Category: Newsletter features

An interesting article on community and social care from Mark Gamsu who concludes his article with this point:
“It is very important that statutory organisations such as big NHS providers, Clinical Commissioning Groups and those professionals funded by the state like GPs understand that it is not good enough to just design pathways that reconnect people with communities.
Communities are not just waiting with lots of spare capacity for people to be referred to them. They need investment too – the Rotherham Social Prescribing scheme, one of the biggest in the country invests two thirds of its resources in local community and voluntary organisations.
We should support social prescribing and personalisation pathways but commissioners need to give at least as much weight to investing in grass roots community organisations and building their capacity.” Read the full article here.

Social prescribing is not a new idea – it is a means of enabling primary care services to refer patients with social, emotional or practical needs to a range of local, non-clinical services, often provided by the voluntary and community sector. It is most commonly used with patients with a mental health or long-term condition. You may have come across it in a variety of other guises such as ‘books on prescription’ or the University College London’s ‘Museums on Prescription’ project.

There are people working with a variety of therapeutic models – ecological, arts and complimentary among others. In Camden, there is a spectrum of social prescribing provision: you may have come across local initiatives like Care Navigators, Community Connectors and Community Health Advocates. These are helping to guide people with complex needs, older people, and patients in GP practices towards non-clinical interventions that help improve health and well-being.

However, social prescribing is not straightforward. Practitioners, GP’s, academics and others with an interest in social prescribing are exploring a variety of issues like definition, integrating non-clinical services with primary care, regulations and standards, creating quality provision and current research in the field.

Those involved in providing services that could be socially prescribed often encounter difficulty working with GPs who have been educated in the medical model. GPs have raised issues about the faith we have in them referring to prescribed medicines, where these are either not taken or are taken incorrectly, and the amount of medical research that offers no clear solution to a particular health problem. Social prescribing could be seen as the “Trojan horse” within the traditional medical model where “subversive commissioning” could occur and patients gain access to services such as complimentary therapies that would not have been commissioned directly by the local Clinical Commissioning Group.

There are challenges for non-clinical service providers too. What does social prescribing mean for the voluntary and community sector? Voluntary and community groups run most of the projects which patients are referred to. This places voluntary and community organisations at the core of any sustainable social prescribing project. What does this mean in the current austere climate where organisations are struggling to stay afloat?

We will be discussing the opportunities’ and challenges’ that social prescribing presents and what we can do to develop a more robust model that suits the Camden landscape at the seminar being held on the 27^th June 2 – 5pm at the St Pancras and Somers Town Living Centre. Booking is essential.

In the meantime, if you would like some further information about social prescribing please contact Peter Simonson, Referral and Signposting Co-ordinator projectsupport@vac.org.uk. 020 7284 6550.

There is a great deal of interest currently in the role of the vcs and civil society in Health and Social Care.  There are a number of reasons, an ageing and unhealthy population costs more and is unhappier.  And as the balance shifts from a young working population to an older, less healthy population public finances will be hard hit as tax revenues decline and spending on health and social care increases.

Early Intervention seeks to spend a small sum on prevention rather than a large sum on crisis intervention –  “A stitch in time saves nine”. Social Prescribing is a way of putting healthy activities on a similar footing to pills and medications that one expects to be prescribed at the GPs.  By prescribing for example a smoking cessation class, or mindfulness, or exercise, the GP promotes adoption of a healthier lifestyle in a sustainable way and quite possibly saves money not just on that current visit but on the visits in the future as the condition of unhealthy lifestyle takes its toll.

The good news for the sector is that these are all areas that are traditionally our strengths.  Many of the groups that have a role are just the sort of groups that the voluntary sector produces in abundance.  The less good news is that funding prevention work can be difficult.  So on a national scale, reducing smoking leads to less lung disease, a healthier population and less call on acute services.  But New Public Management focusses on per unit costs and measurable outcomes which puts prevention work at a disadvantage. At the local scale it is difficult to measure the benefit of a single smoking cessation class.  Even if a group of residents give up smoking, the cost savings are still based on guesswork and occur at some time in the future.  The residents may even move from local authority area A to B and therefore money has been spent in one area but has ultimately saved money in a different area (and in the future).  On the other hand, acute funding and outcomes are much easier to measure.  The smoker collapses with a heart attack and is rushed into hospital and after a stay in intensive care is discharged.  Everything from the ambulance trip to the point of final discharge can be measured, costed and an outcome clearly measured.  But all at much greater cost.  So although the costs of prevention are much much lower, on an individual basis the savings and outcomes are much less certain.  The answer must be to take a more sophisticated management approach that looks at risks and probabilities based on epidemiological data.

Our Health Advocates project is a type of Social Proscribing that attempts to get around some of the issues such a confidentiality.  In our model the volunteer Health Advocate sits in the waiting room of a GP surgery in Camden armed with information about local groups and activities.  They are then able to chat to those in the waiting room and suggest a range of activities and groups that they can try, ranging from activity classes to self help groups. This approach gets round some of the problems – GPs would otherwise face such as either having to learn all the options themselves – or have the Health Advocate in the consulting room.  Either option presents large issues such as confidentiality.  With our approach the patient opts in and and is free to take or leave the advice and signposting offered.

One further issue is that once successful the activities, classes etc that people are being signposted to will gradually have to deal with larger numbers and some small additional funding may be needed.  Trickling some small sums of money for this into this part of the system will be the next piece of the puzzle to put into place.

Currently we run a Health Advocates Project, operating in nine GP surgeries in Camden, and we are just about to start an antenatal mentoring project to spread the word about early antenatal care to newly pregnant women from marginalised groups. We also ran a very successful Mental Health Champions project. Sadly our mental health champions project has just closed as the CCG is reviewing this area of work.  As a small organisation we are not able to sustain this service while our public sector partners ponder the future – a practical example of why this way of working has much potential but also often falls at the first hurdle.

Other examples of this sort of work in the borough include the Ageing Better Community Connectors project   – similar in that isolated individuals are connected to community activity – though in this model the connectors are out in the community rather than sitting in a GP surgery waiting room.

In the past we’ve been part of other projects that have run along social proscribing and early intervention lines, such the Early Cancer Detection Project and the Peer Sexual Health Education Project.

There is great potential for Social Prescribing (in various forms) to be a piece of the puzzle to solve the current health and social care crisis.  You can read more about our Health Advocates Project here.  There is also a health advocates blog and two case studies; Swiss Cottage GP Practice and another from the perspective of a Health Advocate volunteer.

As part of a borough wide process to look at the future of Health and Social care Camden Council recently convened a meeting of Health, Local Authority and some voluntary sector organisations to co-produce a strategy for Adult Social Care in Camden.  The role of social prescribing (in it’s various forms) featured prominently.  In a future blog we will look at the work of that group and look further at the role social prescribing could play in Camden in the future.

We have a page of relevant links, case studies and policy briefings on our website here
https://vac.org.uk/early-intervention-and-social-presecribing-resources-and-links/

The Beginning

About a year ago an inquiry into infrastructure in London was started in response to a decision by London Funders to stop funding pan-london infrastructure in April 2017  – i.e. end funding to London-wide voluntary sector support bodies such as London Voluntary Service Council, London Advice Services Alliance etc.  London Funders simultaneously took the decision to commission a report into the future of london infrastructure. This gave them a year to come up with a strategy for pan-London infrastructure support before the funding ended.

This all seemed logical and there was some logic to looking more widely at voluntary and community sector infrastructure across London at the same time.  It was a decision that local CVSs and Volunteer Centres (the main local infrastructure bodies) weren’t consulted on but it seemed logical and despite being a top down initiative VCSs engaged with good will.

The original brief to the consultants contained both a wish to:

“to understand how civil society in the capital can best be supported in order to optimise its positive impact on Londoners”

and

“know how support should be provided in London for the future to meet the needs of front line organisations”

and

“A robust vision for infrastructure in London”

 

The Middle

There then followed a very lengthy process, involving large numbers of stakeholders. Arguably at this point a critical error was made as the remit of the enquiry was opened up too wide –  to include all of civil society –  without ever defining where civil society begins and ends (relevant to infrastructure if we are to have a role supporting it).  This was a critical juncture in the process and worth unpicking in more detail elsewhere. So rather than dwell on this stage of the process it can be summed up as confusing, often with too many disparate groups in the room all talking at cross purposes to feel that anything useful was being achieved.

After six months an interim report was produced that most agreed left a lot to be desired.

If the reports provocative nature was aimed at galvanizing interest, then it succeeded as a huge effort by key stakeholders was launched to try to bring the project back on track (or at least back down to earth).

 

The End

Finally in November 2016 the final report was unveiled.  It was 69 pages long and it’s central conclusion was to propose a new vision and system for civil society, containing 12 core themes achieved through a system of 10 stakeholder groups (see diagram below).

The 12 themes and key proposals are:

Proposed vision and system

The twelve core aspects of the proposed vision and system are:

1. A shared understanding of need should be co-produced, with communities driving this process,and with the involvement of a range of other players.
2. Communities should be enabled to find and deliver their own solutions where possible.
3. Frontline volunteers, groups and organisations’ role would be to fill gaps in provision which communities can’t or don’t want to provide for themselves.
4. Civil society support would provide a “triage and connect” function to diagnose the issues faced by frontline volunteers, groups and organisations and match them to the right support. Support could be from a range of sources within and beyond civil society.
5. Communities, civil society support and funders should act as catalysts for action and also identify emerging needs.
6. Civil society support, independent funders and the local public sector should share data gleaned through co-producing a shared understanding of need, and information on policy developments and best practice.

1. A London Hub, working with specialist support, should develop standardized resources where possible, which can be customized and delivered locally. The London Hub could be made up of a network of organisations or be a formally constituted body.
2. Frontline volunteers, groups and organisations, civil society support and independent funders should campaign and influence locally and regionally.
3. Civil society support and independent funders should act as catalysts to drive improvements in quality, based on peer support and challenge.
4. The GLA should collate, analyse and provide data on civil society and communities’ needs.
5. The GLA, elected representatives, London Councils and independent funders should bring civil society into strategic planning and decision making about the future of London.
6. London Councils, the GLA, elected representatives, independent funders and the local public sector should work together to ensure consistent commissioning and funding of civil society support.

The core stakeholders identified in the report are:

1. Frontline volunteers, groups and organisations
2. Local support
3. Specialist support
4. London Hub
5. GLA
6. London Councils
7. Local Public Sector
8. Business
9. Elected representatives
10. Independent Funders

The report was launched at Guildhall in the City to much fanfare.  The report was embargoed to the last minute – delegates received their copies on their way to their seats at the launch event. Even after studying it carefully it was unclear what was being proposed.

 

The Next Phase after the End – Implementation

The consultants signed off on their report, got it launched and handed back to London Funders.  London Funders then appointed another consultant (Geraldine Blake) – who was on the Way Ahead reference group. Geraldine was given the tricky task of trying to implement the report (or at least achieve something realistic).

Together with Geraldine Blake a group of pragmatic and clear thinking voluntary sector people have stepped forward (mainly a mixture CVS directors and experienced local infrastructure workers) who have formed a ‘systems change’ group and unpicked half a dozen or so key themes from the report and formed working groups to reach some practical conclusions. The working groups are

1 – Co-production

2 – Data

3 – Triage and connect

4 – Voice & Campaigning

5 – Consistent commissioning

These groups are working hard, trying to be inclusive and base their work on evidence and case studies and come up with pragmatic workable solutions.

 

The Future – A Variety of Risks

• Time is running out.  Pan London organisations have issued redundancy notices. Voluntary infrastructure across the capital is in a critical condition.

• Money is running out.  City Bridge announced a financial commitment at the November 2016 meeting to take the work forward and provide an emergency lifeline to some of the pan London infrastructure, but it appears that some of this may be contingent on match funding and other funders have not come forward yet.

• Local Authorities in general haven’t been especially engaged (Camden more so than most).  Health authorities not at all.
• Trust between the sector and funders and key stakeholders has been damaged as a result of the poorly handled process and there is an urgent need to rebuild trust all round.

• There are many conflicts of interest that do not seem to be managed or even acknowledged. There are particular ways of working that are being promoted such as sub-regionalisation (the super CVS model); Diverting budgets into mass civic participation models of working; The presence of consultants who are both involved in the process, evaluating the sector and bidding against the sector for work.

 

Final Thoughts

Where this will all lead is still too unclear to predict but it looks clear that in many ways that local infrastructure bodies (CVSs and Volunteer Centres etc) are back where we started – any funding for local infrastructure organisations will be heavily dependent on local public authorities. The picture for pan-London bodies is less clear but rather bleak.

CVSs and local infrastructure organisations in general have been rather taken aback by the gaps in understanding of civil society and our work and so one key task is to build a better consensus of understanding between us and funders and policy makers of how civil society, community groups and the voluntary sector interlink and how they can best be supported.

There were too many lazy assumptions among policy makers and funders that the sector was amateurish, poor quality, and old fashioned. The simplistic arguments around ‘digital’ being a classic example  – where there was little understanding of the sector’s difficult but more sophisticated approach to digital – embracing digital yet retaining face-to- face and telephone and in-person support as key to inclusion and equality – and rejecting the public sector’s blanket ‘digital by default’ approach which is heralded as innovative and saves the public sector costs but often excludes the very people we are there to support.

We are determined to demonstrate to London Funders our willingness to try different things and help move the report forward, rebuilding trust with stakeholders, but above all stay firmly rooted in a world that is both realistic and achievable.

 

Camden’s Health and Wellbeing Board convened an interesting meeting recently to look at tackling obesity and low levels of physical activity among residents in the borough.  We started with presentations (pp 10, 11) on the situation in the borough (a surprising number of the over 65s and primary school age children are overweight).  We then worked in groups looking at what we could do. For more background there are some national guidelines on developing local strategies here (warning 250 pages!)

It was good to see the acknowledgement of a deeper role in health at a  policy and a planning level.  We don’t hear much about the social determinants of health, spanning everything from social and economic factors, the physical environment and policy decisions that are the foundation of good health.  We’re used to seeing healthy messages targeted at individual behaviour, but often it’s policy levers influencing social and economic factors and the physical environment that have much bigger effects.  In Victorian England, the vast leap in the health of the nation (such as elimination of Cholera, Diphtheria, TB and so on) were all achieved at the policy level by tackling overcrowding, poor sanitation and poverty through a combination of legislation and public infrastructure building.

There’s lot’s that can be still be done at the policy level.  Camden has powers over planning, speed limits, catering in schools and institutions, even little things like benches and loos can have a big impact on people’s lives.  Ofsted will be looking at measures aimed at physical health and wellbeing in primary schools from 2017. The Mayor is tackling air pollution across London. Transport infrastructure and cycling strategies will impact health and wellbeing too.

The meeting was an opportunity to bring a number of different sectors together.  But what were the voluntary sector there for?  Hopefully we could contribute knowledge and ideas from the sector –  our group spent some time looking at getting people more active and Sofina from KCBNA was able to bring her insights into working with BAME older people and encouraging activity. Our group liked walking and I talked about Kove’s Ageing Better funded bench-to-bench walks in.  Kove discovered that a key barrier for older people was a lack of benches.  They campaigned for more benches  (but not ‘Camden’ benches) and then mapped out routes so that older walkers could have a regular rest.  Lack of public loos can also be a barrier to  older and disabled people getting out more and the community toilet scheme helps there.  For the young the issues seemed to be about risk and safety (for example traffic) and public authorities had a role in creating play streets, lowering speed limits and encouraging walking to school.  We thought a bit about how people could be encouraged to be more active and the sort of messages they might respond to.  Walking can be made goal oriented with apps and challenges, or a social pastime with social and cultural interest walking groups – different approaches favour different age groups.

We also talked a bit about opportunities to make the most of school kitchens as a resource and involve out-of-hours groups supported by celebrity chef led charities to make the most of these resources to improve healthy eating in the borough.  We talked about Rhyll and Mayfield that are working on this and the help that Foundations like Greggs can bring –  and we’ve been involved too, helping with fundraising advice to the PTA.  By the way, now is a good time to approach the Greggs Foundation as their Manager Jackie Crombie is on secondment to Business in the Community as a Business connector in Camden.  With all these connections, there is the potential for lots of good things to happen when public, private and voluntary sector work together on common ends.

Choosing where we think we can have the best impact and then getting the messaging right will be challenging – simple messages work best – think of the 1980s Aids campaign  (safe sex!) or smoking (quit!). But food and lifestyle are more complex and less amenable to simple messages ‘Eat a varied diet in moderation’ may be sound advice but it’s hardly likely to capture the public imagination.  Fortunately  we have onboard  media and marketing specialists – The Campaign Company –  to help us.

Hopefully the voluntary and community sector will be able to contribute all sorts of knowledge and ideas.  For example, we are involved in a social prescribing project where Health Advocates talk to patients in GP waiting rooms and C4 have a related Community Connectors project, both of which are great opportunities to talk to residents about health messages. Of course the others in the room all came up with a huge range of interesting ideas as well, and there is plenty of work still to be done so it’s impossible to predict what the final action plan will look like at this early stage.

However, it’s worth mentioning that there is an unfortunate history of confused nutrition education messaging that has clouded this whole area, and might explain why a maker of sugary drinks can market it as a sports drink for the fit – though only a few years ago the same drink was marketed as a convalescents drink for the sick.

We really have had a bad half century of nutrition advice and public messages.  Starting in the 1960 when the humble egg went from hero (go to work on an egg) to villain just ten years later.  All because of unscientific links between the presence of cholesterol in the yolk and cholesterol in the brain (good!) and blocking arteries (bad!).  Somehow along the way someone forget that there is a both a blood-brain barrier and a gut barrier, so ingredients in food don’t just travel straight into your body.  Oh well.

Things got even worse with the fat vs sugar war.  Yudkin, the head of department at my alma mater, QEC, wrote ‘Pure White and Deadly’ in 1972 convinced that processed sugar was to blame for the rise in heart disease and obesity.  Unfortunately an American, Ancel Keys, thought that saturated fat was to blame and his views were taken up by the powerful American Heart Association.  The fat vs sugar war raged briefly but fat soon won out and Yudkin found his career had come to a sudden end.  Actually, they were both brilliant scientists working in a tricky field and the blame lies as much with public health needing simple messages as it does with powerful vested interests in the food industry.

Sadly the result of trying to correct these historical errors may well be more anger and confusion.  First the myths about fats will have to be tackled both here and in the US.  Then the public will have to get used to new facts. This will essentially mean eating a lot less sugar.  The US has taken tentative steps and the public in the UK are being softened up for the message that sugar is bad with actions like a soft drinks sugar tax in the 2016 budget.  However, a rather alarming backtracking has just occurred in the final draft of the Childhood Obesity Plan, where Theresa May’s government has overseen a dramatic watering down of the original proposals.  Perhaps sugar will continue its miraculous charmed life for a bit longer (if any of us are left alive to buy it).

To finish I want to share the new Brazilian dietary guidelines which have taken the revolutionary step of using social messages rather than biomedical messages.  What I mean by that is that rather than health messages that talk purely about the components of diet (ie eat more fiber, eat less carbohydrate etc) they have come up with messages that tackle the social aspects of eating, such as where and how you buy, prepare and eat your food. This shift from a biomedical approach to health to a social model could have profound implications in health more widely. I think this is a revolutionary and powerful approach and I’m sure other countries will follow  – though interesting to note that these guidelines were very unpopular with industry, who presumably know an effective media campaign when they see one.

The Brazilian guidelines are:

1. Prepare meals from staple and fresh foods.
2. Use oils, fats, sugar, and salt in moderation.
3. Limit consumption of ready-to-consume food and drink products.
4. Eat regular meals, paying attention, and in appropriate environments.
5. Eat in company whenever possible.
6. Buy food at places that offer varieties of fresh foods. Avoid those that mainly sell products ready for consumption.
7. Develop, practice, share, and enjoy your skills in food preparation and cooking.
8. Plan your time to give meals and eating proper time and space.
9. When you eat out, choose restaurants that serve freshly made dishes and meals. Avoid fast food chains.
10. Be critical of the commercial advertisement of food products.

This is a short blog about some attempts in London to look at using digital, data, ideas around the network broadly for social good in civil society – partly stimulated by the Way Ahead report.

I’ll try not to bore you – but hold out for the end because there’s a surprise coming courtesy of Mr Zuckerberg.

At a half day event at City hall we caught up with a number of projects around digital, mapping and participation and then broke into workshops to further our ideas.  I joined Geraldine Blake (London Funders Way Ahead consultant) and Kate White (from Superhighways) in a group looking at London VCS data as this seemed the most aligned with a Way Ahead theme.

The discussion seemed to work broadly at three levels.

1. There was a pure data level where the problem was addressed as a technical issue with a relatively straightforward solutions.  Basically, get those databases talking to each other with APIs and other technical trickery.

2. A slightly more nuanced version which acknowledged the reality that the majority of VCS organisations are not registered charities (or registered anything) so may be on a CVS database, but may or may not be public. For example, here is our public directory showing about 1800 organisations (only approx 600 are registered charities).  However, we have the same number again on our database that do not want to be on the public directory.  So here are two problems already – the significant one that probably only the local CVS has any sort of directory of the majority of local organisations (as they are not registered charities or companies) and secondly the fact that a good proportion of them don’t want to share their data (usually because they are too small or are using private numbers, home addresses etc). This was significant as it revealed a pretty major USP* for local CVSs.  There’s no easy way to get that data from elsewhere and there’s no way to scoop that up into a centralized database. Looks like we’re indispensable!

3. And finally, Way Ahead’s little grenade – civil society.  What does civil society use?  Anything and everything; spreadsheets of email addresses cut and pasted into the bcc field.  Yahoo Groups, Twitter, Facebook, Meetup, mail groups on listeron, riseup, mailchimp, shared files on google drive and dropbox.  And all manner of websites. And facebook.  Network that!

Perhaps the final challenge here for  networked civic participation is that I have a strong feeling that most of these activists are happy with this state of affairs.  They want to be below the radar.  They don’t want outsiders muscling in on their discussions.

This is a conundrum for local government and civic participation.  Matthew Ryder, the Deputy Mayor, challenged us to come up with ideas to deepen engagement. But from local experience this is becoming a fraught area. The impetus for a lot of hyper local civic engagement in London is development and in most cases the peoples are in conflict with their council as many councils are using development as way to back fill their budgets that have been stripped by central government. For example, almost 400 tower blocks are going up.  On top of this is intensification – a euphemism for knocking down an estate and rebuilding it more densely, with luxury apartments to pay for it all, and often less social housing than before.  Dozens have already been redeveloped with mixed results from complete success to abysmal failure (see Heygate and Sweets Way).  And this intensification is nearly all in what were social housing areas – though post intensification the areas are often much more ‘gentrified’. And then there are other developments including major infrastructure such as HS2 and Crossrail.   Councils are also engaging their people about  charges for care, cuts to services and new taxes. So by and large the people are revolting.  Tensions are running high.  And there are local elections next year. Engagement is going to be tricky.

So I’m not sure where we are going with networked civic participation if the bureaucrat view is to centralise and standardise. But it’s worth noting that there have been some attempts at centralising and channelling engagement before.  Camden tried it with a website called WeAreCamden (based on a Cambridge Open Systems platform). The site was quietly taken down in 2015 and now just hosts consultations, but it was  originally aimed to be an all singing all dancing social engagement tool , a ‘social network for Camden’ – but allegedly never had more than 4000 users (around 1% of the boroughs daytime population).  And sadly rather than share the learning it was just quietly shelved.  And there is a more recent example from the enterprising Community Southwark who have set up a Nation Builder site called Southwark CAN which is similarly trying to engage the broad population and is partly organised around local “Community Action Networks” that seem to parallel the council’s community councils (which confusingly each have a facebook page as well). It’s only a year old but numbers look low here as well.

So to conclude, the bureaucrats are still attempting to centralise and standardize (as they always will), but the realization that CVSs engage with a majority of unregistered groups who are recorded nowhere else gives CVSs a strong unique selling point and the CVS network needs to drive this home as a key message in the Way Ahead. Networking deeper into civil society is yet more challenging as the networks become (deliberately) less visible and more hyper local and fragmented. But the experiments with borough wide social networks clearly show that some boroughs are thinking about this – though no one has cracked it yet (I wonder where they share this thinking?).

And then in comes Mark Zuckerberg.  On 18th February, five days before our meeting, Zuck dropped a bombshell –

“For the past decade, Facebook has focused on connecting friends and families. With that foundation, our next focus will be developing the social infrastructure for community — for supporting us, for keeping us safe, for informing us, for civic engagement, and for inclusion of all.”

I’m really not making this up.  You can read his full statement – all 5700 words of it here.

 

Kevin Nunan

Quarterly Policy Briefing for Camden

Welcome to the second VAC quarterly selection of Policy highlights of relevance to the VCS in Camden. The policy highlights are drawn from a wide variety of sources and may have featured in recent editions of the e-bulletin or have been drawn from conferences, workshops or seminars. Please do give us feedback on the briefing and let us know if there are particular issues you would like covered in more depth. The VAC e-bulletin will be back as usual next Friday.

POLICY

NEWS UPDATE VAC AGM Thanks to all those who turned out on a cold February evening and a big thanks to our speakers: Cllr Georgia Gould, Dr Caz Sayer and Charlotte Pace. You can view a storify of the event here. Look out for more follow up next week. Scam Alert Charities are being warned against an unemployed man who threatens organisations with fake disability legislation if they don’t give in to his outlandish demands. Gerry Freedman bombards charities, FE colleges and community groups with job applications demanding hotel rooms, first class transport and cash expenses. We know he has attempted to scam at least two Camden organisations. Full story in Third Force News. Contact Robert Armour if you think you may have been approached by Freedman. Health and Safety Training A date has been set for our free Health and Safety training course – 21st March 10.00 – 1.00. Details to follow next week. Camden International Women’s Day event Women in the arts, media and creative industries Wednesday 8 March 2017 11am to 3pm. Details and booking at Eventbrite Camden and Islington LGBT History Month With so much to celebrate, including 50 years since partial decriminalisation of male homosexuality, why not join us for a night of fun, frolics and community spirit. As a valued partner we would like to give up to 10 members of your organisation/friends free tickets. Simply book at https://queeropolis.eventbrite.co.uk and enter promo code PARTNER100 at ‘Checkout’. The full history month programme is available here. HEALTH Social Care Crisis Social Care is approaching crisis and there is an extensive consultation currently under way in Camden. The full details of the consultations and all supporting papers and consultation dates and links to the online consultation can be found here. The future of social care was the subject of both the VAC AGM and the Camden Disability Action AGM. Cllr Georgia Gould (for Camden Council) and Dr Caz Sayer, Chair of Camden CCG and Sally MacKinnon, Tranformation Lead at Camden CCG have all set out their vision for the future of health and social care in Camden. Their presentations will be available on the VAC website shortly. Meanwhile, there has been a lot of discussion nationally, behind closed doors, on high level ambitions to involve more volunteers in public services. Without warning (or any open consultation) the government has just issued 6 new guidance documents ” to help public sector commissioners embed volunteering and social action in public services” Full story and links to the guidance in Civil Society. North Central London Sustainability and Transformation Plan Camden Council have now held two public meetings about the STP. You can read a summary of the STP here or the full publication here. You can read the Leader of Camden Council’s statement here and Camden CCG statement about the STP here, Campaigners have raised concerns. A major consultation with patients, the public and VCS is expected soon. Navca’s advice for the voluntary sector can be found here. Two notable quotes about STPs are: “locally, the best source of support for linking with the voluntary sector is frequently the council for voluntary services (CVS)…”The full NCL STP draft document and a summary document are available on the Camden website. If you would like feed in ideas or comments on the draft STP document, please send them to the NCL STP office at nclstpmo@nhs.net. You can read the views of Healthwatch Camden on the STP here. Latest Camden council statement and letter on the LB Camden website.. GENERAL Business rates revaluation Do you have premises? Do you pay rates? The central government Valuation Office Agency (VOA) has updated the rateable value of all business properties. The rateable value is used to calculate business rates, which are then collected by councils. In many cases the new rateable values are up to double the old value. The council have told us that they expect the 80% statutory charity rates relief to remain and the Camden arrangements for discretionary rates relief will also remain. If you think your bill is wrong you can appeal it. Use this link to check your current rateable value and the new 2017 rateable value. https://www.gov.uk/correct-your-business-rates Challenges of demonstrating impact for smaller charities New research by Think:Learn:Do commissioned by NAVCA highlights difficulties smaller charities have when using data to demonstrate their value. The research, titled In Sickness and in Health, also looked at how local infrastructure can best support them to overcome these difficulties. This research shows that more needs to be done to support charities to demonstrate impact. Without this support commissioners may wrongly disinvest in smaller charities. The lack of evidence may mean that services providing value for money and producing the best outcomes are overlooked. Big Society become Shared Society then fizzles out in record time Prime Minister Theresa May announced in January that a key part of her “shared society” vision for the UK involves “creating an environment in which our charities and social enterprises can thrive”. She pledged to support initiatives such as National Citizen Service, the Points of Light awards to recognise volunteers and supporting the #iwill campaign which was a central part of David Cameron’s big society agenda. She has also asked Mind CEO to work with “employers and mental health groups to create a new partnership with industry.” She pledged £14M to support mental health (about 20p per person). Full story in Civil Society. The third sector press north of the border was more skeptical of the initiative, with Third Force News calling it a “sham” and warning politicians to “keep off our territory.” Barely a month later the policy seems all but forgotten. Charities and Campaigning Within days of launching the ‘Shared Society’, the Prime Minister, Theresa May, attacked the Red Cross as “irresponsible“. NCVO have produced an excellent guide: “How to talk about charities and campaigning” which sets out the positive argument for why charities should campaign and what is allowed within the law. Paul Perkins, a former Charity Commissioner has also written an excellent piece telling the story of how RNIB campaigning lead to a revolution in NHS services to deaf people. Pensions – What small charities need to know about auto-enrolment Small and micro charities are coming up to their auto-enrolment staging dates. This CFG guide provides a quick refresh for those currently going through the process. All charities that have at least one paid worker will have automatic enrolment duties. Charities need to assess their staff, put those who meet certain criteria into a pension scheme (and make contributions to it), tell them what you’ve done, and complete a declaration of compliance. More details here. GOVERNANCE Making Digital Work: 12 Questions for Trustees If you’re interested in how digital can add value to your charity and are unsure where to start, have a look at the new tool. The contains 12 questions to get you started. Download it from the Charity Commission website. Trustees Feel Under Pressure More than a quarter of charity trustees have considered quitting because of pressure, survey finds Research carried out in partnership with Third Sector indicates that almost three quarters of board members think the demands on them are increasing and almost a quarter thought that the pressure had become too much. Read the full article in Third Sector. CONTRACT CULTURE Small charities ‘priced out of council contracts’ Small charities are being “priced out and scaled out” of bidding for local authority contracts and it is “inevitable” that charities will take over some local government services, local government representatives have told the Lords Select Committee on Charities. Appearing before the committee, Daniel Hurford, head of policy at the Welsh Local Government Association, and Robert Light, a Kirklees councillor, both said that the funding cuts faced by councils and the shift from grants to contracts had had a negative impact on local charities. Hurford said that despite a general understanding from the charity sector that local authorities were facing severe budget reductions, “there is increasing tension over how that funding is distributed to the sector”. He said there was a risk that smaller organisations “are priced out and scaled out of the market” and the increasing focus on larger contracts with bigger organisations meant the charity sector risked losing “some of the value it brought as a body, both as a potential deliverer of services but also as a representative body, as an advocate and as having local community ties”. Lloyds Bank Foundation Director Warns Lords Committee that the Value of Small Organisations is being lost and blames ‘broken commissioning’ He argues that the bar for the third sector is often set higher than that demanded of other sectors. Small charities in particular face an ill-informed presumption that they’re not good at reporting or measuring their impact. “Over the years I’ve met countless small charities and I am yet to meet one that isn’t interested in improving impact measurement. But they struggle to find any money to fund formal evaluations, so they focus on measures that relate directly to their day-to-day work. Many use industry-recognised methods, such as the Outcomes Star, that create a different, nuanced conversation with their beneficiaries at the point of “sale”. Most public and private businesses would give their eye teeth for that degree of bespoke customer experience. Society can’t afford to have these services, or the impact they have on local communities, trivialised in this way. We need to measure impact through the eyes of a person receiving the service: as a good business would its consumers.” Read the full document here. Furthermore Lloyds TSB Foundation are warning that Broken Commissioning Threatens the Survival of Small Charities and warns of widespread closure of small charities. The report warns that we “urgently need common sense reforms to ensure small charities are able to compete for contracts on a level playing field. This isn’t about spending more money, but making better use of the funds that are available”. The Guardian has picked up the story and writes: “Research finds government’s ‘shockingly complicated’ tendering processes threatens the survival of smaller charities. Smaller charities are being shut out of competition for government and council contracts by “shockingly complicated”, bureaucratic and inappropriate processes…” The future of many smaller charities with priceless local knowledge and connections is being put at risk by their inability to comply with the myriad requirements and paperwork that typifies official tendering, the analysis suggests.” Civil Society also has an article about commissioning in crisis. Lloyds TSB Foundation have published a thoughtful article about their reasons for sounding the alarm as well as “Championing Small Charities” containing practical suggestions for funders including: ~ Work with local charities to better understand who they work with, the existing services in your area and learn from their expertise about what support is needed ~ Ensure any commissioning involves contract sizes and processes proportionate to what you are trying to achieve to allow small charities to have a fair chance of succeeding ~ Use grants wherever possible ~ Improve transparency in commissioning and supply chains and challenge bad practice ~ Provide core, long term funding for small and local charities Fairer Contracting and Commissioning The Guardian has an excellent article “Fairer UK charity contracts will demand long-term government support” which pinpoints the current commissioning culture as part of the problem. The article says that small charities are losing out and therefore depriving the public sector (and their clients) of local expertise and reach. The article sets out the governments plan to tackle the problems but warns that the plans may take some time and still depend on local commissioners seeing the value of the sector. Faulty By Design – The State of Public Service Commissioning Faults in publc-service commissioning came to a head when the government’s ‘Troubled Families’ initiative hit 99% success rate and most areas that took part found precisely the number of troubled families that central government predicted they would have. Reform’s latest report, Faulty by design. The state of public-service commissioning, published today, seeks to shed light on the successes and failures of the current framework and serves as a case for change from the current system. More info, interviews and full report here. Locality launches campaign against ‘counterproductive’ commissioning practices Locality has called current commissioning trends “counterproductive” and “inefficient”, and has launched a campaign to keep commissioning local. The Keep it Local campaign and accompanying report is calling for locally-commissioned and delivered public services which provide “substantially better outcomes and value than standardised, one-size-fits-all services”. Full details Civil Society ECONOMY Autumn Budget In the autumn the Chancellor announced announced ~ Banking fines – a further £102m will be committed over the next 4 years to support Armed Forces and Emergency Services charities ~ Tampon Tax Fund – £3m will go to Comic Relief to distribute to a range of women’s charities ~ Gift Aid Small Donations Scheme – will be amended to make it more accessible and flexible ~ Gift Aid Digital – will simplify the process for donors making digital donations In NAVCA’s response, Neil Cleeveley, Chief Executive, said; “On a day when all the talk is about the nation’s multi-billion pounds public finances, it is important to remember that small investments can make a huge difference to people’s lives. The Chancellor has acted in a disappointingly traditional manner. I would argue for a more radical approach to match these very changed times.” More reactions from the voluntary sector in Civil Society and The Guardian and NCVO. A complete failure to mention health and social care has caused alarm among local authorities and the NHS. The Kings Fund said that “the government will have to look again…” Camden Council said “Today’s failure to address this crisis is as saddening as it is staggering.” Spring Budget A coalition of nine charity infrastructure bodies has written to the Chancellor Philip Hammond calling for a range of measures to match tax concessions being giving to the private sector. One of these is increasing business rates relief to 100 per cent. The letter, which was coordinated by the Charity Finance Group (CFG) ahead of next month’s Budget, says that businesses have benefited from a £6.7bn rates cut which will see some businesses paying no rates at all. Businesses now get more favourable treatment on National Insurance, as well as the long standing problem of VAT – which is irrecoverable by charities and costs the sector £1.5bn a year. Details in Civil Society. The demands are contained in a letter that urges the government to deal with the sector in a more strategic way as opposed to the distribution of £0.5bn of libor fines that have been distributed by the treasury in a completely opaque way to a handful of charities. Full story in Third Sector. Local Budget There will be a budget debate at Camden council on the 27th February. Details will be available here. Cllr Theo Blackwell has written a long article setting out some of the difficulties that lie ahead. DISABILITY The Independent Living Fund, one year on The report, One year on: Evaluating the impact of the closure of the Independent Living Fund, was launched in Parliament with the help of Green Party co-leader Jonathan Bartley and Shadow Chancellor John McDonnell. It looks at what has happened, particularly in the 33 London boroughs, since the Independent Living Fund was closed in 2015.

New Quarterly Policy Briefing for Camden

VAC will be sending out a quarterly selection of Policy highlights of relevance to the VCS in Camden. The policy highlights are drawn from a wide variety of sources and may have featured in recent editions of the e-bulletin or have been drawn from conferences, workshops or seminars. Please do give us feedback on the briefing and let us know if there are particular issues you would like covered in more depth. The VAC e-bulletin will be back as usual next Friday.

POLICY

GENERAL Voluntary Sector Statistics Published The NCVO Almanac is the biggest annual survey of the voluntary sector and the release of a new one always provokes lots of interest. This year’s Almanac shows that income for the sector has gone up, but this disguises the true picture for most organisations as the increase is accounted for by a few very large charities often taking on government functions. The Guardian says ‘This year’s dominant narrative of the further flourishing of big charity, while small and medium-sized organisations continue to be battered by spending cuts and contract commissioning practices that work against them, should provide much food for thought.’ A further issue is the conversion of public sector organisations into charities, and the Guardian says that “There is no doubt that a significant wedge of the £506m net rise in government funding will have come via “charitisation” of bodies previously in the public sector, such as creation of the Canal & River Trust in 2012 from the former British Waterways Board. This is continuing apace, not only at national level – the setting up of English Heritage as a charity in 2015, for instance – but also locally where schools and other services are being spun off out of council control.” NAVCA have also joined the debate, criticizing the way in which income is sometime perceived as a proxy for effectiveness to the detriment of smaller vcs organisations. Brexit: Implications for the Voluntary Sector NCVO’s initial analysis of the situation is available at the NCVO website. Stuart Etherington, NCVO gave his reaction to the referendum result: “The voluntary sector is needed now more than ever. These have been troubled times, and they will continue to be so. Britain is facing political and economic unrest for months if not years to come. Your support and advocacy for the people and causes you work for will be essential in this climate. There are millions, even tens of millions in the UK who feel distanced from institutions that are meant to work on their behalf. At best apathetic, at worst, deeply hostile. Meanwhile the debate has left a bitter taste on both sides. It has served to exacerbate other divisions within our society. The referendum has thrown into sharper contrast than ever previously a division in the United Kingdom. Questions of social mobility will rightly now come to the fore again. And we can hope that the racial tensions stoked so crudely and cruelly during the campaigning do not linger, but the risk of this is clear. We must now play our role in healing these divisions. We can and must help people in the communities we work with to understand, respect and cherish each other.” Read the full statement. Since then much has been written about the future implications of brexit for the sector. A fuller briefing worth reading is here and you can view an interesing webcast about brexit and the vcs here. Why infrastructure support matters NPC makes the case for local infrastructure. “‘Everybody wants what we do, but nobody wants to pay for it.’ This is a lament frequently made by voluntary sector infrastructure organisations. The smaller or less experienced organisations most likely to benefit from their services are often those least able to afford it. Local authorities-struggling to fund core statutory duties let alone anything else besides-are cutting back support and/or narrowing the terms of what it should provide. Individual and institutional funders, meanwhile, often want to channel their support ‘to the frontline’. What infrastructure bodies can offer For charities, the benefits are obvious: access to information, advice, training, and even professional services that cannot be provided in-house. Effective infrastructure bodies are also a channel of communication. They can act as conduit between the voluntary and statutory sectors, feeding intelligence both ways and helping the two to work better together. For communities, the benefits are indirect; they stem from the effects that a vibrant, confident, well supported voluntary sector can have on individuals and neighbourhoods. For funders, the benefits are less obvious, but no less useful. The availability of support and guidance from infrastructure organisations can lead to much better funding applications from a wider range of organisations. Six principles for engaging people and communities The six principles were developed by the People and Communities Board, in conjunction with the new models of care ‘vanguards’ sites, to give practical support to services as they deliver the ‘new relationship with people and communities;’ set out in the Five Year Forward View. These ‘six principles’ set out the basis of good person centred, community focused health and care. The six principles require that: 1 Care and support is person-centred: personalised, coordinated, and empowering 2 Services are created in partnership with citizens and communities 3 Focus is on equality and narrowing inequalities 4 Carers are identified, supported and involved 5 Voluntary, community and social enterprise and housing sectors are involved as key partners and enablers 6 Volunteering and social action are recognised as key enablers Full details at the National Voices website. HEALTH General Practice Health Advocates The latest edition of the Camden Patient Participation Groups Newsletter looks at Community health advocates are volunteers who signpost people to health and wellbeing services, websites, and community activities. Most advocates work from GP surgery waiting rooms in two hour sessions. The project is part of Voluntary Action Camden’s health inequalities work which aims to address issues which contribute to poor health outcomes for Camden residents. The service is funded by Camden CCG and Camden Council. You can read the full article in the CPPG Newsletter, read a blog about new models of care and the involvement of the the VCS on the VAC website, or email vac to find out more or get involved. NHS England tell teams developing STPs to talk to local charities and community groups Engaging Local People, new guidance from NHS England for teams developing STPs in the 44 footprint areas, says they should engage with the voluntary sector. And the best way to do this, according to the guidance, is through their “local CVS or development and support agency”. The guidance makes clear that charities and community groups are key stakeholders and says that “the best source for support for linking with the voluntary sector is frequently the council for voluntary services (CVS), sometime is called a local development and support agency”. Also NHS England has published the NHS Operational Planning and Contracting Guidance 2017 – 2019. This emphasises the importance of STPs. The guidance says that “STPs are more than just plans. They represent a different way of working, with partnership behaviours becoming the new norm…although STPs are relatively new, we see them as having a significant ongoing role in the NHS.” Camden and Islington NHS Trust have published a Sustainability and Transformation Plan – Case for Change Sept 2016 and you will find a single mention of the voluntary sector on page 45. CQC Report on Camden Care Navigation Service In the recently published Care Quality Commission (CQC) report Building Bridges, Breaking Barriers, the Primary Care Navigation Service run by Age UK Camden was praised as a good example of multi-agency working. The CQC report was generally critical of lack of integration, calling for improvements, but Camden was held up as good practice, see: http://www.cqc.org.uk/content/older-people-denied-personalised-effective-and-responsive-care-due-poor-integration-across Age UK Camden’s CEO Gary Jones said “We deliver with Camden CCG funding with close links to GPs and other practice staff as well as social care professionals. Voluntary sector partners are also key and our Care Navigation Manager is seconded from Camden Carers Centre and is a nurse by training. We also had some help from Age UK London and Age UK Kensington and Chelsea in developing the model.” Social Prescribing in London As part of the Regional Voices’ strategic partnership work, LVSC is mapping social prescribing activities in London. The map includes links to social prescribing activities in London. Each link takes you to a uniquely created page with information about and contact details of each social prescriber. We are also working with Healthy London Partnership (HLP) to take this work forward across London. We will look at best practice and different models of social prescribing activities in London. The map will be widely shared with the VCSE (voluntary, community and social enterprise) sector in London. We will also share it at a strategic level with commissioners, NHS England (including HLP), London Health Board, Public Health England, local authorities, Social Prescribing Network and academic institutions that are reviewing and evaluating social prescribing activities. If you are a social prescriber, you are cordially invited to complete our survey which will inform your unique page on the map. It will also provide useful information for our work with HLP. If you know of other and emerging social prescribing initiatives not listed on the map, please email me: sandra@lvsc.org.uk. Access the new social prescribing map in London online here New Models of Care: Working Together for a Healthy London In March Peter attended “New Models of Care: Working Together for a Healthy London” an event organised by the London Voluntary Service Council. The title refers to the government’s “Five Year Forward View” of the NHS which argued for a “more engaged relationship with patients, carers and citizens so that we can promote wellbeing and prevent ill-health.” The voluntary and community sector is very much at the core of this and the document specifically referred to Voluntary Action Rotherham’s Social Prescribing Service. Read the full article here. Camden Integrated Digital Record (CIDR) Camden CCG, working in partnership with health and social care providers in Camden, has developed a digital record service that links health and social care data together. This creates a joined up and secure digital record for people registered with a Camden GP. This means your health and social care professionals are able to view vital information about you at the right time, and place, to provide you with the best possible care. Find out more here. CRIME and SAFETY Public Spaces Protection Orders (PSPOs) to tackle antisocial behaviour in London The specific purpose of the research is to test how individuals in the Borough are likely to react to PSPOs in different sets of circumstances. The project is run by Erasmus University, Rotterdam. More information here. CHILDREN and FAMILIES Safeguarding: Myths, Harmful Practices and the BAMER Community For the past 8 years VAC’s Asha-Kin Duale has been delivering training sessions on ‘Safeguarding Children’ and ‘Harmful Practices’ to BAMER community, faith groups and supplementary schools in Camden. These sessions are delivered as part of the Community Partnership Project, funded by Camden Council’s Children Safeguarding Board. The project has been running since 2007 to address issues of child safeguarding amongst Camden BAMER communities. In this time I have met a variety of people, mainly older women, attending these sessions in groups, many of whom are initially wary of Social Services and the Police and their role in protecting children in the community. But recently a young couple with their baby attended my session. It was the first time I have ever seen a young couple attend one of my sessions. Read the full blog at the VAC website. ENVIRONMENT Air Pollution The Mayor of London has recently launched a new public consultation on some measures to improve air quality in London. Find out more here. Camden will be holding an Air Quality Conference on Wednesday 2 November (6 – 8.30pm), Air pollution has a major impact on all of us. Nearly 9,500 people die every year in London as a result of poor air quality and action must be taken to change this. Full details and booking at Eventbrite