Meetings with remarkable people

Our Chief Executive, Paul Streets argues that we need to be proud of the achievements of those leading our smaller charities.

This blog first appeared in Third Sector on 20th June 2016

I’ve led four national organisations but my meetings with countless chief executives of the smaller charities we fund have led me to conclude that overseeing a local charity is something else.

Chief executives of large charities may be pre-occupied with questions of how to maintain contracts and fundraising growth in a post-Olive Cooke world but, as austerity bites, small charity chief executives have seen income from local and central government halve, but demand rise and gets more complex.

Whereas the chief executives of larger organisations are well paid and are supported by a suite of directors, leaders of small charities need to be involved in all the roles and multi-task in ways that would challenge Ganesh. And the pay is poor.

It is surprising anyone does it.

And yet most of the small charity leaders I meet are unfailingly enthusiastic, dedicated and upbeat:

There are the innovators with ambition such as Suzanne Knipe at Norton Hall Children and Family Centre, working in Birmingham to revamp an old community centre and regenerate a run-down park. Or Matt Bell at Exeter Community Initiatives whose core work with homeless people has spawned community spin-offs.

There are the strategists driving cross-sector collaborations such as Carole Dixon at the Education Futures Trust in Hastings, who is engaging local leaders to support young people and persuading cash-strapped schools to fund it. Or Monica Stark atLeicestershire Cares, who is engaging local business to employ the previously unemployable.

We have passionate advocates with an inner fervour that wouldn’t look out of place in religious orders, such as Joanna Kennedy, an ex-commercial lawyer who is chief executive at Zacchaeus 2000, which is fighting poverty cheek by jowl with prosperity in West London. Or Becky Rogerson at My Sister’s Place, providing one-stop domestic abuse services across Middlesbrough.

Then there are the entrepreneurial phoenixes who see opportunities where many would see obstacles. These include Kim Shutler-Jones of the mental health charity The Cellar Trust near Bradford, which is helping to fund its services through its café, conference facilities and wood workshop. Or Tracy Freeman, who is tackling homelessness at First Stop Darlington through the creation of a bike shop.

These are remarkable people in anyone’s book – and they do all this without the caché or benefits associated with running high-profile national organisations.

Most have rich life experience and many have been there for years. Often they’re first-time chief executives stepping up from the frontline, or were the founders, making them instinctive rather than learned in how they lead.

The determination and sheer bloody mindedness that drives them to do these tough roles may not always make them easy to deal with, but it does mean they are prepared to move heaven and earth to make a difference for the people who come through their doors.

You won’t see many of them at sector shindigs in Whitehall or Westminster, but lots of them exist. We fund nearly 1,000 of their organisations but you could multiple that by 46 if we covered all charities with incomes of between £25,000 to £1m a year.

They, and what they do, are what we should be most proud of as a sector.

These great leaders I meet have traits other sectors would give their eye teeth for: a commitment to cause over contract; an inner-reward system geared to sustainable results over short-term fixes; and a proximity to customers that public and private organisations can’t get close to, even with complicated user-engagement mechanisms and expensive focus groups.

It is no coincidence that most of the people I’ve referred to are women – as are the majority who lead the 97 per cent of charities with incomes of under £1m a year. So while public and private sectors endlessly set unmet targets for diversity, those leading our small and medium-sized charities are striding ahead.

Read into this what you will, but it is something else we should shout about as a sector if only we stopped looking over other shoulders and started to look over our own.

Has the behaviour of large charities damaged the whole sector?

Our Chief Executive, Paul Streets participated in NPC’s morning #CharityTrust debate about the consequences of recent high-profile charity scandals on Wednesday 15th June. Here he outlines his main arguments. 

This post first appeared in NPC’s blog on 15th June 2016. You can follow NPC’s Storify of the event here.

Of the 180,000 charities in England and Wales, around 175,000 (97%) have an income under £1m. Just 621 have an income of over £10m. So for every large charity like Cancer Research or Oxfam, there are 28 smaller ones that are far more representative of the sector.

Many of these small charities are so focused on the frontline you probably haven’t heard of them. This is in contrast to their larger counterparts whose fundraising activities literally bring them to every high street and household—and which, rightly or wrongly, have generated a lot of newspaper headlines lately. Yet there’s a danger that these issues and concerns around big ‘charity’ have come to define and indeed tarnish the public perception of all charities.

Small charities are being squeezed

As a funder of smaller charities (under £1m), we know they’re different, and we know they’re up against it. Our day to day experience and recent research has shown:

  • demand is rising and getting more complex, while commissioning is failing them and those they serve;
  • they have been hardest hit by drops in central and local government income since 2008/2009, with a massive shift from grants to contracts. Government income to the largest charities has risen by almost half, for those under £1m it has fallen by almost half.

…but sometimes it’s larger charities doing the squeezing

No organisation has a right to exist. So would it matter if larger organisations took over? If they provided long-term support that thoroughly addressed multiple disadvantage, it wouldn’t. But too often, they don’t. Too often larger organisations see success less in purpose, mission and values but in size, volume and market share. And they can be ruthless in achieving it; including putting small specialist charities out of business or co-opting them as bid candy to entice commissioners, then passing only the hardest cases down the supply chain, without the funding to match.

Their input can be superficial and short-lived. Time and again we’ve heard of larger charities poaching contracts from established and expert smaller charities, and then when their contract ends and they move on, the now weakened smaller provider has to pick up the pieces.

Small charities have a lot to offer

By contrast, small and local charities are typically:

  1. Deeply embedded in communities, with local staff and volunteers developing trusted relationships, reaching those others can’t
  2. Cost effective, keeping overheads low and adapting staff to volunteer ratios as income fluctuates
  3. Responsive to the climate, identifying new needs and opportunities, raising and stretching resources and reducing costs (though not without impact on the services they offer)

…and larger charities can help

The question around small and large charities shouldn’t be either/or. We can be proud of the many fantastic large charities that help to shape a better UK and world. And when small and large organisations work together, likeCatch 22 and Only Connect, they can strengthen each other. Similarly, where commissioners understand and address the issues facing smaller charities, they can ensure local needs are properly met, as Imkaan and Women’s Aid have supported London’s Tri-borough of councils to do.

We must stay focused and not turn against each other

But while the sector and those that represent it are focusing on the headline-grabbing issues that don’t actually affect the vast majority, it deflects from the real scandal; that Government, centrally and locally is withdrawing funds from smaller charities lock, stock and barrel.

If the voluntary sector is really about championing those most at risk to those with power and resources, it’s surely time to focus our efforts on the threats affecting the 97% of the sector. And that needs to include how larger charities themselves behave, compete and collaborate. If we don’t, the tab will be picked up by the poorest and most disadvantaged in our society. And the damage won’t be easily reversed.

Paul Streets Asks Three Wishes of the VCSE Government Review

By Paul Streets, CEO at the Lloyds Bank Foundation

Let’s ask for three wishes of this Government review. If England’s Public Health Services and their local friends in Clinical Commissioning Groups, Local Authorities and Local Health and Wellbeing Boards were Genies, and we were in Aladdin’s cave – what might our three wishes be?

The NHS remains the darling of the public. Health is never far from the top of our personal or Political agendas.

But we need to redefine what ‘health’ means for the needs of the 21st century. And whilst the centre calls for this ever more stridently and often: from The NHS Plan (2000) to Derek Wanless (2002) to the Five Year Forward View (2014) – the VCSE sector quietly gets on doing it.

We saw this in the 1990s with the shift in the focus of effective chronic disease management. This began with Arthritis Care bringing ideas from the USA to introduce self management. When I was at Diabetes UK we plagiarised this and models in Germany to create DAFNE, the patient education programme centred on supported peer learning. Then came Asthma, Osteoporosis – the list goes on. This thinking is now widespread across chronic disease management with an understanding of the expert patient. And now even cancer with the focus on survivorship and the work of Macmillan. It has even begun to flip over into elective care through the growing interest in shared decision making – which reduces elective care demand through a focus on patient over clinical preference.

There are many more examples. End of life care has been transformed through the hospice movement. Alzheimer’s Society has led to thinking on dementia friendly communities and dementia friends: still in its infancy but creeping up as mainstream thinking. The list is almost endless.

What all of these have in common is a subtle but clear paradigm shift in thinking: usually centred on listening hard to those on the receiving end and driving innovation up through the eyes of consumers, rather than down through providers. DAFNE is the example par excellence. It turned conventional thinking on its head with the strapline ‘eat what you like, like what you eat’ : an anathema to (then) current diabetes management.

But because none of these were initiated or planned from the centre and have often been achieved quietly without the brouhaha of the next miracle drug cure we rarely reflect back on the profound impact.

A powerful VCS national advocate or movement has often been critical. Prepared to be tenacious against the grain of current thinking with independent funding to put their money where their mouth is and create leverage.

But the 21st Century challenges health faces often don’t have organised and independent advocacy.

If we look at many of the avoidable health costs we see drivers that often don’t sit in ‘health’ at all and which affect the most disenfranchised in our society: drugs, alcohol, mental health, social isolation in older people, domestic violence, and homelessness. These are the bread and butter of A&E.

But they are also the bread and butter of the VCSE.

Usually this is local. And often small scale with a focus on good relationships as a central philosophy: outwards between the VCSE and its community, and inwards in the relationship formed with those it serves: a physical manifestation of Think Local/Act Personal rather than a strategic wishlist.

But whilst many of the large national charities which drove innovation in self management are independently funded – most local VCSE services whether provided by small charities – or national branches of larger charities – rely on a degree of public funding to survive, albeit often alongside funding from people like us at the Foundation.

NCVO data shows that public funding is both rapidly declining and shifting from a focus on holistic support of complex needs to one of contracting, scale and single outcome.

This is particularly problematic when the ‘spread’ model that works for chronic disease – VCSE pilots/proof of principle to an NHS which picks up the tab – doesn’t cut it for these issues. Success here is often founded on trust based relationships with people who have little faith or trust in public institutions which have often affected their lives so adversely. Effective reach will always require trusted independent agents – the VCSE will always be central.

At the Foundation we are becoming very concerned that these critical organisations are under real threat. Many of the larger foundations like us rely on what we have called the ‘fruitcake’ model. As we can only afford to be the icing and marzipan we often rely on public funded fruitcake. Both are critical but they are symbiotic: without one the other will not thrive.  Recent ESRC research demonstrates that this ecology is especially fragile where the need is greatest. What we have called triple jeopardy: the inverse relationship between need and VCSE capacity; and the direct relationship between areas with high public sector investment in the VCSE, high benefit dependency and high needs. NCVO data shows that at a macro level between and within regions. We see it ourselves: looking at London with the concentration of good VCSE’s in the centre, and near The City, and the scarcity in the outer suburbs where the need is greatest, or in the North East between Durham City one of the wealthiest areas, and Redcar – one of the poorest.

The implication is those most at risk are often supported by a VCSE infrastructure which is also most at risk. It is not hard to extrapolate what that might mean for health and social costs right across the Board and where the greatest impact will be felt if it continues.

So this really matters.

If we are brave the review is an opportunity to turn the tide. And a new electoral cycle the right time to ask for our three wishes.

So here are the 3 wishes to the DH/PHE/NHSE and their local partners in CCGs, Local Authorities and LHWBs: each in order.

The first wish: a more rounded view of where ‘health’ begins and ends. To the NHS it may end in A&E, the elective surgery table, long term care or blocking beds but it starts with people, the lives they lead and the communities they live in.

The second wish: match the recognition of the strategic value of the VCSE intended in this review with the need for well placed national and local funding to those best equipped to tackle these issues. This is hard at a time of fiscal constraint with little new money. It will mean diverting funds from what isn’t working, or from where we are funding the costs of failure, to funding community based prevention and support.

The third wish: take a more flexible approach towards how that support is provided with a determined focus on purpose centred on people as they present with their complex lives and wishes – rather than the service silos we pigeon hole them into. This probably means a radically different approach to how to achieve ‘scale’ and a big rethink of whether contracts are fit for purpose.

If you agree let us know.

Then: once our wishes are granted – we need to hear:

  • examples of how the VCSE is the answer to some of these intractable health problems so we can make a robust case for a strategic and central role, and
  • practical suggestions about what DH, NHSE and PHE and their local system partners need to change – or do – to enable that to happen.

This is not an easy ask and there are no easy answers. We need scale – and yet part of the solution lies in retaining the essential ‘localness’ of many small/local organisations. We will need to turn current orthodoxy of reach through scale up on its head – to create a presumption of achieving reach through replication, collaboration across boundaries and ‘spread’. So this time we need paradigm shifts on how to deliver, how to ‘commission’ and what constitutes ‘scale’.

Tough stuff.

But – as with self management 20 years ago – the answers will come ‘bottom up’ from us and those we serve: turning existing orthodoxy on its head.

So … give us a hand and, like Aladdin, we might even live happily (or at least purposefully) ever after.

A new dialogue for the voluntary sector

By Paul Streets, CEO at the Lloyds Bank Foundation

After decades of (relatively) safe London cycling….a three minute ride to my local choir in a sleepy East Sussex village and a wet manhole cover, did it for me. The full Casualty – even on a Wednesday Night! Blue lights, A&E, multiple scans, fractured skull, scapula, clavicle etc. And spectacular facial cuts and bruises …worthy of Halloween.

Enforced confinement gave me the opportunity to ponder the nature of big and small organisations – having contributed singlehandedly to the NHS overspend through the array of treatments.

Well. Everything that the Localities ‘Diseconomies of scale report’ last year tells me is right. Large organisations pass you from pillar and post (six specialists so far and still counting two months later) and, as part of that, consider you as an exercise in anatomy and different organs, rather than a whole person. Work gets missed because no-one knows who is responsible for what or assumes someone else has done it (spinal scan four hours after I’d been laid out without a neck brace – it was fine!); duplicate effort (everyone in the NHS knows my name, rank and number by heart); repeat communications (no specialist seems to have spoken to any other so I become the means of transmission) and systems that make the easiest things the hardest and most stressful.

Earlier in the year, I reread the seminal work by E F. Schumacher ‘Small is Beautiful’. He perfectly describes this. Writing in 1973 he states ‘Even today, we are generally told that gigantic organisations are an inescapable necessity: but when we look closely we can notice that as soon as great size has been created there is often a strenuous attempt to attain smallness with bigness’. This is exactly true of the organisation of professional teams within the NHS.

But there’s an important rub….it may be chaotic, disconnected and disembodied but it works. Albeit like a set of organs on the dissection table rather than a whole person. Specialists do their thing and you’re grateful they know what they’re talking about and are expert because we have a professional education and regulation system that ensures standards. You do get referred to the right places – eventually.

Whilst you’re laid up they take over by checking, feeding, medicating/checking, feeding; medicating/checking. And reassuring you by telling you what you’re experiencing is normal.

Interestingly, as Shumacher suggests, what’s most impressive is the small team work. Ambulance team – utterly amazing, compassionate and professional. A&E team – ‘we can fix you – you may think you look terrible – we’ve seen worse’. Surgical assessment….lull you into a calm sense of routine which is what you need.  The small teams visibly work in spite, or ignorant of, the dysfunctional system of which they are a part. Schumacher wouldn’t be surprised.

So as a Foundation which has put at the core of its new strategy  supporting small and medium sized (sub £1m) charities does it mean anything? It tells me we need to be clear when small is beautiful and why?

What ‘small’ might have done is treat me as a whole person with a one stop shop that meant I didn’t have to navigate my own very complex and confusing journey. Or it might have become the translator, mediator and advocate if I needed that. It might have considered my mental and longer term health post hospital needs….as well as my acute needs at crisis. And stuck with me beyond the critical few days by making the connections needed to make things happen. Offering the post acute basic needs that mean so much when you’re vulnerable: a decent meal, comfy bed, peace and quiet, rest and no pressure – that rely on family and friends. The voluntary effort rather than the professional.

In the context of our strategy it would probably have dealt with my ‘transition’ far more effectively. These are the things that we need to argue for when we make the case for small charities and their worth. They feel exactly right for people who are vulnerable – often without networks and support.

But we should also be clear when the specialist and large service has its place. Much as the NHS shares the dysfunction of all large entities, I’m sure as hell I wouldn’t have wanted to live this experience through a collection of a dozen different small charities.

Now, I am told that a head injury causes some strange effects so I am going to use my ‘concussion syndrome’ to give license to some personal opinions which may not be shared. In my view, for too long a part of the voluntary sector – and some of its leaders – have argued for level ‘playing fields’ with the inference almost that the sector should take over the state. Their arguments have fallen into the favour of politicians of left and right with dubious motive – or dangerous naivety. Naivety which has done those we wish to reach no favours…because the ‘level playing field’ argument has been far more effectively deployed by the private sector at immense cost to individuals. This was borne out on a visit earlier in the year to a South Devon CAB where we were supporting appeal work (almost always successful) against a large private sector work programme provider assessing whether disabled people could go back to work (bitter sweet for those affected perhaps but they subsequently lost their contract. Even the Daily Mail got angry about the impact on disabled people).

Much as I like the analysis in Locality’s report there is a danger of them also falling into the same trap. With their excellent critique of state provision for people with complex needs they potentially risk not recognising the ‘horses for courses’ argument about when the state and scale can work. Personally I don’t believe the (current) voluntary sector will ever achieve scale and standardisation when it’s really needed as the best option – even the very largest charities in Britain are minnows compared to the size of the public sector – except perhaps in real niche areas.

The voluntary sector at its best is the defender of individuals when scale services fail them (like the South Devon CAB) or ignore them or ‘standardise’ them. We may do worse than look back at some of the things that Schumacher says as a start point. He talks about the need for both freedom and order and states ‘the centre can easily look after order: it is not so easy to look after freedom and creativity’. If we use my analogy – my effective treatment needed order and standards. No thank you ‘creative and free’ medical staff. Creative and free was what I needed when the ‘order’ was done with me!

I believe we urgently need a new (post Big Society?) dialogue about why and when the Voluntary Sector works. But equally importantly when it doesn’t.

With our historic work and reach as a Foundation (30 years; 42,000 small charities; £350m) and our new strategy (promoting practical approaches to lasting change) we are perhaps uniquely placed to contribute to that. As part of our new strategy we aim to develop our national impact to influence policy and practice by looking to generate, challenge and provoke debate around this crucial issue. Making the case for the VCS – and in particular for the small and local VCS – as key tools in tackling disadvantage. That case will be all the stronger if it recognises that small isn’t always beautiful.

As we develop our programmes, thinking and actions further I hope this blog will be the first of many. I hope they provoke thought and debate that you’ll engage with us. We all need to be open to new ideas and ways of working and thinking as we grapple with the shared challenges of most effectively tackling disadvantage against a background of austerity and ever greater complexity in the social issues we face together.