It’s an honour to be here. And it’s a privilege to be asked. But I cannot tell you how hard it is to prepare! To be given a subject like Social Change. And to know that Debra (Allcock, DSC Chief Executive) has asked you and told you that you can talk about anything to do with social change!
As most of you here know Debra – you’ll know that means plenty of scope for lateral thinking!And yet I have been engaged in social change in one way or another for more than 30 years.So I thought I’d share with you some insights and reflections on Social Change from those years!
Let me start in the present.
For the last 4 years I’ve been running the Lloyds Bank Foundation for England & Wales. It’s been a Road to Damascus experience. We fund about 1,000 small local charities working with people who experience a range of multiple disadvantage. In the last 4 years
I’ve visited and spoken with hundreds of them. And I have been amazed by what I’ve seen. They deal with the most difficult social issues we face. Domestic Violence, Homelessness, Offending, Gangs, Sex working, modern slavery. They reach places and people that most of us would seek to avoid.
It’s easy to be rose tinted as a bleeding heart liberal – and they’re not all perfect – but, for the most part, they do a truly remarkable job. Often with the most limited of resources.
They achieve transformations in people lives that most of would regard as impossible and few of us would ever attempt. And I have been wondering how and why?
Whilst they tackle different issues I have come to the conclusion that,
- at the heart of what they do,
- and at the start of what they all do
They establish trust. Trust with people who neither trusted by, not trusting off, Society – and a State – which has largely either failed them, targeted them or censured them. Whether its Prison, the Police, Social Services, the DWP or Housing.
So I’ve spent a lot of time wondering what that means and reflecting back on my past lives. To make sense of it I want to share five stories with you which may at first seem disconnected but that might help get us to some sense of what social change is.
I’ll start in Africa almost 30 years ago with the Malawi Council for the Handicapped (MACOHA) supported by Sight Savers They describe themselves as – ‘torch bearers in disability mainstreaming’. One of the programmes they support works with blind farmers. The concept might seem a bit odd, but Macoha provides seeds and training. And they are pretty good at farming. One reason they’re pretty good is because they farm at night when it’s dark. It’s their choice. Pretty logical decision really. It’s hellishly hot during the day and cool at night.
My second story is about DAFNE. Now Dafne isn’t your aunt or a beautifully pungent bush.
It stands for Dose Adjusted for Normal Eating. Snappy title really dreamed up by a few clinicians. DAFNE was stolen from Germany by Diabetes UK. She started with an understanding that most people with diabetes lived in fear of their insulin. It controlled their lives – and especially when and where they ate.
DAFNE turned all that on its head with her strapline ‘eat what you like, like what you eat’.
She brought groups of people with diabetes together as peers to do just that with clinical support and advice. So they went for curries. They ate ice cream and cakes. They ate whenever they wanted. And they learnt that insulin could help them lead the lives they wanted – rather than the other way round.
I remember speaking to a women who had lived with diabetes for years after she had been through the first programme. Let me call her Moira. I asked her what she thought and whether it had worked and she told me: “amazing, last night for the first time in 23 years I went to the cinema with my kids and ate a pizza with them”.
The metric we normally used for diabetes control was HBa1C – blood sugar. Not pizzas.
So – we developed metrics to measure success with people with diabetes. And two of the key ones were ‘it enables me to eat what I like, when I like’ and ‘it enables me to have sex when I want’. So – these were two of our key outcomes. Since then – largely through Diabetes UK and its members – DAFNE, or similar peer/clinician led diabetes programmes, have been offered to tens of thousands of people with diabetes. And the clinical data tells it all. It might start with sex and food but it ends with improves blood sugar control. It reduces complications. It saves costs. But most of all it improves quality of life. Dramatically. And lets Moira eat her pizza with her kids.
My third story is as significant as DAFNE and again its health. But it doesn’t have a clinical ending. It’s the story of all the ‘ectomies’ that are performed in modern medicine.
Prostatectomy, hysterectomy…even Coronary bypass.. There are heaps of them.
We have legions of surgeons trained to intervene and remove and fix bits of our bodies.
Over the last decade there has been increasing interest in what’s called ‘Shared Decision Making’. In some ways, that’s a bit of a misnomer.
The guru is Professor Al Mulley in New Hampshire. Al talks about moving from clinical preference to patient preference. And the evidence is remarkable. When people have a proper conversation about risk and benefit they often chose not to have the operation at all. It’s especially effective if that involves conversations with ‘peers’ – people who have been there and done it themselves.
Lived experience matters.
The best example I know comes from Arthritis Care. It’s a lovely story. Of an elderly lady with mobility problems. Let’s call her Doris. She was referred by her GP to an orthopaedic surgeon who wanted to do a knee operation. With all the difficult path towards rehabilitation and the cost that would have entailed. But when Arthritis Care asked Gladys what it she was unable to do it was the gardening. So – they scrapped the surgery and built her raised flower beds so she didn’t have to kneel or bend.
My fourth story comes from one of my first visits at the Foundation to a homeless programme we fund in Redbridge called the Healthy Living Project linked to the Baptist Church. I was amazed when I arrived to find that they were offering young homeless men massage. When I asked I was humbled to be told: “They love it and it enormously therapeutic, remember these men are only ever touched violently”.
I’m sure the Daily Mail would have loved it, but it works because it starts to engage them on a different level. They know they are somewhere that cares.
My final story is again one of the charities we’ve supported at the Foundation – Unseen UK. Unseen is only about 10 years old. It started as a local response to the problem of people trafficking in Bristol – providing safe houses and support to women trafficked into the country largely for Prostitution.
Since then its provided over 10,000 safe nights to 125 women from 37 countries. And it’s now started to provide services to men. Their individual stories are moving and they’re horrifying. Powerful individually – Unseen has used the power of their voices collectively to get the issue of modern slavery on the map in the UK. Through its work with the Centre for Social Justice it was at the heart of the Modern Slavery Act championed by Teresa May.
So – what do these stories tell me?
They tell me too that too often our thinking on Social Change starts from the wrong end.
A debate about rights, equity and justice. And we move directly from that to engage with the political process. Of course rights, equality, justice, politics and power are crucial to social change. But if we start there we lose sight of what we – as the voluntary sector – do best. At our best, we start with individuals facing problems and challenges and we listen, we listen hard and by listening we see things that others don’t.
So we end up with very different outcomes and very different services.
- Blind Farmers that farm at night;
- Moira and her Pizza;
- Gladys and her raised beds;
- Massage for homeless men and an awareness and response to the unseen horror of modern slavery.
And when we really listen what we hear challenges current orthodoxy and thinking from the ground up. That’s where the power to create real changes lies.
It gets Society to think again – because instead of numbers and statistics – it’s about people – people who could be anyone of us. Of course, sometimes that means we need to engage with the Political process – as with Modern Slavery. But sometimes what’s needed to create social change is much simpler and it’s much more local, immediate and potentially achievable if only others followed our lead, and listened too.
Can you ever imagine a commissioner purchasing outcomes that triggers payments when:
people are able to eat a pizza with their kids, improve their sex lives or help them garden, or funding interventions like massages, or god forbid insisting that poor blind people farm at night.
So let’s look at how we actually design and deliver services. And who they are designed for.
1948 and the creation of the Welfare State was amazing. Imagine what it was like before – you only need to cross the Atlantic to see what healthcare was like. Although born out of a deep sense of injustice following WWII. In essence the mentality was one of vertical hierarchy – top down paternalism.The state knew best, services needed to reach certain standards and these would be managed, purchased or commissioned from the top down…
and regulated to ensure compliance. And at the coalface – Professionals knew best with a very clear pecking order. Doctors/Police/Social Workers in the lead and at the top. The service recipient at the bottom as a supplicant.
We industrialised provision. Services were organised in much the same way as production lines. The hospital is the example par excellence. Its designed in and around professionals and their disciplines. Patients we pass, like vehicles on a production line, from one team to the next. And as with most public services people are done too, not with. Largely speaking the aim of the welfare state is equity and conformity.
One size fits all.
And it works for most of us. Since 1948 we have achieved amazing advances in health, education, housing, social and pension provision. But it fails in two ways:
First in our approach to services for the minority who are the most marginalised, vulnerable, largely disenfranchised and powerless – where our approach seems to be unremittingly top down – with the voices of those on the receiving end neither seen nor heard.
It’s the approach which led us to label families as ‘Troubled’ and have it delivered by the State in the guise of Local Authorities and DWP and then expect it to work. It’s what has led us to Universal Credit.
Second it places an over-reliance on professionals to set up the right service on in the first place.
I remember when I was at The Department of Health a mental health service user responding to our request for comment on a service by saying he ‘didn’t want to help design your service, he wanted to design his own’. Like Moira and her wish for a service which helped her to eat a pizza with the kids. Or Doris and her raised beds.
Let’s reflect on these stories and the insights I gain from the small local organisations we fund at the Foundation.
What they do and how they work shows us a new way of thinking about services and how to reach people. They don’t start with the service and try and design that through the eyes of professionals, experts or Government officials in Town Halls and Whitehall. They start with the person – and build a relationship to establish trust. Only then do they layer on the service.
A man at one the homeless charities I spoke with recently said it better than I ever could:
“What I need isn’t just to come off drugs, quit alcohol and get a job. I need to know that I’m worth something – then I might want to do those other things”.
That’s why they need to start with Trust.
And because Trust is about relationships it needs to start with something that is intimate, immediate and familiar. In the current local Government parlance these small local organisations really do Think Local and Act Personal. And it works.
For services founded on a bedrock of trust like the work we fund with people who have experienced Domestic Abuse, homelessness, entrenched unemployment, mental health or prostitution. At their best, they put the person who comes through the door back in control over – at least a part of – their lives. This itself can often be the beginning of transformation in people’s lives. People whom the state and society has ignored, side-lined, sanctioned, patronised or pitied get back some means to influence their futures.
Some control. And – counter to the prevailing mantra that local organisations will all collapse or die – they are likely to be more sustainable – even in a tough financial climate – because they’re there because they responded to a need they saw, not a contract they pitched for. They’ve come from the community, designing and delivering a response to a local need – often, precisely because the state – centrally or locally – wasn’t meeting that need. They’ve made a Commitment to Serve – rather than won a Contract to deliver.
So whilst the grant or contract income may be critical to their work – they’ll be there, and they will do something with or without it. Unlike the commercial provider or national charity who will simply pull out if the contract is lost.
The problem with the current approach of Government and Statutory bodies to these organisations is that it transfers a set of logic that works for dustbins, roads, hospitals and schools – provided to everyone – where standards can be set, metrics agreed and performance managed to these small local committed providers.
If small local organisations need to put trust at the heart of their own service – we need also to trust them to know what’s best.
That means accepting that defining a contract with outcomes – and determining what activities to fund at the centre – simply won’t work. We need what Locality has called funding for ‘purpose’. That doesn’t mean we shouldn’t go through proper due diligence to ensure organisations are viable or ensure they are connected to the people they wish to serve, but, having done that, it does mean we should assume they know better than us how to meet need.
And for organisations where trust lies at their heart it should mean a presumption that local is critical and that small is probably best. So, if it means public services need to adopt a different approach what about us? The Voluntary Sector.
Our role as Social Changers has never been more crucial. Those we should champion are at their most vulnerable – as the impact of public sector cuts hits them the hardest.
And they live in a Society that shows all the signs of compassion fatigue. And yet in the headlong rush for growth some of us have bought into a state vision of what social change means that is articulated in the contracts it would have us take. Swapping the voices of those we reach – for the voices of those who commission us to reach them
and determining need on the basis of what they are prepared to pay.
In so doing we have effectively become co-opted – as delivery agents of the state – rather than agents of social change. It feels like dangerous territory.
Just how far do we go to win the contract? How much are we prepared to compromise?
If the last couple of years has taught us anything it’s that we need to return to the values and ethos that differentiate us from the private and public sectors. And that means not aping their top down or market driven approaches – either with respect to those we wish to serve – or with respect to our fellow charities.
The greatest anguish from many of the small charities we support comes when they are on the sharp end of competitive and pricing practices from larger charities. Who sometimes seem happy to use their economic muscle and bid writing prowess to pitch against a long-established local charity – or squeeze them as a sub-contractor if they win. Yet at the same time proclaim their ethos and values in direct mail and PR.
OK times are tough. But if we in this voluntary sector don’t mirror in our own relationships, the value we place in building relationships with those we serve, we only have ourselves to blame if the commissioner decides they might as well go with a private provider. Or the public grow ever more sceptical of our requests for their money.
We need to redress the balance. As a sector we need to reconnect with our campaigning roots – focused on the lives of people who need us to be their champion. And that means connecting local action with national advocacy.
There are great examples of organisations that do this brilliantly.
- Amnesty with its local groups and action networks;
- Membership led health and disability charities like Mind, Diabetes UK;
- Women’s Aid and its advocacy of its members and abused women.
- The Children’s Society and the Refugee Council – fighting for asylum seekers and young refugees
They make a connection between those who have voice and influence at the centre through their size, scale, brand and reach and the 1000’s of local organisations, groups and people who respond to that need from the bottom up.
In them we reach a recognition of what has probably always been true. Politics & Power matter. But real Social Change happens bottom up and it happens to real people. It’s about power at a personal and human level. The power to make a difference to real lives. The power to make a difference to my own life, my family, my neighbourhood, my community or those like me.
So, as we celebrate Social Change Winners today, we should also celebrate the tens of thousands of small local organisations that know what Social Change means to people from the ground up.
They understand that relationships are what counts. They listen, they build trust and they act. And by doing that they create real Social Change. Day in/day out. In the lives they touch.