Dogs, Philanthropists, Independence and all

Settling down to catch up on Coronation St I was disturbed by someone at the door. It turned out to be a fundraiser from the Battersea Dogs Home. My faithful hound having also appeared at the door I felt I could hardly resist taking up the offer to give them a DD donation.

In fact I'm rather prone to signing up to fundraisers. I've done that for people who popped round from the British Heart Foundation and VSO. And I also can't resist the charms of street fundraisers, or ‘chuggers’ as some term them. So I have an eclectic list of charities I support; but then as the CEO of ACEVO I can hardly turn them down. And it’s a bit like market research for me as I get their literature through the post or the emails. Shelter are particularly assiduous in their search for funds. But then they need to be. Getting support for the homeless sector is difficult. Hedge fund managers and their ilk like something more cuddly, and we have such a long way to go before such people match the level of giving that their counterparts do in the States. Of course there are exceptions, but it is still a dismal fact that poorer people give a higher proportion of their wealth to charity than rich people do.

This is a point that people like Thomas Hughes-Hallett have been labouring for some time. I had lunch with him recently and he was outlining his plans for an Institute of Philanthropy. A much-needed innovation and one to be strongly supported. And he has managed to secure the support of a good philanthropist who is putting a substantial endowment behind this project so it can really motor in a big way, making an impact where it is needed. Thomas is one of the sector greats (I got to know him well from the infamous government ‘listening exercise’ where we laboured together on choice and competition), and it was a rather enjoyable lunch – we discovered we both have a love for the English choral tradition. He supports ‘The Sixteen’ and the choir of Westminster Abbey.

Yesterday I was speaking at the launch of the Independence Panel’s final report on ‘An Independent Mission: The Voluntary Sector in 2015’. You can read it here.

It raises some fundamental issues and concerns. It raises he concerns many of my CEO members have been raising about the politicisation of the Charity Commission. It agrees with ACEVO that the Lobbying Act must be repealed as soon as the next government takes office.  And it challenges sector leaders to continue to speak out. We will. Well, I certainly will.

At FareShare in Deptford

So, there I was. On a trading estate in Deptford (not known as the most salubrious part of South London it has to be said) in my high vis jacket. No, not doing a George Osborne on the campaign trail, but visiting FareShare, a charity run by an old colleague, Lindsay Boswell. FareShare receives food surplus (in-date) from the supermarkets that would otherwise go to waste, and redistributes it to charities. It's big business. Big charity business.

Actually I mustn't be too down on Deptford. It has a fine history. Christopher Marlowe is buried up the road in the fine old Church of St Nicholas, Deptford, and just opposite the warehouse is the spot where the first German bomb of the Second World War landed. Some dreadful council developments took the place of much of the bombed areas, so a lot of the fine old houses and spots of this ancient dock area have gone and Samuel Pepys or Peter the Great (former residents) would not recognise it now. At least it means FareShare can rent a decent sized warehouse at a reasonable rent. At least for the time being, I suspect, as London continues to expand.

Winterbourne: closures will happen

One of the perils of having a weekend away is getting a cold. And as any CEO knows, taking any time off for a cold is a no-no. So this was perhaps not the best background for appearing before the Public Accounts Committee (PAC) and the formidable but brilliant Margaret Hodge.

The PAC were taking evidence on the recent National Audit Office report on Winterbourne View and the care of people with learning disabilities. Basically, the report gave more detail about the failures of the health system to provide proper care for people with learning disabilities.

Its evidence very much backed up my own report last November, “Winterbourne view – time for change”, so I was pleased to be able to hammer home messages from my report.

I was keen to be fair and constructive in my analysis, and where I had criticisms to couch them positively. There is no point in not being constructive at this point. And I wanted to be fair in the sense that, as I told the PAC, I have agreed to recall my steering group to review progress in 6 months and then in a year. Woe betide them if they are not making progress on what I have told them needs to be done.

As I said, I think the change of leadership in NHS England is now driving institutional change.

I was critical was on the failure of NHS England, in their response to my report, to confront the need for closures. They retreated behind euphemisms like ‘reconfiguration’ and ‘reshaping’. This simply isn’t good enough. Large-scale institutions have to close. Institutional care is not the right way to look after people with learning disabilities. My report could not have been clearer. I recommended they bring forward a timetable for the closure of inappropriate institutions, but their response did not address this. Indeed it was thoroughly mealy-mouthed about it.

So obviously I laboured this point hard in my evidence session to the PAC.

I was therefore delighted when, in response to grilling by the MPs on the PAC, the CEO of NHS England Simon Stevens said that he wanted to see closures – and he did use the ‘c word’ – and that they will indeed provide a timetable for closures within 6 months. He made a very telling point drawing from his experience in Tyneside, working in mental health, where they closed the old asylums but left open the same style institutions for people with learning disabilities.

This new announcement is significant progress. It signals to the system that things must change. That the  ‘revolving door’, whereby people are discharged into community care and find the beds filled up when they leave, will end. All those lazy commissioners who have block contracts and refuse to properly monitor the people in their care will find they now have to look for community alternatives.

This demonstrates real leadership by Simon Stevens. He should be congratulated for taking a bold step and signalling to the system that the end is nigh for institutional care for people with learning disabilities. Of course it will take time. Community facilities must be developed. But the third sector is there – ready and primed to provide that facility. We now need to be engaged, to scale up our work, so that the institutions can close.

So a really positive outcome to the hearings. I spoke to my old friend Margaret Hodge afterwards and she too was pleased at how positive the hearing had been and a good outcome. She is going to review progress in 18 months so there will be a continuous external review of what the system is doing. This will keep them to the mark.

One of the problems is that there a range of players who need to coordinate actions. For example pooling budgets. I don’t believe a simple call for them will work. I told the PAC the Government should use their powers in the Care Act to mandate pooled budgets. It means the Secretary of State for Health can enforce pooled budgets between local councils and health CCGs. Knowing councils like I do, one-third will willingly pool budgets, one-third will decide it’s not a priority, and one-third will actively resist because it’s cheaper for them to have the health service paying the cost of an institution rather than them supporting people properly in the community. Change will come, but we still need pressure at every level both inside and outside government.

Community transport: put the third sector first!

Last week Labour’s Shadow Secretary of State for Transport, Michael Dugher MP, made an important announcement for community transport charities. He said a future Labour government would look to not-for-profit transport operators to help communities that are poorly served by the unregulated bus markets outside London. This is a good sign for the third sector.

Community transport is an important part of the debate on devolution and local authority powers. Why shouldn’t local authorities be able to shape their local bus services in the public interest? I’m pleased to hear a front bench politician addressing this question.

Politicians often say that a broken market can be repaired by diversifying the provision of services. But they don’t so often go on to say that the third sector should be a central provider of public services. This is the key contention in ACEVO's public service reform agenda.

Since bus deregulation in 1986 the majority of bus services outside London have been run by commercial operators. If services aren’t profitable enough, they can withdraw them. Local authorities have few powers to create a better deal for their residents, other than to subsidise routes they deem to be socially necessary. So usually they will pay commercial operators to run services they had previously withdrawn. Often, it’s the most vulnerable and isolated people and communities who suffer the loss of public transport. Their chances of accessing vital public services and employment are severely curtailed.

Who is lined up to respond to this challenge? The community transport sector has always been there, working with local authorities to address gaps in services and helping people who cannot access conventional bus services.

Community transport operators provide a bridge between the transport industry and the charity sector. They have a lot in common with other charities but are often quite distinct from the rest of the transport industry, not least because of the number of women in positions of leadership. Two of these are members of ACEVO. At our annual dinner last year, Jo Beaumont (who leads a social enterprise that works across the North of England and the Midlands) was chosen to be an ACEVO fellow. Anna Whitty is CEO of the ECT Charity and has recently joined ACEVO; Anna was instrumental in leading a partnership providing accessible shuttle services for the London 2012 Olympic and Paralympic Games, which did wonders to raise the profile of the community transport sector.

Bill Freeman, ACEVO member and a regular at our North West CEO’s forum, is in his second year as Chief Executive of the Community Transport Association, the national body which leads and supports community transport across the UK.

Bill has argued since day one that things could be different. He says it makes no sense for policy-makers only to turn to the community transport sector once everyone else has had a go, spent the money and proved they can’t make it work. He argues that the not-for-profit model should be on the table from the start when thinking about how to meet transport needs within our communities. It is a more reliable and resilient way of addressing unmet needs.

So far in this election campaign there’s been too little debate across the board about the third sector. Community transport is a great example of the contribution we can make to public services in future. At ACEVO we’re currently reaching out to bring more Community Transport operators in to our movement, to strengthen our voice for change in the way our public services work. And let’s hope we can keep up the momentum for the third sector to be showcased in other debates in the weeks left before the polls!

Some information about Community Transport in the UK:

What is community transport?

• Community transport is about providing flexible, accessible and responsive solutions to unmet local transport needs, and often represents the only means of transport for certain user groups.
• Using everything from mopeds to minibuses, typical services include voluntary car schemes, community bus services, school transport, hospital transport, dial-a-ride, wheels to work and group hire services.
• Community transport benefits those who are otherwise isolated or excluded, enabling them to live independently, participate in their communities and access education, employment, health and other services.
• Community transport works to a particular set of regulations designed to enable not-for-profit services run for a social purpose to be able to operate within a safe and legal framework.

Regulation of CT services

• Community transport operators are required to comply with both charity law and transport law. Charity law ensures that the organisation’s activities are focused solely on providing public benefit. Within transport law there are special provisions for services that are run on a non-for-profit basis.
• The key legislation is contained within the 1985 Transport Act and its subsequent amendments.  This was the Act which denationalised the bus industry; it recognised that transport provision in some places was unlikely to be commercially viable and so provision was made to make it feasible for community groups to provide transport.
• The regulatory regime strikes a balance between placing sufficient rules on community transport services to ensure that they are safe and legal but not making them so stringent that they deter community organisations and volunteers from getting involved in operating a transport service.  Any organisation which provides transport using a minibus should have a permit, whether or not they charge a fare to their passengers.
• One type of permit (section 19) support services that take people or groups from door to door, as a taxi or coach might. The second type of permit (section 22) enables them to run scheduled services along fixed routes, like conventional bus services but with smaller vehicles.

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!

Choice and integration

The third sector leads the way in joining social care and health. My recent work on winter pressure in A&E departments has reminded me just how effective we are at reducing demand for hospital services. More news on that to come later in the week...

I've written a piece for the New Statesman today, looking at Labour's plans for a 'National Health and Care Service'. Here it is:

Government NHS reforms adviser: Burnham's plan for patient choice is the right way

Last week, the former Health Secretary Alan Milburn said it would be a "fatal mistake" for Labour to fight the election by spending on, but not reforming, the NHS. He was joined by another Labour luminary – Lord Darzi – on Friday, as a clear group appeared to line up against the shadow health secretary Andy Burnham’s agenda.

These attacks are not just unseemly, but wrong as well. Look behind the headlines and Burnham’s agenda is the right one: to reenvision the National Health Service as a National Health and Care Service. Now we need more detail on how this is to be done.

It’s clear the NHS can’t survive without fundamental reform. As an adviser to this government during the passage of the Health and Social Care Act in 2012, and more recently on care for people with learning disabilities and on winter pressures in Accident and Emergency, I’ve seen the gravity of the situation first hand.

I’ve also seen there are no easy cuts to make. Cuts without strategic thinking have fragmented not only healthcare but also social care across the country. This directly harms our most vulnerable citizens. It means more people falling through the cracks of a breaking structure. We are on borrowed time and on the cusp of a reality where crises like the one we are living through in A&E this winter will become the norm. And it is largely our legislators’ fault.

Poor social care causes more damage every day. Cuts to council budgets have trimmed care for the elderly to the bone. Charity CEOs tell me of reverse auctions for local health contracts being won by the very cheapest service, whatever form it may take. Some private operators – though they are often very effective – may bid so low that they make a loss on social care and recoup the money elsewhere.

In A&E, these cuts send more older people into hospital for preventable problems. Often 20 per cent of beds are filled by elderly people who aren't ill, but end up in hospital because no one else can help. They can't be discharged because there's no social care to help them at home. Cutting costs money; when we run out of beds it can also cost lives.

Burnham's plan is to price in these very real externalities of running a health service. The vision is to change the NHS by replacing competition with integration. When Burnham talks about integrating the work of public, private and third sector providers, he is indicating a situation in which new services are created by new kinds of collaboration.

Collaboration rather than competition becomes the driver of patient choice. This is not merely theoretical. This winter I have chaired an NHS taskforce to get charities in to 29 emergency departments that are under pressure to tackle the immediate problem. We hope to get the charities into action early next week. We will be giving vulnerable patients a choice to receive community care that the market has failed to provide.

No doubt market liberals of the left and right will sniff at this vision of a world of choice beyond how they define it. But politicians of all parties must keep their nerve. The idea of a health service rescued by cuts and efficiencies is debunked. Now they must scale up the radical approach into a sustained plan of action. 

They can build on pilots like the charity intervention into Accident and Emergency, on innovations such as the coalition’s attempts to pilot bringing together budgets for health and social care at a local level, and they can create a new, integrated plan for health and care. The Burnham plan may not be easy to digest or to do – but it is needed.

Shawcross reappointed - my letter to Jeremy Heywood

Last Thursday morning I was surprised to read of William Shawcross’s reappointment as chair of the Charity Commission, which was announced without prior warning or consultation. His three-year term was to end in October, and the reappointment process would usually begin in a few months’ time.

The Commission is an important public body, and not the Cabinet Office’s personal fiefdom. At a time when it has been under sustained and severe criticism - and when as the National Audit Office acknowledge, they are starting to turn things around - this is not what they need. It will only add fuel to the fire of those who accuse the Commission of being a plaything of government patronage, rather than a forceful, independent regulator.

I wrote to the Cabinet Secretary Sir Jeremy Heywood to clarify a number of points about the reappointment process, as was reported by Saturday’s Times.

Here’s a copy of my letter, which is also on the ACEVO website:

29 January 2015

Dear Sir Jeremy,

I am writing to you to express my concern at the process behind today’s appointment of William Shawcross as Chair of the Charity Commission. I would like to seek your assurance that due process has been followed. 

As you know, the position was due for renewal in October 2015. Shawcross’ initial appointment followed a period of advertisement, shortlisting and a pre-appointment hearing from May 2012. I and many of my colleagues in the charity sector, our supporters, donors and beneficiaries are therefore surprised to learn that the appointment has been made already.

The fact that this appointment has taken place less than three months before a general election will serve only to raise those concerns in the mind of the public. They deserve and require assurance as to the absolute propriety of the processes that have been followed to make this appointment. As such I am writing to seek your assurances on the following points of information.

1.    Was recruitment conducted in accordance with the Code of Practice for Ministerial Appointments to Public Bodies? According to this code, reappointments can only be made once evidence of a satisfactory performance has been made.

2.    Who was on the committee that made the appointment? The previous committee was chaired by Mark Addison, a Public Appointments Assessor representing the Commissioner for Public Appointments, who is independent of the Government. It also included Sue Gray, Head of Propriety and Ethics in the Cabinet Office. Given the public nature of this role a committee for reappointment would have been appropriate.

3.    Were other persons considered by the committee and did they meet the requirements stipulated by equalities legislation and in accordance with suitable non-discrimination policies appropriate to the position?

4.    What representations were sought from Cabinet Office’s Propriety and Ethics Team about the process and what notice was taken by the appointments committee of those representations?

5.    Given the crucial public nature of this role, how will the process behind the appointment and the fact of the appointment itself be disseminated and communicated to the charity sector and the wider public?

The charity sector is vital to the health and wealth of our nation. Charities must be independent and free to speak truth to power and to deliver in the public good. To do both they depend upon the trust and confidence of the public. Trust and confidence are fragile. While trust in charities remains high, it would be unacceptable for questions over the regulator to compromise trust and confidence in the charitable sector.

I look forward to receiving your reply. In the interests of transparency I am placing this letter in the public domain.

Yours ever,

Sir Stephen Bubb