can be a tough and unpleasant job to get right.