Digital is important, but face-to-face is still vital

The sector must play to its strengths and ensure people are not just reduced to algorithms, writes our Chief Executive Paul Streets.

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This was originally posted in Third Sector on 23rd January 2018. 

At the Lloyds Bank Foundation for England and Wales we aim to help small and local charities thrive, including by providing funding to help them develop their digital capabilities. But we also acknowledge the critical need for the human touch. Human interaction is vital to reach the digitally and societally excluded.

The small organisations that we fund establish face-to-face relationships with people whom society routinely ostracises as offenders, ignores as homeless, chastises as sex workers, rejects as migrants or misunderstands as mentally ill. The human touch is the only way to re-establish trust and create the kind of bespoke, but direct, customer service and support to which digital platforms can only aspire.

It’s time the charity sector played to its strengths. Rather than follow the commercial sector and reduce people to digital algorithms…

In the thirst for growth, some of the big names in the sector see silver in digital bullets, adopting the best commercial sector practices in their fundraising techniques. But they risk becoming remote and indistinguishable from the myriad commercial organisations that invade the virtual space.

The thirst for scale by a government seeking blanket solutions delivered by fewer, larger providers has driven too much public sector contracting. Standardised payment-by-results specifications distort services in favour of the contract manager as the “client” rather than the person who comes through the door with multiple needs and strengths.

It’s time the charity sector played to its strengths. Rather than follow the commercial sector and reduce people to digital algorithms, the sector needs to keep the human connection at its heart.

When I visit the small local charities we support, I am repeatedly humbled by how much time they spend working one to one with the most disadvantaged. Their staff display great compassion and create more hopeful futures for those who face seemingly insurmountable challenges.

So my new year resolution is to ensure the full story of the sector is told: one where the vast majority of charities operate locally and support the most vulnerable with a helping hand.

Local heroes I’ve encountered over the past few years include Kim Shutler-Jones, chief executive at the Cellar Trust, which supports people with mental health problems in the Bradford area, and Ruth Robb, chief executive of Azalea, which supports street sex workers in Luton. There are thousands more like them working in the charity sector. Their approach is truly person-centred, never assuming that technology can gain the insights that can be gleaned by staff on the ground, nor filtering out who they will help based on whether it helps them hit the targets against which they’re funded. Don’t get me wrong, technology and measurement tools are indisputably important, but not as much as the insight you can glean from the person in front of you as they stare silently into the mug of tea you’ve just made for them.

So my new year resolution is to ensure the full story of the sector is told: one where the vast majority of charities operate locally and support the most vulnerable with a helping hand. That story requires a different measurement of success: not based on commercial sector metrics of growth and a rise in income, but voluntary sector values measured by the quality of human interaction and lives changed. Viewed that way, the sector is a bright jewel in our national crown.

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A sector to be thankful for

Spare a thought for those who will hold the fort over Christmas, writes our Chief Executive Paul Streets.

This was originally posted in Third Sector on 20th December 2017. 

Many of us will be feeling stressed as we hurtle through high streets towards Christmas Day. But away from office parties and well-earned time off, many charity beneficiaries across the country will be experiencing real stress that puts our panic over mismatching baubles into alarming perspective. Not just because problems don’t go away at Christmas, but because it’s a trigger for many kinds of crisis. A time for those struggling with addiction to relapse; a time of acute awareness of loneliness or isolation; a time of bitterly cold nights for homeless people; and a time when those struggling to make ends meet find the pressures even greater.

So how will charities respond to Christmas? For some staff, and a vast number of community volunteers, it will mean that Christmas is a day spent serving others. They’ll trade turkey for ten around their family dining table to cooking for 100 they might not know in their local community centre. At the same time, many local charities will be closing their doors, and that’s important too. One of our grant managers, Emma Beeston, blogged earlier this year that, although it’s hard to find time, we need front-line workers to go on holiday so they can care effectively for those in crisis.

Issues such as financial crises, addiction and domestic abuse are all exacerbated by Christmas, when good cheer can sometimes put a spotlight on what isn’t going so well in people’s lives.

Thankfully, where some charities reduce services or close over Christmas, larger organisations with more capacity will hold the fort, and this is when the breadth and scale of the third sector (and the public sector) are invaluable. Health services and larger charities such as Samaritans or Shelter will stay at the end of the telephone when no one else is, often responding to life-saving calls. This means those in need might still have somewhere to turn until services and support reopen in the new year.

And January will be busy. Issues such as financial crises, addiction and domestic abuse are all exacerbated by Christmas, when good cheer can sometimes put a spotlight on what isn’t going so well in people’s lives. For example, the Somerset and Wessex Eating Disorders Association told us that the prevalence of and emphasis on festive food can make the season hugely daunting for those with eating disorders (it created a video with 12 top tips for beneficiaries while it’s closed).

But like every Christmas story there is hope amidst the dark nights.

Will charities be ready to respond to the extra demand in the new year? They will certainly try. In truth, many of them will be stringing out their funding, approaching the year-end in April, and because the climate remains tough for 97 per cent of the sector, their future hangs in the balance.

But like every Christmas story there is hope amidst the dark nights. First, the spirit of generosity prompts many to give money and volunteer time, sometimes for the first time – and once engaged they might continue to do so into the new year. Second, those who have a break and time with friends and family will probably return renewed and refreshed, ready to help people who experience disadvantage.

And finally, just as we are grateful for the downtime and the presents, we should be thankful for all those willing to give of themselves not just at Christmas, but every single day of the year. Charities are fighting hard to stay afloat as a result of poor commissioning and a mismatch between funding and demand, yet they’ll give what they can often, and way above what it is right to expect. A little like a certain inn-owner in a Middle-Eastern town, come to think of it…

Happy Christmas!

Feeling festive? You can also watch Lloyds Bank Foundation’s Festive Ode

To make impact charities must stay true to local roots

Our CEO Paul Streets joins the debate: is scaling up effective charities the way to solve social issues?

David Ainsworth wrote in Civil Society News this week that “By failing to grow, charities are failing beneficiaries.” His piece highlighted the million dollar question facing a stretched sector – namely how do we find the best that charities offer and ensure that it’s replicated so that everyone has the opportunity to benefit?

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Sajid Javid MP stands by Jackie Hooper, of small charity North Worcestershire Basement Projects at our Parliamentary Reception.

You can’t fault David’s call. It would be wrong to keep small charities small just because they’re beautiful.

At a time when organisations up and down the country are repeatedly being asked to do more with less, sharing great ideas and interventions is surely a no-brainer, and for many services where a high degree of standardisation – such as operating advice helplines – is possible, the economy of scale argument works.

But the point David seems to miss is this: for many small and local charities, the way they’re able to help their beneficiaries comes from the fact they are just that, small and local. Our experience with the charities we fund is that they have a unique understanding of the people they help and the context in which they do it. They’ve built trust with local people and have relationships that allow them to offer highly customised, bespoke and specialist support.

[charities] have a unique understanding of the people they help and the context in which they do it

The benefits of being small

As a funder of small and local charities, we’ve seen some of the great things these organisations are doing in their communities. From charities that support victims of domestic violence in Wales to those providing refugee support services in Manchester, these are some of the most successful and innovative organisations in the sector.

you wouldn’t expect a high-class restaurant to scale up without losing the quality

But just like in a commercial setting, you wouldn’t expect a high-class restaurant to scale up without losing the quality it offers its customers. We must acknowledge that increasing the volume of services in a charity may decrease quality, and lead to less satisfactory responses to the needs they’re addressing. If our independent bistros are driven to provide more scalable ‘fast food’, their specialist knowledge will be lost and our communities all the worse for it.

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Bath City Farm – local charity embedded in the community it serves.

Crucially too, we would lose the additional value small and local charities provide in using local volunteers who, through helping to deliver services, often act as anchors within their community, providing stability and support to other groups. We’ve found small and local charities are uniquely placed to engage directly with those hardest-to-reach, because their independence, history and local connections can foster greater levels of trust than a larger, national organisation could. Local charity leaders have the autonomy to address these problems in their local communities as they see them whereas even the most dynamic of managers in national charities are constrained by pressures from the centre.

The role and rootedness of smaller charities in communities means these charities can also build and nurture social networks, creating positive relationships between people living and working around them. In doing this they have the power to boost levels of social capital building links between the people they serve, other communities and even the government to the benefit of the local area.

Some charities try to achieve the best of both worlds by operating as small charities under a bigger national umbrella. Mind and Emmaus are two who take a more federalist approach with individual groups in local communities operating as independent organisations affiliated to a national charity. At Lloyds Bank Foundation we fund some of these organisations and see their success. But as a model, it’s not right for every small charity.

Sharing what works

We need to learn from charities’ success where we can certainly, but that doesn’t mean expecting them to change how they work and who they serve. Why should a charity from Salford aspire to be a provider in Southend? Would they even be as effective?

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Our recent Small Vital and Vocal Charity Summit

Studies have shown that it is the most disadvantaged who are often failed by one-size fits-all contract driven approaches to service delivery and that these groups can be better supported by a responsive and adaptive local system delivered by a small, local charity that allows a more proactive or person-centred approach to meet their specific needs.

we should be encouraging the sector to do more to learn core lessons

There are ways to take these local success stories and reach more people and we should be encouraging the sector to do more to learn core lessons and adapt them to work in their own areas. Better evaluation and measurement can offer insights that other charities can learn from and apply in a way that best suits them whilst avoiding a cookie cutter model of replication that we know won’t work.

What we can do

Here at the Foundation, we, like many other funders, have worked to bring charities addressing the same issues together. Allowing similar charities to meet through seminars, forums or taking part in learning sets can help them to share their successes and learn new approaches they can apply to their own communities. We know this is something that works but we know we can and should do more.

As David said, we need to be serious about taking the best ideas in the sector and sharing them if we’re going to tackle the challenges that face us as a country. His response to this has attracted much debate and rightly so. But before insisting on scaling up, we need to ask what this means, and ultimately what it adds, because, as we have found, when it comes to charities bigger is not always best.

We need to make the most of research

Given the lack of resources for research in the sector, we must extract every drop of value from what we learn, writes our Chief Executive Paul Streets in his latest column for Third Sector.

This blog was originally published on Third Sector on 3rd October 2017.

GD*40628393I recently spoke about how the foundation uses research at the annual Voluntary Sector and Volunteering Research Conference.

It was a potential undiscovered goldmine of useful research relevant to practitioners on subjects as wide as engaging black, Asian and minority ethnic communities, working with refugees, research methods and working with volunteers. It left me wondering why I’d never heard of it before. Researchers talking to researchers might improve knowledge but it won’t spread learning. And that’s a major challenge for a fragmented voluntary sector.

We know funders are fortunate to have the resources. This is why it’s so important that those who research the sector speak actively to those who work in the sector.

Our detractors, especially those in central and local government, often chastise the voluntary sector for being an evidence-free zone. Often with an assumption that small and local charities are particularly guilty.

When it comes to delivering services, local charities end up having to plead the case to would-be commissioners, often against much larger competitors. In my experience, commissioners should be beating at the doors of local charities that can reach people and places larger providers can’t get near. The Grenfell Tower tragedy showed this starkly. When the chips were down, only the local charities got anywhere near.

The evidence challenge is, of course, a big problem for small and local charities that rarely have the resources for research – or the time to engage with other researchers out there.

So what role can commissioners of research play?

Funders should certainly help practitioners to get back on the front foot – by building an evidence narrative that speaks to the intimate knowledge of local organisations that reach parts of our communities that others can’t.

Large funders such as Lloyds Bank Foundation for England & Wales that work directly with frontline voluntary sector organisations have an important role in this. By bringing together what we learn from the many organisations we fund, we can produce unique insights into what matters and what works to tackle disadvantage. And because we can aggregate data from hundreds of small charities we can create a story of scale through hundreds of delivery points – not a single standard contract or provider.

Given how poorly resourced sector research is, we must extract every drop of value from what we learn.

We know funders are fortunate to have the resources. This is why it’s so important that those who research the sector speak actively to those who work in the sector.

Succinct summary evidence briefings, such as those produced by the Economic and Social Research Council, can be very useful for busy chief executives who only have 10 minutes to spare. But as Karl Wilding, director of public policy and volunteering at the National Council for Voluntary Organisations, said at the research conference this isn’t just about “disseminating findings”; it’s about active engagement between researchers and practitioners.

Given how poorly resourced sector research is, we must extract every drop of value from what we learn.

Those who fund research should insist researchers spend as much effort on discussing their findings with the practitioners they’ve researched, and asking how they can improve their own service evaluation, as they do on a glossy report that may tick a funder box, but will then likely gather dust. Without this, those researched are little more than lab rats.

It’s a huge task, but in gradually bringing together knowledge of what works to tackle disadvantage from those we fund, we hope to help reshape and re-educate the thinking on what others – with deeper public sector pockets – might value. And by doing this, we’ll bring the voices of those at the receiving end of services to the fore and help determine how services are commissioned and paid for. It’s what good consumer-driven organisations strive for and we should do the same.

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.