Wednesday, 27 April 2016

The Value of Charities

Can competition between charities undermine their value? It’s a question – perhaps a controversial one – that sometimes bothers me.

A recent New Philanthropy Capital (NPC) report Untapped Potential looks at the role of charities in health and social care. This is undoubtedly a field where charities can make a real difference, and the potential is widely acknowledged – not least in the NHS Five-Year Forward View. The NPC report is well worth reading, and two key conclusions are:

  • The health and care system needs to ensure funding and contracting arrangements support collaboration between charities and other providers, and minimise the burdens on providers.
  • The charity sector needs to be wary of ‘asking for more’ in a resource-starved system. Frame conversations in terms of added value, not just the resources required.

These are themes most are aware of and many are actively pursuing. The vast majority of charities know that they need to demonstrate real outcomes, not just outputs, to engage commissioners and other funders. This produces a welcome focus on how charities can maximise their impact, and much current debate centres on the best methods and tools to help them do this. This risk however is that, in demonstrating their value, charities will seek to out-do each other and create competition where there should be collaboration.

When I first heard that Leeds alone had around 3,000 charities, it had me wondering. Too many? Surely there can’t be 3,000 different ‘good causes’? Maybe so, but there are many more than 3,000 people who benefit from these charities’ activities. And all of them are individuals, for whom choice could be a critical consideration. Certainly in the mental health field, where I’ve completed several evaluation projects, any “one size fits all” approach would be completely wrong.

Those who run charities are generally passionate people. They believe in what they’re doing and want to show that their approach delivers results. But surviving and thriving when funding is tight inevitably means an element of competition, whatever the source of that funding. I’ve seen instances where there’s a fine line between providing choice and competing to provide essentially the same service. I can think of some great examples of collaboration between charities (even mergers in a few cases), but I’ve also seen cases where these opportunities have been missed.

Charities provide value from many perspectives: service users, families, wider communities, their volunteers, public services and more. But I believe value should focus first and foremost on the people they aim to help. It should be less about “what value can my charity add?” and more about “what added value do people need, and how can my charity contribute to that?” Please, let’s not create the impression – however misleading – of charities putting their own interests above those of the people they serve.

Tuesday, 5 April 2016

Shared Targets

The Department of Health (DH) has just published its latest NHS Outcomes Framework for 2016-17. Like its other two frameworks, for Public Health and Adult Social Care, it sets out “high level areas for improvement, alongside supporting indicators, to help track progress without overshadowing locally agreed priorities”*.

There’s a lot that’s good about such frameworks, not least their focus on outcomes – improvements in the health and lives of all of us – rather than outputs, waiting times, or other details of activity. And it’s pleasing to see mental health addressed alongside different aspects of physical health.

But how does this sit with wider goals of integrated care, those of patient focus and collaboration with social care and other local services? The recent NLGN/Collaborate report Get Well Soon** is one of a number that promotes the idea of place-based health. In this future view, all of the assets of an area – health, social care, pharmacy, third sector, even housing – work together on community health, aiming at prevention and early intervention to reduce the burden of expensive secondary care.

Well, I think the honest answer is “starting to get there”. By which I mean that the NHS Outcomes Framework makes some reference to the other two, through some ‘complimentary indicators’ and even a couple of ‘shared indicators’. But I believe this needs to go further; I’m a passionate believer not just in shared measurement but in shared targets. In other words, several organisations all responsible together for achieving specific outcomes.

Some people oppose the whole idea of targets, believing (as Deming did) that they are counter-productive to genuine improvement. And I agree that if you set an arbitrary target, people will aim to achieve that target, not necessarily the intention behind the target. Worse still if they feel accountable for a target that lies largely beyond their control.

But my answer is not to abandon targets; rather to devise targets that encourage the behaviours we want to inspire. The little story in the text box is a very simple example, but one that could be applied on a much higher level to health and social care. So that if a target is missed, both (or more) organisations have failed. If it is achieved, everyone has succeeded – together.
In fact, the target is almost a side issue compared with the collaboration it should inspire. Aligned and integrated services, probably pooled budgets too, become not just a “nice-to-have” but the only way improvement can realistically be achieved. The defensiveness and silo mentality that so often impedes change becomes that much harder to maintain.

Of course, this is happening to varying degrees already, as examples in Get Well Soon illustrate. But it’s striking that they are just examples, and that many come from abroad rather than the UK. Here in Leeds there is a Joint Health and Wellbeing Strategy for the city, but publication of the 2016 version seems to have been held up, and there are many competing priorities – not least financial – to its implementation.

It all shows, in my view, the need for a greater push for change from DH. Change that I hope eventually leads to a single Outcome Framework with shared indicators and shared targets (locally agreed) for the whole of health and social care. And most important, systems that lead to better health and wellbeing for everyone.

* Improving health and care: The role of the outcomes frameworks, Dept. of Health 2012
**Get Well Soon: Reimagining place-based health, New Local Government Network and Collaborate, March 2016