Battles on the NHS frontline

Battles on the NHS frontline

If charities are to deliver more health and social services they’ll need to become better organisations

Camila Batmanghelidjh and Kids Company: a victim of its own remarkable success. NHS Confederation, CC BY

In a week of Greek tragedies it has also been hard to distinguish the gods from the monsters in civil society. Three recent important stories about charities question the accountability and management of the third sector.

Despite Kids Company being the most successful organisation working with poor children in the country, the charity’s founder, Camila Batmanghelidjh, took a sustained beating from the Cabinet Office which ended up in a demand for her resignation in return for £3m of a £5m funding shortfall – something she says she won’t be bullied into doing before her plan to leave next year.

A former government minister was quoted as saying that governments of all colours recognised that the charity’s work is extremely valuable and reached parts of the statutory social care system that others didn’t, there as an “unsatisfactory process where Camila would effectively come in and say ‘I’m about to fold if you don’t give me £5m’. That happened on a regular basis and more often than not the hole was plugged … the charity keeps growing and there’s been no retrenchment. She [Camila] cannot say no.”

Putting aside the irony that welfare cuts are in response to a sudden and massive private banking crisis, it appears that Kidsco is a victim of its own remarkable success.

Then there was the very different case of Turning Point and Ibukun Adebayo, the IT director who won her case against the mental health charity for unfair dismissal. This was a sorry tale of old-fashioned discrimination and lack of accountability in which Adebayo discovered, among other things, that she was described by the David Hoare, the charity’s deputy chief executive as “Looney Tunes” in an email to the chief executive. Unlike Adebayo, Hoare continues to work at Turning Point.

And then there was the Daily Mail’s exposure of the “boiler room” tactics of the big charities including Oxfam, Cancer Research and Save the Children, who were accused of cold calling people who had signed up to a “no call” list on the UK telephone preference services, pressuring people to donate and asking for donations from vulnerable people who had dementia.

With government policy to expand public funding to the third sector and the decentralisation of commissioning in health there is likely to be a growth in sub-contracting services to this sector. As a result we must be able to map which third sector organisations are working in health and social care and make distinctions about organisations on the basis of their capacity to provide quality care.

The third sector

Around 800,000 people work in the third or “voluntary” sector in the UK, and with more than 164,000 registered charities and a combined annual income estimated at £64 billion, their role in providing social goods is not marginal.

The state funded the third sector to the tune of £13.9 billion in 2010, nearly half of which came from local authorities. An estimated 437,000 third sector workers are employed in health and social care with 115,000 in residential care.

Much of the work with the most disadvantaged is carried out by religious groups, for example churches have historically provided services for prisoners and the homeless, social care and education, with a growing role in managing food banks used by half a million people in the UK. We are also seeing the growth of religious organisations sub-contracted to provide public services, such as welfare services in Scotland and in Kent.

Mhairi Black’s maiden SNP speech: ‘food banks are not part of the welfare state, but a symbol of it failing’

Despite a long history of providing care, many religious groups are fundamentally sectarian in nature raising questions about universality of access when it comes to sub-contracting services.

Social exclusion and the ‘dis-established’

Third sector organisations have a competitive advantage when it comes to providing services: they have access to the people that need the help the most. The poor and vulnerable people who are hardest to reach.

Many people living in the UK are “dis-established” either by choice or necessity, living outside of the social systems set up to protect them. Some, like people with addictions or long term mental health problems, have exhausted state support or are unable to follow the treatment available. From illegal immigration to those working in the grey economy, outside of labour regulation and national insurance systems, many people are excluded from health and social care, unable to give a name and address to even register at a GP practice. We don’t know how many families live by necessity outside of the social contract but as “cashless” welfare reforms take place and poverty goes above 13m people we can anticipate the number is growing.

But one of the inherent conflicts for third sector organisations is how public funding influences the principles on which they were established. This is acutely the case for charities, who legally cannot take a political position on the economic and social policies that are increasing the demand for their work. It means that an organisation like Kidsco has to walk a very thin line between continuing to access government funding and taking a position on the link between austerity and child poverty.

The lack of core funding for charities means that their accounts, although not technically corrupt, are often squeezed to fit the reporting requirements of donors. It means that core salaries are hidden under “project coordination” and numerically defined outputs exaggerated to satisfy demands for value for money. All the while the unsustainability of many services in a climate of economic crisis and austerity is denied. It means that charities are often silenced when under attack.

Getting the house in order

Much of civil society is led by charismatic people who have a deep and sometimes obsessive belief in their cause. One of the problems with this commitment is that it can generate bullying by default. Where leaders are forced to sustain themselves for decades working unchallenged, their organisations can easily undermine the principles on which they are based. Many are run on guilt and the pressure for people within the system to sacrifice their health for the greater good. A demand for total devotion and self sacrifice that walks the thin line between being right and becoming righteous.

The growth of third sector organisations in providing health and social care raises questions about organisational cultures and accountability. It also raises questions of equality and employment practices for the people working within them, when issues of conscience and belief are a requirement for the job.

Challenging leadership is always hard, particularly when they operate on the moral high ground but that’s precisely what we have to do if we are to defend quality care. To do this we have to see civil society as it is. It is this realism that allows us to make the necessary distinctions between corruption and saying something that society doesn’t want to hear. If civil society is to protect the most vulnerable it has to be just that, civil, with the rights and responsibilities this entails.

This column looks at the reality of our health and care systems from the perspective of those working to deliver services. Please send us your anonymous stories from the frontline.

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