The Challenge of Changing Lives

Harriet Stranks, Director of Grant Making North, acknowledges that delivering good services whilst running a smooth back office isn’t always easy

 As a Foundation we ask charities to do the very best that they can with their funding, in good faith, to change peoples’ lives. That is a very tall order, and we know it.

The Foundation knows that charities have a really hard time keeping their head above water. We know there is an exhausting battle between doing the admin, getting the money in and delivering the services. We know that charities are very often living hand to mouth and the funding climate is changing so rapidly it’s hard to keep up.

Under all this pressure of running a charity, we ask you to change lives…to sit and listen to the man who doesn’t have anyone else to turn to, to make a phone call to the housing office to argue his case, to get him a warm coat, to help him understand he is not alone and to make his lot a bit easier, one day at a time.

If this kind of work was simple, the government would do it and we could all pack our bags and go home. Only the not for profit sector has the patience to work with people who are having a really tough time, furthermore, they do it with humility and give people dignity during moments of crisis.

We know that all of this is not easy, and sometimes it doesn’t work out – that’s ok. We trust you to do the best that you can, with the resources that you’ve got and make as much of an impact as possible, one person at a time.

That’s the reason we’ve invested money in what you do since we were founded in 1985. It’s also the reason that this year, as we mark our 30th anniversary, we’re taking the opportunity to celebrate your work with our 2015 Charity Achievement Awards.

Charity Achievement Awards

We know that the most effective work you do doesn’t always take the form of a shiny new idea or a huge scale project, but nevertheless it makes a transformative difference to your community. And given that times will remain tough, with money tight and the need for help growing, whoever is in power following the general election, we feel that recognising, celebrating, indeed shouting about the part you play as small and medium-sized charities across the country is important. We know you’re helping people get back on their feet and rebuild and improve their lives, and your role is more vital than ever.

So we’ve created six categories that we hope will reflect some of the elements of the work you do and the way that you do it:

  • Outstanding Impact
  • Against the Odds
  • Valuing Volunteers
  • Championing Change
  • Unsung Hero
  • Enterprising Collaboration

If your turnover is under £1m and you were in receipt of an active grant* from us in January 2015 or have been awarded a new grant by April 2015 you’re eligible to apply. We will look at your entries firstly within each region and from then, the winners of each category in each region, will go onto a UK-wide round alongside those from our sister Lloyds Bank Foundations for Northern Ireland and the Channel Islands.  Winners will get a small unrestricted grant and we will work alongside you to promote you, your work and your achievements.

So now is your chance to get involved. Don’t hide your lights and achievements under a bushel, tell us about them and enter the Charity Achievement Awards.

We’ve tried to make it as easy to apply with a simple online form and you can enter against as many different categories as you like.

Applications close on 1st June at midnight so don’t delay – apply now!

* An active grant may have been awarded or started some time previous to this date but should not yet have ended and the charity must still be doing work against it. For example any two year grant that started from January 2013 onwards would still be active and therefore eligible.

Harriet Stranks is Director of Grant Making North for Lloyds Bank Foundation for England and Wales. You can read more about Harriet on our website.

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.