Lively Liverpool.

Well, 25 years ago I remember getting the ferry cross the Mersey. You know the song. A cool journey which takes you from one side of the Mersey to the other; from Liverpool to Birkenhead. So obviously I thought ill get that again. Only since I last travelled they have built a tunnel and there is no passenger commute ferry, only one that meanders up and down Mersey full of tourists

I was due at Birkenhead YMCA: the start of a day of visits to some of the Social Investment Business investees. In Birkenhead, Futurebuilders gave the YMCA a loan to pull down their old building and start afresh. A top class CEO and Chair. Doing some great work and with ideas to expand into half way housing for their young clients. The bedroom tax and welfare cuts are proving a major disaster here and they need to find small size accommodation for their people as they move on. Interesting to hear from those working in the homeless- jobless field how the changes are working in fact. Some appalling stories of benefit changes leading to homelessness, and how some of their “rough sleepers" actually have jobs- but can't get homes and are forced out of work. They are looking to take more loans to acquire homes! They were falling over themselves to say how grateful they were to Futurebuilders and how their work would have suffered without the loan to rebuild. A standing rebuke to the Government for cancelling this programme that enabled third sector bodies to access capital. At the time we were told that the new Big Society Capital would replace the need for this programme but so far demand for loans is not being met.

The YMCA is particularly important in the history of charity. The Scout movement was founded here. In the Birkenhead YMCA. See the plaque

Then onto an old favourite of mine! The Alt Valley Community Enterprise. . I came here 7 years ago and the empire continues to expand. Shops, a farm, a church, a warehouse, community uni, library, leisure centre... There appears to be little left in Croxteth that they don't own or control. The latest acquisition is a pub. As they said - it’s a community hub!!  And they're right. Its right next to their “community uni" and their leisure centre. We have given them over 5m in loans over the years but with that they have done much. It is a magnificent demonstration of the power of capital to grow. I suggested to them we should help them do a study of the impact this has had. It would make a magnificent case study. And to those who say the work of Futurebuilders was all soft money I say; nonsense. See what they have done. And they are repaying the loans!

Next up, Riverside Credit Union. A small but dynamic operation. Amusing to walk past a poster proclaiming “we are NOT a bank but so much better ".

All 3 bodies have plans and ambitions to grow and could use loans to do so. They want access to capital. It reinforced my conviction BSC must get cracking with unsecured loans to enable these people to do their jobs effectively.  We must disgorge funds so we can meet this demand. 

The latest survey by SIB on demand for loans shows a total of over £350m has been requested from the 285 organisations who responded to the survey (that has been open since July 2012).

41% said that over half their income in 2011-12 was earned from contracts and other commercial activity so showing ability to repay loans.

 67% of those who specified how much they would request asked for amounts over £100,000.

 So demand is high. Supply negligible. Let's get this sorted. 

  Then off to the “Municipal Buildings" (a grand pile) for a meeting with the Deputy Mayor of Liverpool to talk about the potential for an idea we are developing for a local impact fund. He was keen to talk about our plans though as a barrister he had lots of issues for us to puzzle out. Amusingly I discovered he knows my Irish cousin Tom Somerville who turns out to be in the same chambers. And he did have a nice office.

And I even got a bit of culture; the Chagall exhibition at Tate Liverpool (well worth seeing) and a bit of Choral Evensong in the magnificent Anglican Cathedral.  Liverpool is superb. There are several of my Irish cousins buried up here- one was a doctor and mayor public figure and related to Bishop Chavasse who came from the same village in Co Cork, so I feel a connection. Though not with the accent.

 Liverpool in the sun was particularly gorgeous; though my planning for the tour got a little adrift when I suggested we take the ferry across the Mersey. A 40 minute gap appearing in the itinerary and playing havoc with the investees! But a rather cool cruise nevertheless.

Stephen Bubb

Transition

There is a rather fine new restaurant at Kings Cross station - in the old Great Northern Hotel. Funky decor and good food very reasonably priced. I recommend it! I was having lunch with Paul Breckell, the CEO of Action on Hearing Loss, which I have to admit of still think of as RNID. But as he said they serve a wide range of people from the profoundly deaf to the hard of hearing so they wanted to see that reflected in their name. A good guy with a long career in our sector and he was the FD - appointed by John Low, served under Jacqui Ballard and is now their CEO. A demonstration you can have a career in our sector.

Then I popped into a meeting of the Board of the Transition Institute which was just by at the Guardian. I'm a Board member of this interesting group, ably chaired by old friend and former ACEVO Vice Chair, Allison Ogden-Newton. It works to develop and promote the place of spin outs from the public sector and published research on this - as it has just done. Do check out their website.

Allison is now the CEO of World Child Cancer and we had an interesting discussion about cancer in children, which apparently only affects 1% of the total of cancer patients; but is obviously deeply distressing for those affected. The rapid advance in the care, treatment and research into cancer had been one of the real medical triumphs of later years. We are close to cancer becoming a long term condition. What a change! So, good luck Allison in your new role.

Charity awards and fundraising.

A good charity awards dinner last night (the Civil Society Media one). Third sector one is soon too. Held at the Grosvenor, but as the presenter said they have 2 good restaurants, and then the one in the underground car park we sat in! A good occasion, both to hear about the work of award winning charities and for networking with members.

However, do Civil Society need to review their nutrition policy?  Serving dinner so late and a very unhealthy sugar rich dessert served late (then chocolates and coffee! Shocking. And the CEO of Diabetes UK was sitting at our table).

And then the awards not ending till 11pm. Oh dear. Am I sounding grumpy and old? Still, my white DJ survived on its second outing. It gets another airing for my College Gaudy next week.

At least we get a glass or 2 of bubbly to start with. One of my Directors kindly sent me an article which shows that drinking champagne improves your memory. I knew it was good for you. So all those sandal wearers who “tut, tut” when I mention this subject:  Eat your hats, or preferably the sandals.

See:

http://www.reading.ac.uk/news-and-events/releases/PR503596.aspx

A good chat with Alistair McLean, who heads the excellent Fundraising Standards Board, about fundraising complaints. As he said to me, the overwhelming fact is that charities handled all their complaints so well. Their members reported receiving 33,744 complaints; the overwhelming majority of these were satisfactorily resolved with only 14 escalated to Stage 2, and of those only 3 became Stage 3 complaints.

 This is something to celebrate. The sector may have complaints but they handle them well and should be proud of that achievement. We had a good discussion about how we should celebrate this low level of problems over fundraising, including chugging. I think we need to be more robust in defending ourselves from ignorant and bigoted attacks in reactionary newsprints on chugging. People who complain are nearly always misers who are embarrassed about being reminded how mean they are not donating.

I recently had a call from Shelter who contacted me to up my donation, which I made after being stopped by a charming chugger in Kings Cross. I was happy to do so. It was a silent protest at some of those members of PASC who hate Shelter's campaigning!

Health, campaigning and the networking round.

Well, the week began with an enlightening meeting with Nick Hurd MP. A general round up of what's happening in ACEVO and how we can help push forward the Open Public Services agenda. We even touched on the recent PASC report and I made clear my views!  A useful reminder of how important it is to defend charity campaigning came yesterday from the Cadbury Barrow Trust.

Debbie Pippard, their Head of Programmes, said there needs to be more leadership and action on the matter, after the Trust recently came under attack from some corners of the press for its funding to help migrants.

Pippard warned that there was an increasing hostility in Parliament and other places to the campaigning role of charities. She added that the recent scandals around for-profit groups lobbying Parliamentarians had muddied the waters: “The actions of a few lobbying companies and the campaigning of charities are being seen as one and the same,” she said.

Barrow Cadbury Trust and the Diana Fund have recently been attacked in the Daily Mail and Daily Telegraph for their funding to support migrants in the UK. The Daily Mail has said the Diana Fund had been “cynically hijacked by the Left”, while the Daily Telegraph questions why taxpayers are supporting “pro-immigration” charities.

Pippard said the tone of pieces such as these promoted the ideas that only frontline service delivery organisations were charitable and illegitimised any campaign working to address structural issues in the society. “The charity sector has a role to play in better explaining why running a soup kitchen is not the same as tackling poverty in a structural way.”

Hear, hear. And ACEVO will be at the forefront providing leadership on this.

Tuesday was a little more sedate. I was at an annual reception for Saxton Bamfylde at the gorgeous V+A. I had my Director of Policy, Ralph Michell, in tow as we were going on to dinner so I could thank him for his work with ACEVO; for alas he is deserting me for the Cabinet Office. After 6 years, such a short time in one so young! He has been such a star; huge intellect coupled with a practical bent that delivers strategy into action. I will miss him.  But a good voice in the OCS where he will work on public service reform. And amusing to note re: silly Unite campaign on interns, he started as an intern at ACEVO. Like Seb Elsworth before him. I noted a sarcastic letter in Third Sector recently wondering how many of ACEVO's interns had gone onto jobs. Well, that’s 2 for you.

Wednesday was my health speech (blogged yesterday). I had to deliver my masterpiece over a fire alarm in the Royal Free Hospital and it went on for 10 minutes. Still, it had finished by the time of my peroration!

 Then off to a meeting in the Commons with old friend Gordon Marsden MP followed by dinner in the Lords with Jeremy Hunt MP. We sat looking out over to Tommies hospital- founded as a charity hospital centuries ago and he revealed that he had been born at Tommies and his mother had been a nurse there!

So a leisurely day today in Cambridge. I'm interviewing an intern as it happens...

NHS Charities; sleeping giants or agents of change?

I'm giving the keynote address at the annual meeting of NHS charities today at the Royal Free hospital in London. Chris Burghes is the Royal Free charity CEO and is acting as host. He is also an active ACEVO member and asked me to make a provocative contribution! 

So here is what I'm saying.

“The NHS needs to change in order to meet the health and care needs of today’s population. How can NHS charities promote that change?

What are the key problems?

·         The majority of people in hospital beds are elderly,

·         Long term conditions take three quarters of the NHS budget

·         Resources are stretched and will not meet growing health needs

Do NHS charities have a role to play in arguing for change?  Or are they simply happy to be passive recipients of funding demands from their hospitals?

When NHS charities have an asset base of 2.2 billion this is a sleeping giant that needs to wake up. You have a duty as a charity to use your funds for impact, and to ensure that any responsible investment and engagement is, where possible, aligned to your interests. For NHS Charities,  that could be the challenging areas of Public Health – alcohol abuse, obesity and its related diseases: diabetes, heart disease.

 One example of what fund managers can achieve is illustrated by CCLA - In a recent survey of its clients, they found that 80% of its charities were concerned about alcohol, so they invited charity investors (ranging from health and police charities, to Church of England and national youth charities) to work with them to design a minimum standards framework to reduce corporate complicity in alcohol abuse, resulting in companies changing their policies and removing some products from shelf. Results will be published in 2014.

 CCLA are currently designing a further public health engagement program – addressing obesity and nutrition issues within the food and beverage sector. They will be using the new Access to Nutrition Index and full details and discussions will be had on Wed 26^thJune at the Access to Nutrition Index investor seminar, run by UKSIF (UK Sustainable Investment and Finance).

Maybe NHS Charities need to ask more from their fund managers and fund managers need to change their engagement practices to suit. 

And remember that you are not simply finance institutions sitting on your endowments looking for the best place to invest. You must recapture the charity tradition of advocacy and campaigning; using your funds for better health outcomes for citizens and communities; not a cash cow for the next piece of medical kit. Not that that’s not important. It is. But do you demand enough in return for your investment? When Thomas Guy left his fortune to found a hospital he wanted to better the situation of the poor and ill of a deeply deprived London borough. He understood that hospitals were not simply about operations but needed to provide care and support to the most vulnerable. Shall we regain that charitable instinct?

How can you help move the NHS and its hospitals towards integrated, preventative services that reduce pressure on acute services?  Free them up for the crucial work hospitals do in treating serious illness and breaking the boundaries of knowable science. 

Our country's great charities and social enterprises have the skills , knowledge and innovation to drive real change in how the NHS treats and supports citizens. Without a more active engagement by hospitals with charities we can't meet the growing demand on hospital beds and services. Just look at the A&E crisis. Some quarter of all those presenting are over 65. And it is those patients who often have the poor treatment and care. So tackling this problem by using the sector makes eminent sense.

We must face up to the fact that, unless it undergoes fundamental change, the NHS will not be up to the challenge of meeting the health and care needs of the population. The recent publicity around the Macmillan Cancer report which shows soon half the UK population will face cancer in their lifetimes demonstrates that it’s time to act, not talk. 

The reality of an ageing population presents therefore presents great challenges for NHS services. Life expectancy in the UK is forecast to reach 83 years for men and 86 years for women by the year 2031. In the period to 2031, the proportion of 65-84 year olds and over-85s in the UK are set to increase by 39 and 106 per cent respectively.

An increase in life expectancy is good news, of course. But it does put more pressure on health and care services, particularly around long-term conditions. It is estimated that the number of people requiring formal long-term care services will increase by over 1 million by 2025- a 37% increase.

Conditions such as diabetes and asthma will take up an ever-increasing proportion of the NHS’ budget; Diabetes UK has estimated that, if current trends continue, annual spending on diabetes in the UK will increase from £9.8 billion to £16.9 billion over the next 25 years, meaning that the NHS would be spending 17% of its entire budget on the condition.

And unlike in times gone by, the NHS must no longer expect regular, substantial budget increases to help meet this extra demand. Central government spending will remain restricted for the foreseeable future. Consequently there is no alternative but to do things very differently if we are to meet this demand with the resources we have available.

I'm not sure the NHS has grasped this essential fact. So NHS charities have a role to play in pushing for change. 

The NHS must grow and develop services which meet the population’s health needs in a way that promotes both financial sustainability and better outcomes and experiences for service users. To do so it must move away from the traditional, reactive model of treatment, provided in predominantly clinical settings. How much of your spend from your endowments is here?  What do you spend in prevention or community care?  Time to review this. We must focus on developing preventative, integrated services that treat people in the community or at home where possible; that address the underlying causes of poor health and wellbeing, including social determinants of health, before matters reach a critical stage; that support better self-management of long-term conditions; and that give patients real choice and control over their own pathways of care.

In order to meet the health and care needs of the 21stcentury, service users need strong, integrated pathways of whole-person care that is wrapped around the more traditional interventions by medical staff

There is scope for significantly alleviating the pressure on acute services by providing more intelligent and responsive care and support at an earlier stage.

For example, a recent King’s Fund report suggests that7000 fewer emergency hospital beds would be needed by the NHS if all areas of England achieved the rate of admission and average length of stay for over 65s as those with the lowest use, saving almost £500 million a year. But this can be bettered. 

How can you help achieve that change?

How can this change be achieved? Undoubtedly, charities and social enterprises have a central role to play and NHS charities could enable us to expand our work.

For many years voluntary organisations have led the way in developing the kinds of services we need-innovative, holistic services which provide people with the support they need to stay well, healthy and out of hospital.

For example, the British Red Cross provides wonderful support to help older people re-adjust to life at home after a spell in hospital. After a hospital admission resulting from a fall, volunteers transport the patient home, settle them in, advise neighbours or relatives of their return, help prepare a meal and make a further home visit the next day to ensure they are safe and well. Simple steps such as this not only make a huge difference to the quality of the patient’s experience of care- they also have a very significant impact on rates of readmission, leading to real financial savings. They also provide professional volunteers in some casualty departments to work with staff in helping frail elderly admissions. Why is this not being used more? This is the kind of approach that NHS commissioners all over the country should be embracing. They have yet to do so.

NESTA’s recent People Powered Health project helped to demonstrate the value of interventions that empower service users to improve their health and wellbeing, such as peer support networks, expert patient programmes, social prescribing and time-banking.

Analysis of the project suggests that the NHS in England could realise savings of over £4 billion a year by improving the support and choice available to patients around the management of long term health conditions, based on an estimated 7% reduction in A&E attendance, planned and unplanned admissions, and outpatient admissions.

The NHS needs to face up to reality. When demographic change means bigger numbers of the elderly needing health and social care, why do we not commission third sector organisations that prevent unnecessary admissions to hospital ? When we know that the vast proportion of the health budget is spent on long term conditions why do we not commission the very organisations that provide the support and advice needed to manage conditions outside hospital? Why do we not spend more on preventing ill-health?  

Our society has changed enormously since 1948, but our approach to healthcare delivery has not. Before then the 1000 charity hospitals, some of  the greatest names in the NHS , provided excellent care. We have forgotten the role charities could play in hospitals. . Not just the volunteers selling the newspapers. Hospice in hospital schemes . Intermediate care facilities run by charities in the hospital. Advisory services at A&E. volunteers on the elderly wards working with the nursing staff to provide that essential key to recovery; love, care and attention. Charities working with consultants on their ward rounds of their elderly patients, linking with their home and community. Expanding schemes like that of the Red Cross so they are common in every hospital. Using the alcohol and drugs charities to identify people at risk when they present at casualty. 

So my message to NHS charities is be agents of change. The "agent provocateurs" of the NHS. When you get the next request for funding of a new facility or programme from your beloved consultants, ask them what they are doing to link with community and prevention services locally.”