'We can help make Lancashire healthy - but we don't come for free' - charities' appeal to the NHS
Dozens of Central Lancashire charities have come together to set out how the voluntary sector can improve health and wellbeing in the region – and reduce pressure on NHS and social care services.
More than thirty charity bosses from across the region are approaching the end of their first full year as part of an umbrella group designed to give not-for-profit organisations a collective voice – and help harness their collective power to improve people’s lives.
Known as the Central Lancashire Leaders’ Partnership (CLLP), it also hopes to shift attitudes about exactly what charities have to offer and the way in which they are perceived – and treated – by the public sector.
“We are all professional organisations,” explains Louise Bache, chief executive of Preston-based cardiac charity Heartbeat, as she reflects on the role of what is sometimes known as the “third sector”.
“We don’t want to be harping back to the days when people used to say things like, ‘It’s just a charity.’ That professionalism has always been there, but it’s been very difficult to shout about until now.”
Diane Gradwell, chief executive officer at Citizens Advice Lancashire West, agrees: “You would struggle to find in a lot of statutory organisations the quality of services which we deliver,” she says.
The charitable collaboration was created amidst nationwide moves for the NHS to work more closely with local authorities and voluntary groups in order to improve both healthcare and everyday support services. Its members range from grassroots groups working in individual neighbourhoods to much larger operations covering the whole region – who insist that the time was right for them to form their partnership irrespective of the mood music coming from the NHS.
The voluntary sector features heavily in the NHS long-term plan which was published earlier this year and lays out how the service intends to develop over the next decade.
The potential for charities to better the health and wellbeing of the local population in Central Lancashire has long been recognised by the public sector – which was already tapping in to their services before their role was put on a more formal footing.
But the ad hoc relationship which has evolved in the past has often been missing a key component – cash.
“I did a presentation [for health and social care leaders] recently and was shocked by how many people didn’t understand that they might have to pay for a service provided by a voluntary organisation,” says Joe Hannett, who was appointed last year to a new post designed to strengthen the connection between the public and not-for-profit sectors.
“I used Citizens Advice as an example and asked them how much training they thought somebody would have had before being allowed to give debt advice – a 10-minute sit-down or a rigorous programme that meant they could genuinely help people?
“I told them that if they thought it was the former, then they were mistaken – and if they thought it was the latter, then did they think that training was free?
“You could see this dawn breaking.”
Joe insists that charities are not “holding their hands out” to the public sector – but do require fair treatment if they are to continue to be able to offer the expertise on which health and social care services often rely.
One of the charities under the CLLP umbrella recently took on a case which was passed to them by the NHS, because of complexities revealed by a risk assessment. It cost the charity £125,000 to step in – and they did not see a penny of it from the organisation which had handed them the job.
But the voluntary sector in the region claims that it merits public sector investment, because of its capacity to help take the NHS in the direction which it has already pledged to go – towards prevention and a more individualised approach to care.
“We’re offering our experience in how to look at the whole person rather than just a condition,” Joe explains.
“There are multiple factors which can cause mental ill health or drug and alcohol abuse – and whereas the NHS starts with a diagnosis, the voluntary sector starts by asking, ‘What’s your life like?’
“If you treat someone for a mental health crisis, but the underlying cause is debt and you don’t treat that, then they’ll just ricochet between crises.
“We’ve been doing preventative work for a long time and can help shift the entire [health and social care] system, so that some people don’t even have to touch [statutory] services.”
The CLLP believes that the voluntary sector has sometimes been deemed too sprawling for the public sector to deal with. Joe’s role is designed to overcome that divide – an intention reflected in the fact that the job is funded by Central Lancashire’s integrated care partnership (ICP) between the NHS and social care, which aims to better link the two services and also increase the involvement of voluntary groups in the process.
However, Denise Partington, chief executive officer of Fulwood-based support agency Community Futures, says she is “puzzled” by the NHS preference for the diverse third sector to speak with a single voice.
“They don’t expect that – nor a single point of contact – when dealing with the private sector,” Denise muses.
Yet it is the diversity within their number which the CLLP claims is one of its greatest strengths.
“We all have our specialisms, we deliver good services and we know each other and what we can all offer,” says Diane.
“But we’re not in the business of creating a dependency culture – we want to empower individuals to make the best of their lives.”
Denise adds: “Communities have their own solutions – it’s much better for them to tell us what they need than for us to impose things.
“Some people have struggled when they have traditionally had health and social care services on their doorstep and then these have suddenly been withdrawn. But once you have empowered communities and made sure they have got some control over their lives, then as long as they have [the likes of us] to rely on, they will do really well.
“However, if you take that support away, they won’t be so resilient.”
While Joe acknowledges that the attention of the public sector may have increasingly drifted towards voluntary groups only as a result of austerity, he warns that financial circumstances should not form the sole basis of the relationship which is currently being forged.
“The temptation is [to assume] that we’re there to pick up the pieces and we’re not – although we will help,” he says
“The ICP affords us a unique opportunity for change. It’s hard work, but it gives us a platform that we’ve never had before.”
For Diane, the benefit of greater collaboration with the health and social care system should merely be a bi-product of the simple ambition which charities like Citizens Advice hold dear.
“It’s about helping individuals,” she says.
A common purpose shared by the public and voluntary sectors which may only now be poised to realise its full potential.
WHERE DOES THE CASH FROM?
According to the voluntary organisations represented by the Central Lancashire Leaders’ Partnership (CLLP), public understanding of how they are funded is patchy.
“A lot of people seem to think that we’re all funded by the lottery,” laughs Denise Partington, CEO of support agency Community Futures.
According to Citizens Advice Lancashire West CEO Diane Gradwell, another misconception is that the groups are “part of the government”.
While the NHS and local authority social care departments have a better grasp of how the charitable sector operates, that is not always reflected in how they distribute funds – especially when organisations are forced to compete for any money which is on offer from the public sector, in a process known as commissioning.
Until the formation of the CLLP, the harsh reality of fighting for survival had often hindered any hopes of developing a collective voice for the region’s charities.
“Organisations with an interest in a particular line of work have had to bid against each other,” explains Diane.
“We’ve had to be competitive historically, because we’ve been put in that kind of marketplace – we’ve had no option. My job is to ensure that we can keep our services going, some of which are well-funded and some of which are very poorly-funded.”
Diane says that the collaboration which is now happening under the CLLP umbrella – one of five similar partnerships across Lancashire and South Cumbria – is helping the voluntary sector overcome a shared history which “has not been kind”.
Increasingly, charities are daring to be more charitable towards each other – discussing who may be best placed to bid for public sector contracts or even working together on particular projects to share their expertise.
Heartbeat CEO Louise Bache wonders whether a more harmonious method of sharing out the opportunities for work from the public sector may now be on the horizon, as the partnerships within and between the voluntary, healthcare and social care sectors continue to develop.
“I’d hope that commissioning may change in future, in that [the NHS] would contact us as a group and ask what we could do if there was a certain amount of money on offer.
“I believe we’d able to trust each other enough to throw that around between ourselves rather than compete for it.”
But such a scenario can only come to pass when there is public cash on the table in the first place – and that is far from always being the case. There are still many occasions when the cost of a charity’s contribution to the public sector is borne entirely by the charity itself.
“We get NHS referrals of just about anybody who has a risk of cardiovascular disease,” explains Louise.
“But Heartbeat is entirely [dependent] on fundraising, like a lot of the groups within this sector.”
It is a similar story for Penwortham-based sight loss charity Galloway’s, for whom commissioned work makes up less than 10 percent of its £1.2m annual spend.
“We want to be part of a shared system and recognise that, as a small group, we won’t be at the forefront when it comes to commissioned services,” says Galloway’s chief executive Stuart Clayton.
“But this work isn’t free and if we’re going to be part of the solution, we need to be treated as equals. We would also hope to be able to work with other organisations which are commissioned themselves.”
For CLLP partnership development manager Joe Hannett, commissioning “has a place”, but the public sector should also be more open to alternatives.
“There is a whole set of resources within the system and it’s about how we maximise them – be that people, cash or expertise.
“In some cases, it makes sense to commission services, but in others it makes more sense to have a grant fund that would help [us to] try new approaches. Sometimes it’s not about cash – it’s about resources, people and training.”
But the one thing the voluntary sector never wants to be is an afterthought.
“At the moment, people plan their budgets and decide what they want to do – and then they see they have a couple of grand left over and wonder where they could sprinkle that in the voluntary sector to see what magic we could create,” Joe says.
“The incentives are all skewed towards competition – and that is a complete barrier to putting resources where they need to be to serve people rather than organisational interests.”
As part of its long-term plan, the NHS looks set to step back from the compulsory competitive procurement of contracts – a principle enshrined in legislation introduced as recently as 2012.
Instead, commissioners would be allowed to use their discretion about whether or not to require competition for work, subject to “a best-value test to secure the best outcomes for patients and the taxpayer”.
NHS “RECOGNISES THE VALUE” OF THE VOLUNTARY SECTOR
The NHS long-term plan for the next decade acknowledges the role of not-for-profit groups in health and social care, particularly in the development of new “primary care networks” – collaborations between neighbouring GP practices to increase the volume of services delivered in local communities, of which there are nine across Central Lancashire.
The voluntary sector is also included in the new NHS Assembly – an advisory body which will act as a “guiding coalition” in how to implement the aims of the plan, including its focus on prevention.
Denis Gizzi, chief officer at the Greater Preston and Chorley and South Ribble clinical commissioning groups, said: “We recognise the value of these community organisations and the wide range of skills and expertise that exists across the sector – so we absolutely want to embed their involvement into how we work as a whole health and care system.
“By working together people and communities can be better supported, statutory services can be more effective and our whole health and care system will then feel the benefits of that, so we’ll continue to engage with the sector on how we work together going forwards.
“That is exactly why we have a dedicated representative from the sector on our Integrated Care Partnership Board, too.”
WHAT DO CHARITIES OFFER?
According to analysis by the National Audit Office, the benefits of the public sector working with voluntary organisations include their:
Understanding of the needs of communities that the public sector needs to address;
Closeness to the people that the public sector wants to reach;
Ability to deliver outcomes that the public sector finds it hard to deliver on its own;
Innovation in developing solutions;
Performance in delivering services.
Source: National Audit Office, 2013