At Lloyds Bank Foundation, we support charities working with people facing multiple disadvantage. For these people, holistic interventions are central to long term success and we regularly see what this looks like through the charities we support. Room to Heal in London, providing holistic support to refugees and survivors of torture, is one such example whose success has been recognised through our Charity Achievement Awards this year. As their application said: “It didn’t take us long to realise that it is futile offering counselling to someone who has no bed for the night, no lawyer to fight their case, or no money to buy food. Our therapeutic and casework teams work hand in hand to support each individual through the unique, myriad challenges they face.” Treating people as individuals, rather than statistics means they do not easily fit into a box. Service providers need to be able to adapt to emerging needs and tailor their support for the individual. As a funder, this is something we look for in the charities we support, but in statutory systems this has proved much harder to achieve.
Payment by results and contracts built upon prescriptive outcomes should aim to enable commissioners to commission for long term and holistic outcomes but too often this does not happen in practice. Measurements are needed to demonstrate impact but a focus on narrowly defined outcomes can make it hard to understand the real value of a holistic intervention. The pertinence of this hit home recently when meeting a domestic abuse survivor who had accessed a range of services from a charity we support. She described the importance of the wrap-around person-centred support she’d received which enabled her to be a proper mum to her children, able to provide them with the care and attention they needed because her needs were met by the charity. Hearing this assessment, it was obvious that the charity delivered holistic, long term interventions but translating this into something that could be measured for a statutory service becomes more difficult.
There are no easy answers here but it is a challenge we need to address, in the same way that we need to address the challenges presented by funding. In many cases, funding wide-reaching services demands better integration of budgets but doing so cannot simply be an amalgamation of funding streams that retains all the objectives and reporting requirements of each stakeholder origin. This is where co-production becomes so important, establishing new governance arrangements between organisations and working with service providers to determine how services can be commissioned in a way that meets individuals’ needs.
At the same time, we need to look at the length of grants and contracts. Local authorities may feel their hands are tied by not knowing their budgets from year to year but they need to be bold. For individuals facing multiple disadvantage, you cannot put a time frame on the period a service is needed and statutory funding needs to recognise this. Similarly service providers themselves need a degree of stability with longer term funding to give them the flexibility to innovate and the space to concentrate on service delivery. We have seen evidence of a longer term view in some areas where funding is available for longer time frames. For example, Camden has recently announced a new seven year funding strategy that aims to engage local charities in new forms of collaboration. We have also heard of examples where interventions are working and contracts can be easily extended without re-tendering for services.
The role of small and medium charities
Building long term, holistic interventions into statutory provision means taking a long term view. It means pooling budgets so that charities can be funded to meet a range of needs but in doing so, this cannot mean seeking one provider to deliver all services. Instead it means enabling a range of organisations to deliver a range of services. We know that small and medium sized charities can deliver the long term, holistic interventions that are part of an effective health and social care system. Grounded in their communities, they have a deep understanding of local need and can provide the person-centred, wrap-around support that people need so it is essential that funding opportunities work for them too. Funding is a real issue for these organisations at the moment, with 81% of respondents to our grantee survey listing it as the greatest challenge they face. If government is serious about building long term, holistic outcomes into statutory services, it has to consider how small and medium sized charities can deliver these. It means developing services in consultation with the sector and service users and ensuring contract sizes recognise the different skills and specialisms that a range of different organisations can bring to the table. By working together, these organisations can support government to deliver the services that people need.
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