The role of Government, health and the Taoiseach.

 

Does working with Government hinder or help our sector deliver? The voices that loudly proclaim the dangers of taking Government money often miss the point of Government in working with the sector in delivering for beneficiaries.

 

I listened to a fascinating presentation yesterday from the former head of Obama's Social Innovation Fund, Paul Cartter.

He was arguing that social innovation is needed to support the non profit sector in times of financial troubles. He reminded us that whatever the financial problems let's remember we do still have huge resources. We just need to marshall them better.

We need to look more closely at what we do and how effective we are.

 

Innovation is not always about what is new but what is better. It is an important point. Too often we get told innovation is what is new and shiny. Nothing to do with old organisations. Or large ones.

Social Innovation processes has different stages. The early stage is the ability to find new solutions and ways of working.

But how to get to scale? We need to transition to scale which is where Government comes in because they are often the largest funder and enabler of change. Amount of resources in US that go from Government to non profits is 10 times larger than from philanthropy and foundations. So Government is the "funder in chief". Government is key to promoting innovation and we must consider Government as a key partner. But both are under performing.

 

He made an interesting point on scale. He said the top 10 largest non profits in the US have an average age of founding as 1903! So problem is not invention.

 

There are 30-50,000 new non profits a year in the States. But they don't grow to potential. Hardly anyone grows. 200,000 registered since 1970. Only 134 grew to over $50m. Hardly anyone is growing. I wonder what the stats are in the UK?

He also argues that we have inadequate interest in evidence. We can't establish that our programmes make significant difference to people. we often measure the impact of a project but do we know if what we do makes a real difference to our beneficiaries lives?

We need to find and to evaluate evidence on what interventions make for long term good. But we often don't.

So Government working with sector is important in developing positive interventions; for example the RNIB works for better lives for blind people by campaigning and providing services but it knows that only Government can develop national policies to make lives better which is why they developed the UK wide vision strategy and argues for Government ot adopt it. Which they did.

 

Meanwhile back in Blighty the NHS Mandate was published by Jeremy Hunt. It's good. It provides a real opportunity for the sector, whether that is in advocacy and community campaigns, or in research or in delivery of health and social care services.

 

ACEVO and the Foundation Trust Network (FTN) have welcomed the new NHS Commissioning Board mandate and we announced a new work programme to assess how NHS Trusts and third sector organisations can jointly contribute to delivering the new mandate.

The work programme between our two organisations will:

• Showcase existing best practice that has been developed by NHS trusts and voluntary organisations working together in the mandate’s priority areas;

•  Assess how this partnership can develop further to deliver the improvements the mandate requires;

 

• Identify up to 20 concrete actions that either NHS trusts or voluntary organisations, or both in partnership, can undertake to drive the required improvements;

  

• Identify what is needed from the rest of the NHS to deliver these actions.

 

Results in a joint report to be published in spring 2013

 

 

Third sector organisations and NHS trusts already do a great deal in partnership; but there is huge untapped potential for us to achieve more. The UK has one of the most vibrant third sectors in the world, and one of the best health systems. Getting the two working better together could be key to the NHS's success in responding to the new mandate.

 

 

Chris Hopson, the new CEO of the FTN is an ACEVO member and I've been impressed with how he has grasped on this agenda as a way to develop Foundation Trust's work in better health outcomes.

 

 

And finally, a great evening at Trinity College. Had an interesting chat with the Irish Prime Minister. We got on well as you can see;

 

 

 

 

 

He made an interesting speech on the role and importance of Ireland's voluntary sector.

 

 

 

 

 

 

And finally, outside the birthplace of Wellington. My Great Grandfather x4, Colonel William Somerville Limrick, fought with him in India, notably at the Battle of Seringapatam. I didn't mention this to the PM!

 

 

 

 

In Dublin's Fair City; leaving clear footprints!

I have put on my Social Investment Business hat and arrived in Dublin for the European Venture Philanthropy Association's annual conference. A relatively new organisation (but then social investment is a fairly new concept) it gathers together those involved in social finance, venture philanthropy and impact measurement.

The Conference started in a supposedly traditional Irish way with drummers. See them here:

I've been involved in social finance now for 8 years in my role as non exec Chair of the Adventure Capital Fund and the Social Investment Business group. The ACF celebrates its 10 year anniversary this year and its interesting to reflect that back then the idea of making loans to charities and community enterprise was seen as esoteric, if not positively dangerous. Loans were seen as a tool of the devil. Indeed there are still people around who think like that! But I always took the view that the devils tool can be turned to social advantage. And the last decade has shown the power of that idea.

The work of the SIB group in Futurebuilders, the community builders programme and the health social enterprise investment fund has been independently evaluated twice. The record is clear. Loans work. Our default rate is very low and our investee organisations have grown. And for me the fact that we have been able to invest in small community organisations and help them grow is a tribute to the power of loans to grow the sector.

Our loan work is based on the concept of the "engaged investor" so differs from the devil banks approach. That does not mean we shy away from taking drastic action to correct problems (we have had to step in and remove poor management and governance in a number of cases) but generally it's about supporting organisations on their growth journey.

Now, a decade later, social finance is the new fashion. Nearly everyone is an expert. Why, even the EU Commission has got into the act (not unhelpfully I have to add). The EVPA conference is packed out. New trends tend to attract geeks and fools as well as those making some remarkable innovations. There is now a lot of interest in bonds and equity. These seem very sexy and exciting. Yet what the sector now needs most are straightforward loans. So let's not get carried away with the new. Its a point I intend to ram home in my interventions.

One of the participants from Norway talked about her organisation's mission to make impact and "leave clear footprints". I wonder if we in the sector are always clear on that need. So we get involved in innovation and then fail to scale it up or spread the lessons. So one of the key aspects of social finance needs to be measuring impact and scaling what we do. How many examples of good practice do we hear about and then wonder why they are not spread around the country?

Great to be in Dublin. I feel at home; indeed my family used to have a house in Merrion Square before the Troubles. And tonight our reception with the Taoiseach is in Trinity College where generations of my mother's family studied; many of them to become Priests in the Church of Ireland. So I'm observing their footprints; the books of my Grandmother's cousin, Edith Somerville, for example, but also the silent footprints of the contribution the many Limricks and Somervilles; alive and dead, have made to building this beautiful country.

A transparent NHS and a gorgeous weekend.

A depressing story fronting the Guardian on Saturday about a former GP collective going private, with its founders taking large profits from the sale of Harmoni to Care UK.

But the irony of this story was lost on the Guardian. GPs are not public sector workers; they are in fact private sector contractors and as such free to make such arrangements as this. However, I think many of us do feel uneasy that money that might otherwise go back into providing health services is now in private hands. I have always felt this is one of the strong selling points of the many charities and social enterprises that operate in the health service. It is one of the reasons I believe the right for health service professionals to set up on their own as a mutual is so powerful. There are over a hundred of these new mutuals, doing well and where they ensure the surplus they make goes back into the business.

But the bottom line must always be the service standards to the NHS client. Commissioning must ensure that the patient gets the best service regardless of the uniforms worn by the employee.

One of the issues that emerged in the listening exercise that caused much debate and concern was over the transparency and accountability of the new commissioning arrangements at local level. I believe GP commissioning will be an advance but it is clear that, following the guardian article, we must ensure proper handling of conflicts of interest and transparency of the commissioning processes.

What a wonderful weekend that was! Charlbury looked particularly great for the annual Remembrance Sunday parade and the usual walk to the Plough with Hound was thereputic.

We now await the publication of the new NHS Mandate tomorrow. I think this will be a good document, setting out the priorities we expect from the new NHS Commissioning Board.

And finally; have you booked up yet for the annual national ACEVO Conference? It's our 25 anniversary one and mixes academic input with good speakers on issues from governance to how to tackle the recession. This has traditionally been the chance for our CEOs to come along with their Chairs or other trustees and we make concessions particularly to encourage that. So book now.

Bookings can be made via the website:
http://acevoannualconference.org.uk/

Or by emailing:
events@acevo.org.uk

Chatsworth and Barnsley Hospice.

An unlikely pairing perhaps? Yesterday I went across the Yorkshire Dales into Derbyshire and to one of Britain's most magnificent stately homes, Chatsworth and today visited Barnsley Hospice.

In 60 years I had never got to Chatsworth so this was one to tick off that list. And what a stunning place it is; not just the marvellous building and historic treasures but the stunning grounds set in the splendour of a British hillside autumn. Deborah, the Dowager Duchess is the last surviving of the 5 Mitford sisters who lived at Astall in Oxfordshire, just 6 miles from Charlbury and one of my favourite pub runs. In fact she still has a house and the Swan pub in Swinbrook where you lunch surrounded by the Mitford girl's in photos on the walls. Her 4 sisters are buried in the lovely Swinbrook churchyard.

And talking of lunch we (Hound and I!) had a delicious Derbyshire pie in the Devonshire Arms nearby after the Hound had romped through the gardens. A splendid country pub that welcomes dogs; pity London is not more like this.

ACEVO member Ian Carey runs the Barnsley Hospice; a small but highly effective organisation much loved in the town. Good to be able to look round and meet staff and to hear about their building expansion plans.

Palliative care is now much more in the news. Lord Warner has recently been sponsoring a debate in the Lords on amending the NHS Constitution to give people the right to die at the place of their choice. Too often people die in hospital when they would like to end their days in a hospice or cared for at home. These days a lot of health care can be provided in homes and many hopsices help support this. So, for example, many of those who come to the Barnsley Hospice stay for a period- around 11 days and then are able to spend the last few days at home with their loved ones. They also have a well equipped day centre which also provides much needed support. Ian says they have plans to expand the care they can provide for people in their homes.

Why do the majority of people at the end of life die in hospital? We talked about how the NHS culture can sometimes be hostile to perceived "outsiders" like Hospices and so hospitals and GPs fail to see the advantage of working in partnership to enable people to exercise choice. The vision of Dame Cicely Saunders all those years ago, of a quiet and spiritual place which can offer superb medical care as well as love and dignity at the end of ones day's is yet to be fully realised but Ian and his team are battling to do this in Barnsley. They well deserve support.

Well, my few days in Yorkshire have been a joy and it's now depressing to be blogging from a traffic jam on the M1 as we head back to Charlbury!

Yorkshire

Well, after 60 years, a weeks leave to recover is in order I think! I'm up in Yorkshire for a few days and today spent a glorious autumn morning in the Yorkshire Sculpture Park at Bretton Hall in Wakefield. Magnificent and massive Moore and Hepworth sculptures that pepper a typically bucolic Yorkshire landscape. The Hound enjoyed a clandestine run around (you are supposed to have them on a lead but I object to such fascistic controls; mind you I did pop the lead on when I spotted the flock of sheep. No lamb lunch for Sparkles.

Good to see the " Tower Hamlets" Henry Moore. The Council is trying to sell "drapped seated figure" for a cool £20m. You can't blame them but it would be a shame to see it leave the Park. Its looks splendid as you can see.

Just up the road is the National Mining Museum, run by redoubtable Dr Margaret Faul, long standing ACEVO member, which makes a visit to Wakefield all the more enjoyable. Then back to Barnsley for lunch at the Coopers Art Gallery and some rather excellent Christmas craft shopping.

I also happened on a stall in the Market run by the Dog's Trust. The Dogs Trust is a great charity run by active ACEVO member Clarissa Baldwin. They were encouraging people to sponsor dogs and, with Hound pulling at her lead, I signed up. Important to support such charities; there has been a big increase in dogs being abandoned because families feel they can't afford to support them. A worthy cause and good to support Clarissa.

It's one of the great attibutes of ACEVO that we have such a diverse membership; not just the great traditional charities, or service delivery social enterprises but organisations like museums, arts and heritage and the wonderful animal charities. The diversity of our Chief Executive membership is one of its strengths.

The Sixth Decade.

 It was just before 4pm on Guy Fawkes Day 1952, as mother said, "Just in time for tea", that I emerged into the world! In those days, no nonsense about hospital births; Nurse Massey; the midwife, was summoned to the house by my father, who then cycled off for a days teaching at his school: fathers not encouraged to be present.

So it seemed just right to celebrate my 60th with a tea party in the House of Lords on Monday! And an eclectic mix of family and friends, ACEVO members, parliamentarians, churchmen, media, old college pals, trade unionists, Baronesses, cabinet ministers gathered to celebrate with me. I even had a note from Ed Miliband to wish me well, though as he said," 60; hard to believe it!". And a card from Tony and Cherie Blair. Tony's nice note was rather touching "thanks for your fantastic contribution to the nation and its voluntary sector". I think the PM's card got lost when he posted it in Dubai!

Baroness Hayter, an old friend from Young Fabian days, and an ACEVO Founding member gave a welcome speech to which I responded; a mercifully short contribution!


It was good to have a wide number of my distant cousins present; from Union Hall in Ireland, from Devon and from Kent. Here they are;

And one of my mother with some of the Devon tribe

And obviously you need a birthday cake! This one baked by Martha in Brixton; Caribbean rum soaked fruit cake! Then back to my house on Brixton Hill for champagne and fireworks. I grew up with a firework party every year; in those days always on the 5th and not at weekends as now. I'm afraid my garden can't quite take a bonfire and Guy now!

It's rather fun being 60. Boris has kindly supplied me with free tube and bus travel in London and I have my senior rail card; mucho savings on train fares for ACEVO! But as I said at my tea in the Lords: Bubb is neither shy nor retiring! The days when one retired at 60 are long gone. There is much to do leading ACEVO through troubled waters and challenging Government to do what is right and just. So ever onwards!

Stephen Bubb

Hinchingbrooke

Now I'm not doing a George Bernard Shaw, arriving back from Moscow and declaring "I have seen the future and it works!" but I have seen how Circle run Bath and Hinchinbrooke hospitals and it's working there. The ways of working and the innovations at these hospitals have lessons for the NHS. Competition does have a role in driving more choice and replication of good practice.

Hinchingbrooke hospital is an interesting experiment in how things could be run. The hospital is still part of the NHS; its assets are still state assets and its staff NHS employees. But Circle have been able to make dramatic changes in the running to give control to doctors and nurses and to put patients first in delivery.

I was shown round by the eneregtic and inspirational Massoud Faroudi, himself a Consultant and partner of the effervescent Ali Parsa.

At lunch in the now greatly improved restaurant (they believe good quality food is part of the healing process- goodness how you want the NHS to learn that!) I met a group of the leading Consultants. I aked them what was the major change for them since Circle took over the running.

One said it was the staff empowerment and the raised morale. They have put a lot of time into re-engineering systems and processes by getting teams of doctors, nurses, staff and patients together.

One said it was about their ability to better manage risk; which is now a more collegial affair rather than top down instruction.

Just to give you a striking example of how the NHS can learn; the majority of people in hospital beds are over 60. We know that many old people end up in hospital and stay too long , with often serious consequences for their overall health and well being. So effective early discharge is crucial. Yet in most hospitals they only have 2 consultant led ward rounds a week. Sometimes less at bank holidays. Junior doctors rarely discharge patients. So they are to introduce 7 day ward rounds. So a simple measure to cut unnecessary legth of stay. A person not fit to be discharged on Thursday may wait till Tuesday to get home even though they and their condition would enable that.

There are other parts of the NHS working on this. It's an important nut to crack.

I suggested they also need to have a much stronger link with third sector bodies because older people need to have more support at home and with council budget cuts to social care this is increasingly a problem.

Another simple but highly effective initiative was to cut night time noise. One of the most frequent criticisms of hospitals (apart from food) is the inability to sleep at night with all the noise that goes on. They got together a team of patients, staff and managers to look at the causes, like waste bins with squeaky lids, and have made changes.

They also face serious financial challenges. They faced bigger problems than they anticipated and so their financial projections are of course. So time will tell if they can make it work on a financially sustainable model. 

For me the most important change has been in the clinical leadership of decision making and the patient centred approach. It is not because there are not superb examples in the NHS but the culture is a top down, centrally driven one. A huge organisation like the NHS inevitably becomes over bureaucratised and so staff involvement can be hard to achieve.

So a good day, though as a strong Episcopalean with Roman leanings I did not enjoy seeing the place of birth of one king killer and kill joy Oliver Cromwell ( Hinchingbrooke House ).

I topped this off by a visit to Addenbrooke's in Cambridge . I have to admit to finding the health service fascinating. Talking to doctors and consultants about their experiences and their expertise is hugely rewarding. I'm acquiring all sorts of extraneous medical knowledge with which I regale assorted staff and members. Usually about disease and death. Anyway it's the weekend for me. I'm having a day off to visit a stately home and eat well. Though in a healthy way obviously.