Charity and health provision

Well, we know when dealing with Government that rhetoric can outrun reality. Whether it's Blair or Cameron they are eloquent on the need for an expansion of the third sector in health . And, let's face it, given the challenges of long term conditions and the preponderance of the elderly in hospital beds we know a major expansion of charity and social enterprise provision is the bedrock of reform.

So it was interesting to read recent evidence from the Foundation Trust Network on the strains on casualty show a looming crisis in secondary care provision unless we act to move resources into primary and community care.

 The Nuffield Foundation has produced a report this week on the independent's sector involvement in secondary care. See here for link to the study.

It has the following startling conclusion:

"despite policy interest in social enterprises and the voluntary sector, spending on secondary care services provided by the voluntary sector between 2006/07 and 2011/12 has hardly changed. PCTs spent £410 million with the voluntary sector in 2006/07 (in 2011/12 prices) rising to £600 million in 2011/12 less that 1% of their total secondary care budget. Over this period PCTs spent less of their secondary care budget on services provided by local authorities and others."

Now, a word of caution about this. Clearly the strength of charities does not lie in the provision of hip and knee replacements!  And often the data confuses charity from private, lumping all together as “independent provision". Of course in social care, in mental health and other community provision the third sector share is much higher. In mental health over a third of all provision is third sector and many disability services are provided through charities.

However, I would argue that our charity and social enterprise sector has much to offer secondary care; particularly in growing partnerships between charities and hospitals, around better use of hospital facilities for the elderly or those reaching their end of their lives. ACEVO is working on a study of just such links with the FTN. The new CCGs could be encouraging hospitals to look at radical reconfigurations like hotel-style intermediate wards for the elderly, hospice wards run by charities, social enterprises established to run parts of the hospitals at the weekend so expensive kit is fully utilised, or community-style hospitals carved out of the current hospital estates. Indeed, why not contracts between charities like RNID or RNIB to take over the running of eye and hearing departments?

The crisis in funding requires more lateral thinking. It was less than a century ago charities ran hospitals; some of the finest in the world. Closer partnership working between charities and hospitals has the potential to produce more efficient use of resources and better health outcomes for service users. Charities and social enterprises have an outstanding track record of developing innovative services that can address the underlying causes of ill-health and alleviate pressure on acute services, and the NHS must make the most of this capacity.

But perhaps the most important lesson from the Nuffield study is that the Any Qualified provider system is not guaranteed to lead to an expansion of third sector provision. The reform provisions of the recent HSC Act will have failed if we fail to see a big expansion of third sector provision. Let's be warned.

The Work Programme

A critical report from the Work and Pensions Committee says the Work Programme is not working well for people furthest from the labour market. The report finds that, while the programme is more effective for mainstream job seekers, members of vulnerable groups are being “parked”- i.e. the providers commissioned to run the payment-by-results schemes are choosing to focus on those most likely to get a job anyway, rather than devoting resources to the harder-to-help client groups. Work Programme providers are only paid once they get people into sustainable jobs lasting six months or more, and higher payments are made for more difficult clients. However, the report suggests that these differential payments are not sufficient to incentivise providers to focus their resources on those with complex needs.

According to the report, during the first 14 months of the scheme, 3.6 per cent of claimants moved off benefits into a job lasting over six months. But people in the most vulnerable groups, including the mentally ill, the disabled and the homeless, fared worse. Of the 9,500 former incapacity benefit claimants in the programme, only 20 people were placed in a job that lasted three months. Anne Begg, chair of the Committee, said that the Programme has proved much less successful to date in addressing the problems faced by jobseekers who face more serious obstacles to finding a job — people with disabilities, homeless people, and those with a history of drug or alcohol abuse. She said, “It is clear that the differential pricing structure is not a panacea for tackling creaming and parking.” This message is repeated in a letter in today’s Times, in which the chief executives of Crisis, Mind and Drugscope argue that Work Programme is not delivering as it should for the most vulnerable client groups.

If the Work Programme is to fulfill its potential, it must cater to those furthest from the labour market as well as those with less severe barriers to employment. It is essential that additional payments for hard-to-help clients are sufficient to ensure that they receive full support into employment.  The select committee report shows the Government spent £248 million less on the Work Programme than anticipated in 2012/2013 because of under-performance. ACEVO strongly supports the proposal that the sum saved should now be targeted to help prepare more vulnerable people, such as those dealing with drug or alcohol problems, for the workplace. This could ensure that providers have an appropriate financial incentive to work with hard-to-help clients, and fund the specialist expertise and support that those with complex needs may require.

The Work Programme has potential to help tackle unemployment but it must not allow hard-to-help cases to fall by the wayside. It is now time for the Government to act to ensure the Work Programme delivers for everyone, including those most in need of help.

Nuptials and Rhododendrons

In London this weekend for the third sector wedding of the year; Sir Stuart and Lady Rosamund Etherington! A rather splendid Do at the Reform. The happy couple pictured here;

And the unaccustomed London weekend meant the Hound and I could go and see the rhododendrons in Brockwell Park. 

Friday saw me getting down to further work on my History of Charity. I went to the Lambeth Palace Library to search out what they have on charities and found myself ploughing through old sermons. All rather fascinating in fact. Much on the importance of alms-giving as a duty. But the most amusing discovery was a transcript of one William Ewart Gladstone MP, then Chancellor, addressing the Commons on the need to end the exemption of charities from taxation. This was 1863. But like George, our current day Chancellor he was roundly defeated in this dastardly attack.

My sister, Sara is advising me on the intricacies of getting a book published. She has 13 to her name and currently working on a second edition of one standard text. All about teacher training and induction, on which she is an expert. Someone needs to be. It all sounds a major flaff, though I have the bare bones of the book. Any publishers reading this Blog do get in touch. I can see the BBC series already...

Whit Sunday saw me at All Saints, Margaret Street. Whit Sunday was always a bank Holiday when I was a kid and a big day, but since they mucked around with the bank holidays its seen less attention. Shame. 

And now I'm off to the Bodleian Library in Oxford to search their catalogues.

Atos

Yet again the private sector company doing disability benefit assessments is under fire. Charities have for months been drawing attention to abuse and incompetence here.

Yet nothing happens.

The BBC are to be congratulated for drawing attention to the revelations of a doctor who worked for the private company which assesses people for disability benefits says its methods are "unfair".

Greg Wood, a former Royal Navy doctor, resigned from ATOS earlier this month, after working as an Assessor for two-and-a-half years.

He told the BBC the system was "skewed against the claimant ".

ATOS, which has been criticised in the past by disability charities and MPs, carries out work capability assessments on contract for the Department for Work and Pensions.

Claimants have to score a required number of points in order to qualify for the full sickness benefit under the Employment and Support Allowance.

In an interview with the BBC, Dr Wood says he believes ATOS Assessors are not free to make truly independent recommendations.

He said he felt compelled to speak out because it was "embarrassing to be associated with this shambles".

Dr Wood, who was given special responsibility to champion mental health at ATOS, said: "I was instructed to change my reports, to reduce the number of points that might be awarded to the claimants. I felt that was wrong professionally and ethically.

Dr Wood says the people being most adversely affected by the system have significant, mid-ranging disabilities, such as Parkinson's disease, mental illness, and head and spinal injuries.

He also claims some of the most severely disabled people are being asked to attend face-to-face assessments, instead of the normal practice of examining their application on paper.

On the BBC news last night he spoke movingly about the disgrace of him having to assess someone terminally ill. He is right to be outraged. We all should be.

So what is the response of the DWP? Yet again they brush this away. Mark Hoban MP could not even bring himself to acknowledge the claims and say he would review them. He blathered on about getting disabled people into work. We all share that aim. We want efforts made to get disabled people into work. But this cannot excuse bad practise. He must now review the ATOS contract and if he finds the stories of incompetence and abuse proven, the contract should be terminated.

The BBC is collecting evidence of bad practice by ATOS. I hope all our charities with bad experience of their claimants suffering will be putting pen to paper. Or finger to email. We must speak out.

Charity Commission.

Stuart is absolutely right. The Commission has brought the sector into disrepute. The defensive response of the Commission chair in his letter to The Times demonstrates they have not learnt the lessons of their lamentable handling of the Cup Trust. For Shawcross to try and excuse inaction by "waiting for HMRC" is simply not good enough.

People want to know that there is a regulator that is fearless in pursuit of wrongdoing. Not one that hides behind legalisms and process. The problem with the Cup Trust case is that we don't know how many others there are, where the Commission is inactive.

Will the arrival of new people on the Board help?  Looking at the names I think not. Apart from Orlando Fraser, who I like, these are not inspiring appointments. But you never know; they may provide the much needed impetus for a more aggressive Commission that looks to exercise its powers in a way that inspires confidence, not looking over their shoulder to lawyers and making excuses for lack of action about patently obvious abuse.

As Joe Irvin said about this, “The commission needs to admit it got this wrong, dust itself down and then look at how it can better tackle rogue charities."