If there’s one thing worse the swingeing cuts to public services, it’s the expectation of more swingeing cuts to public services and the evidence so far suggests both local and national battles for resources are going to get messy.
In one recent example, many will sympathise with the desire of health campaigners and GPs in the London Borough of Hackney to campaign for as much funding as possible allocated to frontline health services but some may question whether slagging off council funding for specialist voluntary sector public health initiatives is the most useful way of making that point.
Last week’s Hackney Gazette saw local campaign group, Hackney Coalition To Save the NHS take aim at Hackney Council’s Healthier Hackney Fund – a funding scheme set up by the council as (one, relatively small) part of their new responsibilities for local public health services under the 2012 Health and Social Care Act.
In its first year of operation the fund has awarded £370,000 to 32 projects run by charities and social enterprises with intention of finding: “new ways to tackle some of Hackney’s most complex health challenges such as smoking, mental health, substance misuse and sexual health.”
In a storming interview with the Hackney Gazette, Bronwen Handyside from Hackney Coalition To Save the NHS explains that: “These are all good projects but they are niche services, they are quite specialised small projects.”
And that: “I would prefer the money was allocated to the NHS which is suffering a haemorrhage of cash funds because of the £22billion cuts which are taking place.”
Before adding: “We have a huge problem with the NHS being broken up and sold off to the private sector and the voluntary sector has been used as a stalking horse for the private sector – you might start off commissioning services to the voluntary and charity sector and you will eventually end up with the private sector.”
Beyond the (perfectly legitimate) statment of principle, it’s not clear what Hackney Coalition To Save the NHS actually would actually like their council to do in this context.
As of 2013, Public Health is not part of the NHS and councils receive government funding to deliver it. Whether or not it would be desirable for Hackney Council to stop doing public health and send a cheque to the local CCG for general provision of local health services, it’s not an option that’s open to them.
While it might be acceptable for volunteer campaign groups to be unaware of (or uninterested in) the overall funding framework that councils operate within in, the Hackney Gazette article also contains quote from a local GP who, given his job, should know better.
Dr Nick Mann of Well Street Surgery notes that the £370,000 could’ve funded a ‘full clinical team’ for a year before storming: “At a time when basic medical services are under threat, it seems wrong to be further fragmenting the limited health budget.”
Adding: “However well-meaning, this diversion of essential health funding will lead to further fragmentation, not integration, of health services in Hackney.”
And that: “Voluntary organisations do great work, but cannot substitute for properly planned and funded public health services.”
This, like the Coalition’s statement, is wrong on a basic level – the funding in question isn’t being ‘diverted’, it’s being spent for the purposes it’s allocated for, rather than on something else that Dr Mann thinks would be better – but that’s just the tip of his reductive iceberg.
The more important question is whether a £370,000 block of extra ‘properly planned and funded’ basic health services is a useful alternative to 32 community projects looking for new approaches to complex health challenges.
If you take £370,000 and split it between City and Hackney CCG’s 43 GP Practices they’d get just over £8,600 each. It’s £1.43 of extra basic service for each of Hackney’s 257379 residents. It’s 3% of the cost one GP appoitment per person.
None of these figures tell us anything much because you can’t make meaningful comparisons between general healthcare and the kind of projects that Healthier Hackney Fund is supporting. They’re not alternative forms of healthcare but they are projects that – in various different ways – aim to help people to be less dependent on healthcare.
Dr Mann takes the view that: “Voluntary organisations do great work, but cannot substitute for properly planned and funded public health services.”
This may be true but it presuppposes: (a) that we’d he’d consider ‘properly planned and funded public health services’ are an option and (b) that they’re the best solution to ‘complex health challenges’.
It’s equally true that GPs and hospitals should not be put in the position of substituting for services that could be better provided by the voluntary sector.
One of the projects funded by the Healthier Hackney Fund is: “Hackney Posh Club – a weekly entertainment and social club for elderly and older people, which will reduce social isolation and prevent the onset of mental ill health.” GPs cannot cure loneliness – and generalist public health information delivered by medical professionals isn’t much help either – but effective voluntary sector projects may be able to reduce it.
It’s understandable that GPs and campaigners feel and embattled, and it’s right that they do defend core services but not expense of being open to new ideas that might ultimatly help them and their patients more than a bit more of what they’re already doing.
Basic medical services are vitally important but arguing that funding for those services should always take precedence over new ideas and projects that might reduce the need for those services – and help people general medical professionals are not best placed to help – is ultimately just an argument for things to get worse more slowly.
The challenge for charities and social enterprises operating in these fields is to develop projects and services that genuinely do make things better.
I haven’t been blogging much over the past few months, due to my work on the (now published) report of The Alternative Commission on Social Investment. There’s been lots of reports, events and launches during that time that are worth catching up so, while I’ll also hopefully be responding to new stuff, I’m going to be posting a few delayed responses to February and March’s biggest stories!
Those tracking the rise of ‘big data’ will have been particularly interested in this Civil Society story from early March, which saw Directory of Social Change boss Debra Allcock Tyler take a series of engagingly absurd swipes at the growing popularity of ‘data’ and measurement.
Speaking at an NPC seminar – and apparently shouldering the burden of ensuring the discussion didn’t subside into a slurry of polite agreement – Allcock Tyler warned that: “A great deal of the time data is pointless” before adding: “Very often it is dangerous and can be used against us and sometimes it takes away precious resources from other things that we might more usefully do“. She then offered a further warning that “vast majority of people” analysing data are not: “good people who are sensible and think things through and understand the broader picture.”
We are not told whether any of those present asked where that ‘vast majority’ figure came from or what percentage of voluntary sector data analysts Allcok Tyler believes are sensible broad picture types but, while the rhetorical approach is exaggeratedly combative, few would disagree with the underlying point that collecting the wrong data and using it badly is undesirable.
Some of Allcock Tyler’s subsequent points are more contentious and raise, albeit in an overly simplistic way, big questions for the data driven industry of impact measurement.
Too small for stats
One is that: “The vast majority of good work that is done by good people in this country is done at very very small charities or community groups working on a local basis where they know people.”
And therefore: “It isn’t the data about Mrs. Jones going to the social centre that matters to that charity – it’s the fact that they know [they are doing a good job] because she smiles. They are not going to count the number of times that she smiles. People at local levels don’t engage in charitable activity because Mrs Jones is going to feel 8 per cent happier.”
This is a statement that will intuitively make sense to huge numbers of people working or volunteering for small charities, social enterprises and other community groups – many of whom feel ground down by years of councils and grant funders demanding they justify their actions by monotonously ticking boxes that seem irrelevant and/or incomprehensible to them and meaningless to the people who use their services.
What it’s not is an argument about the value of data. Data is: ‘Facts and statistics collected together for reference or analysis’. Whether or not Mrs Jones smiles is data but it’s very limited data.
The fact that Mrs Jones has: (a) turned up at/allowed herself to be taken to the centre and (b) is smiling, does tell the people running the social centre something about her feelings about their service but it doesn’t, for example, tell them where she is on the spectrum between ‘delighted by what the centre has to offer’ and ‘too lonely and/or polite to explain that she’d like it more if they offered something completely different’.
It’s true we don’t ‘engage in charitable activity because Mrs Jones is going to feel 8 per cent happier’ but hopefully we do engage charitable activity in order to do something useful. This particular situation may not call for a complex spreadsheet or an SROI report but surely we can accept that there may be some relevant information about whether Mrs Jones is getting the help she wants and needs beyond our own personal opinion?
All you need is love
The implication of the final Allcock Tyler quote in the Civil Society article is that in many situations, for her, the answer to that question may actually be “no”.
She warns that: “As part of a data revolution thing, it can be incredibly dangerous because people say if you can’t measure it, it’s not worth doing – but actually some things you can’t measure. There is something about the nature of charitable endeavour which is about love and trust and faith and not about numbers and data.”
This is, once again, a statement many of us will instinctively sympathise with but equally, it’s a line that can be (and often is) used to explain why a particular organisation is using other people’s money to continue to do the same stuff decade after decade irrespective of whether it’s any use to the people they claim to exist to help.
More than anything, this discussion illustrates the difficulty that our growing impact measurement industry in convincing the voluntary sector (and social enterprises) that it is on their side and can offer them something they either want or need.
In theory, organisations should welcome the growing opportunities to decide for themselves what data – whether or not its focused primarily on numbers – can best help to understand, explain and improve what they do. In practice, not many do and while Allcock Tyler worries about the data revolution, much of the impact measurement activity that is happening – beyond the world of SIBs and other large scale PbR contracts – seems to take place in funder-designated sidings that even funders have forgotten about.
The questions about how local organisations decide what they’re doing, who they’re doing it for and whether it’s succeeding are more important than ever. We need to find more practical and proportionate ways to answer them.