Charity leadership: keeping the show on the road - By Richard Gutch

A GLASS HALF EMPTY OR HALF FULL?

Richard Gutch revisits 20 chief executives he last interviewed in 2008 before the recession took hold and finds a mix of pessimism and optimism about the future outlook for their charities. Although there were major concerns about the likely public expenditure cuts, particularly from April 2011 onwards, they felt the role of the third sector would increase whoever won the election and the sector’s profile was continuing to rise.

Managing a charity at the present time is even more challenging than usual, but my interviewees showed they are well up to the task. These are the 10 issues which most preoccupied them:

1. The April 2011 Abyss

All the larger charities have experienced significant growth in income from contracts and in most cases are achieving at least full cost recovery. Some of the smaller ones, like Relate, have also benefitted from the Government’s Recession Action Plan because of the nature of their work. But all this could come to an abrupt end in March 2011. In the words of Simon Knighton of the Expert Patient Programme CIC ‘2010/11 is the crunch year for contracts’. Kevin Williams of KIDS says all but one of their £7m of contracts ends then. Nearly all ring-fenced government funding is also due to end and already, according to Anne Roberts of Crossroads Care, some of the funds allocated to PCTs to provide breaks for carers have ‘disappeared into a black hole’. Paul Jenkins of Rethink is worried that ‘when the moment comes the Government will panic, rather than having a well-thought through strategy’. Others spoke of the dangers of crude salami slicing- or even of in-house public sector services being given special protection.

2. Planning for survival

In 2008, most of the chief executives were planning for growth; now, most are planning for survival. They are trying to grow their voluntary income, whilst ensuring their contracted services are as cost efficient as possible. United Response and Turning Point have both successfully reduced the number of agency staff they use and the National Autistic Society is cutting its overhead. Smaller charities like Arthritis Care, Independent Age and Carers UK are already experiencing financial difficulties through reductions in legacies, reduced investment income and loss of grants and have had to restructure and/or introduce changes in services or increased reliance on volunteers. Even the largest charity interviewed, Barnardo’s, has just launched a £3m appeal because of a drop in its voluntary income. One of the few areas of voluntary income to grow has been shops, with Mind reporting their best year ever. This may change as we come out of recession, but the hope is that other sources of voluntary income, such as individual giving, legacies and corporate sponsorship will begin to pick up.

3. A new Government

Martin Narey of Barnardo’s and Anne Longfield of 4Children talked of a current ‘paralysis’ of Government and a ‘loss of momentum and impetus’, but they, and others, thought there would be a bigger role for the third sector whoever wins. Martin thought ‘there was not much to fear from a Conservative Government’. Not surprisingly, everyone has been busy developing relationships with shadow ministers. There was a general feeling of a lot of shared policy concerns- for example, around the family, the well-being agenda, self-management, personalisation, social care and older people- but uncertainty about what practical outcomes this might lead to. One word of caution from Jackie Ballard of RNID was about the apparent anti-big charity line taken by Ian Duncan-Smith and others.

4. Demonstrating Outcomes

Given the uncertainties that lie ahead, a number of people emphasised the importance of being able to demonstrate outcomes and measure the savings which could be achieved through early interventions and preventative strategies. Jon Barrick of the Stroke Association is commissioning some health economics research to help demonstrate the cost/benefit of their services and measure their quality against the six criteria in Our Health, Our Say. The aim is to have the results published in time to fight against any proposed cuts.

5. Influencing Policy

Charities are getting increasingly adept at influencing policy from the inside track. Phil Butcher of the Muscular Dystrophy Campaign (MDC) has been running a project to improve NHS provision. This has involved meetings with specialist commissioners in each region and then bringing them together with doctors and patients. They then do an audit of services in the region, analyse gaps in provision and develop a business plan for meeting the gaps. As a result, one region now has 15 new staff costing £1.5m pa, another is about to agree £1.4m and three others are in the pipeline. MDC are able to demonstrate a saving to the NHS through a reduction in unplanned hospital admissions. The Stroke Association have also successfully used an NAO report to persuade the DH to develop a Stroke Strategy; Mind have worked closely with DWP on issues around mental health and employment; and the National Autistic Society has been closely involved in a private members bill on Autism for Adults and the subsequent development of a DH strategy to be published shortly.

6. Commissioning

A year ago some of the chief executives’ strongest comments were directed at commissioning, which was variously described as ‘appalling, dreadful and a complete disaster’. Martin Narey of Barnardo’s, one of the most forthright on this issue, thinks there has been some improvement, but is still critical of the timescale of most contracts. Others like Imelda Richmond of Carers UK think commissioning is still ‘truly dreadful’, whilst RNID decided to withdraw from a DWP contract because there was no recognition of the higher costs involved in working with their client group. An area of growing concern is the complexity and time-consuming nature of the tendering process; as Kevin Williams of KIDS put it, ‘the staff sometimes feel worn out before they have even started to deliver the service’. Kevin prepared a procurement guide for commissioners to try and overcome his concerns; Anne Roberts of Crossroads Care has contributed to ‘Commissioning for Carers’, an action guide developed by a number of statutory and voluntary organisations, whilst the National Autistic Society is planning to run training days for commissioners. Heather Wood of Rainbow Trust has been successful in securing a number of contracts for the delivery of short break care for disabled children through local authorities and PCTs from the Government’s Aiming High scheme. Meanwhile, the policy context for commissioning in the NHS has been thrown into turmoil by Andy Burnham’s speech about the NHS as preferred provider, whilst Su Sayer of United Response talked about the shift by local authorities from block contracts to framework agreements, which then lead to individual service agreements as required- a system better suited to bigger providers than smaller ones.

7. Personalisation

Last time, some people spoke as if commissioning would soon be superceded by the introduction of individual budgets, but the new arrangements still seem to be very much in development with a number of local authority and NHS pilots taking place. Some organisations like United Response and Rethink are busy changing their financial and marketing systems and/or developing the delivery of existing services to allow for a more person-centred approach; others, like Mind, have been developing a network of personalisation champions to work with service users. But there remains a lot of uncertainty about how the financial climate will impact on personalisation, as well as concerns from some, like the Stroke Association, about how continuity of services will be maintained without contracts.

8. Coalitions, mergers and partnerships

The drivers for various forms of partnership working appear to be gathering pace. Sometimes the driver is a campaign, such as the Coalition of Autistic Societies convened by the National Autistic Society to campaign on the Autism and Adults Bill; or the Kids in the Middle coalition chaired by Claire Tyler of Relate, which campaigns on the impact of family breakdown on children; or the Communications Trust set up by ICAN to develop the workforce involved in improving children’s communication skills. Mergers are also gathering pace as the reduction in the number of local Crossroads from 130 to 98 in the space of a year testifies; here the driver is the viability and sustainability of the local schemes. A number of the larger charities expect to take over struggling smaller charities in their field as the financial context worsens. Equally partnerships for tendering are also increasing- not just within the sector, but with the private sector. Barnardo’s, 4Children and Turning Point are all partnering Serco on different contracts, while KIDS are looking to develop more partnerships with commercial play manufacturers.

9. The new localism

The era of top down targets and ring fenced national programmes is being replaced by a new localism with greater potential for local variation alongside a duty to involve and consult local people. For national charities, this development makes it harder to influence and monitor policy objectives and to secure new national initiatives like Aiming High for Disabled Children and Improving Access to Psychological Therapies. It also makes it all the more important to mobilise local supporters of the charity’s cause, particularly when services are threatened with cuts. National networks like Mind have local groups as members, who they already have well developed relationships with; others like the National Autistic Society are planning to build up their local membership, whilst ICAN are keen to find ways of mobilising parents locally.

10. In the public eye

Since beginning my second round of interviews, James Partridge of Changing Faces has spent a week reading the Channel 5 News as part of their Face Equality campaign; Victor Adebowale of Turning Point has been on Any Questions and Martin Narey of Barnardo’s has been on the Sunday Morning Breakfast show on Radio 4. At the same time, Mind and Rethink are in the second year of their Time to Change campaign funded by the Big Lottery, which now has 25,000 fans on Facebook, whilst the Stroke Association is partnering the DH on two TV awareness campaigns on stroke (one around the impact of alcohol in enabling serious disease with the British Heart Foundation and Cancer Research UK). Neil Betteridge of Arthritis Care, who has arthritis himself, is the Department of Health’s Patient and Public Adviser on Elective Care for England and advises on aspects of patient experience relating to the 18 weeks waiting time targets and enhanced recovery work in a range of conditions, including joint replacements and cancer. Charities are in the public eye more than ever, which is perhaps a good omen for tackling the April 2011 Abyss and for Planning for Survival.

Structure of the Survey

In 2008 I interviewed 110 third sector chief executives, from both national and local organisations, to find out what were the most important challenges and opportunities facing voluntary organisations. A year later, in autumn 2009, I contacted 20 of them again to see what had changed in the wake of the financial crisis and the forthcoming election. The organisations covered children, disabled people, health and social care and included six with turnovers between £1m and £6m, seven between £6m and £40m and seven over £40m. Clearly the interviewees were far from being representative of the sector as a whole, as well as all being national organisations, but their opinions provide an interesting snapshot of some chief executives’ outlooks.